Community Nursing Review: Week 1 Concepts and Roles

Here is the converted markdown format of the provided text: ### COMMUNITY NURSING- WEEK 1 1. **Historical practices and foundations** Early community health nursing in Canada can be traced back to Indigenous medicine and healing practices, as well as the work of the Duchesse d'Aiguillon siste...

Here is the converted markdown format of the provided text: ### COMMUNITY NURSING- WEEK 1 1. **Historical practices and foundations** Early community health nursing in Canada can be traced back to Indigenous medicine and healing practices, as well as the work of the Duchesse d'Aiguillon sisters in 17th-century New France. The Grey Nuns were the first Canadian community nursing order and understood health inequity and made significant contributions to providing access to health services, food, shelter, and education for the most vulnerable. Their work also involved relationships with First Nations. Jeanne Mance, Canada's first nurse, established a range of community health services, advocated for social justice, and was an administrator of the Hotel-Dieu Hospital. These early efforts focused on health inequities, determinants of health, community outreach, and advocacy. The current community health nursing practice emulates these qualities. 2. **Community health nursing and nursing education interplay** The Nightingale model significantly influenced the development of the nursing profession, with the first nursing school established in St. Catharines, Ontario, in 1874. The Red Cross played a pivotal role in advancing the education of Public Health Nurses (PHNs) by providing funding for certificate courses in public health at five Canadian universities. The Weir Report (1932) recommended increasing the number of nurses in Canada and supported university standards of education and public health nursing as a specialty. 3. **Socioecological context** Socioecological challenges arose due to immigration and the inability to provide basic health services to settlers and Indigenous peoples, who experienced epidemics introduced by immigrants. Health promotion was influenced by Florence Nightingale and Mary Seacole, emphasizing epidemiology, statistics, environmental factors, and social determinants of health. 4. **Contributions and leadership** Pioneer Community Health Nurses (CHNs) were adventurous, independent, courageous, and humanitarian. They offered services in poor urban districts and isolated rural communities. They met immediate community needs through direct care, midwifery, and health and prevention education. Volunteerism and leadership were integral to the development of CHNs. Lady Aberdeen and women's groups created the Victorian Order of Nurses (VON), which developed community health services for rural, poor, and immigrant women. The Canadian Indigenous Nurses Association has been instrumental in establishing culturally competent healthcare and cultural safety in the North. Elizabeth Smellie's military nursing demonstrated competencies of CHN, population health, primary, secondary, and tertiary prevention, and emergency preparedness. 5. **Future responsibilities** CHNs need to be strong policy advocates, focusing on the social determinants of health. The Romanow Commission's report (2002) recommends shifting policy toward primary healthcare, home healthcare, and health promotion, with nurses playing a key role. CHNs are responding to health inequities in Northern Indigenous communities, collaborating with Indigenous communities and organizations, and addressing the Truth and Reconciliation Commission's calls to action. 6. **Historical milestones** In 1947, Saskatchewan established publicly funded healthcare, followed by the federal government in 1957. The Canada Health Act (1984) reinforced five central points across provincial healthcare systems: public administration, comprehensiveness, universality, portability, and accessibility. 7. **Paradigm shift** The Lalonde Report of 1974 presented a vision for health promotion services. Lalonde's framework identified four determinants of health: environment, lifestyle, human biology, and the healthcare system. The Epp Framework formed the basis of the Ottawa Charter for Health Promotion, marking a dramatic shift in health promotion. 8. **Organization of community health nursing care** Many factors influence how community health nursing is organized and delivered across Canada, including emerging diseases and health emergencies. Most provinces and territories have moved to regional health authority structures for health service delivery, striving to integrate most or all health services, including CHN services. Some provinces lack specific legislative frameworks for healthcare responsibilities in Indigenous communities. Ontario was the first province to develop an Indigenous Health and Wellness Strategy in 1990 and an Aboriginal Health Policy in 1994. 9. **Policy, politics, and power** Community health nursing practice occurs in a sociopolitical environment. CHNs must understand how policy and politics impact the quality, safety, and accessibility of patient care and their working conditions. Health equity is undermined when social conditions prevent people from making decisions or taking actions that promote health. 