Maurer: Community/Public Health Nursing Practice, 5th Edition fileAll community/public health nurses...

Copyright © 2013, 2009, 2005, 2000, 1995 by Saunders, an imprint of Elsevier Inc.

Maurer: Community/Public Health Nursing Practice, 5th Edition

Chapter 01: Responsibilities for Care in Community/Public Health Nursing

Discussion of Focus Questions

1. What is the nature of community/public health nursing practice?

Community/public health nursing practice is nursing care that is population-focused and

community-oriented. Care is aimed at improving the health of one or more populations and is

usually provided in settings outside of hospitals and nursing homes. The community/public

health nurse must have formal education specific to public health nursing that complements

basic nursing education.

2. What values underlie community/public health nursing?

The values at the foundation of community/public health nursing are derived from visions

and include commitments. Nurses make a commitment to help clients take responsibility for

their own health and well-being; the vision is of healthy, whole, vital individuals, families,

and communities. Mutuality of goals is the cornerstone on which community/public health

nursing provides caring assistance to help others responsibly explore alternatives when

promoting health or responding to illness. Nurturing the growth and development of

individuals, families, groups, and communities is an imperative that necessitates skillful

leadership and management.

3. How is empowerment important in community/public health nursing?

The nurse must employ the empowerment process to assist clients in recognizing and using

their innate and learned skills to solve problems in the areas of concern. Community/public

health nurses must demonstrate assertive leadership as the individuals, families, groups, and

communities become empowered. Community/public health nurses use knowledge gained

from education and experience in assisting individuals, families, groups, and communities to

have opportunities to make choices that promote health and wholeness.

4. What health-related goals are of concern to community/public health nurses?

There are several major goals for community/public health nursing. (See Box 1-6.) All nurses

address these goals, but most do so with individuals, with hospitalized individuals and their

families or friends, and with small groups. In addition, community/public health nurses

formulate such goals with families, groups, aggregates, and organizations within the

community.

5. Who are the clients of community/public health nurses?

The explicit naming of families, groups, and aggregates or populations as clients is a major

focus. Community/public health nurses do care for individuals; however, individuals are

cared for in the context of a vision of a healthful community. Community/public health

nurses seek to empower individuals, families, and groups to participate in creating healthful

communities.

Discussion of Focus Questions 1-2


6. What are the basic concepts and assumptions of general systems theory?

This chapter discusses only the open system, in which information, energy, or matter is

exchanged with the external environment, along with its constituent characteristics. General

systems theory is used in the community/public health setting to assess and analyze clients

and their interaction with the environment.

7. What is meant by the terms population-focused care and aggregate-focused care?

Population-focused care is aimed at improving the health of one or more populations.

Population may refer to people in an area or community, as well as to a group or set of

persons under statistical study. Aggregate-focused care is aimed at addressing the health of a

population whose members share similar characteristics but have limited face-to-face

interaction (e.g., pregnant teenagers).

8. What are the responsibilities of community/public health nurses?

The traditional historical responsibilities of community/public health nurses are summarized

in Box 1-9. Although many of these are responsibilities of all nurses today, several strategies

in particular are of great importance in community/public health nursing: (1) identification of

unmet needs; (2) advocacy and referral to ensure access to health and social services; (3)

teaching, especially for health promotion and prevention; (4) environmental management; (5)

collaboration and coordination; and (6) political action for adequate standards of living and

health care services and resources.

9. What competencies are expected of novice community/public health nurses?

The novice community/public health nurse is expected to apply the nursing process with

limited supervision and to adapt care to the preferences and needs of the individuals,

families, groups, and aggregates. In addition to performing adroitly as an agent of change, the

novice community/public health nurse must be skillful in screening and evaluating behaviors,

consultation, crisis intervention, family and community assessment, conflict resolution,

group dynamics, and assessment of an entire caseload as necessary.

10. How are community/public health nurse generalists and specialists similar and different?

All community/public health nurses can contribute to improving nursing practice.

