Health: A Community View

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NUR 4636C Community Partnered Care

Fall 1999




Health: A Community View


Regina L. Payne, EdD, RN, CWOCN

Anne Nolan, MS, RN, FRCNA

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Health: A Community View


How do we define health?



Depends on who is defining it & why
defining it



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晡浩汹Ⱐ捯浭畮楴yⰠ慧杲敧慴攬e灯灵污l楯i



Are there common characteristics of
health regardless of who or why defining it
& unit of analysis?




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Health: A Community View


Definitions of Health



Personal



80 year old female caretaker of husband



Relative



Surgeon



Mexican migrant farm laborer



Director of Nursing County Health


Department



School health nurse

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Health: A Community View


Definitions



WHO, 1986: …extent to which an individual or
group …realize aspirations and satisfy needs …
change or cope with the environment. … Health …
resource for everyday life … not object of living …
positive concept … social and personal … physical
capacities.”



DON:
Health is the extent to which an individual
or group is able, on the one hand, to realize
expectations and satisfy needs, and, on the other
hand, to change or cope with the environment
(WHO, 1984, p.3).

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Health: A Community View


Definition & Focus of Public Health & Community
Health



What is Public Health
?



Definition: How is Public Health different from
Private Health?



Focus: Health promotion/education & disease
prevention



Examples of PH Health Promotion/Education
Activities?



PH Disease Prevention Activities?



Primary Prevention



Secondary Prevention



Tertiary Prevention

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Health: A Community View



Focus of Public Health &




Community Health




Focus of


Public Health versus


Focus of Nonpublic Health



National Level
:





Local level
:


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Health: A Community View


Focus of Public Health & Community Health



Focus of


Public Health



COMMUNICABLE DISEASE CONTROL
(Prevention?)


Examples:



HEALTH EDUCATION
(Level of Prevention?)


Examples:


EARLY DIAGNOSIS of DISEASE
(Level of
Prevention?


Examples:


SOCIAL PROGRAMMING

(Level of Prevention?)


Examples:

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Health: A Community View


Focus of Public Health & Community Health



Functions of

Public Health



ASSESSMENT
: WHAT IS THE HEALTH
STATUS OF THE POPULATION?



Proxy Measure: Disease



ASSURANCE
: IS CARE AVAILABLE?



Uninsured Children



Accidental Deaths


POLICY DEVELOPMENT
: LOCAL, STATE, &
FEDERAL

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Health: A Community View


Focus of Public Health & Community Health



Focus of


Community Health



Health of local communities organized
through partnerships between pubic tax
supported & private agencies: American
Heart Assoc, American Cancer Society,
hospitals, schools, HDs, United Way
agencies, universities



Examples of partnerships you have been
involved in which focused on the health of a
community

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Health: A Community View



Public Health and Community Health Nursing



How would you define and ‘level’ each of the
following?



Community



Family



Individual



Aggregate



Population



Group



Neighborhood


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Health: A Community View



Population Based and Aggregate Based Care



Population
: Large collection individuals with
common personal or environmental
characteristic(s):Give examples:



Geographic locale:



Special interest:



Other characteristics:


Subpopulations
-
Special groups within populations:



High risk infants under 1 year age



Unmarried adolescent mothers


Grade Schoolers (5
-
11 year olds)



Population Based Care: Define:



CHN Role: Specialist? Generalist? Where would this
person work with populations?

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Health: A Community View



Population Based and Aggregate Based Care



Aggregate
: Group of individuals (smaller than
population) with common personal or
environmental characteristic(s):

Example:



Geographic locale:



Special interest:



Other characteristics:


Other aggregate groups:



High risk infants under 1 year age: Hispanic, RCMA



Unmarried adolescent mothers: Lee County HD


Grade Schoolers (5
-
11 year olds): Rural Lee County



Aggregate Based Care: Define:



CHN Role: Specialist? Generalist? Where would this
person work?

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Health: A Community View



Public Health and Community Health Nursing



Public Health Nursing & Community Health


Nursing



How does PHN differ from CHN?



What are the defining characteristics of
each?



What is their focus of practice for each?



What are their goals?



What education and titles do nurses hold
in each sphere?




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Health: A Community View



Preventionistic Approach

Marie is an 8 year old Haitian girl at San Carlos
Park Grade School. You are the school nurse who
has found that Marie has the following needs:


Understands little English; family speaks no
English


Scored at 60th percentile for age/weight on growth
chart


Has head lice, dental caries, & poor hygiene

Identify short term goals & primary, secondary, and
tertiary level coventions for Marie

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Thinking Upstream



Microscopic vs Macroscopic Approaches



Microscopic

Approach to Health Care



Focus:



Disease Causation:



Coventions:



Macroscopic

Approach to Health Care



Focus:



Disease Causation:



Coventions:


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Thinking Upstream



Models for Public Health Planning



Individual Focus
:
Thinking Downstream



Orem: Self Care Deficit Theory



Health Belief Model



Societal Focus
:
Thinking Upstream



Milio’s Framework for Prevention



Critical Social Theory

Identify one health problem of a population in
FGCU service region. Formulate coventions using
downstream/upstream approaches. How are these
analogous to microscopic/macroscopic
approaches and individual/societal foci?

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Historical Factors:

Community Health in Context


Identify one highlight of historical
significance in public health for class
discussion (Text, Chapter 2)



Why did you select this event?



Is there a counterpart event today?