Introduction to Community Health PDF

COMMUNITY AND FAMILY HEALTH NURSING LECTURE 1 A Community View OUTLINE  A Community View OUTLINE Definitions of Health and Community Health Community Determinants of Health and Disease Indicators of Health and Illness Definition an...

COMMUNITY AND FAMILY HEALTH NURSING LECTURE 1 A Community View OUTLINE  A Community View OUTLINE Definitions of Health and Community Health Community Determinants of Health and Disease Indicators of Health and Illness Definition and Focus of Public Health and Community Health Preventive Approach to Health  Health Promotion and Levels of Prevention Prevention versus Cure Healthy People 2020 Definition and Focus of Public Health Nursing, Community Health Nursing, and Community Based Nursing Public and Community Health Nursing Community-Based Nursing Community and Public Health Nursing Practice  OBJECTIVES Upon completion of this chapter, the reader will be able to do the following: 1. Compare and contrast definitions of health from a public health nursing perspective. 2. Define and discuss the focus of public health. 3. Discuss determinates of health and indicators of health and illness from a population perspective. 4. List the three levels of prevention, and give examples of each. 5. Explain the difference between public/community health nursing practice and community based nursing practice. 6. Describe the purpose of Healthy People 2020 and give examples of the topic areas encompass the national health objectives. 7. Discuss public/community health nursing practice in terms of public health’s core functions and essential services. 8. Discuss public/community health nursing interventions as explained by the Intervention Wheel. Community/Public Health Nursing: Community/public health nursing is the synthesis of nursing practice and public health practice. The major goal of community/public health nursing is to preserve the health of the community and surrounding populations. It focuses on health promotion and health maintenance of individuals, families, and groups within the community. Community/public health nursing is associated with health and the identification of populations at risk, rather than with an episodic response to patient demand. Public Health: Public Health is often described as the art and science of preventing disease, prolonging life, and promoting health. It involves organized community efforts to benefit each citizen. The mission of public health is social justice. Social justice entitles all people to basic necessities such as adequate income and health protection. Public health accepts collective burdens to make it possible. Definitions of Health and Community Health: The early definition of health by the World Health Organization (WHO) shifted towards describing health in social terms rather than medical terms. The WHO defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Social health refers to the interaction among groups within a community and connotes community vitality. Positive interaction among community groups contributes to social health, with an emphasis on health promotion and illness prevention. Examples of community groups promoting social health include sponsoring food banks to address hunger and nutrition issues and forming organizations to tackle violence and lack of opportunity, which can negatively impact social health. Expanded Definition of Health: In the mid-1980s, the World Health Organization (WHO) expanded the definition of health to include social implications. Health is defined as the extent to which an individual or group is able to: Realize aspirations and satisfy needs. Change or cope with the environment. Health is seen as a resource for everyday life, rather than the sole objective of living. It is a positive concept that emphasizes social and personal resources, as well as physical capacities (WHO, 1986, p. 73). This expanded definition recognizes health as a holistic concept that encompasses various aspects of well-being.  Models of health: In her classic work, Smith (1981) identified four models of health: 1. Clinical model: elimination of disease or symptoms. Some people feel that they are well when they have no symptoms or diagnosed diseases and would not classify themselves as sick otherwise. 2. Role-performance model: health that involves a match between people and social roles. For example, some people, even if they have symptoms of disease, would classify themselves as unhealthy only if they could not fulfill their roles in life, such as parent or worker.  3. Adaptive model: health that involves adaptation to the environment. For example, some people consider health to be determined by their ability to adapt in the face of adversity or disease. 4. Eudaimonistic model: health that is the actualization or realization of human potential. In this model, for example, people would consider themselves to be healthy if they are functioning not only physically but also emotionally and socially. The WHO (1947) definition of health actually strives(‫( يسعى‬for this level of health. Dimensions of Health: 1.Saylor (2004) pointed out that the WHO definition of health considers several dimensions: physical (structure/function), social, role, mental (emotional and intellectual), and general perceptions of health status. 2.It takes a macro perspective, viewing health as a resource to be used rather than a goal in itself. Varied Definitions of Health: 3. The nursing literature contains diverse definitions of health. 