Community/public health nurses can do this by obtaining professional certification, by using

quality assurance programs, and by generating new knowledge through nursing research.

Generalists have a baccalaureate nursing degree and may be certified as community/public

health nurses or school nurses. Specialists usually have a master’s degree and provide

support, orientation, staff development, consultation, and professional leadership to

generalists.

The following is true for specialists:

A. They have a graduate degree.

B. They provide leadership in community/public health nursing.

C. They may be certified as clinical specialists or nurse practitioners.

Discussion of Focus Questions 1-3


D. They provide consultation and professional leadership to nurse generalists (staff

development).

E. They focus on aggregates.

F. They are social political activists.

G. They engage in all phases of nursing research.

Community/Public Health Nursing Practice: Health for Families and Populations: 5th ed.

Copyright © 2013, 2009, 2005, 2000, 1995 by Saunders, an imprint of Elsevier Inc. Maurer

1 Lesson Plan for

Responsibilities for Care in Community/Public Health Nursing

OBJECTIVES

1. Describe the nature of community/public health nursing practice.

2. Identify the values that underlie community/public health nursing.

3. Explain why empowerment is important in community/public health nursing.

4. List the health-related goals that are of concern to community/public health nurses.

5. Identify the clients of community/public health nurses.

6. Describe the basic concepts and assumptions of general systems theory.

7. Define the terms population-focused care and aggregate-focused care.

8. Describe the responsibilities of community/public health nurses.

9. List the competencies expected of beginning community/public health nurses.

10. Compare and contrast community/public health nurse generalists and specialists.

TEACHING FOCUS

Community/public health nurses synthesize their knowledge of nursing and public health to promote the health of populations in communities. Nursing knowledge helps in the understanding of problem solving and creative empowerment, of human experiences and responses related to health and illness, and of relationships between people and their environment. Public health knowledge helps make clear the magnitude of disease, disability, and premature death in human populations and suggests methods of prevention.

Community/public health nurses seek to empower persons in families, groups, organizations, and communities to achieve their individual potentials and to care for one another. Empowerment is accomplished by using interpersonal relationships to create opportunities for people to promote their own health.

Health promotion involves decreasing preventable diseases, disability, and premature death; reducing experiences of illness, vulnerability, and suffering; and fostering experiences of human caring, connectedness, and fulfillment.

Baccalaureate-prepared community/public health nurses (generalists) apply the nursing process with individuals, families, groups, and populations as guided by Public Health Nursing: Scope and Standards of Practice (ANA, 2007b).

Generalists work with community/public health nurse specialists, other professionals, and community members to identify the populations or aggregates at greatest risk for compromised health.

General systems theory is useful in studying clients at multiple ecological levels. Individuals, families, groups, organizations, and communities are open systems that exchange energy with their environment to survive and develop. Population aggregates are not systems because the members

2 Chapter 4 Financing of Health Care: Context for Community/Public Health Nursing _________________________________



are not related interpersonally. Instead, they have one or more health-related characteristics in common.

Physical, social, cultural, spiritual, economic, and political facets of our environment all have an impact on community health. Community/public health nurses need to be broadly educated to recognize human–environment interactions. Community/public health nurses seek healthful environments while preserving natural resources.

Prevention is a complex public health concept linked with the natural history of diseases. Primary prevention activities preclude the occurrence of a disease or injury. Secondary prevention activities focus on early identification and treatment of diseases. Tertiary prevention seeks to reduce negative consequences of illness and restore health as much as possible.

Community/public health nurses use a variety of nursing interventions. Identifying persons with unmet health and social needs, ensuring access to health and social services, teaching for health promotion, screening and case finding, promoting healthful environments, providing and coordinating direct care, and participating with others to influence community decisions and policy are especially important to community/public health nurse generalists.

