Guidebook Electronic Version

MLHU - Community Health Nursing Certification Guidebook FOR STUDY GROUP USE ONLY
In collaboration with

Community Health Nursing
Certification Guidebook

December 2006
Revised October 2009

For information, please contact:
Community Health Nursing Specialist
Middlesex-London Health Unit
50 King Street
London, Ontario
N6A 5L7
phone: 519-663-5317 ext. 2259
fax: 519-663-8241

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Table of Contents

I. Acknowledgements ................................................................................................................... 3

II. Top 10 Reasons to Become Certified.......................................................................................... 4

III. Introduction.............................................................................................................................. 5

IV. Comments on How Certification Impacted Practice .................................................................... 6

V. Recommendations from Former Exam Writers........................................................................... 7

VI. Study Group Roles and Responsibilities .................................................................................... 9

VII. Prior to First Study Group Meeting.......................................................................................... 11

VIII. Competency #1: Facilitating Access to Services in an Efficient and Effective Manner .............. 13

IX. Competency #2: Restoring and Maintaining Health and Providing End-of-Life Care ................ 18

X. Competency #3: Promoting Health and Preventing Illness and Injury of Vulnerable
Populations, Aggregates and Targeted Groups within the Community........... 30

XI. Competency #4: Promoting Health and Wellness Across the Life Span.................................... 38

XII. Competency #5: Providing Infection Prevention and Control and Communicable Disease
Services........................................................................................................ 61

XIII. Competency #6: Being Involved in Emergency Preparedness/Disaster Management ............... 75

XIV. Competency #7: Promoting a Healthy Environment ................................................................ 79

XV. Competency #8: Building Community Capacity to Improve Health.......................................... 99

XVI. Competency #9: Demonstrating Professional Responsibility and Accountability.................... 106

Appendix A Learning Styles Assessment...................................................................................... 117
Appendix B Co-operative Learning Strategies............................................................................... 119
Appendix C Internet Resources.................................................................................................... 121
Appendix D Minnesota Wheel of Public Health Nursing Interventions .......................................... 123
Appendix E Immunization Quiz ................................................................................................... 124
Appendix F Review Questions Multiple Choice.......................................................................... 128

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Acknowledgements

ParaMed graciously contributed to this guidebook, ensuring that the home health nursing perspective
was well represented and incorporated throughout.

Thanks and congratulations are extended to our first study group. This group of trailblazers was
dedicated, enthusiastic, and knowledgeable. Without exception, they were not only generous in sharing
the resources they developed to prepare for the exam, but were also willing to review and provide feedback
on this guidebook.

Yvette Laforet-Fliesser, Program Manager with the Middlesex-London Health Unit, has been and
continues to be a strong advocate and supporter. Her knowledge was invaluable, and she carefully
balanced providing support to the group and maintaining confidentiality regarding the exam.

Diane Bewick, Senior Nurse Leader with the Middlesex-London Health Unit, has consistently
demonstrated support and leadership throughout the certification experience. From offering
encouragement and thoughtful personal messages to supplying resources and study materials, her
contributions have been significant in the success of the study group.

The Middlesex-London Health Unit Research Education Evaluation and Development Library Services has
provided generous support. Yvonne Tyml, our librarian, and Susie Noble were vital to accessing and
organizing our learning resources.

Anda big thank you to the Community Health Nurses Association of Canada (CHNAC)
and Barb Mildon for having the vision of achieving speciality status and certification with the Canadian
Nurses Association.


Top Ten Reasons to Become Certified

Community Health Nurse Certification:

1. promotes pride in our chosen nursing
practice focus - community health nursing

2. actively demonstrates personal commitment
to professional development

3. sustains high quality nursing practice
through the identification and integration of
current, evidence-based knowledge into
community nursing practice

4. creates public confidence in our knowledge
and skills

5. actively demonstrates personal commitment
to excellence in community health nursing
practice

6. represents a significant career achievement

7. provides official recognition by our nursing
colleagues and all health system stake
holders for our unique practice focus and
competencies

8. lends credibility to community health nurses
during these tumultuous times of change for
the health care system in Canada

9. offers an opportunity to confirm our
competence in this specialty

10. enables us to meet the national standards of
our specialty through a recognized
credential

Modified from: Prepared on behalf of CHNAC by
Jane Underwood and Barb Mildon (December 1,
2003). Proposal for Specialty Designation for
Certification of Community Health Nursing.
http://www.chnac.ca/index.php?option=com_co
ntent&task=view&id=21&Itemid=40 retrieved
November 9, 2006.
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Introduction

In order to prepare nurses for the Community
Health Nursing Certification exam, our public
health unit organizes a study group each year.
Initially the group was comprised of public
health nurses from the Middlesex-London
Health Unit (MLHU). Over time our groups have
grown to include other health units, home
health agencies and a First Nations Community
Health Centre, in Ontario and beyond.

This Community Health Nursing Certification
Guidebook was developed to share the successes
and knowledge gained from the past MLHU
study groups. In this guidebook, you will find
suggested formats for future groups, reading
lists for each competency, and lots of review and
practice questions.

The process that has been developed to assist in
exam preparation has been shown to be an
effective strategy to support Community Health
Nurses; all members of the 2006, 2007 & 2008
groups were successful in achieving certification
in community health nursing.

After nurses receive confirmation from the
Canadian Nurses Association that they will be
writing the certification exam, a meeting is held
in the late fall with all the potential group
members. At this initial meeting, participants
discuss and confirm how they will proceed with
studying the competencies from January until
the exam date in April. The study group uses a
participatory model, and each nurse is
responsible for leading the group through the
study of 1-2 competencies of their choice.

Information on the roles and responsibilities of a
study participant and a study lead are included
in this guidebook. In general, the lead for each
competency provides group members with
suggested readings one week prior to the group
session. For the first hour of the session, they
review the content of the competency being
covered. The second hour focuses on discussion
of the topics, applying knowledge to practice,
and thinking critically about practice situations.

After writing the exam, former group
participants indicated that knowledge
application and critical thinking requires special
attention during exam preparation. A number of
discussion questions taken from various
resources have been included in this guidebook
to support study group participants knowledge
application and critical thinking. It is strongly

recommended that at least half of the study
group time be spent engaging in group
discussion, critically reviewing and applying the
material. The goal of this guidebook is to
encourage participants to actively think their
way through the material and not become
passive recipients.

To date, the study group experience has been
very rewarding, with nurses expressing
appreciation for the renewal of their knowledge
and the building of new relationships. A synergy
between home health, public health and First
Nations has been developed that will be
beneficial for many future endeavors.

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Comments on How Certification Impacted Practice

Thoughts from Public Health Nurses and
Community Health Nurses on how achieving
certification impacted their practice:

"In terms of applying it to my practice, I know
how important it is to check in with the
community throughout the process, from
planning, implementation and evaluation. I
know that I have been extremely cognizant of
that ever since and I have been asserting that
this is important; kind of pushing it at the table
with community partners. It is really in the
forefront of my mind now. This is best practice.
We can't just think that something is a good idea
and go with it. So I have been checking in with
the target audience more...Studying for
certification has really helped remind me to
know that this is something you have just got to
do."

In communicable disease I learned so muchit
was eye opening. Wowand that is relevant to
my practice, not in my areabut I really
benefited from that

I work in a small office. At times Im the only
one in the office. A couple of weeks ago I had
this one gentlemen bring in results from a water
sample, he did not know what the results
meant. Normally I wouldnt either and would
have had to call someone. But now I know! I
knew what to do next and how to help him. It
was so much faster and simpler for both of us.

"Certification has increased my knowledge base
and I can utilize that knowledge in specific
areas, such as communicable disease. I feel I
also gained confidence in my practice area."

"Part of my motivation for writing the CHN Exam
was to test myself to see if I could handle the
juggling act of studying, family and work.
Successfully completing the CHN exam
motivated me and gave me the reassurance I
needed to go back to school to get my Masters
Degree. I discovered I enjoyed studying again
and hitting the books."

The competency on vulnerable populations
really increased my awareness of barriers to
access. Its foremost in my thoughts now.
When developing new community programs Im
actively looking for barriers now, and I dont
think I would have considered them as much
before. For example, what are our hours of
service, locations, and how many people does a
client have to talk with or go through, before
they get the help they need. I much more
conscious of this now and it impacts on my
decision making.

Makes me realize what I dont know and how
fast things are changingI just cant sit on what
I know now without doing something. It gives
something to make sure I stay on top of my
practice.

I went to a reproductive health meeting and
they wanted me to talk on housingI thought I
did a much better job speaking about housing
and the lack of housing in X because I could
connect that with homelessness, determinants
of health and poverty and the impact that has
on everybodys health. I took some of our
readings and handed them outThis is the
connection between that and the determinants
of health and that is why it is so important for
all of us to put it on our agenda.

I found I have asked people a lot more about
their culture when I go on home visitswhere
before I may have ignored it or skimmed over it.
Now Ive really tried to ask the question What
happens in your culture after you have had a
baby. Its amazing how much they tell you
where I had a hard time getting that much
information before.

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Recommendations from Former Exam Writers

The following are a list of recommendations on
how to effectively prepare for the exam from the
MLHU study groups.

Consider years of experience when
deciding to write the exam.
Some participants felt that more than 2 years
experience would be necessary to write the
exam. If you dont have enough hours to apply,
consider participating in a variety of staff
development opportunities until you are ready.
For example, the Public Health Agency of
Canada offers a series of online skills
enhancement workshops free to public health
workers. See http://www.phac-
aspc.gc.ca/sehs-acss/training_modules-eng.php
for more information.

Study Canadian content and invest in a
Canadian community health nursing text.
American texts may provide conflicting
information around some topics (e.g., case
management and insurance benefits). You can
purchase texts through most bookstores or
online, or borrow from your local health science
library. Suggested texts include:
1. Stamler, L. L. & Yiu, L. Community
health nursing: A Canadian
perspective 2
nd
ed. (2008). Pearson
Prentice Hall: Toronto
2. Stewart, M. J. (2000) Community
Nursing: Promoting Canadians
Health (2
nd
ed). W. B. Saunders:
Toronto.

Review content that is consistent and
recognized nationally.
Questions were only included on the exam if
they reflected practices that were consistent
across Canada. However, local strategies and
information related to the competencies can
provide examples of these competencies in
practice, and are easy to access.

Use internet resources.
Appendix C contains community health
resources that are free, current and reliable.
Some helpful resources are the Registered
Nurses Association of Ontario (RNAO) Best
Practice Guidelines (BPGs) at www.rnao.org and
the Public Health Agency of Canada found at
http://www.phac-aspc.gc.ca/new_e.html

Personalize your study time.
The amount of time each participant studied
varied. How much time you need depends on
your learning needs and study habits. In
addition to the study group time, plan to do
some independent reading and studying every
week.

Make the competencies work for you.
Think about what you are reading and learning.
How could what you are learning be applied to
the work you are currently doing? What are
some possible questions that could be developed
from this content?

Network with other Community Health
Nurses in different practice settings.
Connecting with Community Health Nurses from
other settings allows for the sharing of
knowledge and expertise. This invaluable
networking is highly recommended.

Remember that you wont have time to
reread everything.
Make your own summary and/or study notes.
Dont rely on others notes, as your colleagues
may have different learning needs than you.
Review your summary notes about two weeks
prior to the exam.

Concentrate on application and critical
thinking when working on practice
questions.
Some questions from textbooks tend to be
knowledge-recall questions. If you cant find
application and critical thinking questions,
develop some with your colleagues.

Consider the depth of knowledge required
for the competencies.
When studying for the exam, a common
question that surfaced was What is the extent
or scope of knowledge expected? Even after
writing the exam, it was a difficult question to
answer. Better refine their content study by
focusing primarily on national and Canadian
content.

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Keep the scoring method in mind as you
study.
It may be helpful to understand how the exam is
graded. According to the CNA website the
purpose of the certification exam is to determine
whether a candidate has met the standards
required to be certified, not to rank-order
candidates. The questions are designed to best
classify the candidates into two categories: pass
or fail.

The exam committee for each specialty sets the
pass mark using a modified Angoff method by
rating each question according to its difficulty
and the expected success rate of nurses with at
least two years of full-time experience in the
specialty. As well, testing consultants use
statistical information to ensure that the pass
mark is fair and valid. The exam determines
how well a candidate has mastered the nursing
competencies required for a particular specialty.
A competency describes the integrated
knowledge, skills, judgment and attributes
required of a registered nurse to practise safely
and ethically in a designated role and setting.
(from http://www.cna-
aiic.ca/CNA/nursing/certification/apply/faq/de
fault_e.aspx, retrieved August 8, 2006).

Study Tip

To maximize your study time consider completing the learning style assessment
found in Appendix A from the RNAO Educators Resource: Integration of BPGs (2005).
Suggestions on how to boost your learning based on the assessment is given. Any
study group should aim to provide a number of methods of learning for all the
different learning styles: visual, auditory, and kinesthetic.
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Study Group Roles & Responsibilities

Facilitator

Seek relationships with other
Community Health Nurses/agencies.
Foster a learner-centred atmosphere.
Develop and maintain schedule for
study group sessions.
Organize an initial group planning
meeting.
Assist competency leads in developing
the content for the study group,
including discussion and practice
questions.
Co-ordinate and locate resources
information as needed (a Health
Sciences Librarian can be very helpful
with this).
Provide individual support and
information to the nurses as necessary.
Act as a liaison between CNA and other
organizations (e.g., post information
about study group on the CNA website).
Develop relationships and connections
with other study groups and facilitators.
Ensure sessions stay on topic and
relevant to certification.
Maintain and support connections with
CCHN(C) mentors.
Seek feedback on group process and
outcomes on an ongoing basis.
Facilitate a debriefing session within 4-6
weeks after the exam.

Competency Lead

As each session is usually lead by a different
group member, the following outline provides a
guide for the key responsibilities of this
individual. Some groups may choose to have co-
leads for each competency, and may want to
have both home health and public health nurses
represented as leads.
Assess and review the learning needs of
your group for the competency. You will
be unable to cover the entire scope of
the competency in the study group.
Prioritize the information that needs to
be shared. For example, if everyone
around the table has years of experience
in supporting breastfeeding with
families, you may want to focus on
immunization instead.

Develop a suggested reading list. This
guidebook already contains reading
lists. Review these and determine what
is relevant for your group. Competencies
dont cover everything in CHN practice.
For the purpose of exam preparation, let
the competencies guide your learning.
Focus only on a few key readings.

Consider what key content points you
want to review at the study group. Are
there some points in the readings that
are contentious? Do the readings reflect
current local practice? Is there
information some group members may
not be familiar with? Think about how
you are going to balance the discussion
with participants who work in a range of
areas. Aim to complete the content
review in one-third to one-half of your
total session time. Remember that 20-
30% of the exam covers knowing and
understanding definitions, facts,
principles and interpreting data.

Ensure you focus on building skills in
knowledge application and critical
appraisal. The majority of the exam
questions (65-85%) are knowledge
application and critical thinking
questions.

Knowledge application questions (40-
50% of the exam) are about:
Applying knowledge to situations
Applying rules, methods, principles
of therapeutic communication
Identifying consequences

Critical thinking questions (25-35%)
test your ability to:
Judge the relevance of data, to deal
with abstractions, to solve nursing
problems
Formulate conclusions and make
judgements concerning clients
Appraise a situation and identify the
most appropriate intervention

Choose or develop questions to help
with the discussion. The Stamler & Yiu
(2008) text includes study questions and
critical thinking exercises. Many other
texts include similar types of questions.
If you are unable to find good questions,
consider developing your own.
Appendix B includes strategies to use
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during the group to enhance knowledge
application and critical thinking.

Participant

Come to the session prepared. Usually
this requires having a good
understanding of the content for each
competency. Having an opportunity to
read and understand the topic prior to
the study group meeting is essential to
being able to participate in the
application of the information. Learning
is more than listening and reading.
Come to the group with any questions
that you may have or topics and issues
that may need to be clarified.

Participate in the discussion. You dont
need to be an expert in the content to
provide meaningful contributions to the
discussion. Others can learn from your
thoughts and questions.

Reflect on how this information can be
used or is being used in your practice.
Incorporating the information into your
practice can increase your motivation
and your ability to retain information.

Maintain an attitude of respect at all
times for study group participants. We
all learn better in a comfortable, non-
threatening environment. Do your part
to keep the atmosphere positive.

Provide feedback to the facilitator and
mentors on the process of the study
group and the impact of the process on
your practice. After the exam, in the
debriefing session, provide your
constructive feedback. It is up to you if
you wish to share if you were successful
or not.

Study Tip

Prior to studying a competency in detail:

Recognize there is a lot of
information to review; strive to keep
your task manageable. Only read
the information that is mentioned in
the certification competencies.
Consider what you already know.
Consider what you need to know.
Think about what the competency
includes that is not covered in the
suggested readings.

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Prior to First Study Group Meeting

Facilitator

In early September, offer information about
certification to your colleagues (those in your
agency and beyond). This will help nurses to
make an informed decision regarding their
participation in certification. Information on
certification could be provided through a formal
presentation or various other appropriate
venues. Ensure you let those considering
certification know that you will be facilitating a
study group to support their exam preparation.

Once nurses have received confirmation that
they have been accepted to write the certification
exam, you can organize the initial study group
planning meeting, for November or December.
At this meeting, you can discuss issues such as
study group process, privacy, timetable or
schedule, available resources, and contact
information. This is also when the study group
participants can indicate which competency they
would like to take leadership for.