4.Examples of these definitions include: 1. "A state of well-being in which the person is able to use purposeful, adaptive responses and processes physically, mentally, emotionally, spiritually, and socially" (Murray, Zentner, & Yakimo, 2009). 2. "The individual's total well-being, the regular patterns of people and their environments that result in maintaining wholeness and human integrity" (Roy, 2009). These definitions highlight the multidimensional nature of health, encompassing physical, mental, emotional, spiritual, and social aspects. Varied Definitions of Health: 3. A definition by Pender, Murdaugh, & Parsons (2011) states that health is the realization of human potential through goal-directed behavior, competent self-care, and satisfying relationships with others. 4. Greiner (2014) defines health as a state of physical, mental, spiritual, and social functioning that realizes a person's potential and is experienced within a developmental context. These definitions highlight the importance of goal-directed behavior, self-care, relationships, and holistic well-being in understanding health. Global health Global health was defined by the Institute of Medicine (IOM, 1997) as the presence of health problems, issues, and concerns that extend beyond ( transcend) national boundaries and require collaborative actions and solutions for effective resolution(p. 2). Community In recent nursing literature, community has been defined in multiple ways: Rector (2017) defines community as a collection of people who interact and share common interests or characteristics, leading to a sense of unity or belonging. Lundy and Janes (2016) describe community as a group of people who share something in common, interact with each other, and may exhibit commitment, possibly within a specific geographic boundary. Shuster (2012) defines community as a locality-based entity that consists of formal organizations reflecting societal institutions, as well as informal groups and aggregates.  Maurer and Smith (2013) explored the concept of community and identified three key attributes: people, place, and social interaction. According to their findings, a community can be defined as a group of individuals who interact in social units. These individuals share common interests, characteristics, values, and goals.  main types of communities Maurer and Smith (2013) identified two main types of communities: 1- Geopolitical communities  Are the more commonly recognized or imagined form of communities.  Geopolitical communities are defined or formed by natural or man-made boundaries, such as cities, counties, states, and nations.  Other examples: school districts, census tracts, zip codes, and neighborhoods. 2- Phenomenological communities,  Are characterized by relational and interactive groups.  In phenomenological communities, the focus is on the shared perspective or identity of the group, based on culture, values, history, interests, and goals.  Examples: schools, colleges, and universities; churches, synagogues, and mosques; as well as various social groups and organizations, including social networks. Exploring Communities of Solution: a type of phenomenological communities A community of solution falls under the category of phenomenological communities. It is a collection of individuals who come together as a group with the specific purpose of addressing a common need or concern. Examples of community of solution include the Sierra Club, whose members advocate for the preservation of natural resource lands, and a group of disabled individuals who challenge building owners for equal access to public buildings, education, jobs, and transportation. These groups or social units collaborate to promote overall "health" and to address existing and potential health threats and needs.  ‫‪Sierra Club: A Pioneering Environmental Organization in the United‬‬ ‫‪States‬‬ ‫‪ ‬تأسس‪S‬ت جمعي‪S‬ة س‪S‬ييرا كل‪S‬وب في ‪ 28‬م‪S‬ايو ‪ 1892‬في س‪S‬ان فرانسيس‪S‬كو‪ ،‬كاليفورني‪S‬ا‪ ،‬وهي منظم‪S‬ة بيئي‪S‬ة‬ ‫أمريكية‪.‬‬ ‫‪ ‬تأسس‪S‬ت الجمعي‪S‬ة من قب‪S‬ل ج‪S‬ون م‪S‬وير‪ ،‬األم‪S‬ريكي االس‪S‬كتلندي األم‪S‬ريكي‪ ،‬وك‪S‬ان أول رئيس للجمعي‪S‬ة وأط‪S‬ول‬ ‫فت‪S‬رة لرئاسة الجمعية‪ S،‬حيث‪S‬قضى‪S‬ما يقرب م‪S‬ن ‪ 20‬عاًما في هذا‪ S‬ال‪S‬منصب‪.‬‬ ‫‪ ‬يعم‪S‬ل الن‪S‬ادي فق‪S‬ط في الوالي‪S‬ات المتح‪S‬دة ويحم‪S‬ل الوض‪S‬ع الق‪S‬انوني ‪ 501‬كمنظم‪S‬ة رعاي‪S‬ة اجتماعي‪S‬ة غ‪S‬ير‬ ‫ربحية‪.‬‬ ‫‪ ‬ك‪S‬ان الن‪S‬ادي واح‪ًS‬دا من أوائ‪S‬ل منظم‪S‬ات الحف‪S‬اظ على البيئ‪S‬ة على نط‪S‬اق واسع في العالم‪.‬‬ ‫‪ ‬يش‪S‬ارك الن‪S‬ادي حالًيا في الض‪S‬غط على السياس‪S‬يين لتعزي‪S‬ز السياس‪S‬ات البيئية‪.‬‬ ‫‪ ‬تش‪S‬مل النق‪S‬اط ال‪S‬تي يرك‪S‬ز عليه‪S‬ا الن‪S‬ادي حالًي ا تعزي‪S‬ز الطاق‪S‬ة المس‪S‬تدامة والتخفي‪S‬ف من ظ‪S‬اهرة االحتب‪S‬اس‬ ‫الحراري‪ ،S‬فضًال عن معارضة‪ S‬استخد‪S‬ام الفحم‪ S‬والطاقة الك‪S‬هروم‪S‬ائية والطاقة النووية‪.‬‬ ‫‪ ‬يش‪S‬تهر الن‪S‬ادي بتأيي‪S‬ده السياس‪S‬ي للمرش‪S‬حين الليبرال‪S‬يين والتق‪S‬دميين في االنتخابات‪.‬‬ ‫‪ ‬باإلض‪S‬افة إلى المناص‪S‬رة السياس‪S‬ية‪ ،‬ينظم الن‪S‬ادي أنش‪S‬طة ترفيهي‪S‬ة في اله‪S‬واء الطل‪S‬ق ويعت‪S‬بر مرجعي‪S‬ة في‬ ‫الواليات ال‪S‬متحدة‪S.