Social justice is important in the promotion of community/public health. Concern for the "greatest good for the greatest number" sometimes allows community/public health nurses to force clients to do something (take antituberculosis medications) or not to do something (abuse a spouse) to protect others. However, education and empowerment are preferred to enforcement and coercion.

Mechanisms to ensure quality of nursing care include licensure, continued professional development, certification, quality assurance, research, and evidence-based practice.

KEY TERMS

Aggregate, p. 10

Commitments, p. 4

Community-based nursing, p. 3

Community health nursing, p. 3

Community/public health nurse, p. 4

Distributive justice, p. 12

General systems theory, p. 7

Group, p. 9

Population, p. 9

Population-focused, p. 3

Professional certification, p. 25

Public health nurse, p. 4

Public health nursing, p. 3

Risk, p. 10

Social justice, p. 13

Visions, p. 4

NURSING CURRICULUM STANDARDS

QSEN

Patient-Centered Care o Referral and Advocacy, pp. 15-17 o Teaching, p. 17 o Direct Care with Individuals, p. 23 o Direct Care with Families, p. 23 o Direct Care with Groups, pp. 23-24 o Direct Care with Aggregates/Populations, p. 24 o Box 1-3: Commitments of Nursing, p. 5 o Box 1-6: Major Goals for Community/Public Health Nursing, p. 11 o Box 1-8: Standards of Care of Public Health Nursing Practice, p. 14

________________________________ Chapter 4 Financing of Health Care: Context for Community/Public Health Nursing 3



o Box 1-9: Responsibilities of Community/Public Health Nurses, p. 14 o Table 1-4: Public Health Interventions with Definitions, p. 16

Teamwork and Collaboration o Case Management, Coordination of Care, and Delegation, pp. 19-20 o Partnership/Collaboration, p. 20

Evidence-Based Practice o Community/Public Health Nursing Research and Evidence-Based Practice, pp. 25-26 o Figure 1-4: Minnesota Public Health Interventions Wheel, p. 15 o Table 1-4: Public Health Interventions with Definitions, p. 16

Quality Improvement o Quality Assurance, p. 25

Concepts

THEME: ATTRIBUTES/ROLE OF NURSE

Concept: Professionalism o Exemplar: Responsibilities of Community/Public Health Nurses, pp. 14-15 o Exemplar: Box 1-3: Commitments of Nursing, p. 5 o Exemplar: Box 1-6: Major Goals for Community/Public Health Nursing, p. 11 o Exemplar: Box 1-7: Code Ethics for Nurses, p. 12 o Exemplar: Box 1-8: Standards of Care of Public Health Nursing Practice, p. 14 o Exemplar: Box 1-9: Responsibilities of Community/Public Health Nurses, p. 14

Concept: Leadership o Exemplar: Leadership in Community/Public Health Nursing, pp. 24-25

Concept: Ethics o Exemplar: Nursing Ethics and Social Justice, p. 11

Concept: Patient Education o Exemplar: Teaching, p. 17

Concept: Health Promotion o Exemplar: Empowerment for Health Promotion, pp. 6-7

THEME: CARE COMPETENCIES

Concept: Collaboration o Exemplar: Case Management, Coordination of Care, and Delegation, pp. 19-20 o Exemplar: Partnership/Collaboration, p. 20

Concept: Evidence o Exemplar: Community/Public Health Nursing Research and Evidence-Based Practice, pp.

25-26 o Exemplar: Figure 1-4: Minnesota Public Health Interventions Wheel, p. 15 o Exemplar: Table 1-4: Public Health Interventions with Definitions, p. 16

Concept: Health Care Quality o Exemplar: Quality Assurance, p. 25

THEME: HEALTH CARE DELIVERY

Concept: Caregiving




o Exemplar: Direct Care of Clients with Illness, Infirmity, Suffering, and Disability, p. 15 o Exemplar: Surveillance, Monitoring, and Evaluation, p. 18 o Exemplar: Expected Competencies of Baccalaureate-Prepared Community/Public Health