Study group meetings should begin in early
January to ensure sufficient time to complete
the study process prior to the exam in April. In
our experience, study group meetings need to be
two hours in length, on a weekly basis. Ensure
you have prearranged the needed meeting space.

Participant

With your acceptance to write the exam, you will
receive the CNA Preparation Guide. This Guide
includes information on the exam, exam-taking
strategies and studying for the exam.

Review the competency list including the
assumptions listed in the beginning. Develop a
personal learning plan. Consider:
the exam blueprint
your learning needs (consider taking one
of the sample quizzes to identify the
areas you may need to focus on more
comprehensively)
time

Review the Canadian Community Health
Nursing Standards of Practice.

Consider looking at organization specific
education modules on the Canadian Community
Health Nursing Standards that have been
developed.

Read about Community Health Nursing in
general. Think about the similarities and
differences between home health and public
health nursing. Why do you think they are
being tested together? How does this affect your
preparation? Below is a suggested reading list
that may help you.

Recommended Readings

Canadian Community Health Nursing:
Standards of Practice (May 2003). Community
Health Nursing pg. 3-4, Community Health
Nurses Association of Canada.
(This includes information on sources of
knowledge for practising Home Health Nurses
and Public Health Nurses, practice settings, and
goals of care. The relationship between Home
Health and Public Health Nurses is explained in
using the metaphor of a camera lens).

Additional Readings

Haugh, E. B. & Mildon, B. L. (2008). Chapter 3:
Nursing Roles, Functions and Practice Settings.
In L. Stamler, & L. Yiu (Eds.), Community Health
Nursing: A Canadian Perspective 2
nd
ed. (pp. 41-
64). W. B. Saunders: Toronto.

Minnesota Department of Health (2001). Public
Health Interventions: Applications for Public
Health Nursing Practice Manual.
http://dhs.wisconsin.gov/phnc/InterventionWh
eel/index.htm retrieved August 14, 2006.
Also read the accompanying learning guide
(Satellite Learning Kit and Videotapes of the
National Satellite Broadcasts), found on the
same website

For information on the concept of health
promotion:

Cohen, B. (2008). Chapter 6: Population Health
Promotion Models and Strategies. In L. Stamler,
& L. Yiu (Eds.), Community Health Nursing: A
Canadian Perspective 2
nd
ed. (pp. 93-110). W. B.
Saunders: Toronto.
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Review Questions
1. Haugh, E. B. & Mildon, B. L. (2005).
Chapter 4: Practice Settings, Roles, and
Functions. In L. Stamler, & L. Yiu (Eds.),
Community Health Nursing: A Canadian
Perspective (pp. 55-71). W. B. Saunders:
Toronto.
See Study Questions and Individual
Critical Thinking Exercises (p.69)

2. Public Health Nursing Section, Minnesota
Department of Health (2000). Public Health
Nursing Practice for the 21
st
Century:
Competency Development in Population-
based Practice. St. Paul, MN.
http://www.health.state.mn.us/divs/cfh/op
hp/consultation/phn/21st-
century_grant.html retrieved January 2,
2008.
Learning Guide Handout 5
Discussion Questions (p.19)

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Competency #1: Facilitating Access to Services in an
Efficient and Effective Manner

Study Tip

The readings below apply to all of Competency 1.


Minnesota Department of Health (2001). Public Health Interventions: Applications for Public Health
Nursing Practice Manual Retrieved from
http://dhs.wisconsin.gov/phnc/InterventionWheel/index.htm on October 15, 2009.

Stewart, M. (2000). Community Nursing: Promoting Canadians Health. 2
nd
ed. W.B. Saunders:
Toronto. Accessibility of health and health care pg. 59-62.

Canada Nurses Association (April 2009). Ethics in Practice: Social Justice in Practice. Retrieved from
www.cna-aiic.ca on October 15, 2009.

Additional Readings

Hadjistavropoulos, H. Managing Continuity of Care through Case Coordination. (October 15, 2003).
Retrieved from http://www.chsrf.ca/final_research/ogc/pdf/hadjistavropoulos_e.pdf on November
13, 2008.

Maurer, F. A. & Smith, C. M. (2005). Community/Public Health Nursing Practice: Health for Families
and Populations. (3
rd
ed.). Elsevier: St. Louis. Coordination of care/delegation p. 17

Norris, T.L., & Aiken, M. (2006). Personal access to health care: a concept analysis. Public Health
Nursing 23(1), p. 59-66.

Peter, E., Sweatman, L., & Carlin, K. (2008). Chapter 4: Advocacy, Ethical, and Legal Considerations.
In Stamler, L., & Yiu, L. (Eds.). Community Health Nursing: A Canadian Perspective. Prentice Hall:
Toronto p.73-74

Canadian Community Health Nursing: Standards of Practice (May 2003). Community Health
Nursing, Community Health Nurses Association of Canada.
- Standard 4: Facilitating Access and Equity

- 13 -

Components of Competency #1 Suggested Readings

1.1 Organizes delivery of services in a cost-
effective manner based on identified priorities

For example:
location,
resources
staffing
volunteers
transportation
access
parking
processes
supplies
target population
advertising
time of day
security
cleaning
partnering

1.2 Coordinates stakeholders to develop or
implement comprehensive plan of care

For example:
case conference
social services
community agencies.

1.3 Identifies effective strategies to ensure
access to services

For example:
case finding
outreach
referrals
meeting people where they live
work and play
advocacy.

1.4 Implements and evaluates strategies
designed to ensure access

For example:
attendance
time
location
transportation
financial costs
childcare services
senior care
legislation and policy considerations

Maurer, F. A. & Smith, C. M. (2005).
Community/Public Health Nursing Practice:
Health for Families and Populations. (3
rd
ed.).
Elsevier: St. Louis. p. 17

Stewart, M. (2000). Chapter 3: Framework based
on Primary Health Care principles. In M.
Stewart (Ed.), Community Nursing: Promoting
Canadians Health (pp.5117-552). 2
nd
ed. W.B.
Saunders: Toronto.

Hadjistavropoulos, H. Managing Continuity of
Care through Case Coordination. (October 15,
2003). Retrieved from
http://www.chsrf.ca/final_research/ogc/pdf/ha
djistavropoulos_e.pdf on August 16, 2006.

Public Health Interventions: Applications for
Public Health Nursing Practice Manual (2001).
Retrieved from
eel/index.htm on August 2006. Case finding,
outreach, referrals, advocacy.

Norris, T.L., & Aiken, M. (2006). Personal access
to health care: a concept analysis. Public Health
Nursing 23(1), p. 59-66.

Peter, E., Sweatman, L., & Carlin, K. (2008).
Chapter 4: Advocacy, Ethical, and Legal
Considerations. In Stamler, L., & Yiu, L. (Eds.).
Perspective. Prentice Hall: Toronto p.73-74

Canadian Community Health Nursing: Standards
of Practice (May 2003). Community Health
Nursing, Community Health Nurses Association
of Canada.
- Standard 4: Facilitating Access and Equity

Canada Nurses Association (April 2009). Ethics in
Practice: Social Justice in Practice. Retrieved from
www.cna-aiic.ca on October 15, 2009.

- 14 -

- 15 -

Defining Attributes of Access to Health Care (Norris & Aiken, 2006)
Norris, T. L.., & Aiken, M. (2006). Personal access to health care: a concept analysis. Public Health
Nursing 23(1), p. 59-66.

Availability
geographic proximity of the source of
health care must be reasonable for the
consumerwhat is reasonable and
acceptable is determined by each
individual (p.61).
For example, rural clients may find it
acceptable to drive 20 km for
healthcare; however, a wheel-chair
bound client without a vehicle may find
it to be unacceptable to travel across
town with bus stops 3 blocks away in
January.

Amenability
has to do with the willingness of the
consumer to utilize available health care
services (p. 62).
The individual must have knowledge of
his health status/needs and what the
health care system offers, and a
willingness to access available
resources.

Compatibility
Ideally the provider helps the patient to
reconcile personal values and treatment
decisions (p. 62).
For example, when considering
culturally competent care, if an
individual and the health care source
have incompatible values, clients are
unlikely to utilize the health care
source.

Eligibility
refers to the economic qualifications of
the consumerfactors of eligibility
include income and insurance coverage
(p. 61). Might also include age, sex,
cultural group, etc.
Also relevant in Canada (e.g.
pharmaceuticals, family support not
available away from home, supplies). In
2002, Canadians spent $2.3 billion out
of pocket for prescription medications
(CIHI, 2002).


Competency #1 - Review Questions

1. Community Centre A with early childhood
and parenting programming has identified
the need to include some programming
specifically for fathers and their children.
The centre is located in a small rural town
with the main industry being agriculture.
About 45 km from the community is a larger
municipality. In this neighbouring
municipality, a Sunday breakfast program
for fathers and children has been very
successful. There is huge attendance with
guest speakers and many teachable
moments. Community Centre A decided to
implement this program in their community.
Despite advertising and promotion over a
number of months, attendance never rose
beyond a couple of fathers, and sometimes
no fathers attended at all. Using the
defining attributes of access to health care
how can the CHN work with the centre to
increase attendance?

2. Provide brief examples of how a Home
Health Nurse applies this competency at the
client and family levels. How would a Public
Health Nurse apply this at the systems
level?

3. The Home Health Nurse is providing care to
a client who is newly diagnosed with
diabetes. Describe the actions the nurse
can take to link the client to appropriate
community resources.

4. Stewart, M. (2000). Chapter 3: Framework
based on Primary Health Care principles. In
M. Stewart (Ed.), Community Nursing:
Promoting Canadians Health (2
nd
ed.). W.B.
Saunders: Toronto.
Consider question #3 (p. 74)

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- 16 -

Competency #1 Discussion of Review Questions

1. Talk to the target population
Timing: morning responsibility with farm
animals (Availability)
Fathers had no interest in cooking or
preparing breakfast, may have more a
traditional home situation and dont usually
make breakfast (Compatibility)
Dont understand need can have breakfast
at home (Amenability)
Fathers may identify that they do not care
for supportive talking and listening but like
doing things with their kids. Can change to
sports, construction activities (constructing
bird houses) instead of crafts (Amenability)
Service restricted to families in a certain
geographic location (Eligibility)

2. Example #1 & #2 from ParaMed, January
2006

Example #1: HHN asks client/family to identify
problems:
No parking at office of family doctor which
located in the downtown core. Available paid
parking lot is located 2 blocks away from
office. The significant other does not drive a
car.
CHN encourages client/family to name
strategies to eliminate or avoid perceived
obstacles to going to doctors office
Solicit the help of a neighbor or a friend
at their convenience
Book an appointment with local transit
Transportation Company who specialize
in providing services to senior citizens
and offer reduced rates
Lobby the city to create reserved parking
space to accommodate senior clients
within few meters of family physicians
office.
CHN assists client/family in determining the
best resolution to exercise that will satisfy
the client/family
Book appointments with Transit
Company. Transit fees are less than the
cost of parking and the service is
reliable during inclement weather.

Example #2: HHN - Family
At the end of an interaction (at end of care
or case conference), the HHN asks the
client/family if strategies to facilitate access
to care and services met their needs and
offers the opportunity to discuss alternate
strategies if their needs were not met.
Evaluation needs to be done on a
daily/ongoing basis.
Example #3: PHN - Population perspective
At a meeting you and your colleagues are
discussing trends regarding Somali women
in your town. Although a health fair was
offered in their neighborhood, you dont
understand why this particular group
attended the fair poorly since it seemed to
address their health concerns. What
strategies could be adopted as a group to
solve the problem for the next monthly fair?
Engage the community to identify needs
and determine culturally appropriate
strategies
Make an announcement about the fair
at their place of worship, study & work
Increase buy-in: solicit the help of
Somali community leaders and
members in the organization of the fair,
marketing, pamphlet production
(translation).
Organize transportation for those who
do not have access to cars or are
dependent on the local bus system (bus
stop locations could be key)

Example #4: HHN Client & Family perspective
At a nursing visit, assess individual/family
barriers that are limiting their access to
health care
Social-cultural
Financial
Geographical
Technology
Engage in dialogue regarding how the
client/family can influence the factors (i.e.,
marshalling resources)
For example
Client could be living in a community
with limited access to a family
physician.
Nurse may need to complete a cultural
assessment to gain deeper
understanding of client & factors

3. Process for linking to community resources:
Assess clients situation & environment (e.g.,
social status, social support, knowledge)
Develop a specific care plan in collaboration
with the client
Help access funding to obtain supplies such
as syringes, insulin, & glucometer (i.e.,
through social worker, etc.)
Involve team members from a diabetic clinic
Involve the foot care nurse in the care
Involve the dietician to provide nutritional
education, if needed.
- 17 -

Competency #2: Restoring and Maintaining Health and
Providing End-of-Life Care

Study Tip

You will need a current medical-surgical text
Organization-specific education manuals could be helpful

Summary of Readings

Health Canada (2004). Recommendation for
Duration of Exclusive Breastfeeding.
Retrieved January 19, 2006 from
http://www.hc-sc.gc.ca/fn-
an/nutrition/child-enfant/infant-
nourisson/excl_bf_dur-dur_am_excl-eng.php

Heymann, D. V. (2004). Hepatitis C. Control
of communicable disease manual (18
th
ed.).
Washington, DC: American Public Health
Association.

Keast, D. & Orsted, H. (n.d.). The basic
principles of wound healing. Retrieved
August 15, 2006 from
http://www.cawc.net/open/conference/best
-practice-series/Wound-Healing.pdf

Mayo Clinic (1998-2006). Ostomy: Adapting
to life after colostomy, ileostomy or
urostomy. Retrieved September 27, 2006
from
http://www.mayoclinic.com/health/ostomy
/SA00072

Middlesex-London Health Unit (n.d.).
Breastfeeding Handbook. Retrieved
September 27, 2006 from
www.healthunit.com

Minnesota Department of Health (2001).
Public Health Nursing Practice Manual.
Retrieved August 14, 2006 from
http://dhs.wisconsin.gov/phnc/Interventio
nWheel/index.htm

Pearson, C. (2006). How wounds heal: A
guide for the wound care novice. Wound
Care Canada, 4 (2). Retrieved August 15,
2006 from
http://www.cawc.net/open/wcc/4-
2/pearson.pdf

Perry, A., Potter P., (2006). In Clinical
nursing skills & techniques (6
th
ed.) St.
Louis, MO: Mosby.
Chapter 27 Intravenous and Vascular
Access Therapy (p.899-902, 922-962)
Skill 43-12 Measuring Blood Glucose
Level after Skin Puncture (pp. 1452-
1457)
Skill 42-7: Enteral Nutrition in the
Home (pp. 1394-1399).
Skill 32-3 Care and Removal of the
Indwelling Catheter (pp. 1085-1088)
Tracheotomy Care (pp. 1380-1387)
Ventilation (pp. 784-793)
Routes of Administration (pp. 615, 617)
5 rights (pp. 618-623)
Client and Family teaching on
Medication Administration (pp. 629-
630)
Medication Safety (pp. 630)
Cultural Considerations (pp. 992)

Public Health Agency of Canada (2002).
Nutrition and Healthy Aging. Retrieved
January 2006 from http://www.phac-
aspc.gc.ca/seniors-
aines/pubs/workshop_healthyaging/pdf/nu
trition_e.pdf

Nutrition and Hepatitis C. Retrieved
November 13, 2008 from http://www.phac-
aspc.gc.ca/hepc/pubs/nt-cn/feelyourbest-
eng.php

- 18 -
Registered Nurses Association of Ontario
(2002). Best Practice Guidelines. Retrieved
August 14, 2006 from http://www.rnao.org
Assessment and Management of Pain
Primary Prevention of Childhood Obesity
Breastfeeding Best Practice Guidelines
for Nurses
Assessment and Management of Foot
Ulcers for People with Diabetes
Care and Maintenance to Reduce
Vascular Access Complications
Client Centred Care
Supporting and Strengthening Families
Through Expected & Unexpected Life
Events

Riordan (2005). Breastfeeding and Human
Lactation. (3
rd
ed.). Jones & Bartlett:
Toronto.
Chapter 8: Postpartum Care
Chapter 11: Jaundice and the Breastfed
Baby

Stamler, L. & Yiu, L. (2008). Community
Health Nursing: A Canadian Perspective (2
nd

ed.). Prentice Hall: Toronto.
Chapter 10: Family Care (pp.162-175)
Chapter 18: Clients in the Community
Mental Health System (pp. 285-310)
Chapter 3: Nursing Roles, Functions,
and Practice Settings (p. 47-48)

Stewart, M. (2000). Community Nursing:
Promoting Canadians Health. 2
nd
ed. W.B.
Saunders: Toronto.
Nutrition of children (pp. 379-80)
Nutrition and socioeconomic status (pp.
182-83)
Children with chronic conditions and
their families in the community (pp.
212-217)

- 19 -

Components of Competency #2 Suggested Readings

2.1 Assesses clients to determine whether
community health nursing intervention is
needed

For example:
referral and follow-up
outreach
case finding
intake
triage

http://dhs.wisconsin.gov/phnc/InterventionW
heel/index.htm
Review the public health interventions
related to assessment in the community.

(2002). Client Centred Care. Toronto, Canada:
Registered Nurses Association of Ontario.

2.2 Manages caseload

For example:
frequency of visit
time of visit
acuity of the situation
support system
geographic location
length of visit
health history
safety
resource management
documentation

Patrick, L. & Edmunds, K. (2008). Chapter 10:
Family Care. In L. Stamler & L. Yiu (Eds.).
Perspective 2
nd
ed. (pp. 171-172). Prentice
Hall: Toronto.