10. **Challenges** CHNs face health system challenges, a lack of role clarity, a need for strong leadership, and issues in interprofessional relationships. A central strategy for CHNs is developing leadership and community influence. Nurse leaders must create a clear purpose and vision, incorporating multiple aspects of communities, the political environment, and the larger health and social systems. Attributes that support community and public health nursing practice include management practice, organizational culture, and government policy. --- ### COMMUNITY NURSING-WEEK 2 **LEARNING OBJECTIVES** 1. **Blueprint for Action** * The Blueprint for Action for Community Health Nursing in Canada (2011) provides a national framework for the development of community health nursing practice in Canada. * It guides decisions and activities to promote and protect the health of Canadians. * The Blueprint identifies six areas of action: * Scope of Practice * Leadership * Interprofessional and intersectoral partnerships * Health Systems * Nursing Education * Workplace Development 2. **Professional Practice Model and Standards of Practice** * There are eight Canadian Community Health Nurses Standards of Practice. * The standards are used by employers to implement professional development programs, inform educational curricula, and guide research. * Current practice reflects a greater emphasis on social justice and the social and environmental determinants of health. * The next version of the standards will integrate Indigenous nursing and health. 3. **CHN Roles, Competencies, and Practice Settings** * CHNs work in various settings, including homes, schools, workplaces, streets, shelters, churches, field hospitals, community health centers, and outpost nursing stations. * Various roles within community nursing include: * Public Health Nurse * Home Health Nurse * Rural Nurse * Occupational Health Nurse * Community Mental Health Nurse * Primary Care Nurse * Forensic Nurse * Military Nurse * Parish Nurse * Telehealth Nurse * Outreach/street Nurse * Specific roles: * **Home health nurses** provide clinical care in clients' homes, schools, or workplaces. * **Primary care nurses** provide the first contact with the health care system. * **Telehealth nurses** triage health issues, consult, advise, support, educate, and coordinate care. * **Outreach/street nurses** focus on building relationships with clients while maintaining safety, dignity, and respect. * **Rural and Northern Canada nurses** work in communities, homes, schools, clinics, outpost nursing settings, and First Nation, Inuit, and Métis communities. * **Occupational health nurses** base their practice on individual, health, occupational health nursing, and the environment. * **Parish nurses** integrate faith and health into nursing practice within a faith community. * **Forensic nurses** provide healthcare and collect evidence for police and the legal system, respecting clients' dignity and rights. * **Community mental health nurses** blend community nursing with mental health/psychiatric nursing. * **Public health nursing** utilizes knowledge from public health, nursing, social and environmental sciences, and research. 4. **Expansion and Regulation of Practice** * In Canada, there are four regulated nursing groups: RNs, nurse practitioners, licensed/registered practical nurses, and registered psychiatric nurses. * Nurse practitioners (NPs) are advanced practice nurses with varying titles across practice settings and provinces/territories. * Registered psychiatric nurses are educated and regulated in western provinces and the Yukon. 5. **Emerging Trends** * Practice standards for CHNs include using political and social advocacy to change conditions leading to marginalization and inequities. * Information communication technology (ICT) is expanding nursing practice. * Evidence-based practices are increasingly important. * Preparation for CHNs in undergraduate programs is becoming more important due to rising rates of chronic preventable diseases. 6. **Ethical Values** * Ethical nursing practice requires critical reflection, sound ethical decisions, and appropriate action. * CNA's ethical values include: * Providing safe, compassionate, competent, and ethical care * Promoting health and well-being * Promoting and respecting informed decision-making * Honouring dignity * Maintaining privacy and confidentiality * Promoting justice * Being accountable * Ethics refers to values, norms, moral principles, virtues, and traditions that guide human conduct. 7. **Attributes of Social Justice** * Social justice emphasizes equitable distribution of societal benefits and responsibilities. * It focuses on the relative social advantage of individuals or groups and the root causes of inequities. * Attributes of social justice include equity, human rights, democracy and civil rights, capacity building, just institutions, enabling environments, poverty reduction, ethical practice, advocacy, and partnerships. * Social justice assumes societies experience systematic oppression and inequities. * Social justice approaches are concerned with the ethical use of power in health care. * Social justice views persons relationally, connected to others, and interdependent. * Social justice elicits concern for issues of everyday life. * CHN advocacy often has a strong social justice orientation for populations sensitive to health inequities and/or otherwise marginalized. 8. **Ethical Issues** * Ethical issues in community health nursing include health promotion, prevention, health protection, health maintenance, restoration, and palliation. * Specific areas of ethical and legal concern relate to capacity building, access and equity, and professional responsibility and accountability, as well as negligence. 9. **Legal Responsibilities** * Maintaining privacy and confidentiality is a legal responsibility of CHNs. * CHNs must disclose health information on a need-to-know basis and abide by privacy legislation. * Legal issues may arise from negligence resulting from a breach in the standard of care. 10. **Capacity Building and Advocacy** * CHNs work collaboratively when building individual and community capacity by using strategies involving empowerment and advocacy. * CHN advocacy takes a stand for practices, aims, and reforms aligned with the moral goals of public health. 