Nurses, pp. 22-23

THEME: HEALTH CARE INFRASTRUCTURES

Concept: Health Care Economics o Exemplar: Social, Political, and Economic Activities, p. 20

Concept: Health Policy o Exemplar: Policy Enforcement and Development, p. 18

BSN Essentials

Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice o Expected Competencies of Baccalaureate-Prepared Community/Public Health Nurses,

pp. 22-23

Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety o Leadership in Community/Public Health Nursing, pp. 24-25

Essential III: Scholarship for Evidence-Based Practice o Community/Public Health Nursing Research and Evidence-Based Practice, pp. 25-26 o Figure 1-4: Minnesota Public Health Interventions Wheel, p. 15 o Table 1-4: Public Health Interventions with Definitions, p. 16

Essential V: Health Care Policy, Finance, and Regulatory Environments o Policy Enforcement and Development, p. 18

Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes

o Case Management, Coordination of Care, and Delegation, pp. 19-20 o Partnership/Collaboration, p. 20 o Consultation, p. 20

Essential VII: Clinical Prevention and Population Health o The Nursing Process in Community/Public Health, pp. 13-14

Essential VIII: Professionalism and Professional Values o Responsibilities of Community/Public Health Nurses, pp. 14-15 o Box 1-3: Commitments of Nursing, p. 5 o Box 1-6: Major Goals for Community/Public Health Nursing, p. 11 o Box 1-7: Code Ethics for Nurses, p. 12 o Box 1-8: Standards of Care of Public Health Nursing Practice, p. 14 o Box 1-9: Responsibilities of Community/Public Health Nurses, p. 14

BSN Essentials for Public Health Nursing

Communication o Referral and Advocacy, pp. 15-17 o Teaching, p. 17

Community/Population Assessment o Surveillance, Monitoring, and Evaluation, p. 18




o Environmental Management, p. 18 o Table 1-4: Public Health Interventions with Definitions, p. 16

Community/Population Planning o Environmental Management, p. 18

Policy Development o Policy Enforcement and Development, p. 18 o Community/Public Health Nursing Research and Evidence-Based Practice, pp. 25-26

Assurance o Case Management, Coordination of Care, and Delegation, pp. 19-20 o Quality Assurance, p. 25 o Partnership/Collaboration, p. 20 o Consultation, p. 20

Health Promotion and Risk Reduction o Empowerment for Health Promotion, pp. 6-7 o Preventing Illness and Injury, p. 17 o Promoting Wellness and Transcendence of Suffering, pp. 17-18

Illness and Disease Management o Direct Care of Clients with Illness, Infirmity, Suffering, and Disability, p. 15 o Direct Care with Individuals, p. 23 o Direct Care with Families, p. 23 o Direct Care with Groups, pp. 23-24 o Direct Care with Aggregates/Populations, p. 24 o Table 1-2: Examples of Health Outcomes Related to Goals of Community/Public Health

Nursing, p. 11

Ethics and Social Justice o Nursing Ethics and Social Justice, p. 11 o Ethical Priorities, p. 12 o Distributive Justice, pp. 12-13 o Social Justice, p. 13 o Social, Political, and Economic Activities, p. 20 o Box 1-7: Code Ethics for Nurses, p. 12 o Table 1-3: Basic Ethical Principles in Health Professions, p. 12




STUDENT CHAPTER RESOURCES

Chap. 1 PREPARE FOR CLASS, CLINICAL, OR LAB READ – Textbook (pp. 2-30) REVIEW – Evolve Resources

Glossary ANSWER – Evolve Resources

Critical Thinking Questions for Case Studies

PREPARE FOR EXAMS Chapter 1: NCLEX Review Questions




INSTRUCTOR CHAPTER RESOURCES

TB TESTING RESOURCES - Test Bank Chapter 1: Test Bank

PPT TEACHING RESOURCES – PowerPoint Presentation (Slides 1-24)

Chapter 1: PowerPoint Presentation

IC TEACHING RESOURCES – Image Collection

Figure 1-1. Estimated community health nurses by work sites—2008 (total community health nurses = 355,100).