(2002). Supporting and Strengthening Families
Through Expected & Unexpected Life Events.
Toronto, Canada: Registered Nurses
Association of Ontario.

2.3 Assesses clients requiring the following
care (see 2.4 for competency details):
Wound care
Infusion therapy
Glucose monitoring
Pain management
Enterostomal therapy
Enteral feeding
Dialysis
Catheterization intermittent & indwelling
Tracheotomy care
Ventilator
Medication administration oral,
subcutaneous, intramuscular,
intravenous, inhalation, epidural,
intradermal
Nutrition
Phototherapy
Chronic disease management
End-of-life care
Palliative care

(see 2.4 for suggested readings)
Components of Competency #2

Suggested Readings
- 20 -
2.4 Implements and evaluates client-centred
plans of care in collaboration with the client,
family and other service providers for the
following situations:
(see following page for competency details for
2.3 and 2.4)

2.4a Wound care

For example:
signs and symptoms of infection
diet
response to treatment
comfort
mobility
skin integrity
cause
type, stage
co-morbidity
impact of the home environment
type of wound care products
dressing change
dieting counseling
health teaching
topical application
coordinating services and resources
promoting mobility
administering medication and other
comfort measures
consultation
referral
building individual and family capacity
selecting appropriate wound care product

Canadian Association of Wound Care,
www.cawc.net

Keast, D. & Orsted, H. (n.d.). The basic
principles of wound healing. Retrieved
November 13, 2008 from:
http://www.cawc.net/open/conference/best-
practice-series/Wound-Healing.pdf

Pearson, C. (2006). How wounds heal: A guide
for the wound care novice. Wound Care
Canada, 4 (2). Retrieved November 13, 2008
from http://www.cawc.net/open/wcc/4-
2/pearson.pdf

(2005). Assessment and Management of Foot
Ulcers for People with Diabetes. Toronto,
Canada: Registered Nurses Association of
Ontario.

Stanhope & Knollmueller (2000). Skin and
Wound Care. In Handbook of Community-
Based and Home Health Nursing Practice (pp
444-449). 3
rd
ed. Mosby: Toronto.

- 21 -


Suggested Readings
2.4b Infusion therapy

For example:
fluid balance
medication
patency of central lines and peripheral
lines
appropriateness of ambulatory infusion
pumps
opportunity for safe handling and disposal
of products
side effects
fluid replacement
administering medication
administering TPN
management of central lines and
peripheral lines
management of infusion pumps
safe handling and disposal of products
referral
consultation
health teaching
counseling
troubleshooting equipment and lines

Appendix D

Health Nursing Practice Manual. Retrieved
heel/index.htm

Perry, A., Potter P., (2006). Chapter 27
Intravenous and Vascular Access Therapy. In
Clinical nursing skills & techniques (p.899-902,
922-962) (6
th
ed.) St. Louis, MO: Mosby.

(2005). Care and Maintenance to Reduce
Vascular Access Complications. Toronto,
Canada: Registered Nurses Association of
Ontario.

Stanhope & Knollmueller (2000). Central
Venous Catheter Management. In Handbook of
Community-Based and Home Health Nursing
Practice (pp. 490-495, 513-519). 3
rd
ed. Mosby:
Toronto.

Stanhope & Knollmueller (2000). Intravenous
Care. In Handbook of Community-Based and
Home Health Nursing Practice (pp. 473-480,
486-489). 3
rd
ed. Mosby: Toronto.

Canadian Vascular Access Association,
www.cvaa.info

2.4c Glucose monitoring

For example:
blood levels
equipment
signs & symptoms of hyperglycemia and
hypoglycemia
diet
health teaching about diet and blood
testing
administering insulin
exercise program
blood testing

Appendix D

heel/index.htm

Perry, A., Potter P., (2006). Skill 43-12
Measuring Blood Glucose Level after Skin
Puncture. Clinical nursing skills & techniques
(6
th
ed.) (pp. 1452-1457). St. Louis, MO:
Mosby.

Stanhope & Knollmueller (2000). Diabetes. In
Handbook of Community-Based and Home
Health Nursing Practice. 3
rd
ed. Mosby:
Toronto. Diabetes pg. 450-451, 455-456.

- 22 -

Components of Competency #2 Supporting Literature

2.4d Pain management

For example:
polypharmacology
alternative pain therapies
pain assessment
total pain
health teaching about total pain
counselling on medication regime and
comfort measures
health teaching about breakthrough pain
management
referral
mobility tolerance
monitoring medication usage

(2002). BPG Assessment and Management of
Pain. Retrieved August 14, 2006 from
http://www.rnao.org/Page.asp?PageID=1212&
SiteNodeID=155&BL_ExpandID=

Stanhope & Knollmueller (2000). Pain. In
Health Nursing Practice (pp. 290-297). 3
rd
ed.
Mosby: Toronto.

2.4e Enterostomal therapy

For example:
opportunity for safe handling and
disposal of products
skin integrity
appropriateness of products
body image
diet
sexuality
health teaching regarding detection and
prevention of impaired skin integrity
selecting products
health teaching & counselling regarding
body image
diet
elimination and sexuality

Mayo Clinic (1998-2006). Ostomy: Adapting to
life after colostomy, ileostomy or urostomy.
Retrieved September 27, 2006 from
http://www.mayoclinic.com/health/ostomy/S
A00072

Stanhope & Knollmueller (2000). Ostomy Care.
In Handbook of Community-Based and Home
Health Nursing Practice (pp.539-543). 3
rd
ed.
Mosby: Toronto.

2.4f Enteral feeding

For example:
nutrition
appropriateness of products & equipment
nutrition counseling
selecting products
equipment troubleshooting
identifying financial sources
health teaching regarding hydration &
weight

A medical surgical nursing text can provide
additional information

Perry, A., Potter P., (2006). Skill 42-7: Enteral
Nutrition in the Home. In Clinical nursing skills
& techniques (6
th
ed.) (pp. 1394-1399). St.
Louis, MO: Mosby.

- 23 -
- 24 -


2.4g Dialysis

For example:
dietary regime adherence
fluid intake
weight
equipment
opportunity for safe handling & disposal
of products
infection control
sexuality
medication regime adherence
individual and family capacity
nutrition counselling
fluid balance
health teaching regarding target weight
infection control
health teaching & counselling regarding
sexuality
referral
consultation

Appendix D

heel/index.htm retrieved October 15

Perry, A., Potter P., (2006) Clinical nursing skills
& techniques (6
th
Pg. 1106.

Stanhope & Knollmueller (2000). Dialysis. In
Health Nursing Practice (pp. 420-423). 3
rd
ed.
Mosby: Toronto.

2.4h Catheterization: Intermittent &
Indwelling

For example:
environment
products
infection
body image
sexuality
fluid output
adjusting care to environment
selecting products
hydration
health teaching regarding clean and
sterile technique
infection control
health teaching and counselling
regarding sexuality and body image

Appendix D

heel/index.htm

& techniques (6
th
Pg.1085-1088. Includes information on home
care considerations.

2.4i Tracheotomy care

For example:
respiratory function
device
equipment
supplies
body image
emergency plan
skin integrity
suction
tracheotomy care
selecting supplies
health teaching regarding body image
self-care
referral
consultation
airway management
emergency and safety plan

see Appendix D

heel/index.htm

Perry, A., Potter P., (2006). Tracheotomy Care.
Clinical nursing skills & techniques (pp. 1380-
1387) (6
th
ed.). St. Louis, MO: Mosby. [Includes
information on home care considerations]
2.4j Ventilator

For example:
respiratory function
equipment
supplies
power sources
emergency plan
support system
client and family capacity
airway management
providing mouth car
supplies
power supplies
emergency plan
arranging respite care

Perry, A., Potter P., (2006). Ventilation. Clinical
nursing skills & techniques (6
th
ed.) (pp. 784-
793). St. Louis, MO: Mosby.

- 25 -

2.4k Medication administration: oral,
subcutaneous, intramuscular, intravenous,
inhalation, epidural, intradermal
For example:
type of medication
safe storage
route
dose
administration time
medication regime adherence
side effects
security
health teaching on medication use
referral and consultation
identifying financial sources
direct observation therapy for TB
Appendix D

heel/index.htm

& techniques (6
th
Routes of Administration p. 615, 617
5 rights, p. 618-623
Client and Family teaching, p. 629-630
Medication Safety, p. 630

Stanhope & Knollmueller. Handbook of
Community-Based and Home Health Nursing
Practice. 3
rd
ed. Mosby: Toronto. Pharmalogical
issues pg. 582-632.
- 26 -
- 27 -
2.4l Nutrition

For example:
diet
food security
culture
age
equipment
breastfeeding
hydration
weight
health teaching on diet and proper food
handling
identifying financial resources
supporting and promoting breastfeeding
referral
Health Canada (2004). Recommendation for
Duration of Exclusive Breastfeeding. Retrieved
January 19, 2006 from http://www.hc-
sc.gc.ca/fn-an/nutrition/child-enfant/infant-
nourisson/excl_bf_dur-dur_am_excl-eng.php

Middlesex-London Health Unit (n.d.).
Breastfeeding Handbook. Retrieved September
27, 2006 from www.healthunit.com

Perry, A., Potter P., (2006). Cultural
Considerations. Clinical nursing skills &
techniques (6
th

Nutrition and Healthy Aging. Retrieved
November 13, 2008 http://www.phac-
aspc.gc.ca/seniors-
aines/pubs/workshop_healthyaging/pdf/nutrit
ion_e.pdf

(2003). Breastfeeding Best Practice Guidelines
for Nurses. Author: Toronto

(2005). Primary Prevention of Childhood
Obesity. Author: Toronto.

Riordan (2005). . Chapter 8: Postpartum Care
(pp.217-234). In Breastfeeding and Human
Lactation. (3
rd
ed.). Jones & Bartlett: Toronto.

Stewart, M. (2000). Community Nursing:
Promoting Canadians Health. 2
nd
ed. W.B.
Saunders: Toronto. (Child Nutrition, p. 379-
80; nutrition and SES p. 182-183)


2.4m Phototherapy

For example:
equipment
bilirubin levels
hydration
breastfeeding
health teaching regarding use of
equipment
hydration
consultation
blood testing

heel/index.htm

Riordan, J. (2005). Chapter 11: Jaundice and
the breastfed baby. Breastfeeding and Human
Lactation. (3
rd
ed.) Jones and Barlett: Toronto.

2.4n Chronic disease management

For example:
diabetes
obesity and activity
hepatitis C
congestive heart failure
COPD
MS
children with special needs
mental health conditions
health teaching
monitoring
consultation
counselling of client and family
respite care
medication administration
anticipatory guidance

Burke, S. O., Kauffmann, E., Wiskin, N., M.,
W., & Harrison, M. B. (2000). Chapter 11
Children with chronic conditions and their
families in the community. In M. J. Stewart
Community Nursing: Promoting Canadians
Health (pp. 212-217). 2
nd
ed. W.B. Saunders:
Toronto.

Mordoch, E. (2009). Chapter 18: Clients in the
Community Mental Health System. In L.
Stamler & L. Yiu. Community Health Nursing: A
nd
ed. (pp.285-300).
Prentice Hall: Toronto.

Heymann, D. V. (2004). Hepatitis C. Control of
communicable disease manual (18
th
ed.).
Association.

Nutrition and Hepatitis C. Retrieved January
2006 from http://www.phac-
aspc.gc.ca/hepc/pubs/nt-cn/feelyourbest-
eng.php

For information on congestive heart failure,
chronic obstructive pulmonary disease and
multiple sclerosis, review a medical-surgical
text.

- 28 -


2.4o End-of-life care

For example:
pain management
symptom control
monitoring
total pain management
respite care
counselling

Crooks, D. (2005). Chapter 25: Hospice and
Respite care. In L. Stamler & L. Yiu (Eds.),
Perspective (pp. 325-332). Prentice Hall:
Toronto.

(2002). Assessment and Management of Pain.

2.4p Palliative care

For example:
pain management
symptom control
counselling
medication administration
advocacy
respite care
Crooks, D. (2005). Chapter 25: Hospice and
Respite care. In L. Stamler & L. Yiu (Eds.),
Toronto.

(2002). Assessment and Management of Pain.

Principles that Guide Home Health
Nursing Care

1. Practice as a guest in the home
Advance Directives
Living will
2. Client education/teaching
Teach and reduce approach to reach
client independence
3. Risk Management
At what point in time is too much risk to
them / to us
Appropriateness of procedures
Management of the environment (for the
client and for the nurse)
Balancing risk to self vs. client
needs/choice to live at risk
4. Developmental Care
Across the life span
5. Collaboration
Balancing the professional nurse and
the client preference
Client/family preferences
Partnership with clients/families

Clients are active participants in
decision-making process
6. Choice
7. Comprehensive Assessment
8. Informed Consent
Consent to treatment
Release of information
9. Release of information
10. Infection Control
Clean vs. sterile
Access to supplies
11. Settings (home, school, long-term care,
group homes, retirement homes)
Working within the policies of others
Anticipatory planning r/t access
- 29 -

Competency #2 Review Questions

1. Stewart, M. (2000). Chapter 11: Children
with chronic conditions. In M. Stewart (Ed.),
Health (2
nd
ed.). W.B. Saunders: Toronto.
Questions #2 - #4 (pp.235-236)

2. Perry, A., Potter P., (2006) Chapter 42: Home
Care Teaching. In Clinical nursing skills &
techniques (6
th
Questions #7 - #16 (pp. 1400-1401)
these are knowledge review questions
To develop critical thinking questions,
create case studies that would require
some problem-solving

3. Crooks, D. (2005). Chapter 25: Hospice and
Respite Care. In Stamler, L. & Yiu, L. (Eds).
Toronto.
Case study (p. 329)
Group critical thinking exercises (p.330)

4. England, M. (2005). Chapter 17: Clients in
the Community Mental Health System. In
Stamler, L. & Yiu, L. (Eds). Community
Health Nursing: A Canadian Perspective (pp.
255-264). Prentice Hall: Toronto.
Case study (p. 261)

5. Develop questions or case studies regarding
jaundice/phototherapy and the breastfed
baby, and hydration.

6. Mr. B is a 75 year old with osteoarthritis.
Mr. B has been taking large doses of opioids
and has not had a bowel movement in 4
days. The last 24 hours, Mr. B has been
feeling nauseated.
a) What does your assessment include?
b) What health teaching would you do?

7. You have received a referral to teach a client
how to self-inject his medication to treat
Hepatitis C. Your client had received a
blood transfusion in 1985 that was infected
and is now living with some of the common
symptoms of chronic HepC infection
a) You recognize the potential emotional
impact of this diagnosis for this client.
What can you do to support him?
b) What education would you provide?
c) How would you suggest the client
manage each of the common side effects
of drug treatment (joint aches, nausea,
dry & itchy skin, hair loss, depression,
mouth ulcers)?

8. Mrs. R. has recently returned home from the
hospital with her new baby. She and her
husband recently immigrated to Canada.
They have a young child with cerebral palsy.
They are new to the area and have no family
in Canada. You have been asked to see Mrs.
R. because the incision from her c-section
has become infected. Describe your
assessment and intervention for this family.

9. Janet is a 68-yr old with Parkinsons
disease. She lives with her husband, Henry,
a retired school principal. Janet has been
dribbling urine for a year and now has
developed urinary frequency and urgency to
the point where she no longer leaves the
house as she does not want to be too far
from a bathroom. Janet has seen a urologist
and he has determined that Janet is not
emptying her bladder and is retaining urine.
You are a home care visiting nurse and you
have received a referral from the urologist to
teach Janet intermittent self-catheterization.
Henry greets you at the door stating, Lets
get this show on the road the urologist
says Janet should have no problem going
out once she gets on to this procedure.
When you meet Janet, who is lying down in
the bedroom, she does not mirror her
husbands enthusiasm.
a) What will you include in your
assessment?
b) How would you structure your
teaching?
c) What would you do if Janet is not
interested in learning how to perform
self-catheterization?
d) How would you plan for future changes
to Janets physical abilities?

10. You are going to visit a 39-yr old man with
cellulitis & a wound (2cmx3cm) to right
lower leg. Client has been receiving home
care for 3 days. The doctor ordered 1gm
Ancef q8hx7days via gravity. Client has had
10 doses of antibiotic. The IV catheter was
replaced yesterday, in left lower arm
(cephalic vein). IV site remains dry & intact.
The redness & edema in the right leg has
decreased since initial visit. On admission,
redness measured 20cmx10cm. Redness
now measures 10cmx5cm. Client states he
is experiencing moderate pain (7/10 on pain
scale). The wound is draining sero-sang, &
a small amount of purulent drainage. His
vitals are T-38.0, P-88, R-18, BP-130/82.
a) What would you assess during your
visit?
b) What would you teach this client?
- 30 -
c) What skills would you perform (both
wound & IV)? In what order would you
perform the skills?
d) What wound care products would you
consider for the wound?
e) What side effects from the medication
could the client experience?
f) How many doses of antibiotics does the
client have remaining?

11. You are scheduled to visit the same
client the next day. During your visit, you
notice that his arm appears to be reddened
and slightly swollen. He reports a burning
feeling during medication infusion. His
vitals are T-39.0, P-88, R-20, BP-138/84.
Redness measures 15cmx8cm on lower right
leg. The client states he feels unwell.
a) What does your assessment include?
b) What actions will you take?