‬‬ ‫تسل‪S‬ق الجبال‪ S‬وتسلق‪ S‬الصخور‪S‬في ‪S‬‬  Population vs Aggregates: Key Terminology in Public and community Health Nursing Population refers to a group of individuals who share similar personal or environmental characteristics, or it can encompass all individuals within a defined community. Aggregates, on the other hand, are subgroups or subpopulations that share common characteristics or concerns. Community health nursing interventions can be directed towards different targets based on the specific situation, needs, and practice parameters. Interventions may be focused on a community, such as the residents of a small town. They may also target a specific population, such as all elders in a rural region. Additionally, interventions can be aimed at a particular aggregate, such as pregnant teens within a school district. Determinants of Health and Disease The health status of a community is influenced by various factors including access to healthcare, economic conditions, social and environmental issues, and cultural practices. Community health nurses need to understand the determinants of health and how these factors interact, leading to disease, death, and disability. Studies estimate that about 50% of premature deaths in the United States can be attributed to individual behaviors (Cassidy, Trujillo, & Orleans, 2015). Individual biology and behaviors play a significant role in influencing health, as they interact with each other and with the social and physical environments. Policies and interventions can play a crucial role in improving health by targeting harmful factors related to individuals and their environment. key determinants of health Global health is a dynamic concept that involves multiple components. Several factors need to be considered when examining the determinants of health. Skolnik (2016) identifies key determinants of health that fall into the following domains: 1. Physical environment 2. Social environment 3. Health behaviors and coping skills 4. Access to health services 5. Healthy child development 6. Employment and working conditions These determinants of health are considered within the broader context of factors such as access to health services, as well as health policies and interventions (Skolnik, 2016, p. 21).  Healthy People 2020 Topic Areas Access to health services Adolescent health Arthritis, osteoporosis, and chronic back conditions Blood disorders and blood safety Cancer Chronic kidney disease Dementias, including Alzheimer Diabetes Continued……. Disability and health Early and middle childhood Educational and community-based programs Environmental health Family planning Food safety Genomics Global health Health communication and health information technology Health care–associated infections Health-related quality of life and well-being Continued……. Hearing and other sensory or communication disorders Heart disease and stroke HIV Immunization and infectious diseases Injury and violence prevention Lesbian, gay, bisexual, and transgender health Maternal, infant, and child health Medical product safety Continued……. Mental health and mental disorders Nutrition and weight status Occupational safety and health Older adults Oral health Physical activity Preparedness Public health infrastructure Continued……. Respiratory diseases Sexually transmitted diseases Social determinants of health Substance abuse Tobacco use Vision From U.S. Department of Health and Human Services. Healthy People 2020 topics & objectives— objectives A-Z. Retrieved from.  In a seminal(‫ )عمل مهم او ملهم‬work, McGinnis and Foege (1993) described what they termed “actual causes of death” in the United States, explaining how lifestyle choices contribute markedly to early deaths. Their work was updated a decade later (Mokdad et al., 2004). Leading the list of “actual causes of death” was tobacco, which was implicated in almost 20% of the annual deaths in the United States — approximately 435,000 individuals. Poor diet and physical inactivity were deemed to account for about 16.6% of deaths (about 400,000 per year), and alcohol consumption was implicated in about 85,000 deaths because of its association with accidents, suicides, homicides, and cirrhosis and chronic liver disease. Other leading causes of death were microbial agents (75,000), toxic agents (55,000), motor vehicle crashes (43,000), firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000).  Although all of these causes of mortality are related to individual lifestyle choices, they can also be strongly influenced by population-focused policy efforts and education. For example, the prevalence of smoking has fallen dramatically during the past two decades, largely because of legal efforts (e.g., laws prohibiting sale of tobacco to minors and much higher taxes), organizational policy (e.g., smoke-free workplaces), and education. Likewise, concerns about the widespread increase in incidence of overweight and obesity have led to population-based measures to address the issue (e.g., removal of soft drink and candy machines from schools, regulations prohibiting the use of certain types of fats in processed foods).  because people become ill less often (McKeown, 2003; Russo, 2015). Indeed, at the population level, better health can be attributed to higher standards of living, good nutrition, a healthier environment, and having fewer children. Furthermore, public health efforts, such as immunization and clean air and water, and medical care, including management of acute episodic illnesses (e.g., pneumonia, tuberculosis) and chronic disease (e.g., cancer, heart disease), have also contributed significantly to the increase in life expectancy.  