Transcript Opening the Door to Health Care in the Community

Opening the Door to Health
Care in the Community
A Closer Look at Health
• “A state of complete physical, mental, and
social well-being and not merely the
absence of disease or infirmity” (World
Health Organization, 1958)
• In 1986 the WHO definition expanded to
include a community concept of health
Historical Insights
• During the 19th century the causes of
communicable disease began to emerge and
public health measures were established
• In the 20th century technology and medical
science grew and the health care system
focused on diagnosis and treatment of disease
Nursing in the New Millennium
What has changed?
– who delivers
health care
– what is provided
– when and where
clients are seen
Educating Nurses for Community
Health Nursing Practice
Educational Competencies for Graduates of
Associate Degree Nursing Programs (NLN,
2000) provides recommendations regarding
ADN educational content essential for entry
level in community health nursing practice.
Community-Based Care
• refers to both setting and practice of the
nursing role
• setting refers to any kind of health care
other than acute care setting
• nurse referred to as a community health
nurse (CHN)
Communities and Populations
A community is a group of people who
share something in common and interact
with one another, who may exhibit a
commitment with one another and may
share a geographic boundary.
Communities and Populations
A population is a
group of people
who have at least
one thing in
common and who
may or may not
interact with each
other.
Population- and CommunityFocused Care
• interventions
aimed at disease
prevention and
health promotion
that shape a
community’s
overall health status
Public Health Nursing
• Population-focused,
community-oriented
nursing practice
• Dominant
responsibility is to
the care of the larger
community
Acute Care Versus CommunityBased Nursing: Benefits for Nurse
• Predictable routine
• Maintenance of
hospital policy
• Predictability of
nursing and
medical goals
Acute Care Versus CommunityBased Nursing: Benefits for Nurse
• Resource availability
• Collegial collaboration and consultation
• Controlled client compliance with plan
of care
• Standardization of care
Acute Care Versus CommunityBased Nursing: Benefits for Client
• Familiar and comfortable environment
• Routine that is less determined by the nurse
or health professional
• Diverse resources, including friends, family,
pets, available for support and comfort
• Autonomy and choice in health decisions
Reform and Reinvention of
Systems of Care
• Nursing’s Agenda for Health Care Reform
– prominent values: health services for all,
illness prevention, and wellness
• Managed Care and the Future of Nursing
– care management is a growing practice
arena for nurses
From Hospital to Community,
from Cure to Prevention
• Home Health Care
• Cure and Prevention
–lifestyle
–human biology
–environment
–health care
• Benefits Versus Costs
Healthy People 2010:
Goals for the Nation
• Two overarching goals
– increase years of
healthy life
– eliminate health
disparities
Healthy People 2010:
Goals for the Nation
• Four enabling goals
– promote healthy behaviors
– promote healthy and safe communities
– improve systems for personal and public
health
– prevent and reduce diseases and disorders
Priority Area:
Promote Healthy Behaviors
• Physical activity
and fitness
• Nutrition
• Tobacco use
Priority Area:
Promote Healthy and Safe
Communities
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Educational and community-based programs
Environmental health
Food safety
Injury/violence prevention
Occupational safety and health
Oral health
Priority Area:
Improve Systems for Personal
and Public Health
• Access to quality
health care services
• Family planning
• Maternal, infant,
and child health
• Medical product
safety
• Public health
infrastructure
• Health
communication
Priority Area:
Prevent and Reduce Diseases
and Disorders
• Arthritis,
osteoporosis, and
chronic back pain
• Cancer
• Diabetes
• Disability and
secondary conditions
• Heart disease and
stroke
• HIV
• Immunizations and
infectious diseases
• Mental health and
mental disorders
• Respiratory diseases
• STDs
• Substance abuse
Influences on a Community’s Health
• Culture
• Environment
• Ethics
Epidemiology:
The Science of Public Health
• Epidemiological model
– host
– agent
– environment
• Natural History of Disease
– prepathogenesis
– pathogenesis
Levels of Prevention
• Primary prevention refers to those measures
that focus on prevention of health problems
before they occur
• Secondary prevention begins when pathology
is involved and is aimed at early detection
through diagnosis and prompt treatment
Levels of Prevention
• Tertiary prevention
consists of activities
designed around
rehabilitation
when a permanent,
irreversible
condition exists
Measuring a Community’s Health
• Health statistics
– birth rates
– infant mortality
rates
– incidence
– prevalence
• Patterns of behavior