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- 31 -
Competency #3: Promoting Health and Preventing Illness
and Injury of Vulnerable Populations, Aggregates and
Targeted Groups within the Community


College of Nurses of Ontario.,(2004). Practice
Guideline: Culturally Sensitive Care. Author:
Ontario. Retrieved from www.cno.org on
February 2006.

Public Health Nursing Practice Manual
(2001).
nWheel/index.htm retrieved August 14,
2006.

Stamler & Yiu (2008). Community Health
Nursing: A Canadian Perspective (2
nd
ed.).
Chapter 8: Epidemiology
Chapter 16: School Health
Chapter 20: Multicultural Clients
Chapter 25: Adolescent Sexual Health
and Pregnancy
Chapter 26: Violence in Families
Chapter 27: Poverty, Hunger and
Homelessness
Chapter 28: Substance Abuse
Chapter 29: Sexually Transmitted
Infections and Blood Borne Pathogens

Additional Readings

Diem & Moyer (2005). Chapter 3: Starting
Well: Beginning a Small Scale Project. In
Community Health Nursing Projects: Making
a difference. Lippincott, Williams & Wilkins:
New York.

Harrington-Selby, M. & Tesh, S. (2004).
Epidemiology, Demography, and
Community Health. In A. Vollman, E.
Anderson, & J. MacFarlane (Eds.),
Canadian Community as Partner (pp.28-33,
44-57). New York: Lippincott Williams &
Wilkins.

(2005). Woman Abuse: Screening,
Identification and Initial Response. Toronto,
Canada: Author.

Stanhope, M. & Lancaster, J. (2004).
Chapter 31. Community and public health
nursing (6
th

Stewart, M.J. (2000). Community Nursing:
Promoting Canadians Health. W.B.
Saunders: Toronto
Chapter 9: Socioeconomic Determinants
of Health
Chapter 10: Culturally Diverse
communities: The impact on the role of
community health nurses
Chapter 17: Role in injury prevention
(Epidemiological principles pp. 336-
341)
Chapter 22: Community needs and
capacity assessment

- 32 -

3.1 Identifies demographics

For example:
number of persons
age characteristics
gender characteristics
racial/ethnic characteristics
residence/geographical location
average household income
educational level of head of household
occupation of head of household
economic indicators for the geographic
area, such as unemployment rates,
income, job sources, transportation to
jobs, family composition
Diem & Moyer (2005). Chapter 3: Starting Well:
Beginning a Small Scale Project. In Community
Health Nursing Projects: Making a difference.
Lippincott, Williams & Wilkins: New York.

Edwards, N. C., & Moyer, A. (2000). Chapter
22: Community needs and capacity
assessment. In M. Stewart (Ed.), Community
Nursing: Promoting Canadians Health (pp.420-
442). WB Saunders: Toronto.

Harrington-Selby, M. & Tesh, S. (2004).
Epidemiology, Demography, and Community
Health. In A. Vollman, E. Anderson, & J.
MacFarlane (Eds.), Canadian Community as
Partner (pp.28-33, 44-57). New York: Lippincott
Williams & Wilkins.

Stamler, L. L. (2008). Chapter 8: Epidemiology.
In. L. L. Stamler & L. Yiu (Eds.), Community
Health Nursing: A Canadian Perspective 2
nd
ed.
(pp. 125-141). Prentice Hall: Toronto.

3.2 Accesses relevant data sources

For example:
Observation
Epidemiological data
Surveillance data
client records
organization records and reports
interviews
electronic data source
web-based resources

See resource list from 3.1
3.3 Chooses appropriate data collection
techniques and tools to evaluate
intervention

For example:
questionnaire
monitoring
client feedback
observation
survey
focus group


- 33 -

3.4 Interprets the following data using
informal and formal sources

3.4a Demographics
For example:
Number of persons
Age characteristics
Gender characteristics
Racial/ethnic characteristics
Residence/geographical location
Average household income
Educational level of head of household
Occupation of head of household
Economic indicators for the geographic
area, such as unemployment rates,
income, job sources, transportation to
jobs, family composition

3.4b Observational data
For example:
Trends
Unusual events
Community identified concerns
Number of calls on same issue
Walk-about
Drive-about

3.4c Epidemiological data
For example:
Incidence rates
Prevalence
Medical health officer reports
Mapping of income levels
Education levels
Languages

3.4d Surveillance data
For example:
Health events

3.4e Client Records
For example:
Number of visits
Trends, outcomes

3.4f Organization records and reports
For example:
number of influenza cases
hospital emergency visits

3.4g Interviews with community stakeholders
and agencies
For example:
emergent and resurgent health trends
significant events
safety concerns

- 34 -

3.5 Implements and evaluates interventions
to improve health of vulnerable
individuals, populations, aggregates and
targeted groups within the community.

For example:
low-income families
substance users
migrant families
refugees
homeless
pregnant and parenting teens
seniors
persons living with chronic disease
victims of violence
persons with literacy challenges
persons with special needs
children at risk
school-age children
isolated individuals and families
persons with STI
families using the food bank
preschool children

3.5a health teaching

3.5b case reporting

3.5c case finding

3.5d advocacy

3.5e coalition building

3.5f community organizing

3.5g social marketing

3.5h policy development & enforcement

3.5i screening

3.5j surveillance

3.5k counselling

3.5l consultation

3.5m collaboration

3.5n facilitation *

3.5o negotiation/mediation *

3.5p case coordination (NB: case
coordination & case management are
used interchangeably on the exam)
College of Nurses of Ontario.,(2004). Practice
Guideline: Culturally Sensitive Care. Author:
Ontario. Retrieved from www.cno.org on
February 2006.

Edmunds, K. & Kinnaird-Iler, E. (2008).
Chapter 20: Multicultural Clients. In L.
Stamler & L. Yiu (Eds.), Community Health
Nursing: A Canadian Perspective 2
nd
ed. (pp.
311-319). Prentice Hall: Toronto.

Kulig, J. C. (2000). Chapter 10: Culturally
Diverse communities: The impact on the role of
community health nurses. In M.J. Stewart
(Ed)., Community Nursing: Promoting
Canadians Health (pp.194-210). W.B.
Saunders: Toronto

Linwood, M. E. & Willis, L. D. (2000). Chapter
17: Role in injury prevention. In M.J. Stewart
(Ed)., Community Nursing: Promoting
Saunders: Toronto.

Laforet-Fliesser, Y., MacDougall, C., &
Buckland-Foster, I. (2008). In L. Stamler & L.
Yiu (Eds.), Community Health Nursing: A
Canadian Perspective (pp. 263-275) 2
nd
ed.

Mannion, C. (2008). Chapter 25: Adolescent
Sexual Health and Pregnancy. In L. Stamler &
L. Yiu (Eds.), Community Health Nursing: A
nd
Ed. (pp. 360-367).

Malloy, P. & Stamler, L. (2008). Chapter 27:
Poverty, Hunger and Homelessness. In L.
Stamler & L. Yiu (Eds.), Community Health
Nursing: A Canadian Perspective (pp. 377-384)
2
nd
ed. Prentice Hall: Toronto.

Malone, M. (2008). Chapter 26: Violence in
Families. In L. Stamler & L. Yiu (Eds.),
Perspective (pp. 368-376) 2
nd
ed. Prentice Hall:
Toronto.

Wilkinson, H. (2008). Chapter 28: Substance
Abuse. In L. Stamler & L. Yiu (Eds.),
nd
ed. Prentice Hall:
Toronto.

Lokanc-Diluzio, W., Nelson, A., Wayne, J. L., &
Hettler, J. B. (2008). Chapter 29: Sexually
Transmitted Infections and Blood Borne
Pathogens. In L. Stamler & L. Yiu (Eds.),
- 35 -

3.5 (continued)

3.5q disease or health event investigation

3.5r outreach

3.5s referral

nd
ed. Prentice Hall:
Toronto.

heel/index.htm retrieved August 14, 2006.
Review:
Levels of practice
Levels of intervention
Definitions of each intervention,
Examples at all practice levels,
Relationships to other interventions,
Basic steps for the intervention

Reutter, L. I. (2000). Chapter 9: Socioeconomic
Determinants of Health. In M.J. Stewart (Ed).,
Health (pp.174-193). W.B. Saunders: Toronto

(2005). Woman Abuse: Screening, Identification
and Initial Response. Toronto, Canada: Author.

*Facilitation, negotiation, and case
reporting are not included in the wheel.
Case reporting; difficult to locate a
definition. An example would be a SARS
case reporting form.
Negotiation is, The process of
bargaining in order to arrive at an
agreement or compromise on a matter of
importance to the parties involved (From
Medical Subject Headings, National
Library of Medicine, 1992).

- 36 -
- 37 -


1. Edwards, N. C., & Moyer, A. (2000). Chapter
22: Community needs and capacity
assessment: Critical component of program
planning. In M. Stewart (Ed.), Community
Nursing: Promoting Canadians Health
(pp.420-442). Toronto: W.B. Saunders.
Questions #1 & #2 (p.436)

2. Moyer, A., (2005). Chapter 3: Starting Well:
Beginning a Small Scale Project. In E. Diem
& A. Moyer (Eds.), Community Health
Nursing Projects: Making a Difference. New
York: Lippincott, Williams & Wilkins.
Discussion Question #1 (p.64)

3. For each of the interventions listed in 3.5
provide an example of the intervention in
your community at all applicable levels of
population health (e.g. individual,
community, systems). Consider both public
health and home health settings. Which
interventions do you feel are similar? Is this
consistent with the Minnesota Wheel?

4. DiCenso, A. & Van Dover, L. (2000).
Chapter 13: Prevention of adolescent
pregnancy. In M. Stewart (Ed.), Community
Nursing: Promoting Canadians Health
(pp.194-210). Toronto: W.B. Saunders.
Questions #1-#3 (p.280)

5. Malinowski, A. (2005). Chapter 23:
Adolescent Pregnancy. In L. Stamler & L.
Canadian Perspective (pp. 309-316).
Toronto: Prentice Hall.
Case Study & Discussion Questions
(p.313)
Individual Critical Thinking Exercise
(p.314)

6. Malone, M. (2005). Chapter 19: Family
Violence. In L. Stamler & L. Yiu (Eds.),
Perspective (pp. 273-282). Toronto: Prentice
Hall.
(p.280)
Individual Critical Thinking
Exercises, #2 (p.281)
Group Critical Thinking Exercise
(p.281)

7. Edmunds, K. & Kinnaird-Iler, E. (2005).
Chapter 16: Multicultural Clients, Migrant
Workers and Newcomers. In L. Stamler &
L. Yiu (Eds.), Community Health Nursing: A

Canadian Perspective (pp. 247-254). Prentice
Hall: Toronto.
(p.252)
Group Critical Thinking Exercises,
#1 (p.253)

8. Reutter, L. I. (2000). Chapter 9:
Socioeconomic determinants of health. In M.
Stewart (Ed), Community Nursing:
Promoting Canadians Health (pp.174-193).
Toronto: W.B. Saunders.

9. Kulig, J. C. (2000). Chapter 10: Culturally
Diverse communities: The impact on the role
of community health nurses. In M. Stewart
(Ed.), Community Nursing: Promoting
Canadians Health (pp.194-210). Toronto:
W.B. Saunders.

10. Sebastian, J. (2004). Chapter 31:
Vulnerability and Vulnerable Populations:
An Overview. In M. Stanhope & J.
Lancaster (Eds.), Community and Public
Health Nursing (pp.746-773)(6
th
ed.). St.
Louis, MO: Mosby.

11. Jenn, a community health nurse, will be
facilitating a parenting session with a group
of Hispanic-speaking women. All of the
women have immigrated to Canada within
the last year. While Jenn has taken some
professional development workshops on
culture, and the principles that can enable
her to provide culturally sensitive/
competent care, she is feeling somewhat
anxious because she does not have any
experience working with this population.
She really wants to provide effective care.
What is the first step Jenn should
take to prepare for her health
promotion class?
What are some of the challenges
that Jenn may face?
How can she best provide culturally
competent care?
If a Home Health Nurse had a
Spanish-speaking client and
needed to do some health teaching
in the home, how would the nurse
proceed?

12. Joan, a Public Health Nurse, has been asked
to do a presentation at a woman abuse
shelter on the health effects of woman abuse
and strategies/resources to deal with the
health effects. Joan has not had any
experience working with women who have
been abused and has limited knowledge
related to woman abuse. She has visited a
few women who have left abusive
relationships. Joan recognizes she needs to
be competent in the violence against women
issues to make her class effective.
What should Joans plan be to
prepare for the class? What are
some of the key points she may
share?
What resources/supports in the
community should Joan access to
prepare for her class

13. Linwood, M. E. & Willis, L. D. (2000).
Chapter 17: Role in injury prevention. In M.
Stewart (Ed.), Community Nursing: Promoting
Canadians Health (pp.336-341). Toronto:
W.B. Saunders.
Question #1 (p.348)

14. How do Home Health Nurses use statistical
data to inform their practice?

15. Yiu, L. (2005). Chapter 10: Community
Care. In L. Stamler & L. Yiu (Eds.),
Hall.
Case Study (p.161)

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- 38 -
Competency #4: Promoting Health and Wellness Across the
Lifespan

Study Tip

Focus your reading and studying on the life stages you are least familiar with.

Be sure to use the Canadian immunization schedule. The one for Ontario is
slightly different because we have additional vaccines that are provincially
funded.

Many of the local health unit websites have a lot of information and good web
links related to family health, child health, prenatal health, postpartum health
and much more. Middlesex-London Health Units website is
www.healthunit.com


Craig, D. M. (2000). Chapter 14: Health
promotion with older adults. M. J. Stewart
(Ed.), Community Health Nursing: Promoting
the Health of Canadians (pp. 283-295).
Harcourt Press: Toronto.

Health Canada (2005). Canadas Food
Guide to Healthy Eating. Retrieved
September 27, 2006 from: http://www.hc-
sc.gc.ca/fn-an/food-guide-
aliment/index_e.html

Minnesota Department of Health. (2001).
Retrieved November 15, 2008 from:
nWheel/index.htm

National Advisory Committee on
Immunization (NACI). Recommended
Immunization Schedule for Infants, Children
and Youth (updated March 2005) retrieved
aspc.gc.ca/im/is-cv/index.html

Patrick, L., & Edmunds, K. (2008). Chapter
10: Family Care. In Stamler, L., & Yiu, L.
(Eds.). Community Health Nursing: A
Canadian Perspective. Prentice Hall:
Toronto.

Public Health Agency of Canada. (2004,
August 4). Adult Health. Retrieved
http://www.phac-aspc.gc.ca/ah-sa_e.html

Public Health Agency of Canada. (2002-09-
02). Childrens Rights and International
Policy. Retrieved September 19, 2006 from
http://www.phac-aspc.gc.ca/dca-
dea/allchildren_touslesenfants/rights-
index_e.html

Public Health Agency of Canada, Healthy
Pregnancy: For Health Professionals.
Retrieved September 18, 2006 from:
http://www.phac-aspc.gc.ca/hp-
gs/prof_e.html

Public Health Agency of Canada. (2004-05-
04). Parent Child Relationships and
Attachment. Retrieved September 19, 2006
from http://www.phac-aspc.gc.ca/dca-
dea/family_famille/index_e.html

Public Health Agency of Canada. (2005).
Violence and Abuse. Retrieved September
19, 2006, from: http://www.hc-
sc.gc.ca/hc-ps/violence/index-eng.php
Public Health Agency of Canada. What
Determines Health? (2003, June 16).
Retrieved November 15, 2008 from:
http://www.phac-aspc.gc.ca/ph-
sp/determinants/determinants-eng.php

(2003). Breastfeeding Best Practice
Guidelines for Nurses. Retrieved November
15 2008 from http://www.rnao.org/ A
breastfeeding self-learning package is also
available on the website

- 39 -
(2002). Enhancing Adolescent Development.
Retrieved November 15, 2008 from
www.rnao.org

Additional Readings

Drew, J. C. (2004). Chapter 7: Cultural
competence in partnerships with
communities. In Vollman, Anderson, &
McFarlane (Eds.), Canadian Community as
Partner (pp. 157-186). New York: Lippincott,
Wilkinson, & Williams.

Gillis, A. J. (2000). Chapter 12: Adolescent
health promotion: An evolving opportunity
for community health nurses. M. J. Stewart
the Health of Canadians. (pp.241-261).
Harcourt Press: Toronto.

Middlesex-London Health Unit Breastfeeding
Handbook. Retrieved August 11, 2006 from
http://healthunit.com

Public Health Agency of Canada. Division of
Childhood and Adolescence: Prenatal to six
years. Retrieved September 18, 2006 from:
dea/prenatal/index_e.html

Public Health Agency of Canada. Oral
Health. Retrieved September 18, 2006 from:
http://www.hc-sc.gc.ca/hl-vs/oral-
bucco/index_e.html

Ruetter, L. I. (2000). Chapter 9.
Socioeconomic determinants of health. In
M. J. Stewart (Eds.), Community Nursing:
Promoting Canadians Health (p. 174-193).
Harcourt Canada: Toronto.

- 40 -

4.1 Identifies the determinants of health

For example:
Social environment
physical environment
biology and genetic endowment
income and social status
social support networks
employment and working conditions
education/literacy
healthy child development
gender
culture
personal health practices and coping
skills and health services

Drew, J. C. (2004). Chapter 7: Cultural
competence in partnerships with
communities. In Vollman, Anderson, &
McFarlane (Eds.), Canadian Community as
Partner (pp. 157-186). New York: Lippincott,
Wilkinson, & Williams.