Figure 1-2. Social systems.

Figure 1-3. A, Model of an open system. B, Residence for older adults viewed as an open system.

Figure 1-4. Minnesota Public Health Interventions Wheel (March, 2001).

Unn Figure 1-1. Community health nursing focuses on the health of a group, community, or population.

Unn Figure 1-2. Children in a sports league are one example of a group, because they have one or more characteristics in common as well as a face-to-face relationship.

OC TEACHING RESOURCES – Community/Public Health Nursing Online Course

Module 1: Population-Focused Practice

ETC. TEACHING RESOURCES

Chapter 01: Discussion of Focus Questions

Chapter 01: Teaching Strategies for Learning by Experience and Reflection




TEACHING STRATEGIES

CONTENT FOCUS CONTENT HIGHLIGHTS LEARNING ACTIVITIES DISTINGUISHING FEATURES OF COMMUNITY/PUBLIC HEALTH NURSING

Healthful Communities Empowerment for Health Promotion

Discuss the features of community/public health nursing that make it distinct from general nursing.

Online Activity: Have students visit

http://www.countyhealthrankings.org/ and have them find their home

state (or search by zip code) and locate the state or zip code’s health rankings. Then have the student prepare an analysis of the relationship between the health ranking and the community’s social and economic factors (this information is included with the particular community’s rankings).

NURSING ETHICS AND SOCIAL JUSTICE

Ethical Priorities Distributive Justice Social Justice

Discuss the role of ethics and the challenges that arise with balancing multiple contrasting concerns in community/public health nursing.

Small Group Activity: Have students identify the pros and cons of an egalitarian and utilitarian system of justice. Instruct them to consider each system’s impact on an individual client’s access and quality of care compared to the impact on the entire health care delivery system.

RESPONSIBILITIES OF COMMUNITY/PUBLIC HEALTH NURSES

Direct Care of Ill, Infirm, Suffering, and Disabled Clients

Referral and Advocacy

Teaching Surveillance, Monitoring, and Evaluation Policy Enforcement and Development Environmental Management Case Management,

Discuss the various responsibilities and interventions unique to community/public health nurses

Individual Activity: Look through several copies of a major newspaper to find articles related directly or indirectly to human health. Describe any inequalities in access to health care, access to a basic standards of living, or exposure to environmental hazards. Identify implications for community/public health nursing practice.




Coordination of Care, and Delegation Partnership/Collaboration Consultation

Social, Political, and Economic Activities Empowerment for Creativity Self-Care and Development LEADERSHIP IN COMMUNITY/PUBLIC HEALTH NURSING

Professional Certification

Quality Assurance

Community/Public Health Nursing Research and Evidence-Based Practice

Discuss the responsibilities and qualities of leaders in community health nursing.

Small Group Activities: Have students discuss the ways in which evidence-based practice can reduce health costs.

IN-CLASS/ONLINE CASE STUDY

Jane is in her last semester of nursing school and chooses community nursing as her senior elective

course. The requirements of the course dictate that the students pair up on clinical days and walk the

Vietnamese neighborhood of an urban area to assess the health needs of the residents. During the 8-

week course, the students go door to door to inquire whether the residents are in need of health care.

The students perform assessments, initiate and maintain documentation on the residents, and refer to

the county hospital persons who are in need of further medical attention.

At the end of the semester, the students hold a health fair at the local police precinct for the

Vietnamese neighborhood residents. Part of the students’ learning is to organize the health fair,

promote it among the residents to ensure an effective turnout, and then evaluate the effectiveness of

the event. Jane is responsible for having Vietnamese translators available at the fair and for

implementing the fair’s documentation system.

1. When the students hold the health fair at the neighborhood police precinct, they are exercising:




A. Systems management

B. Environmental management

C. Client monitoring

D. Client advocacy

Answer: B Rationale: Environmental management is the promotion of a place conducive to healing and well-being.