11. **Political Nature of Ethics** * Ethical problems in the community can take on a political nature. * The use of power is of ethical significance. * Efforts to prevent disease and injury restrict individual liberty. --- ### COMMUNITY WEEK-3 1. **Defining Theory and its Importance in Achieving Health Equity and Social Justice:** * A theory is an organized and systematic articulation of statements related to significant questions in a discipline. * Understanding theory is essential because it provides a foundation for both practice and research in nursing. Theory can guide practice where research-based evidence is lacking. * Theory assists practitioners, decision makers, educators, and researchers in explaining experiences, informing actions/decisions, and articulating possible outcomes. * Core public health concepts include social justice, health equity, and commitment to the community. Community health nursing concepts also include health equity and determinants of health. Health equity is achieved when all people have the opportunity to reach their full health potential, regardless of social factors. 2. **Core Public Health Concepts in Community Health Nursing Practice:** * Key public health concepts include social justice, population health, health promotion, and ethics. * Community health nursing concepts include health equity, determinants of health, capacity building, a strengths-based approach, cultural safety, and collaboration. 3. **Historical Development of Nursing Theory and Integrating Indigenous Perspectives:** * Nursing theories focused on illness in clinical settings are not always easily adapted to community health nursing. * Perspectives of First Nation, Métis, and Inuit peoples are not well represented in community health nursing theory and practice due to a lack of acknowledgement of colonial roots. * Two-Eyed Seeing and Two-Row Wampum demonstrate both traditional Indigenous knowledge and Western scientific understanding. 4. **Theoretical and Conceptual Foundations of Community Health Nursing:** * The theoretical foundations include the CHN metaparadigm, philosophies encompassing CHN ethics and values, and broad theoretical perspectives such as complexity science theory, social ecological theory, feminist theory, and postcolonial theory. * It also includes conceptual models and frameworks, such as various health promotion models and the Intervention Wheel, as well as grand, middle range, and practice theories. 5. **Theory-Informed Practice in Community Health Nursing:** * Theory-informed practice is important to clients, including Indigenous peoples and people experiencing social and health inequities, as well as to the health system, the profession, policy, and research. * For Indigenous peoples, the First Nations Perspective on Health and Wellness model is used to guide care and decolonize and redesign health programs for First Nations in BC. * Theories help to broaden the scope of effective and considerate care beyond treating illness in a clinical context. * Critical social theory supports nurses in collaborating with other sectors to influence public policy and address the structural and systemic determinants of health. 6. **Concepts of Health and Health Promotion:** * Health is a dynamic process with multiple assumptions and understandings that evolve over time and with varying professional perspectives and purposes. * Health promotion is the process of enabling people to increase control over, and to improve, their health. * An Indigenous understanding of health includes the family and community and focuses on a balance between the body, mind, emotion, and spirit. For many Indigenous people, health includes nature as an integral component. 7. **Upstream vs. Downstream Approaches:** * Upstream approaches are often prevention and promotion strategies focused on policy interventions that benefit the whole population, addressing the root causes of preventable diseases and injuries. * Downstream interventions include acute care services that are usually tertiary prevention measures focused on individual treatment and cure. 8. **Primary Health Care:** * The underlying values of Primary Health Care (PHC) are social justice and equity. * The five principles of PHC are accessibility, public participation, health promotion, appropriate technology, and intersectoral collaboration or co-operation. 9. **Significance of the Ottawa Charte**r * The first international conference on health promotion was held in Ottawa in November 1986, resulting in the Ottawa Charter for Health Promotion. * It outlined five key actions: building healthy public policy, creating supportive environments for health, strengthening community action, developing personal skills, and reorienting health services toward preventing diseases and promoting health. 10. **Variations in the Social Determinants of Health:** * Serious illness and early death related to poverty are connected to low social standing. * The Toronto Charter recognized that Canadian women, Canadians of colour, and new Canadians were significantly more at risk than others. 