Public Health Agency of Canada. What
Determines Health? (2003, June 16). Retrieved
August 11, 2006 from: http://www.phac-
aspc.gc.ca/ph-
sp/determinants/determinants-eng.php

Ruetter, L. I. (2000). Chapter 9. Socioeconomic
determinants of health. In M. J. Stewart
(Eds.), Community Nursing: Promoting
Canadians Health (p. 174-193). Harcourt
Canada: Toronto.

4.2 Assesses the health needs of the following:

4.2a Child-bearing family prenatal period
access to prenatal care
access to health & community services
previous pregnancy history
food security
nutritional status of the mother
pre-existing health conditions
medications
mental health status
addiction
dental health
preparation for childbirth
infant feeding options
preparation for parenting
abuse and neglect
immunization
sexuality
housing
education
finances
support system
literacy
activities/rest
culture
physical, emotional, psychological &
spiritual well-being
signs and symptoms of potential
complications such as hypertension,
diabetes
social changes
potential postpartum depression
family functioning
strengths
Health Canada (2005). Canadas Food Guide to
Healthy Eating. Retrieved September 27, 2006
from: http://www.hc-sc.gc.ca/fn-an/food-
guide-aliment/index_e.html

Minnesota Department of Health. (2001). Public
August 14, 2006 from:
eel/index.htm

years. Retrieved September 18, 2006 from:
dea/prenatal/index_e.html.

Public Health Agency of Canada, Healthy
Pregnancy: For Health Professionals. Retrieved
September 18, 2006 from: http://www.phac-
aspc.gc.ca/hp-gs/prof_e.html

Public Health Agency of Canada. Oral Health.
Retrieved September 18, 2006 from:
bucco/index_e.html

Public Health Agency of Canada. (2005).
Violence and Abuse. Retrieved September 19,
2006, from: http://www.hc-sc.gc.ca/hc-
ps/violence/index-eng.php

- 41 -

4.2b Child-bearing family postpartum period
access to postpartum care
previous childbearing history
nutritional status of the mother
pre-existing health conditions
medications
mental health status
addiction
dental health
breastfeeding
family planning
sexuality
housing
education
activities/rest
finances
support system
literacy
culture
signs & symptoms of potential
complications such as inability to void
episiotomy and lochia
abuse/neglect
immunization
social changes
family functioning
sibling adjustment
newborn behaviour
strengths
actual/potential postpartum depression
attachment and bonding

Most medical surgical nursing texts or health
assessment texts have a chapter on growth
and developmental milestones.

National Advisory Committee on Immunization
(NACI). Recommended Immunization Schedule
for Infants, Children and Youth (updated March
2005) retrieved September 27, 2006 from
http://www.phac-aspc.gc.ca/im/is-
cv/index.html

years. Retrieved September 18, 2006 from
dea/prenatal/index_e.html

Public Health Agency of Canada. Oral Health.
bucco/index_e.html

(Eds.). Community Health Nursing: A Canadian
Perspective. Prentice Hall: Toronto.

4.2c Child-bearing family parenting
access to parenting services
previous parenting history
breastfeeding
nutrition
parenting skills
normal growth and development
family planning
sexuality
housing
education
finances
support system
literacy
culture
abuse/neglect

Middlesex-London Health Unit Breastfeeding
Handbook. Retrieved August 11, 2006 from
http://healthunit.com/index.asp?mode=sectio
nList&sectionID=297

(2003). Breastfeeding Best Practice Guidelines
for Nurses. Retrieved September 18, 2006
from
http://www.rnao.org/Page.asp?PageID=122&
ContentID=1273&SiteNodeID=156&BL_Expan
dID= )
a breastfeeding self-learning package is also
available on the website

- 54 -

Parenting (continued)
immunization
social changes
family functioning
strengths

4.2d Infant
access to newborn care
immunization status
nutrition
safety and security
nurturing
attachment
stimulation
physical, emotional, psychological
spiritual growth and development
cry
behaviour
culture
special needs
strengths

Public Health Agency of Canada. (2004-05-04).
Parent Child Relationships and Attachment.
dea/family_famille/index_e.html
4.2e Children
immunization status
nutrition
safety and security
nurturing
behaviour
stimulation
socialization
such as vision and oral
access to child care
equipment
screening
inclusion
access to education
physical activity
culture
sexuality
special needs
strengths
activities of daily living

Public Health Agency of Canada. (2002-09-02).
Childrens Rights and International Policy.
dea/allchildren_touslesenfants/rights-
index_e.html
4.2f Youth
immunization status
nutrition
safely and security
nurturing
stimulation
Gillis, A. J. (2000). Chapter 12: Adolescent
health promotion: An evolving opportunity for
community health nurses. M. J. Stewart (Ed.),
Community Health Nursing: Promoting the
Health of Canadians. (pp.241-261). Harcourt
Press: Toronto.
- 55 -

Youth (continued)
hysical, emotional, psychological &
socialization
access to childcare
equipment
body image
self-esteem
peer and adult relationships
inclusion
sexuality
contraceptive use
access to education
physical activity
culture
special needs
strengths

(2002). Enhancing Adolescent Development.
Retrieved August 2006 from www.rnao.org

4.2g Adult
immunization status
nutrition
safety and security
nurturing
stimulation
social support
equipment
body image
self-esteem
relationships
inclusion
housing
food security
work
finances
sexuality
physical activity
physical, emotional, psychological, &
spiritual growth & development
culture
strengths

Public Health Agency of Canada. (2004, August
4). Adult Health. Retrieved September 19, 2006
from http://www.phac-aspc.gc.ca/ah-sa_e.html
4.2h Older adult
immunization status
nutrition
safety
nurturing
stimulation
social support
Craig, D. M. (2000). Chapter 14: Health
promotion with older adults. M. J. Stewart (Ed.),
Community Health Nursing: Promoting the Health
of Canadians (pp. 283-295). Harcourt Press:
Toronto.
- 56 -

Older adult (continued)
and illness services
equipment
security
body image
self-esteem
relationships
inclusion
housing
food security
activity
finances
physical activity
culture
strengths
sexuality
medication regime

to improve health

4.3a Child-bearing family prenatal care
ensuring access to prenatal care
case management
health teaching
advocacy
communicable disease control
promotion of breastfeeding
outreach
case finding
counseling
consultation
building individual & family capacity

A definition of anticipatory guidance is in
Stanhope & Lancaster, 2000, G-2.

eel/index.htm

Includes information and definitions for
many of the interventions listed throughout
4.3

See 4.2a
4.3b Child-bearing family postpartum care
health teaching
promotion of effective breastfeeding
promotion of maternal/family self-care
consultation
outreach
case management
bereavement support

See 4.2b
4.3c Child-bearing family parenting
health teaching
referral to programs/other services
See 4.2c
- 57 -

Parenting (continued)
counseling
relationship building
consultation
establishing partnerships with
community resources
advocacy
case finding
outreach
case management

4.3d Infant
parental anticipatory guidance
counseling
health teaching on developmental
milestones & injury prevention
immunization
collaboration
partnership
advocacy
consultation
case finding
outreach

See 4.2d
4.3e Child
parental anticipatory guidance &
counseling
health teaching on developmental
milestones & injury prevention
immunization
collaboration and partnership with
preschool & school community
advocacy
community development
consultation
case finding
outreach
case management
bereavement support

See 4.2e
4.3f Youth
immunization
health teaching
collaboration
partnership
advocacy
community development
Information on harm reduction can be found in
Stamler & Yiu (2008) pg 389.

See 4.2f

- 58 -
- 59 -

consultation
policy development
case finding
harm reduction
outreach
case management
bereavement support

4.3g Adult
immunization
health teaching
collaboration
partnership
advocacy
consultation
case finding
harm reduction
outreach
bereavement support

See 4.2g
4.3h Older adult
immunization
health teaching
collaboration
partnership
advocacy
consultation
case finding
harm reduction
outreach
bereavement support

See 4.2h

Competency #4 - Review Questions

1. Ruetter, L. (2000). Chapter 9.
Socioeconomic determinants of health. In
Toronto: W. B. Saunders.
Question #1 (p. 188)

2. Gillis, A. J. (2000). Chapter 12: Adolescent
health promotion: An evolving opportunity
for community health nurses. M. Stewart
the Health of Canadians. (pp.241-261).
Questions #2 & #5 (p. 258)

3. Develop a case study on breastfeeding and
hydration assessment.

4. Patrick, L. & Edmunds, K. (2005). Chapter
9: Family Care. In L. Stamler & L Yiu
Hall.
(p. 148)

5. Edwards, N. (2000). Chapter 15: Prevention
of falls among seniors in the community. In
Questions #1-#3 (p. 310)

6. Craig, D. M. (2000). Chapter 14: Health
promotion with older adults. In M. J.
Stewart (Ed.), Community Health Nursing:
Promoting the Health of Canadians (pp. 283-
295). Toronto: W. B. Saunders.

7. A CHN is providing care in a postpartum
drop-in, which focuses on the supporting the
emotional health and well being of new
moms. The drop-in allows for women (and
their families) to have support from a
professional, as well as a trained peer
support person. Lisa, pregnant with her
second child, attends the drop-in to discuss
her anxiety. She experienced postpartum
depression after her first child, and required
short-term hospitalization, and is worried
that she will have similar challenges after
her second baby is born.
What might the CHNs assessment
include?
What interventions could the CHN
consider?
How would these strategies
increase individual capacity?
Are there any strategies the nurse
may consider to build community
capacity?

8. Over the last number of months, you have
provided wound care to multiple clients due
to their infected C-section incisions and
episiotomies. As part of your reflective
practice, you notice a trend where clients
who have been discharged from a particular
facility are not healing well.
a. What would you do about this
observation?

9. You have been home visiting Miriam
periodically for the last 8 weeks. You
initially went to support her in breastfeeding
her new baby, Leanne. Breastfeeding is now
going well for both Miriam and Leanne.
However, you have continued to visit for a
variety of other reasons. Miriam also has a
16-month old, Jacob, and a 6-yr. old, Sarah.
You have observed that Jacob seems
significantly distressed crying, sometimes
banging his head when Miriam leaves the
room to change Leannes diaper or check on
her when she is sleeping. Your efforts to
distract &/or comfort Jacob are ineffective.
When Miriam returns to the room, it takes
longer than you would expect for Jacob to
settle down; he sometimes even seems angry
with this mother. You have also observed
that he does not explore his environment as
comfortably as many other 16-month olds.
Jacob is very gentle with Leanne and likes to
sit near her while he plays. At your last
visit, when in the kitchen with Miriam, you
noticed that Jacob was attempting to open
the dishwasher detergent container under
the sink. When you pointed it out to
Miriam, she shouted at him to stop and
threatened to spank him if he didnt.
Miriam does spend time reading to Jacob
every other day, and indicates that they both
enjoy this time together. Sarah is doing well
at school academically, but is having some
difficulty socially. All the childrens
immunizations are up-to-date. Although
Jacobs dad is quite busy with his work, he
does take Jacob and Sarah swimming once
a week. Miriams parents come over
regularly to help with housework and the
kids. Miriam is frustrated that Jacob is a
picky eater, who doesnt eat much. He
does drink 3-4 cups of milk and 2-3 cups of
juice each day. Miriam would like some
- 60 -
suggestions to help with Jacobs eating. In
addition, she is concerned that Sarah does
not have any of her permanent teeth yet.
a. What strengths can you identify in this
family?
b. Identify some of the developmental
norms you would expect to see in an 8-
wk old, 16-month old, & 6-yr old.
c. What concerns might you have?
d. What would your assessment include?
What are some areas in particular that
you would like to assess further?
e. Talk about your interventions (try to
include information from the Canadian
Community Health Nursing Standards
&/or the Minnesota Wheel).
f. Identify at least 6 Rights of the Child.

- 61 -
Competency #5: Providing Infection Prevention and Control
and Communicable Disease Services


Brunt, J. H., & Sheilds, L. E. (2000).
Chapter 29: Epidemiology in community
health nursing: Principles and applications
for Primary Health Care. In. M. Stewart
(Ed.). Community Nursing: Promoting
Canadians Health (pp. 564-583). W.B.
Saunders: Toronto.

Department of Health and Human Services:
Centers for Disease Control and Prevention
(2005). FAQ: VRE. Retrieved August 18,
2006 from
http://www.cdc.gov/ncidod/dhqp/ar_VRE_
publicFAQ.html

(2005). Food borne illness: Frequently Asked
Questions. Retrieved on February 2006 from
http://www.cdc.gov/ncidod/dbmd/diseasei
nfo/foodborneinfections_g.htm

(2004). Information about MRSA for
Healthcare Personnel. Retrieved August 18,
2006 from
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_
healthcareFS.html

Health Canada (2002). Canadian
immunization guide. Retrieved September
28, 2006 from www.phac-
aspc.gc.ca/publicat/cig-gci/index.html.
Readings specific to immunization
Read introduction

Heymann, D. V. (2004). Control of communicable
diseases manual (18
th
ed.). Washington, DC:
American Public Health Association.
see index for listed diseases
readings are specific to diseases listed in
competencies

Health Interventions: Applications for Public Health
Nursing Practice Manual. Retrieved August 14,
2006 from
http://dhs.wisconsin.gov/phnc/InterventionWhe
el/index.htm

Canadian Guidelines on Sexually
Transmitted Infections 2006 Edition.
Retrieved November 11, 2008 from
http://www.phac-aspc.gc.ca/std-mts/sti-
its/index-eng.php

Hantavirus Pulmonary Syndrome in Canada.
In Canada Communicable Disease Report
Volume 26-08. April 15, 2000. Retrieved
August 2006 from www.phac-
Study Tip

Focus your studying on what is included in the competencies, e.g. not all
communicable diseases are listed.

When reviewing transmission of infection, consider how transmission is specific
to the diseases listed.

When studying the signs and symptoms, be able to recognize the disease from a
list of symptoms

Apply the chain of infection to each disease. How would you break the chain of
infection for each disease?

Many local health units post fact sheets and information about various
communicable diseases on their websites.
- 62 -
aspc.gc.ca/publicat/ccdr-
rmtc/00vol26/dr2608ea.html

Sexually Transmitted Infections, Sexual
Health Facts and Information. Retrieved
August 11, 2006 from http://www.phac-
aspc.gc.ca/std-mts/faq_e.html

Public Health Agency of Canada (2003). STD
Self-Learning Modules. Retrieved August 11,
aspc.gc.ca/slm-maa/index.html
Two case studies with pre and post test
multiple choice questions
Clinical slide gallery

Selby-Harrington, M. & A. S. Tesh (2004).
Epidemiology, Demography, and
Community Health. In Vollman, A.,
Anderson, E., McFarlane, J. (Eds.)
Canadian community as partner (pp.
2833,42-57). New York: Lippincott Wilkins
& Williams.

Stamler, L. & Yiu, L. (2008). Community Health
Nursing: A Canadian Perspective. Prentice Hall:
Toronto.
Chapter 8: Epidemiology
Chapter 9: Communicable Diseases
Chapter 29: Sexually Transmitted Infections
and Blood Borne Pathogens

Additional Readings

Gold, R. (2002). Your Childs Best Shot: A
parents guide to vaccination. Canadian
Pediatric Society.

The Lung Association (2003). Tuberculosis:
Information for Health Care Providers. (3
rd

ed.). Author.

- 63 -


5.1 Understands the principles of
immunization

5.1a Informed consent

College of Nurses of Ontario. (2004). Consent
(pp. 6). Author: Ontario. Retrieved February
2006 from www.cno.org

5.1b Screening Minnesota Department of Health (2001).
http://dhs.wisconsin.gov/phnc/Intervention
Wheel/index.htm

5.1c Anaphylaxsis

immunization guide. Retrieved September 28,
2006 from www.phac-
aspc.gc.ca/publicat/cig-gci/index.html (pp.
14-15).

5.1d Valid & invalid contraindications to
vaccinations
2006 from www.phac-
5-6).

5.1e Monitoring Minnesota Department of Health (2001).
http://dhs.wisconsin.gov/phnc/Intervention
Wheel/index.htm
Chapter on screening discusses
differences between screening and
monitoring. Screening is an early
detection of risk.

5.1f Cold chain

2006 from www.phac-
33).

Transportation and storage of vaccine
between +2 and +8 Celsius, equipment and
procedures to protect vaccines from
inappropriate temperature and light. From
the manufacturer to the administration to
client.

- 64 -


5.1g Immunity Health Canada (2002). Canadian immunization
guide. Retrieved September 28, 2006 from
www.phac-aspc.gc.ca/publicat/cig-
gci/index.html (pp. 46).

Malloy, P. & Yiu, L. (2008). Chapter 9:
Communicable Disease. In L. Stamler & L. Yiu
Perspective (pp.190). Prentice Hall: Toronto.

5.2 Monitors immunization rates Monitoring purpose is to track the progress
once a risk has been identified, after the fact,
affects only a few, focuses on persons with
known risk (Stanhope & Lancaster, 2004, p.
917).

5.3 Educates clients on the benefits and
risks of immunization to the population

Health Canada (2002). Canadian immunization
gci/index.html (pp. 2, 42-53).

Gold, R. (2002). Your Childs Best Shot: A
parents guide to vaccination. Canadian
Pediatric Society.