In this scenario, the police precinct serves as the place conducive to healing and well-being.

2. On the day of the health fair, Jane asks the Vietnamese translators to organize the clients in a single-

file line and to help the clients complete the brief intake form. Jane’s actions are a form of:

A. Control

B. Advocacy

C. Delegation

D. Management

Answer: C Rationale: Delegation is the assignment of responsibility to another person. Community/public health

nurses delegate to non-baccalaureate registered nurses, licensed practical nurses (LPNs), nursing

assistants, and other people such as homemakers, parent aides, and community workers.

3. After the health fair, the nursing instructor calls a meeting and asks the students to share their

experiences of the day, including the positive outcomes of the health fair and examples of when

things did not work according to plan. The group is engaging in:

A. Peer sharing

B. Networking

C. Collaboration

D. Soul searching




Answer: A Rationale: Peer sharing occurs when nurses share their experiences, both successful and disappointing,

in providing care.

CHAPTER 1: ANSWER KEY TO TEXT CASE STUDY CRITICAL THINKING QUESTIONS

Note: Answers to these questions can also be found on the Evolve site. Click here.

Case Study: Being Present

1. What do you think the nurse’s vision was in this case study?

CORRECT ANSWER: The vision of the nurse was to respect the mother as a human being while

remembering that her primary professional goal was to promote the well-being of the child.

2. How did the nurse empower the mother?

CORRECT ANSWER: The community/public health nurse slowly developed her relationship with the

mother. The nurse spoke the mother’s name and followed her lead as they discussed how the mother

was providing stimulation for her son’s development. The nurse said that it must be difficult to feed a

child with frequent seizures. The nurse acknowledged the mother’s request to get seizure medication

and the desire to not return to the initial pediatrician. The nurse found a second pediatrician in a city 40

miles away and arranged for transportation. The nurse was “present” for the mother; she was physically

present in the home several times and psychologically present to acknowledge the mother’s strengths

and perspective of the circumstances. In addition, the community/public health nurse was spiritually

there and could honestly claim that she liked the mother, despite all her troubles.

3. How did the nurse use the theory of general systems as part of her assessment of the client?

CORRECT ANSWER: The nurse provided home focus of the problems that the mother was having with

feeding the infant. The nurse identified the system as consisting of the mother, the infant, and two

other children in the home environment. The nurse identified inputs that were stressors to this family:

mother with a history of “crack” use, infant with almost constant seizures, two other children in the

house, and refusal of the pediatrician to prescribe strong antiseizure medication. Also, the nurse

identified inputs that were resources: mother’s denial of the use of “crack” at this time, a pediatric




neurologist who is willing to see the infant, and volunteers to transport the mother and infant to the

doctor 40 miles away.

4. What short-term and long-term goals did the nurse develop for this family?

CORRECT ANSWER: The short-term goal developed by the nurse was to control the infant’s seizures. The

long-term goal was to teach the family to incorporate behaviors that are conducive to the promotion of

self-help and also to educate the family about the appropriate use of health resources.

5. What actions by the nurse would be considered preventive?

CORRECT ANSWER: Screening, education, and immunizations that were offered at the health

department’s well-child clinic could be considered preventive actions by the nurse.

6. Which partnership did the nurse form so that the client could be assisted?

CORRECT ANSWER: The nurse formed a partnership with the pediatric neurologist, who agreed to see

the mother and infant.

7. How did the nurse use resources in the community to assist the mother?

CORRECT ANSWER: The nurse used volunteers in the community to transport the mother and infant to

the doctor’s appointment. The public school system was a community resource used by the nurse in

addressing the infant’s delayed developmental progress. Also, the nurse referred the mother to an

institution that offered job training.