Community and public health nurses should understand these concepts and appreciate that health and illness are influenced by a web of factors, some that can be changed (e.g., individual behaviors such as tobacco use, diet, physical activity) and some that cannot (e.g., genetics, age, gender). Other factors (e.g., physical and social environment) may require changes that will need to be accomplished from a policy perspective. Public health nurses must work with policy makers and community leaders to identify patterns of disease and death and to advocate for activities and policies that promote health at the individual, family, aggregate, and population levels. Indicators of Health and Illness A variety of health indicators are used by health providers, policy makers, and community health nurses to measure the health of the community. Local or state health departments, the Centers for Disease Control and Prevention (CDC), and the National Center for Health Statistics (NCHS) provide morbidity, mortality, and other health status–related data. State and local health departments are responsible for collecting morbidity and mortality data and forwarding the information to the appropriate federal-level agency, which is often the CDC. Some of the more commonly reported indicators are life expectancy, infant mortality, age-adjusted death rates, and cancer incidence rates.  Indicators of mortality in particular illustrate the health status of a community and/or population because changes in mortality reflect a number of social, economic, health service, and related trends (Shi & Singh, 2016). These data may be useful in : analyzing health patterns over time, comparing communities from different geographic regions, or comparing different aggregates within a community  When the national health objectives for Healthy People 2020 were being developed, a total of 12 leading health indicators were identified that reflected the major public health concerns in the United States (see Healthy People 2020 box). They are individual behaviors (e.g., tobacco use, nutrition, physical activity, and obesity), physical and social environmental factors (e.g., environmental quality, injury, and violence), and health systems issues (e.g., access to health services). Each of these indicators can affect the health of individuals and communities and can be correlated with leading causes of morbidity and mortality. For example, tobacco use is linked to heart disease, stroke, and cancer; substance abuse is linked to accidents, injuries, and violence; irresponsible sexual behaviors can lead to unwanted pregnancy as well as sexually transmitted diseases, including human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS); and lack of access to health care can contribute to poor pregnancy outcomes, untreated illness, and disability. Healthy People 2020 Leading Health Indicator Topics(till here S1) Access to Health Services Clinical Preventive Services Environmental Quality Injury and Violence Maternal, Infant, and Child Health Mental Health Nutrition, Physical Activity, and Obesity Oral Health Reproductive and Sexual Health Social Determinants Substance Abuse Tobacco From U.S. Department of Health and Human Services. Healthy People 2020 leading health indicator topics. Retrieved from https://www.healthypeople.gov/2020/Leading-Health-Indicators  Public health nurses should be aware of health patterns and health indicators within their practice. Each nurse should ask relevant questions, including the following: What are the leading causes of death and disease among various groups served? How do infant mortality rates and teenage pregnancy rates in my community compare with regional, state, and national rates?  What are the most serious communicable disease threats in my neighborhood? What are the most serious environmental risks in my city? The public health nurse may identify areas for further investigation and intervention through an understanding of health, disease, and mortality patterns. For example, if a school nurse learns that the teenage pregnancy rate in their community is higher than regional and state averages, the nurse should address the problem with school officials, parents, and students. Likewise, if an occupational health nurse discovers an apparent high rate of chronic lung disease in an industrial facility, the nurse should work with company management, employees, and state and federal officials to identify potential harmful sources. Finally, if a public health nurse works in a statesponsored AIDS clinic and recognizes an increase in the number of women testing positive for HIV, the nurse should report all findings to the designated agencies. The nurse should then participate in investigative efforts to determine what is precipitating the increase and work to remedy the identified threats or risks. Definition and Focus of Public Health and Community Health Public health is the Science and Art of : (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community effort for: (a) sanitation of the environment, (b) control of communicable infections, (c) education of the individual in personal hygiene, (d) organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and (e) development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity. Core Public Health Functions Assessment: Regular collection, analysis, and information sharing about health conditions, risks, and resources in a community. Policy development: Use of information gathered during assessment to develop local and state health policies and to direct resources toward those policies. Assurance: Focuses on the availability of necessary health services throughout the community. It includes maintaining the ability of both public health agencies and private providers to manage day- to-day operations and the capacity to respond to critical situations and emergencies. From Institute of