5.4 Conducts surveillance activities

For example:
unusual age distribution
a large number of cases
mortality rate
morbidity rate
temporal or geographic cluster
prevalence
incidence

Brunt, J. H., & Sheilds, L. E. (2000). Chapter
29: Epidemiology in community health
nursing: Principles and applications for
Primary Health Care. In. M. Stewart (Ed.).
Health (pp. 564-583). W.B. Saunders: Toronto.

Selby-Harrington, M. & A. S. Tesh (2004).
Epidemiology, Demography, and Community
Health. In Vollman, A., Anderson, E.,
McFarlane, J. (Eds.) Canadian community as
partner (pp. 2833,42-57). New York: Lippincott
Wilkins & Williams.

Surveillance is a process that detects trends
and seeks to identify changes in the incidence
and prevalence. Surveillance gathers the who,
when, where and what: these elements are
then used to answer why: Note: Surveillance
activities can passive (ex. Physicians offices
reporting cases of disease) or active (PHN calls
Physicians offices to inquire about new cases).
Surveillance for immunization is formal and
on-going (not time limited).

- 65 -


5.5 Interprets surveillance findings

For example:
trends
outbreaks

diseases manual (18
th

American Public Health Association. Pg. xxii-
xxxiii

eel/index.htm

5.6 Implements and evaluates action based on
surveillance findings

For example:
reporting to appropriate authority
implementing policy

See 5.5
5.7 Differentiates various types of immunity

5.7a active

5.7b passive

5.7c cross

5.7d herd
gci/index.html (pp. 2, 46).


- 66 -


5.8 Understands the modes of transmission of
vaccine-preventable communicable
disease: agent/organism, reservoir,
portal of exit, mode of transmission,
portal of entry, susceptible host.

diseases manual (18
th
American Public Health Association. P. xxii-
xxxiii

Stamler, L. (2008). Chapter 8: Epidemiology. In L
Stamler & L. Yiu (2008). Community Health Nursin
A Canadian Perspective (pp. 103). Prentice Hall:
Toronto.


Infectious Agent: any disease-causing
microorganism (pathogen)

Reservoir: the organism in which the infectious
microbes reside (human, animal, object)

Portal of Exit: route of escape of the pathogen from
the reservoir (e.g. respiratory secretions, blood
exposure, breaks in skin

Mode of Transmission:-method by which the
pathogen gets from the reservoir to the new host
(e.g. direct contact, air, insects)

Portal of Entry: route through which the pathogen
enters its new host (e.g. inhalation, ingestion,
sexual contact)

Susceptible Host: The organism that accepts the
pathogen. The support of pathogen life & its
reproduction depend on the degree of the hosts
resistance.

- 67 -


5.9 Implements appropriate infection control
practices to prevent transmission of
infectious/communicable diseases

For example:
routine practices including hand hygiene
personal protective
practices and personal protective equipme
additional
precautions
airborne droplet and contact precautions
gloving
isolation
cleaning
disinfection
sterilization of equipment

How to interrupt the chain of infection:

1. Pathogen identification: identification of
infectious agent & appropriate treatment

2. Asepsis and Hygiene: potential hosts & carriers
must practice asepsis & maintain proper
personal hygiene.

3. Control portals of exit: practice standard
precautions.

4. Prevent route of transmission by: proper hand
washing, disinfection & Sterilization techniques,
isolation of infected patients, not working when
contagious.

5. Protect Portal of Entry: Health professionals
must make sure that ports of entry are not
subjected to pathogens.

6. Recognition of Susceptible Host: Health
professionals must make sure that ports of
entry are not subjected to pathogens.

5.10 Recognizes symptoms of communicable
diseases that are vaccine preventable.

For example:
diphtheria, tetanus, polio
measles, mumps, rubella
varicella, meningoccoccal
hepatitis B, hepatitis A
influenza
pneumococcal
smallpox, thyphoid
yellow fever
tuberculosis.

gci/index.html.
Look at each vaccine. Note: pertussis is not
included.

5.11 Understands transmission of vaccine-
preventable communicable diseases:
agent/organism, reservoir, portal of
exit, mode of transmission, portal of
entry, susceptible host

- 68 -


5.12 Implements and evaluates nursing
interventions to prevent spread of
vaccine-preventable disease

For example:
immunizing
screening
case finding
reporting
health teaching
consultation and communication
infection control practices

Heymann, D. V. (2004). Control of
communicable diseases manual (18
th
ed.).
Association. P. xxvi-xxxii.

heel/index.htm

5.13 Recognizes symptoms of communicable
diseases that are non-vaccine-preventable

For example:
febrile respiratory illness (FRI)
HIV
STI
hepatitis C

Heymann, D. V. (2004). Control of
communicable diseases manual (18
th
ed.).
Association. P. xxvi-xxxii.

Lokanc-Diluzio, W., Nelson, A., Wayne, J. L., &
Hettler, J. B. (2008). Chapter 29: Sexually
Pathogens. In Stamler, L., & Yiu, L. (Eds.).

heel/index.htm

Sexually Transmitted Infections, Sexual Health
Facts and Information. Retrieved August 11,
2006 from http://www.phac-aspc.gc.ca/std-
mts/sti-its/index-eng.php

Public Health Agency of Canada (2003). STD
Self-Learning Modules. Retrieved August 11,
2006 from http://www.phac-aspc.gc.ca/slm-
maa/index.html
Two case studies with pre and post test
multiple choice questions; Clinical slide
gallery

5.14 Understands transmission of non-
disease: agent/organism, reservoir,

Apply readings in 5.8 to non-vaccine-
preventable communicable disease
- 69 -


interventions to prevent spread of non-
diseases

For example:
screening
case finding
outreach
reporting
health teaching

Apply readings in 5.12 & 5.13 to non-vaccine-
preventable communicable disease
5.16 Recognizes symptoms of health-care-
acquired infections

For example:
MRSA
VRE

(2005). FAQ: VRE. Retrieved August 18, 2006
from
http://www.cdc.gov/ncidod/dhqp/ar_VRE_pu
blicFAQ.html

(2004). Information about MRSA for Healthcare
Personnel. Retrieved August 18, 2006 from
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_he
althcareFS.html

5.17 Understands transmission of health-
care-acquired infections: agent/
organism, reservoir, portal of exit,
mode of transmission, portal of entry,
susceptible host

Apply readings in 5.8 to health-care acquired
infections
health-care-acquired infections

For example:
screening
follow-up
reporting
health teaching
infection control practices.

Apply readings in 5.12 & 5.13 to health care
acquired infections
- 70 -


Supporting Literature
5.19 Recognizes symptoms of emerging and
resurgent infectious diseases

For example:
West Nile,
hantavirus pulmonary syndrome
febrile respiratory illness (FRI)
tuberculosis
Clostridium difficile

Heyman, D.V. (2004). Control of Communicable
Diseases Manual (18
th
American Public Health Association. (West Nile
Virus p.46 or p.159)

Hantavirus Pulmonary Syndrome in Canada. In
Canada Communicable Disease Report Volume
26-08. April 15, 2000. Retrieved Aug 2006 from
www.phac-aspc.gc.ca/publicat/ccdr-
rmtc/00vol26/dr2608ea.html

The Lung Association (2003). Tuberculosis:
Information for Health Care Providers. (3
rd
ed.).
Author. - Call 1-800-972-2636 to order.

5.20 Understands transmission of emerging
and resurgent infectious diseases: agent/
organism, reservoir, portal of exit, mode
of transmission, portal of entry,
susceptible host.

Apply readings in 5.8 to emerging and resurgent
infectious diseases

practices and interventions to prevent
spread of emerging and resurgent
infectious disease

For example:
screening
case finding
outreach
health teaching
treatment
routine practices and additional
precautions

Apply readings in 5.12 & 5.13 to emerging and
resurgent infectious diseases

5.22 Recognizes symptoms of common
food-borne illnesses

For example:
E. coli
hepatitis A
salmonella
parasitic

diseases manual (18
th

See index for listed diseases

5.23 Understands transmission of common
food-borne illnesses: host, agent and
environment.
Stamler, L. (2008). Chapter 8: Epidemiology. In L
Stamler & L. Yiu (2008). Community Health Nursin
A Canadian Perspective (pp. 103). Prentice Hall:
Toronto.

- 71 -


common food-borne illnesses

For example:
screening
case finding
health teaching
treatment

Apply readings in 5.12 & 5.13 to common food-
borne illnesses

(2005). Food borne illness: Frequently Asked
Questions. Retrieved on February 2006 from
http://www.cdc.gov/ncidod/dbmd/diseaseinfo
/foodborneinfections_g.htm
5.25 Recognizes symptoms of parasitic
infections

For example:
lice
ring worm
scabies

NOTE: Ring Worm (Tinea Corporis) is a fungal
infection, not parasitic (Heymann, D. V., 2004,
p. 154)

diseases manual (18
th

5.26 Understands transmission of parasitic
infections: agent/organism, reservoir,

Apply readings in 5.8 to parasitic infections
parasitic infections

For example:
screening
health teaching
treatment.

Apply readings in 5.12 & 5.13 to parasitic
infections
5.28 Recognizes symptoms of common
water-borne illnesses

For example:
shigella
E. coli
Entamoeba
cryptosporidium
diseases manual (18
th
Shigellosis p. 487 (shigella is agent not
illness)
E. coli p. 160
Entamoeba p. 12 (agent, not illness)
Cryptosporidiosis p.138 (agent is
cryptosporidium parvum)

5.29 Understands transmission of water-
borne illnesses: agent/organism,
reservoir, portal of exit, mode of
transmission, portal of entry,
susceptible host.

Apply readings in 5.8 to water-borne illnesses
- 72 -


water-borne illnesses

For example:
screening
health teaching
health communication
treatment

Apply readings in 5.12 & 5.13 to water borne-
illnesses

5.31 Defines the concepts of pandemic,
epidemic and endemic outbreaks

- 73 -

- 74 -

1. What steps would you take if you believed
the cold chain was broken?

2. Stamler, L. (2005). Chapter 7: Epidemiology.
In L. Stamler & L. Yiu (Eds.), Community
Health Nursing: A Canadian Perspective
(pp.101-116). Toronto: Prentice Hall.
(p. 113)

3. Malloy, P. & Yiu, L. (2005). Chapter 12:
Communicable Disease. In L. Stamler & L.
Canadian Perspective (pp.187-204). Toronto:
Prentice Hall.
Exercises - #1, #2, #4, #5 (p. 202).
Group Critical Thinking Exercises -
#2 (p. 202).

4. Brunt, J. & Shields, L. (2000). Chapter
29: Epidemiology in community health
nursing: Principles and applications for
Primary Health Care. In. M. Stewart (Ed.).
Health (pp. 564-583). Toronto: W.B.
Saunders.

5. Wayne, J. & Hettler, J. (2005). Sexually
Pathogens. In L. Stamler & L. Yiu (Eds.),
Perspective (pp.291-298). Toronto: Prentice
Hall.
(p. 295)
Exercises - #1 (p. 297)
Group Critical Thinking Exercises -
#2 (p. 297)

6. See Appendix D for Immunization Quiz
developed by Wendy Holmes and Yvonne
Wigboldus from the 2006 Study Group.

7.
For Home Health Nurses, there is a
requirement to balance infection control
with the realities of working in a clients
home. You are providing wound care to a
client who lives in an apartment complex
that is geared to income. Upon entering the
apartment, you notice cockroaches in the
kitchen & living room. The kitchen sink is
filled with dirty dishes, the stove top is food-
splattered & greasy. The client is wearing
dirty clothes. Discuss measures you could
take to prevent the clients wound from
getting infected.
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
_______________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
_______________________________________________

Competency #6: Being Involved in Emergency
Preparedness/Disaster Management


Simpson, M. A. & Yiu, L. (2008). Chapter
24: Disaster Nursing and Emergency
Preparedness. In Stamler & Yiu (Eds.),

Additional Readings
Health Canada (2006). Emergencies and
Disasters. Retrieved November 30, 2008
from http://www.hc-sc.gc.ca/hc-ps/ed-
ud/index-eng.php

Jakeway, C. C., LaRosa, Gl., Cary, A., &
Schoenfisch, S., (2008). The Role of Public
Health Nurses in Emergency Preparedness
and Response: A Position Paper of the
Association of State and Territorial Directors
of Nursing. Public Health Nursing, 25(4),
353-361.

Emergency Preparedness. Retrieved
aspc.gc.ca/ep-mu/index.html

Chapter 20: Disaster Management
Community and public health nursing (6
th

ed.). St. Louis, MO: Mosby.
- 75 -
MLHU - Community Health Certification Guidebook - FOR MLHU STUDY GROUP USE ONLY

- 76 -

6.1 Plans nursing interventions following
notice of emergency or disaster events
that impact on the health of the
community

For example:
contaminated water supply
bioterrorism
environmental or natural events/disasters
human-made such as pollution,
structural collapse, transportation
accidents

6.2 Implements activities to decrease risk of
emergencies or disasters

For example:
policies to reduce weapon carrying by
adolescents on school property
teaching to reduce infections caused by
food-borne pathogens
teaching regarding symptoms of
bioterrorism
teaching regarding fire hazards,
preparedness, capacity building,
pandemic flu preparedness planning

6.3 Participates in the implementation and
evaluation of components of disaster
plans at the workplace and in the
community

For example:
emergency numbers
use of 911
use of water, gas and electricity main switc
roles and responsibilities of individuals and
organizations
type and amount of supplies required
levels of disaster
mental health
case finding, triage
screening
surveillance
shelter management
outreach
recovery
capacity building

Health Canada (2006). Emergencies and
Disasters. Retrieved September 28, 2006 from
http://www.hc-sc.gc.ca/hc-ps/ed-ud/index-
eng.php
Information on Health Canadas plans
regarding:
Natural events & disasters such as
outbreaks of disease, floods, earthquakes,
fires & tornadoes.
Emergencies such as transportation
accidents, large chemical spills, nuclear
incidents, power outages and terrorist
threats.

Simpson, M. A. & Yiu, L. (2008). Chapter 24:
Disaster Nursing and Emergency Preparedness.
In Stamler & Yiu (Eds.), Community Health
Nursing: A Canadian Perspective. Prentice Hall:
Toronto.

Emergency Preparedness. Retrieved September
28, 2006 from http://www.phac-aspc.gc.ca/ep-
mu/index.html
Information regarding:
Emergency Preparedness
Laboratory Safety and Security
Public Health Security Emergency
Preparedness, Planning and Training


- 77 -

Compentency #6 Review Questions

From Stanhope & Lancaster (2004):

1. Disaster-related nursing is an evolving
specialty. Which answer best describes this
specialty?

a) The goal of disaster-related health
promotion is to minimize the health
hazards and life-threatening damage
caused by disasters in collaboration with
other specialized fields.
b) Disaster-related intervention to treat and
limit sequelae from disaster related
event(s).
c) Disaster-related planning, development of
recovery and response partnerships,
planning and participating in disaster
preparedness drills, and disaster
response.
d) Planning for the unlikely event that an
enemy of the United States uses a
biological weapon and a community
response is needed.

2. A nurse is assigned to provide community
outreach to a small town which was partially
destroyed by a tornado three years ago, but
has now been rebuilt. Her first patients are a
family that lost their home and their best
friend in the tornado. Her intervention
should include:

a) An avoidance of discussing the disaster
unless one of the family members
mentions it.
b) The knowledge that disaster recovery is a
long-term process, and the family will
have worked through the emotional
aftermath in the first two years after the
disaster.
c) An assessment of the family's home
environment to rule out safety issues and
to ensure the family is aware of the local
tornado alert system.
d) Helping the family prepare a personal
disaster response plan; assessing the
family's long term adjustment in the
aftermath of the tornado and providing
counselling referral(s) if needed.

3. The highest priority for a nurse who is
among the first responders to a disaster is:

a) Immediately begin plans for effective
triage and patient management.
b) Begin community assessment as soon as
possible to ensure a rapid recovery.
c) Begin surveillance and plan needed
health education for disaster survivors.
d) Arrange for shelter for disaster providers.

4. A nurse is working with a Disaster Medical
Assistance Team as they respond to a
disaster. One of the team members tells the
nurse he is having difficulty sleeping and
concentrating. What is the best
intervention?

a) Help the team member implement better
self-care practices and call home to speak
with family.
b) Arrange for the team member to be
transferred to another unit and begin a
journal.
c) Arrange for the team member to leave
duty, return home, and talk with his
pastor.
d) Counsel the team member regarding
effective self-care strategies and
encourage him to talk with a Red Cross
mental health team member.

5. Simpson, M. A. & Yiu, L. (2008). Chapter
24: Disaster Nursing and Emergency
Preparedness. In Stamler & Yiu (Eds.),
Canadian Research Box 24.1 Question
#1 & 2
Group Critical Thinking Exercises # 1.

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Compentency #6 Answers to Review Questions

From Stanhope & Lancaster (2004):
1. c
2. d
3. a
4. d


Competency #7: Promoting a Healthy Environment


Canadian Partnership for Childrens Health
and Environment (2003). Creating a
Healthy Environment for Kids. Retrieved
www.healthyenvironmentforkids.ca

Health Interventions: Applications for Public Health
Nursing Practice Manual. Retrieved August 14,
2006 from
http://dhs.wisconsin.gov/phnc/InterventionWhe
el/index.htm

Vollman, Anderson, & McFarlane (2003).
Chapter 4: Healthy Environments. Canadian
community as partner. Philadephia, PA: Lippincott
Williams and Wilkins.