8. How should the nurse evaluate the effectiveness of interventions?

CORRECT ANSWER: To evaluate the effectiveness of interventions, the nurse must examine the goals

that were developed before the interventions were implemented. If the goals have been achieved, then

the nurse knows that the interventions were indeed effective. In this particular case study, the short-

term goal was met in that the infant’s seizures were controlled with medication. The long-term goal was

met because the mother had been taught to feed the child, the child was accepted into a special




education program in the public school system, and the mother was beginning to talk about seeking job

training.


Maurer: Community/Public Health Nursing Practice, 5th Edition

Chapter 01: Responsibilities for Care in Community/Public Health Nursing

Teaching Strategies for Learning by Experience and Reflection

1. Look through several copies of a major newspaper to find articles related directly or

indirectly to human health. Describe any inequalities in access to health care, access to a

basic standard of living, or exposure to environmental hazards. Identify implications for

community/public health nursing practice.

Teaching Strategy for Question 1 Before class, obtain a variety of print media for a specific date (e.g., if August 4 is chosen,

the newspapers and the magazines would be for that day, that week, or the month closest to

that date). Suggested materials include national, local, neighborhood, or ethnic newspapers;

news magazines such as Time, Newsweek, and U.S. News and World Report; and women’s

magazines such as Family Circle, Woman’s Day, and Essence.

In the class, form groups of two to four students. Give each group a newspaper or magazine.

Have them complete the nursing care plan based on their findings in the materials. A

suggested format is as follows:

Assessment Plan Interventions Evaluation

1. How many

articles are related to

health?

1. What needs to be

completed first?

1. What actions

would be appropriate

for the nurse to

perform to cause

change with the

health problem cited?

1. Write a criterion for

evaluation of success

and satisfaction of the

planning and

intervention phases.

2. List the categories

of health issues.

2. List your short- and

long-term goals.

2. Consider what

difference may be

indicated for each

population group.

2. What concerns are

universal, local, etc.?

3. How is the basic

standard of living

affected?

3. List the means that

may be used to

decrease any

inequities for the

population groups

involved.

3. What are the health-

related impacts of your

objectives/interventions

that need modification?

4. Write a nursing

diagnosis for any

inequities related to

health care access

for the health issues

identified.

2. Express your vision of a healthy family and of a healthy community. List some of your

commitments related to your choice of nursing as a profession. As your experience in

community/public health nursing broadens, consider modifying your list of commitments.

Teaching Strategies for Learning by Experience and Reflection 1-2


Teaching Strategy for Question 2

Before class, take two sheets of paper and label one “Vision of a Healthy Family” and the

other “Vision of a Healthy Community.” Set up four columns on each sheet as shown in the

suggested format that follows. In the first column, the student should write those elements

that he/she believes nursing promotes and to which the nurse has committed.

Throughout the semester, the student may write any additional visions in a different color of

ink. Interim evaluation dates for written comments should be selected. For the final entry, the

student may note areas that have changed or need modification.

VISION OF A HEALTHY FAMILY

Beginning Visions

Committed

Elements from

Nursing

Dates/Comments

Dates/Comments

Final Comments

1. Two-parent family 3/12—Parental roles

need to be coordinated.

2. Children share

chores

2/12—The older child

should not have full

responsibility for the

younger children.

VISION OF A HEALTHY COMMUNITY

3. Express your vision of an empowering work environment. If you are a student, consider

what an empowering clinical practice environment would be like for you. Identify what

commitments you are willing to make for this vision. Share your visions and commitments

with your work group or learning group in an attempt to identify some common visions and

commitments as a basis for partnership.


Working in small groups, have each student write a contract in triplicate (one copy for

student, one for peer review, and one for instructor). Using the chapter definition of

empowerment, write the behaviors to which the student will be committed throughout the

learning experience. Any in-between modification of the contract must be mutually

negotiated with the student, peer, and instructor. Share the commitments with the class. The

instructor may make a contract with the class as a means to role model and establish trust.

Beginning Visions

Committed

Elements from

Nursing

Dates/Comments

Dates/Comments

Final Comments

1. Feeling secure 2/12—Neighbors look

out for each other.