11. **Strategies and Methods in Population Health Promotion:** * Population health promotion involves taking action on interrelated conditions affecting a population's health to create healthy change. * Collaborative and partnership approaches are effective community development and relationship-building strategies. * These approaches build trusting relationships, enhance personal confidence and skills by valuing clients' expertise, and engage empowering educational strategies. * The Population Health Promotion Model (PHPM) emphasizes comprehensive action on all determinants of health, multiple entry points for planning, and the understanding that health problems may disproportionately affect certain groups. * The PHPM also recognizes that health is a result of individual practices and the impact of social and physical environments, emphasizing social justice, equity, and mutual respect. * Meaningful community member participation is essential. 12. **Social Marketing and the "Four Ps" of Marketing:** * Social marketing uses marketing principles to advance a social cause, idea, or behavior to promote changes in social behaviors. * The goal is to encourage health-promoting behaviors or reduce those that negatively impact health. * The "marketing mix" includes the four Ps: product, price, place, and promotion. * Additional Ps might include "policy change" or "people" (e.g., training). * Interventions using only promotion are considered social advertising, not social marketing. 13. **Social Justice Issues in the Context of "At Risk" Populations:** * The term "at risk" can create stigmas and prejudices such as racism, sexism, and ageism, affecting health care professionals' assumptions and potentially leading to oppressive behaviors. * Communication of risk is vital due to the rapid changes in risks associated with new technologies. * A risk management approach is more amenable to implementing multiple strategies to address various determinants of health. 14. **Nursing Interventions Exemplifying Five Levels of Prevention:** * Prevention interventions occur at primordial, primary, secondary, tertiary, or quaternary levels. * Primordial prevention focuses on avoiding illness or injury by addressing issues before they become risk factors. * Primary prevention uses risk factor identification and public awareness to avoid illness or injury. * Secondary prevention promotes health through early disease identification and timely treatment. * Tertiary prevention begins once an individual is symptomatic, focusing on maintaining or restoring function and preventing further disability. * Quaternary prevention identifies those at risk for medical mishaps, focusing on patient safety and ethical practices. 15. **Harm Reduction Philosophy and the Role of the Community Health Nurse:** * Harm reduction focuses on protecting the health of individuals engaging in high-risk activities and reducing secondary harm. * The goal is to reduce immediate harms from these behaviors, addressing health inequities and providing care to marginalized individuals. * It seeks to protect health by reducing harm while recognizing the complexity of social issues. 16. **Importance of Research, Activism, and Advocacy in Health Promotion Practice:** * Activism has been used to effect change for people living in poverty, address child labor, fight for women's rights, and distribute birth control information. * Research and action should seek partnerships with individuals and communities to promote health. * Advocacy is a social justice issue and a mandatory component of public health and community nursing practice. * Community nursing offers opportunities for health promotion and various forms of advocacy and activism. --- ### COMMUNITY NURSING- WEEK 4 1. **Definition of Public Health:** * Public health involves organized societal efforts to prevent injury, illness, and premature death. * It aims to protect and promote the health of all Canadians through programs, services, and policies. 2. **Roles of the Public Health Nurse (PHN):** * PHNs practice in various settings, focusing on disease prevention, chronic diseases, injuries, and lifestyle risks. * They prioritize the health of the environment, especially considering climate change and ecosystem deterioration. * PHNs are committed to social justice and reducing health inequities. * They promote and advocate for the health and quality of life of mothers and children, particularly those who are younger or of low socioeconomic status. * PHNs also deliver immunization and vaccination programs. * They function under the laws of government bodies, sometimes challenging laws to support community health, and must have knowledge of federal, provincial, territorial governments, and Indigenous organizations. 3. **Historical Evolution of Public Health Nursing in Canada:** * Early PHNs worked with low-income communities, differentiating them from hospital or private nurses. * They focused on improving physical environmental conditions to reduce maternal and child morbidity. * Many early PHNs worked for religious or charitable organizations. * As public health programs became more complex, PHNs were hired to work in civic health departments. 4. **Fundamental Concepts, Principles, and Values of Public Health Nursing:** * PHNs focus on social justice, striving for equal rights and opportunities for all. * They aim to reduce health inequities by addressing basic prerequisites for health like shelter, education, food, and income. * A population-oriented approach allows for effective intersectoral collaboration. 5. **Discipline-Specific Competencies of Public Health Nurses:** * Knowledge derived from public health and nursing science. * Skills related to assessment and analysis. * Conducting policy and program planning, implementation, and evaluation. * Achieving partnerships, collaboration, and advocacy. * Promoting diversity and inclusiveness. * Effective communication exchange. * Leadership capabilities. * Professional responsibility and accountability. 