Laforet-Fliesser, Y., MacDougall, C., and
Buckland Foster, I. (2008). Chapter 16: School
Health. In L. Stamler & L. Yiu. Community health
nursing: A Canadian perspective 2
nd
ed. (173-
178). Toronto.

Additional Readings

Bergeron, K. (June 2006). Designing Active
Communities Built Enironment and Health:
The Role of Community Health Professionals
(June 2006). Paper presented at CHNET-
Works, Haliburton, Kwartha, Pine Ridge,
Ontario.

Ministry of Health and Long Term Care
(n.d.) Fact Sheet on Smog. Retrieved
http://www.health.gov.on.ca/english/publi
c/pub/pubhealth/pdf/smog.pdf

Ministry of the Enviroment, Ontario (n.d.)
Information about air quality. Retrieved
http://www.airqualityontario.com/science/i
ndex.cfm

Comprehensive School Health. Retrieved

Childhood and Adolescence: Safe, Healthy
Environments. Retrieved September 18,
aspc.gc.ca/dca-
dea/allchildren_touslesenfants/she_main_e.
html

Chadwick, S. L., & Doyle, B. (2008).
Chapter 11: Occupational Health. In L.
Stamler & L. Yiu. Community health
nd
ed. (pp.
197-211). Toronto.

http://www.phac-aspc.gc.ca/dca-dea/7-18yrs-ans/comphealth_e.html

- 79 -

- 80 -

7.1 Conducts a health assessment of the
social and physical environment in the
following settings:

7.1a School and daycare

For example:
playground
classroom
washroom
safety of cafeteria equipment
bullying
accessibility to washroom
cafeteria noise
food handling practices
food choices

Canadian Partnership for Childrens Health and
Environment (2003). Creating a Healthy
Environment for Kids. Retrieved September 28,
2006 from www.healthyenvironmentforkids.ca
Information on why children are at greater risk
than adults
Specific health concerns before conception
and during pregnancy
Concerns while cleaning, feeding, playing,
renovating/decorating

Laforet-Fliesser, Y., MacDougall, C., and
Buckland Foster, I. (2008). Chapter 16: School
Health. In L. Stamler & L. Yiu. Community
health nursing: A Canadian perspective 2
nd
ed.
(173-178). Toronto.

Comprehensive School Health. Retrieved
September 28, 2006 from http://www.phac-
aspc.gc.ca/dca-dea/7-18yrs-
ans/comphealth_e.html

7.1b Community

For example:
geographical location
social and cultural diversity
municipality services
access to transportation
access to food supplies

community as partner. Philadephia, PA:
Lippincott Williams and Wilkins.

7.1c Home

For example:
scatter rugs
crowding
smoking
lack of shelter
substance use
unsafe stairs
access to wheelchair
disability accommodations
mould
pestilence
fire risks
animals
violence
potential for aggression
exposure to the elements
hazardous waste
Public Health Agency of Canada (2005). The
Safe Living Guide: A guide to home safety for
seniors. (3
rd
ed.). Retrieved November 23, 2008
from http://www.phac-aspc.gc. ca/seniors-
aines/pubs/safelive/index.htm

Information on Stairs: From CHNET-Works
retrieved August 22, 2006:

1. Pictures of stairs in homes and public places
(e.g. churches, legions, banks, pharmacies,
stores, community centres, schools, parks...etc)
(see Review Questions)
2. Pictures showing good stair safety features (e.g.
same height risers, 7 risers x 11" treads, good
lighting, handrails on both sides, contrast edge
markings, signs encouraging people to use the
stairs, handrails that extend beyond the
top/bottom of flights, closed 'back' of stairs, etc)
3. Pictures showing unsafe stair features (e.g. poor
lighting, inconsistent risers, no handrails,
obviously shaky handrails, handrails that are
inappropriate shape/size for users, no edge
markings, broken stairs, frayed carpeting,
obstacles on stairs...etc)


- 81 -


7.1d Built environment

For example:
traffic
noise
housing
sanitation
lighting
roads

7.1e Natural environment

For example:
water quality
air quality
soil
sun
well water
fluoridation
second-hand smoke,
stubble burning
forest fire smoke
allergens

Bergeron, K. (June 2006). Designing Active
Communities Built Enironment and Health: The
Role of Community Health Professionals (June
2006). Paper presented at CHNET-Works,
Haliburton, Kwartha, Pine Ridge, Ontario.

Ministry of the Enviroment, Ontario (n.d.)
Information about air quality. Retrieved
http://www.airqualityontario.com/science/i
ndex.cfm

Ministry of Health and Long Term Care (n.d.)
Fact Sheet on Smog. Retrieved September 19,
2006 from
http://www.health.gov.on.ca/english/public/p
ub/pubhealth/pdf/smog.pdf

Childhood and Adolescence: Safe, Healthy
Environments. Retrieved September 18, 2006
from http://www.phac-aspc.gc.ca/dca-
dea/allchildren_touslesenfants/she_main_e.
html

Vollman, A. R., Anderson, E. T. &
McFarlane, J. (2004). Chapter 4: Healthy
Environments. Canadian Community as
Partner. New York: Lippincott, Williams &
Wilkins.

7.1d Recreational and community facilities

For example:
availability and accessibility of
facilities
wheelchair accessibility
baby friendly
temperature control
mould
second-hand smoke

community as partner. Philadephia, PA:
Lippincott Williams and Wilkins.
7.1g Workplace

For example:
location of where nursing care is provided
location of where client works
baby friendly
sick-building syndrome
second-hand smoke
risk for injury of the nurse

Chadwick, S. L., & Doyle, B. (2008). Chapter
11: Occupational Health. In L. Stamler & L.
Yiu. Community health nursing: A Canadian
perspective 2
nd
ed. (pp. 197-211). Toronto.

- 82 -


7.2 Implements and evaluates health
promotion activities to build a healthy
social and physical environment in the
following settings:

7.2a School and daycare

7.2b Community

7.2c Home

7.2d Built environment

7.2e Natural environment

7.2f Recreational and community facilities

7.2g Workplace

Using the following interventions:
Advocacy
Consultation
Collaboration
Capacity building
Coalition building
Healthy public policy
Health teaching
Health-promoting schools
Lobbying
Policy development
Reporting
Referral

Apply the interventions to each of the settings listed.

heel/index.htm


- 83 -

2. In the pictures below identify which are good
stairs and which are not. As a CHN what
can you do to improve these stairs?
(Pictures retrieved from CHNET-Works! on
August 22, 2006.)
1. In Stamler & Yiu (2008) Chapter 12:
Occupational Health. Read the Canadian
Research Box 12.1 on pg. 203. In addition
to the discussion questions what strategies
do you use to balance work and life? What
has been ineffective?


Competency #7 Review Questions (contd)

3. From Stanhope & Lancaster (2004). Chapter 10:
Environmental Health.

John Johnson is a school nurse at Jackson
Elementary School, which was built in 1960. Nurse
John has noticed that many students from Ms.
McGregor's second grade class have come to the
clinic complaining about coughing, sneezing, runny
nose, and watery eyes. Nurse John has also noticed
that Steven Tea, the only asthmatic student in Ms.
McGregor's class, has had more asthma attacks
this year than he did last year. Since the rest of the
school is not experiencing the same respiratory
problems, Nurse John is concerned that something
in Ms. McGregor's classroom is causing students to
feel ill.

Nurse John decides to visit Ms. McGregor's
classroom. Upon entering the classroom, one of the
few located in the school's basement, John is struck
by the powerful musty smell inhabiting the room.
While talking to Ms. McGregor, John learns that the
classroom has "smelled bad for years" and that
students from previous years have complained
about respiratory problems. Nurse John notices
that Ms. McGregor has stuffed a blanket at the base
of the classroom's small rectangular window near
the ceiling because the window does not close
completely.

John suspects that Ms. McGregor's
classroom walls are contaminated with mould.
Upon further research, Nurse John learns that if
water gets between the exterior and interior of a
building's wall, mould can grow in the moist
environment. This situation can occur due to
construction defects in the building (e.g., leaky
window). Nurse John also learns that people
exposed to extensive mould growth may experience
allergic reactions, such as hay fever-like allergy
symptoms, and people who already have a chronic
respiratory disease, such as asthma, may
experience difficulty breathing when exposed to
mould. Nurse John is concerned about the possible
mould contamination effect on his asthmatic
student, Steven.

a) Identify the agent, host, and environment in
this case study and describe how they
interacted to bring about the occurrence of
disease.

b) What can Nurse John do to learn more
about indoor air quality and about what to
do in case of mould?

c) What are some possible interventions that
Nurse John could do to address the mould
contamination in Ms. McGregor's room?
4. A CHN nurse practices in many different
environments, schools, homes, shelters, clinics
and many others. The CHN exam competencies
provide examples of many environmental health
concerns in each of these settings. The levels of
prevention used in public health can be applied
to these environmental health problems.
Choose an environmental health problem in
different settings and name various
interventions the CHN could use at all three
levels of prevention.

5. Case Study from Clark, M. J. (2000). Nursing in
the community: Dimensions of community health
nursing (3
rd
ed.) Philadelphia, PA: Prentice Hall
Case study on page 167

6. You are asked to visit a client with COPD, lives
on his own and must be taught how to use an
inhaler and manage his condition. On
admission he tells you he has been a smoker
for 45 years, has worked in a factory for 40
years, and has to work for 5 more years. What
information can you share with him to improve
his lung health and assist him to continue his
work?

7. You are supporting a client who is being
treated for cellulitis. The client happens to
mention to you that they are going to renovate
their century home. What advice and support
could you offer as a CHN? What resources
would you encourage them to access.

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- 84 -

Competency #7 - Case Study Answers (John
Johnson)

3. (a) The agent is the mould, the hosts are the
students in Ms. McGregor's classroom,
and the environment is the damp wall from
the leaky window. The leaky window allows
water to seep into the wall insulation,
creating a moist environment in which
mould likes to grow. The growth of the
mould aggravates the students with old
allergies and exacerbates pre-existing
respiratory diseases.

(b) Health Canadas website has a number of
useful links on air quality.
- Information on air quality from Health
Canada http://www.hc-sc.gc.ca/ewh-
semt/air/in/index_e.html#protecting.
Retrieved December 23, 2008.

- Tools for Schools Action Kit
http://www.hc-sc.gc.ca/ewh-
semt/air/in/school-ecole/index-
eng.php . Retrieved December 23,
2008.

- For Health Professionals and Industry.
Residential Indoor Air Quality
Guidelines. http://www.hc-
sc.gc.ca/ewh-semt/air/in/prof-
ind/index-eng.php. Retrieved December
23, 2008

(c) Nurse John can talk to the school's
principal about different methods to get rid
of the mould and fix the broken window.
Nurse John could also suggest that Ms.
McGregor's class be moved to a new mould-
free location in the interest of protecting the
students from further allergic reactions and
asthmatic episodes.

4. For example, in the home, primary prevention
for carbon monoxide poisoning includes
providing information about the health effects
of carbon monoxide poisoning and assisting the
client in modifying origins of the problem.
Secondary prevention would involve using a
carbon monoxide detector. Tertiary prevention
is aimed at minimising disability and
maximising functional capacity and may occur
through out the rehabilitation process with the
support of a home health agency.

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- 85 -

- 86 -

Competency #8: Building Community Capacity to Improve
Health


Yiu, L. (2008). Chapter 11: Community
Care. In Stamler & Yiu (Eds.). Community
Health Nursing: A Canadian Perspective.

For a more indepth understanding:
Vollman, A. R., Anderson, E. T., &
McFarlane, J. (2004). Canadian Community
as Partner. New York: Lippincott, Williams &
Wilkins.
Chapter 9: Community Assessment
Chapter 11: Planning a Community
Health Program
Chapter 12: Implementing a Community
Health Program
Chapter 13: Evaluating a Community
Health Program

Additional Readings

Diem & Moyer (2005). Community Health
Nursing Projects: Making a difference.
Lippincott, Williams & Wilkins: New York.
Chapter 4: Collaborative Assessment
Chapter 10: Community Capacity
Building
Chapter 11: Building Coalitions
Chapter 13: Community Health
Programs and Evaluation

Downs, M. H., Kaminsky, A, & Lewis, J.
(2006). Open the door whenever opportunity
knocks. Public Health Nursing, 23(5). p.
433-441.

Stewart, M.J. (2000). Community Nursing:
Promoting Canadians Health. W.B. Saunders:
Toronto.
Chapter 20: A pragmatic approach to
community health promotion
Chapter 21: Community development
Chapter 22: Community needs and
capacity assessment: Critical
component of program planning

- 99 -


8.1 Identifies community health issues and
needs with the community stakeholders

For example:
community needs assessment data
trends
opinions of community leaders
national issues
evidence
citizen-expressed needs
organization or other program expressed
needs
observations
Downs, M. H., Kaminsky, A, & Lewis, J. (2006).
Open the door whenever opportunity knocks.
Public Health Nursing, 23(5). p. 433-441.

Information and readings from competencies
3.1-3.4 are also relevant to this competency.

Reilly, S. M. (2000). Chapter 20: A pragmatic
approach to community health promotion. In
M. J. Stewart (Ed.), Community Nursing:
Promoting Canadians Health (pp. 386-402).
W.B. Saunders: Toronto

Vollman, A. R., Anderson, E. T., & McFarlane, J.
(2004). Chapter 9: Community Assessment. In
Canadian Community as Partner. New York:
Lippincott, Williams & Wilkins.

8.2 Assesses the readiness of the community
for action and change

For example:
perception of needs
key formal and informal leaders
potential financial and human
resources
decision-makers
ability to mobilize
anticipated opposition
urgency
general level of community awareness
previous history and response to
change

3.1-3.4 are also relevant to this competency

Vollman, A. R., Anderson, E. T., & McFarlane,
J. (2004). Chapter 9: Community Assessment.
In Canadian Community as Partner. New York:

Edwards, N. C. & Moyer, A. (2000). Chapter 22:
Community needs and capacity assessment:
Critical component of program planning. In M.
J. Stewart (Ed.). Community Nursing: Promoting
Canadians Health (pp. 420-442). W.B.
Saunders: Toronto.

English, J. C. B. (2000). Chapter 21:
Community Development. In M. J. Stewart
(Ed.). Community Nursing: Promoting
Saunders: Toronto.

8.3 Assesses the barriers that impede action
and change

For example:
coping skills
level of understanding
participation level
perceived negative impact
lack of financial resources
mismatch with the cultural values
leaders not trusted or liked

3.1-3.4 are also relevant to this competency

J. (2004). Chapter 11: Planning a Community
Health Program pp. 263-267. In Canadian
Community as Partner. New York: Lippincott,
Williams & Wilkins.

Diem & Moyer (2005). Chapter 4: Collaborative
Assessment. Community Health Nursing
Projects: Making a difference. Lippincott,
Williams & Wilkins: New York.

- 100 -
- 101 -

8.4 Develops a plan of action with the communi
stakeholders

For example:
goals
purpose
activities
costs
resources
strategy
how, who, when, why, where
communication strategy

Diem & Moyer (2005). Chapter 10: Community
Capacity Building. Community Health Nursing
Projects: Making a difference. Lippincott,
Williams & Wilkins: New York.

J. (2004). Chapter 11: Planning a Community
Health Program. In Canadian Community as
Partner. New York: Lippincott, Williams &
Wilkins.

8.5 Implements and evaluates with
community stakeholders the community
plan to address an agreed upon health
issue

For example:
community organization
policy development
coalition building
advocacy
collaboration and partnership
communication campaigns
social marketing

Diem & Moyer (2005). Chapter 13: Community
Health Programs and Evaluation. In
Community Health Nursing Projects: Making a
difference. Lippincott, Williams & Wilkins: New
York.

J. (2004). Chapter 12: Implementing a
Community Health Program. In Canadian
Williams & Wilkins.

J. (2004). Chapter 13: Evaluating a
Community Health Program. In Canadian
Williams & Wilkins.



1. Simpson, M. A. & Yiu, L. (2008). Chapter
21: Aboriginal Clients. In Stamler & Yiu
(Eds.), Community Health Nursing: A
Canadian Perspective. Prentice Hall:
Toronto.
Chapter 21: Case Study (pg. 327)
Discussion Questions 1-4.

2. Edwards, N. C., Etowa, J., and Kennedy, M.
A. (2008). Chapter 13: Aboriginal Clients.
In Stamler & Yiu (Eds.), Community Health
Nursing: A Canadian Perspective. Prentice
Hall: Toronto.
Exercises 1-4 (p. 223)
Group Critical Thinking Exercises
#3 (p. 223)

3. Yiu, L. (2008). Chapter 11: Community
Care. In Stamler & Yiu (Eds.). Community
Health Nursing: A Canadian Perspective.
Case Study: What Does Health Mean
to People in a Slum Area? Questions
1-3 (p. 185)
Exercises 1-5 (p. 193)

4. Diem, E. (2005). Chapter 10: Community
Capacity Building. In E. Diem & A. Moyer
(Eds.), Community Health Nursing Projects:
Making a Difference (pp.264-296). New York:
Practice and Application #3 (p. 293)

5. Moyer, A. (2005). Chapter 11: Building
Coalitions. In E. Diem & A. Moyer (Eds.),
Community Health Nursing Projects: Making a
Difference (pp.297-323). New York:
Practice and Application #1 (p. 319)

6. Moyer, A. (2005). Chapter 13: Community
Health Programs and Evaluation In E. Diem
& A. Moyer (Eds.), Community Health
Nursing Projects: Making a Difference
(pp.347-370). New York: Lippincott, Williams
& Wilkins.
Discussion Question #2 (p. 366)

7. Who are the experts in assessing and
determining what the community health
needs are?

8. As a HHN, how does a community needs
assessment relate to your practice? Give
examples of a time when you applied this
competency.