2. Convenient

transportation

3/12—Need easier

access to health care,

shopping.



MODIFICATIONS FOR EMPOWERING THE WORK ENVIRONMENT

(FOR STUDENTS)

Initials Date Comments

1. I will avoid stereotyping

the client.

2. I will be punctual in

documenting upon

returning from my visit.

Signature: ______________________________________________

Date: __________________________________________________

MODIFICATIONS FOR EMPOWERING THE WORK ENVIRONMENT

(FOR STUDENTS)

Initials Date Comments

1. I will return assignments

in 5 days with constructive

feedback.

2. I will have individual

conferences with each

student weekly.

Signature: ______________________________________________

Date: __________________________________________________

4. Select a public health problem of interest to you, such as falls among the elderly, and

describe primary, secondary, and tertiary prevention strategies.


Arrange the students into small groups. In the interest of time or if the students cannot readily

generate a list of public health problems, have a list of several concerns from which they can

choose. Some examples include violence, pollution, healthy snacks, health insurance, and

falls among elderly.

On a separate sheet, have the students make a form with three columns for strategies for the

three levels of prevention. See the suggested format that follows:

HEALTH PROBLEM: FAMILY VIOLENCE

Primary Prevention

Strategies

Secondary Prevention

Strategies

Tertiary Prevention

Strategies

1. Teach and practice clear

value-beliefs about

discipline while maintaining

self-esteem (e.g., hitting

anyone is unacceptable

behavior).

1. Parental aids, support

groups.

1. Remove the victim from

the abuser. Provide therapy

for the victim and the

abuser.



2. Continue with more

examples.

5. Using the same health problem you identified in activity 4, discuss how interventions may

be directed toward individuals, families, groups, and the public. To whom would you target

interventions, and why? Explore evidence of best nursing practices related to this health

problem and proposed interventions.


Before class, make a four-column chart for each client level. See the suggested format that

follows.

In class, form small groups and instruct the students to use the same health problems as in

activity 4. Have them write appropriate interventions with rationales for each of the client

levels.

HEALTH PROBLEM: FAMILY VIOLENCE

Interventions

Individual Family Groups Public

No corporal

punishment of child

except for immediate

safety problems (e.g.,

running out in

traffic).

Have weekly family

meeting where all

concerns are

discussed without

retaliation or

denigration.

In group meetings,

encourage all

members to actively

listen and provide

constructive

feedback.

Hold school-based

nonviolence

programs for all

levels of the

population.

Rationales

Individual Family Groups Public

This provides the

stimulus for

employing alternative

means of

communicating limit-

setting.

Problems may be

addressed before the

problems get out of

hand.

This demonstrates

respect for and

understanding of

other ideas.

This allows more

interaction with

others outside the

family unit, while

reinforcing positive

values for the rights

of others.

6. Interview or accompany a community/public health nurse to identify his or her

professional responsibilities. To what degree does the nurse provide care with individuals,

families, or groups? How does the nurse use data about the public or aggregates to target

care? How does the nurse participate in continuing professional development and

improvement of nursing care? What current research findings does the nurse use to

strengthen evidence-based practice?


(1) Select several agencies where community/public health nurses are employed. Have

student pairs take the role of inquiring reporters to elicit answers to the following

questions:

a. What is the community/public health nurse’s definition of community health?

b. What is the community/public health nurse’s position in the agency?

c. Which basic educational subject helped the nurse prepare for this role?



d. What is the focus of the nurse’s care to individuals, families, groups, and the

community?

e. How do the nurse’s responsibilities change with the different client entities?

f. How does the nurse develop care plans that reflect culturally competent care for

individuals, families, groups, and the community?

g. How does the nurse participate in continuing professional development and

improvement of nursing care?

(2) How does the above information dovetail with the students’ ideas of community/public

health nursing?

Date post:	21-Jul-2018
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