6. **Roles of the Public Health Nurse in Relation to Core Functions of Public Health:** * The core functions include health protection , health surveillance, population health assessment, disease and injury prevention, health promotion, and emergency preparation and response. 7. **Significance of Social Justice to the Role of the Public Health Nurse:** * PHNs work towards achieving equal rights and opportunities. * They address issues by lobbying for community-wide programs or policy changes and through direct contact with citizens. * PHNs advocate for healthy public policy and social justice by participating in legislative and policy-making activities. 8. **Public Health Nursing Interventions and Levels of Prevention:** * Primordial prevention: Initiatives prevent conditions that enable risk factors for disease. * Primary prevention: Risks of illness, disease, and injury are eliminated. * Secondary prevention: The disease process is suspended before symptoms occur. * Tertiary prevention: The impairment or disability from the disease process is halted. * Quaternary prevention: Initiatives identify individuals at risk of over-medicalization. 9. **Evolution of Home Care and Home Health Nursing in Canada:** * The first home care was provided by religious orders in Quebec in the seventeenth century, in the form of direct care and disease prevention. * By 1988, the federal government and all provinces and territories had launched home care programs, extending to First Nations and Inuit communities in 1999. 10. **Role and Unique Characteristics of Home Health Nursing:** * Home health nursing provides care to acute, chronically ill, and well clients of all ages in various community settings. * HHNs work within an interprofessional team and collaborate with clients and families to identify healthcare needs. * They apply knowledge of primary health care, nursing science, and social science, focusing on prevention of health deterioration and on health restoration, maintenance, or palliation. * HHNs also assess a family's coping and ability to provide ongoing care for a client. 11. **Key Areas of Practice, Competencies, and Desired Outcomes of Home Health Nurses:** * Competencies for Home Health Nursing have three overarching categories: Elements of Home Health Nursing; Foundations of Home Health Nursing; and Quality and Professional Responsibilities. * HHNs work according to local health authority policies and procedures, provincial legislation, nursing evidence, and doctors' orders. * A core competency is to facilitate access to healthcare that is respectful and culturally sensitive. * The ability to communicate and build relationships with clients and their families is central. 12. **Organizational Supports Required for Home Health Nurses:** * HHNs require supports and infrastructure to maintain high-quality clinical care and a positive work environment, including support for evidence-informed decision making and evidence-informed practice. * They need the support of clinical experts and organizational infrastructures to provide care excellence. 13. **Current Rewards and Challenges in Home Health Nursing:** * Rewards include the autonomous nature of the role, the ability to work to their full scope of practice, and the therapeutic relationships developed with clients and families. * Challenges include changing client demographics, difficult working conditions, inadequate funding, and a lack of national home care strategy. 14. **Issues Related to Health Equity in Home Health Nursing:** * Vulnerable populations such as First Nations and Inuit communities, people who are homeless, people experiencing mental illness, and people in rural and remote areas do not receive equitable home care. 15. **Opportunities and Future for Home Health Nursing:** * Home care will continue to grow, and technology will play an increasing role in managing data and benefiting clients. --- ### COMMUNITY WEEK 5 Here's an overview of key concepts in community health nursing, based on the provided source: 1. **Concepts of Community:** * A community is a group sharing an environment, time, and often place, beliefs, interests, or virtual connections. * Community functions are essential for sustaining daily life. * Community dynamics support these functions through communication, leadership, and decision-making. * Healthy communities involve health promotion and partnerships for a sustainable, healthy environment. 2. **Community as Client and Partner:** * The Community-as-Partner model emphasizes the community and nursing process. * A community participatory approach is crucial for planning, empowering people to take responsibility for their health and effect change. * Nursing interventions succeed when the community is engaged and empowered throughout the nursing process. 3. **Community Assessment Models and Frameworks:** * Community assessment is an ongoing appraisal of the community, both quantitative and qualitative. * The Community Health Promotion Model considers social determinants of health to guide community planning, intervention, and evaluation. * The epidemiologic triangle (host-environment-agent) is used to examine disease frequency and distribution. 4. **Community Health Nursing Process:** * The nursing process is continuous and cyclical, involving assessment, planning, implementation, and evaluation. * Intervention plans should address health challenges by reducing inequalities, increasing prevention, and enhancing community coping. 