Medicine: The future of public health, Washington, DC, 1988, National Academy Press. Essential Public Health Services Monitor health status to identify and solve community health problems Diagnose and investigate health problems and health hazards in the community Inform, educate, and empower people about health issues Mobilize community partnerships and actions to identify and solve health problems Develop policies and plans that support individual and community health efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and assure the provision of health care when otherwise unavailable  Assure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solutions to health problems From Centers for Disease Control and Prevention, Office of the Director, Office of the Chief of Public Health Practice, National Public Health Performance Standards Program: 10 essential public health services, 2014. Retrieved from: https://www.cdc.gov/nphpsp/essentialservices.html.  Community health services, which protect the public from hazards such as polluted water and air, tainted‫ ملوث‬food, and unsafe housing Personal health care services, such as immunization and family planning services, well infant care, and sexually transmitted disease (STD) treatment Preventive Approach to Health Health Promotion and Levels of Prevention Contrasting with “medical care,” which focuses on disease management and “cure,” public health efforts focus on health promotion and disease prevention. Health promotion activities enhance resources directed at improving well-being, whereas disease prevention activities protect people from disease and the effects of disease. Leavell and Clark (1958) identified three levels of prevention commonly described in nursing practice: primary prevention, secondary prevention, and tertiary prevention (Fig. 1.2 and Table 1.1).  Primary prevention relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of two elements: general health promotion and specific protection. Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Examples include promotion of good nutrition, provision of adequate shelter, and encouraging regular exercise. Specific protection efforts reduce or eliminate risk factors and include such measures as immunization, seat belt use, and water purification.  Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis. Secondary prevention is implemented after a problem has begun, but before signs and symptoms appear, and targets those populations that have risk factors. Mammography, blood pressure screening, scoliosis screening, and Papanicolaou tests are examples of secondary prevention.  Tertiary prevention targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation. Aims of tertiary prevention are: to keep health problems from getting worse, to reduce the effects of disease and injury, and to restore individuals to their optimal level of functioning. Examples include teaching how to perform insulin injections and disease management to a patient with diabetes, referral of a patient with spinal cord injury for occupational and physical therapy, and leading a support group for grieving parents.  Much of public health nursing practice is directed toward preventing the progression of disease at the earliest period or phase feasible using the appropriate level(s) of prevention. For example, when applying “levels of prevention” to a client with HIV/AIDS, a nurse might perform the following interventions: Educate students on the practice of sexual abstinence or “safer sex” by using barrier methods (primary prevention) Encourage testing and counseling for clients with known exposure or who are in high-risk groups; provide referrals for follow-up for clients who test positive for HIV (secondary prevention) Provide education on management of HIV infection, advocacy, case management, and other interventions for those who are HIV positive (tertiary prevention) Examples of Levels of Prevention and Clients Served in the Community Ethical Insights Inequities: Distribution of Resources , inequities in the distribution of resources pose a threat to the common good and a challenge for community and public health nurses. Factors that contribute to wide variations in health disparities include education, income, and occupation. Lack of health insurance is a key factor in this issue and a major rationale for health care reform efforts. Lack of insurance is damaging to population health, as low-income, uninsured individuals are much less likely than insured individuals to receive timely primary health care and preventive dental care. Community-Based Nursing Community-based nursing practice refers to “application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system” (McEwen & Pullis, 2009, p. 6). Community-based nursing is setting specific, and the emphasis is on acute and chronic care and includes such practice areas as home health nursing and nursing in outpatient or ambulatory settings.  Zotti, Brown, and Stotts (1996) compared community-based nursing and community health nursing and explained that the goals of the two are different. Community health nursing emphasizes preservation and protection of health, and community-based nursing emphasizes managing acute or chronic conditions. In community health nursing, the primary client is the community; in community-based nursing, the primary clients are the individual and the family. Finally, services in community-based nursing are largely direct, but in community health nursing, services are both direct and indirect (Williams, 2016).