5. **Population Health Promotion and Related Concepts:** * Population health promotion builds on health promotion and public health with a focus on prevention and disease management. * Risk assessment involves identifying and targeting clients likely to contract diseases or develop unhealthy behaviors. * Community governance refers to decision-making that meets community health needs. * Community engagement is a participatory process based on communication, trust, and common understanding. * Capacity building strengthens the ability to develop and implement health promotion initiatives. * Community development involves working with communities to define goals, mobilize resources, and develop action plans. * Community mobilization involves grassroots action to solve common problems. 6. **Community Participatory Tools:** * Community Needs Matrix Tool: This allows participants to discuss and rate health problems to determine which are most important. * Community mapping provides a visual representation of health-related factors, resources, and barriers. * Present-Future Drawings help visualize the community's aspirations and formulate intervention goals. 7. **Role of the Nurse in the Community:** * Community Health Nurses (CHNs) use the community health promotion process to address health inequities. * CHNs demonstrate leadership in health promotion and advocate for population-focused health initiatives. * CHNs use community participatory tools to engage stakeholders and address health needs. 8. **Assessment–Planning–Evaluation Cycle:** * This cycle includes situational analysis, problem identification, solution consideration, alternative selection, implementation, monitoring, evaluation, analysis, and modification. * Logic models support planning, analysis, and evaluation by documenting and structuring health programs, exposing gaps, and providing a clear overview. * Two planning stages in developing a logic model are CAT (components, activities, and target groups) and SOLO (short-term outcomes and long-term outcomes). 9. **Program Planning, Monitoring, and Evaluation:** * CHNs plan programs, redesign services, monitor implementation, and evaluate impact. * Frameworks guide information gathering and organization for a coherent plan. * Gantt charts present the sequence and timing of activities for program objectives, especially in complex programs. 10. **Multiple Interventions Framework:** * This framework targets the complexity and root causes of problems. * It involves an iterative cycle where lessons from implementation and new research inform program adjustments. * Key elements include identifying the health issue, describing socioecological features, intervention options, optimizing strategies, and monitoring impacts. 11. **Socio-Structural Determinants of Health:** * Authentic community engagement is essential for addressing social determinants of health. * Determinants are interrelated, and changes in one can affect others. * Population health interventions should be implemented at multiple system levels. 12. **Engaging Citizens and Stakeholders:** * Involving the community in setting priorities is crucial. * Guiding principles for priority setting are buy-in, transparency, and communication. 13. **Indicators for Program Accountability:** * Monitoring and evaluating program outputs, outcomes, impacts, spin-offs, and sustainability are central. * Outputs indicators relate to critical steps, outcomes are medium-term changes, and impacts are longer-term results. * Spin-offs are unintended effects, and sustainability concerns the long-term viability of interventions. 14. **Social Determinants of Health:** * These include factors such as disability, early child development, education, employment, food insecurity, gender, geography, globalization, health services, housing, immigration, income, indigenous ancestry, race, social exclusion, social safety net, and unemployment. --- ### COMMUNITY NURSING- WEEK 6 1. **Theoretical Underpinnings and Value to CHNs:** * The epidemiologic process involves describing health-related events by answering who, what, when, and where, and further exploring how and why, to examine causality and transmission. * This process helps make predictions to guide interventions and resource allocation, implementing controls to prevent illness, cure the sick, and rehabilitate those with chronic diseases. * CHNs benefit from epidemiology as it helps them understand the relationships between environment and health, as noted by Hippocrates, and implement practices to decrease death rates, similar to Florence Nightingale's work. Modern CHNs can use epidemiology as a tool to address complex health challenges. 2. **Association vs. Causality:** * Association is a connection between a stressor/environmental factor and a health challenge, while causation is a confirmed cause-and-effect relationship between a stimulus and a disease. * Criteria suggesting a causal relationship include temporal relationship, strength of association, dose-response, specificity, consistency, biologic plausibility, and experimental replication. * Establishing causality requires the presence of a particular stressor and sufficient exposure to result in disease. CHNs can use the "web of causation" model to visualize the multiple factors influencing a health challenge. 3. **Screening vs. Surveillance:** * Screening involves testing asymptomatic individuals to detect health problems, while surveillance is the continuous monitoring of diseases to assess patterns and identify unusual events. 4. **Measurements in Epidemiology:** * Epidemiological data is analyzed to determine the extent and effects of a disease on a population, considering factors like population size, time frame, and human characteristics. * Data is used to produce rates, such as mortality (death) rates and morbidity (illness) rates, to understand population susceptibility and the effectiveness of health promotion or treatment. Prevalence and incidence are also used to describe morbidity. * CHNs can use these measurements to gain a picture of a population and disease over