9. For the past 4 years your agency has been
offering diabetic teaching in nursing clinics.
You are asked to prepare a report on the
benefit of this service. How do you proceed?

- 102 -

Competency #9: Demonstrating Professional Responsibility
and Accountability


Beuthin, R. (November 2006). To shower or
not to shower. A community health nurse
asks, what are our limits of
accommodation? Canadian Nurse, 102(9)
p[. 34-35)

Canadian Nurses Association:
Code of Ethics for Registered Nurses
(June 2008) http://www.cna-
aiic.ca/CNA/practice/ethics/code/defa
ult_e.aspx
Public Health Nursing and Ethical
Challenges (February 2006)
http://www.cna-
aiic.ca/CNA/practice/ethics/inpractice/
default_e.aspx

Community Health Nurses Association of
Canada (2003). Canadian Community
Health Nursing (CCHN) Standards of
Practice. Retrieved August 11, 2006 from:
http://www.chnac.ca/index.php?option=co
m_content&task=view&id=19&Itemid=35

Ekman Ladd, R., Pasquerella, L., & Smith,
S. (2000). What to do when the end is near:
ethical issues in home health care nursing.
Public Health Nursing, 17(2), p.103-110).

Pauly, B., Goldstone, I., McCall, J., Gold, F.,
& Payne, S. (October 2007). The ethical,
legal and social context of harm reduction.
The Canadian Nurse, 103 (8), p. 19-23.

Peter, E., Sweatman, L, and Carlin, K.
(2008). Adocacy, Ethical, and Legal
Considerations. In Stamler, L. & Yiu, L.
Canadian Perspective (2
nd
edition, pp. 65-

Study Tip

In Ontario, there is no Public Health Act the Health Protection and Promotion Act
is the Ontario legislation.
Examples of duty to report are child protection laws and reportable infectious
diseases.

Additional Readings

College of Nurses of Ontario. Practice
Standards: www.cno.org
Therapeutic Nurse-Client Relationships
Refusing Assignments and
Discontinuing Nursing Services
Ethics
Nurse Abuse

Kass, N. E. (2001). An ethics framework for
public health. American Journal of Public
Health, 91(11) p. 1776-1782.

Best Practice Guidelines.
Establishing Therapeutic Relationships
Best Practice Guideline.

Rodger, G. L. & Gallagher, S. M. (2000).
The move toward Primary Health Care in
Canada: Community health nursing from
1985 to 2000. In Stewart, M. J. (Eds.),
Health (pp. 44-46). Harcourt Canada:
Toronto.

Upshur, R. E. G. (2002). Principles for the
Justification of Public Health Intervention.
Canadian Journal of Public Health, 93(2) p.
101-103.

Chadwick, S. L., & Doyle, B. (2008).
Chapter 11: Occupational Health. In L.
Stamler & L. Yiu. Community health
nd
ed. (pp.
197-211). Toronto.

.

- 106 -

9.1 Identifies potential and real role conflicts
when working in a community setting

For example:
boundary issues
resource allocation
guest in the home/community
voluntary relationship
legislated mandate
differing values between client and
community health nurse
unclear role with other health-care
providers
role overlap
College of Nurses of Ontario. Therapeutic Nurse-
Client Relationship (2006). Retrieved August
2006 from
http://www.cno.org/pubs/compendium.html

College of Nurses of Ontario (2005). Refusing
Assignments and Discontinuing Nursing
Services. Retrieved August 2006 from
page 7 outlines a 4-step approach to
addressing issues, values and conflicts.

Community Health Nurses Association of
Canada (2003). Canadian Community Health
Nursing (CCHN) Standards of Practice.
Retrieved August 11, 2006 from:
http://www.chnac.ca/index.php?option=com_c
ontent&task=view&id=19&Itemid=35
Refer to standard 5 on pg.14

Peter, E., Sweatman, L, and Carlin, K. (2008).
Adocacy, Ethical, and Legal Considerations. In
Stamler, L. & Yiu, L. (Eds.), Community Health
nd
edition, pp.
65-79). W. B. Saunders: Toronto.

(2005). Establishing Therapeutic Relationships
Best Practice Guideline. Retrieved August 2006
from www.rnao.org.
e-learning resources also available under
implementation tools

9.2 Acts in accordance with the Code of
Ethics of CNA

For example:
abandonment
service discontinuation
transfer to other service providers
consent

See suggested readings for 9.3
- 107 -


to prevent or intervene when role conflict
occurs

For example:
defining role and responsibilities
communicating
maintaining confidentiality
respecting clients right to refuse service
enforcing legislation as required such as
child protection
Public Health Act
power of attorney
obtaining informed consent clarifying
role with other health-care providers
respecting cultural differences
sharing vision of healthy community and
health

Canadian Nurses Association (June 2008).
Code of Ethics for Registered Nurses. Retrieved
December 23, 2008 from: http://www.cna-
nurses.ca/cna/documents/pdf/publications/
CodeofEthics2002_e.pdf

Canadian Nurses Association (February 2006).
Public Health Nursing and Ethical Challenges.
Retrieved December 23, 2008 from:
http://www.cna-
nurses.ca/cna/documents/pdf/publications/
Ethics_in_Practice_Jan_06_e.pdf

College of Nurses of Ontario (2005). Ethics.
Retrieved December 23, 2008 from
Covers differing values, privacy and
confidentiality. Includes case studies of
ethical situations. Page 16 how to work
through ethical situations in practice.

College of Nurses of Ontario (2005). Refusing
Assignments and Discontinuing Nursing
Services (2005). Retrieved August 2006 from:

9.4 Balances the rights of
individuals and the rights of
communities

For example:
immunization programs,
fluoridated water supply,
communicable disease control,
needle exchange programs,
tobacco legislation
http://www.cna-
nurses.ca/cna/documents/pdf/publications/E
thics_in_Practice_Jan_06_e.pdf

Kass, N. E. (2001). An ethics framework for
public health. American Journal of Public
Health, 91(11) p. 1776-1782.

nd
edition,
pp. 65-79). W. B. Saunders: Toronto.
Describes each Community Health Nursing
Standard of Practice; outlines good
examples of public health ethical dilemmas;
discusses individual rights vs. rights of
communities.

Rodger, G. L. & Gallagher, S. M. (2000). The
move toward Primary Health Care in Canada:
Community health nursing from 1985 to 2000.
In Stewart, M. J. (Eds.), Community Nursing:
Harcourt Canada: Toronto

- 107 -

9.5 Recognizes risk-to-self situations

For example:
client drug use during a home visit
inclement weather
exposure to harmful substances
unsafe neighbourhood
unsafe home
abusive and violent situations
pets
driving

December 23, 2008 from: http://www.cna-
nurses.ca/cna/documents/pdf/publications/C
odeofEthics2002_e.pdf
page 8 Quality practice environments,
page 9 awareness of values, page 18, #7
nurses are justified in using reasonable
means to protect against violence

College of Nurses of Ontario. Nurse Abuse
(2005). Retrieved December 23, 2008 from:

9.6 Identifies actual and potential situations
that put others at risk

For example:
sexual abuse
physical abuse
verbal abuse
financial abuse
emotional abuse

9.7 Implement and evaluates nursing inter-
ventions to deal with actual and potential
situations that put others at risk

For example:
reporting to appropriate authority

http://www.cna-
nurses.ca/cna/documents/pdf/publications/E
thics_in_Practice_Jan_06_e.pdf

nd
edition,
pp. 65-79). W. B. Saunders: Toronto.

9.8 Implements and evaluates
action to prevent or
intervene during risk-to-self
situations

For example:
delaying service if in risky situation
obtaining colleague assistance
routine practices and additional
precautions

College of Nurses of Ontario (2005). Nurse
Abuse. Retrieved December 23, 2008 from

Beuthin, R. (November 2006). To shower or not
to shower. A community health nurse asks,
what are our limits of accommodation?
Canadian Nurse, 102(9) p[. 34-35)

- 108 -
- 109 -


9.9 Uses formal and informal networks to
facilitate access to health resources

For example:
lobbying
testifying
issuing press releases
disseminating information
working with legislators
interviewing
assertiveness
negotiation
self-management
legal knowledge
conflict management

Rodger, G. L. & Gallagher, S. M. (2000). The
move toward Primary Health Care in Canada:
Community health nursing from 1985 to 2000.
In Stewart, M. J. (Eds.), Community Nursing:
Harcourt Canada: Toronto.
Movements of community health nursing
associations on pages 44-46

9.10 Interprets legislation, regulations and
standards to promote health and
prevent adverse health events

For example:
informed consent
vulnerable persons act
child protection
Public Health Act
organizational policies
human rights
labour laws
power of attorney

Pauly, B., Goldstone, I., McCall, J., Gold, F., &
Payne, S. (October 2007). The ethical, legal and
social context of harm reduction. The Canadian
Nurse, 103 (8), p. 19-23.

Chadwick, S. L., & Doyle, B. (2008). Chapter
11: Occupational Health. In L. Stamler & L.
Yiu. Community health nursing: A Canadian
perspective 2
nd
ed. (pp. 197-211). Toronto.
page 200 Legislation and Standards,
Human Rights Legislation, Informed
Consent info.- Substitute Decision act

College of Nurses of Ontario. Confidentiality
and Privacy Personal Health Information
(2005). Retrieved August 2006 from

9.11 Ensures a client-centered care approach
by integrating the consent to treatment
process in all nursing care activities
August 11, 2006 from http://www.cna-
nurses.ca/cna/documents/pdf/publications/C
odeofEthics2002_e.pdf
p. 14 Confidentiality

College of Nurses of Ontario. Confidentiality
and Privacy Personal Health Information
(2005). Retrieved August 2006 from

Ekman Ladd, R., Pasquerella, L., & Smith, S.
(2000). What to do when the end is near:
ethical issues in home health care nursing.
Public Health Nursing, 17(2), p.103-110).


1. Peter, E., Sweatman, L, and Carlin, K.
(2008). Adocacy, Ethical, and Legal
Considerations. In Stamler, L. & Yiu, L.
Canadian Perspective (2
nd
edition, pp. 65-
Canadian Research Box 4.1
Canadian Research Box 4.2
Case Study pg. 76
Study questions 3,4 5
Individual Critical Thinking Exercises 1,
3, 5
Group Critical Thinking Exercises 1, 2,
3

2. Consider reviewing one or two of the case
studies in the CNA or CNO documents.

3. A HHN accepts a palliative shift. Upon
arriving at the clients home, the nurse is
met by the clients family who express some
concerns. The client has a DNR order in
place; he wishes to maintain it, yet the
family wants to revoke it since the client
seems to be doing fine now. What should
the HHN do? What should be documented?
Discuss the role of all involved in this
situation.

Discussion:
5. Options:
Speak with the client who wishes to
have the order remain
Facilitate conversation between the
client & the family to resolve the issue
Document the outcome of discussion &
have wishes written down (Living Will)
Review the College of Nurses
Standards/CNA recommendations
relating to situations regarding ethical
issues
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- 107 -
Appendix A: Internet Resources

Canadian Nurses Association
www.cna-nurses.ca

Code of Ethics for Registered Nurses (2002)
http://www.cna-
nurses.ca/cna/documents/pdf/publications/Codeo
fEthics2002_e.pdf

Public Health Nursing and Ethical Challenges
(2006)
http://www.can-
nurses.ca/can/documents/pdf/publications/Ethic
s_in_Practice_Jan_06_e.pdf

Public health nurses may face unique challenges in
their distinct focus on the health of the population
in addition to individuals. This practice review
includes a couple of case studies that highlight
some of the unique ethical dilemmas in public
health nursing practice.

(RNAO): Best Practice Guidelines (BPGs)
http://www.rnao.org

There are currently 29 BPGs published. Full texts
for all these BPGs are available free online. Some of
the BPGs used in preparation for the exam include:

Woman Abuse: Screening, Identification, and
Initial Response
Enhancing Healthy Adolescent Development
Breastfeeding Best Practice Guidelines for
Nurses (a breastfeeding self-learning package is
available at:
http://www.rnao.org/Page.asp?PageID=122&C
ontentID=1273
Assessment and Device Selection for Vascular
Access
Care and Maintenance to Reduce Vascular
Access Complications
Assessment and Management of Pain
Client-Centred Care
Establishing Therapeutic Relationships (e-
learning module and video available at:
http://www.rnao.org/Page.asp?PageID=122&C
ontentID=1336

Minnesota Department of Health: Section of
Public Health Nursing
http://www.health.state.mn.us/divs/cfh/ophp/con
sultation/phn/21
st
-century_grant.html

While this is an American site, the Public Health
Nursing Intervention Wheel and supporting
documentation is used for the preparation of many
competencies. The information is relevant and
applicable to Canada.

Two resources from this website are very useful.
Public Health Nursing Practice Manual
(2001). This manual includes what is often
referred to as the Minnesota Wheel. This
wheel is a diagram of 17 public health nursing
interventions. Definitions for each intervention
at all levels of public health practice,
individuals/families, communities, and
systems, are included. Best practices and
research notes are also listed. These
interventions are repeated throughout the
certification competencies. A good
understanding of these is important.

Public Health Nursing Section: Minnesota
Department of Health (2000). Public Health
Nursing Practice for the 21
st
Century:
Competency Development in Population-
based Practice. St. Paul, MN.
This learning guide describes the scope of
population-based public health nursing
process, identifies principles underlying the
practice of public health nursing, and describes
the public health nursing interventions.
Multiple choice review questions are also
included.

Public Health Agency of Canada
www.phac-aspc.gc.ca

Sexual Health
Self-Learning Module on Sexually Transmitted
Diseases (STD). http://www.phac-
aspc.gc.ca/slm-maa/index.html
Includes:
Two case studies with pre- and post- test
multiple choice questions
Clinical slide gallery

Sexually Transmitted Infections (STI), Sexual
Health Facts and Information for the public
(2007). http://www.phac-aspc.gc.ca/std-
mts/faq_e.html

- 108 -
Canadian Guidelines on Sexually Transmitted
Infections 2006 Edition. http://www.phac-
aspc.gc.ca/std-
mts/sti_2006/sti_intro2006_e.html
This document provides
recommendations for the prevention,
diagnosis, treatment and management of
STIs in Canada.

Immunization
Canadian Immunization Guide, Seventh Edition
2006. http://www.phac-
aspc.gc.ca/publicat/cig-gci/index.html.
This site also has the Recommended
Immunization Schedule. http://www.phac-
aspc.gc.ca/publicat/cig-gci/p03-01-eng.php

Emergency Preparedness
http://www.phac-aspc.gc.ca/ep-mu/index.html

Determinants of Health
http://www.phac-aspc.gc.ca/ph-
sp/phdd/determinants/

College of Nurses of Ontario
www.cno.org

This is Ontario content, however, the practice
standards are often consistent across the country.
Content for these guidelines and standards are
often from other Canadian sources, e.g. Registered
Nurses Association of British Columbia.

References to provincial legislation should be
avoided for the purpose of this exam. For example,
the Personal Health and Information Privacy Act,
2004 controls health care information in Ontario.
Standards such as Documentation and
Confidentiality and Privacy-Personal Health
Information are influenced by this legislation.

Practice Standards
Some standards reviewed include:
Confidentiality and Privacy Personal
Health Information
Decisions About Procedures and
Authority
Infection Prevention and Control
Medication
Professional Standards, Revised 2002
Therapeutic Nurse-Client Relationship

Practice Guidelines
Some guidelines reviewed include:
Consent
Culturally Sensitive Care
Disagreeing with the Multidisciplinary
Plan of Care
Influenza Vaccinations
Medical Directives, Revised 2000
Refusing Assignments and Discontinuing
Nursing Service

Health Canada
www.hc-sc.gc.ca

Eating Well with Canadas Food Guide
Information on nutrition for adults, children, and
pre-schoolers on Health Canadas website:
http://www.hc-sc.gc.ca/fn-an/food-guide-
aliment/index_e.html

- 109 -
- 110 -
Appendix B: Minnesota Wheel of Public Health Nursing
Interventions

Public Health Interventions
Applications for Public Health Nursing Practice

Retrieved January 28, 2008 from
http://www.health.state.mn.us/divs/cfh/ophp/resources/docs/wheel.pdf

Appendix C: Immunization Quiz
Developed by Wendy Holmes and Yvonne Wigboldus from the 2006 MLHU Certification Study Group.

1. The term cold chain refers to a system:
a) of distribution for vaccines
b) which ensures that vaccines arrive at their
final destination with their
immunogenic properties intact
c) of storage for vaccines
d) which maintains the temperature of the
vaccine between 2 degrees Celsius and
degrees Celsius
e) all of the above

2. What steps should be followed to ensure the
cold chain has been maintained?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

3. Mona, a 16 year old female. Has just received a
Td booster. She states that she is feeling faint
and is having some difficulty breathing.
a) She is definitely experiencing an
anaphylactic reaction.
T___ or F ___
b) You should have her lie down and measure
her BP, pulse & respirations.
T ___ or F___
c) Adrenaline is required immediately.
T___ or F ___ .
d) If adrenaline is administered, it should only
be given s/c.
T___ or F ____
e) In the event of an anaphylactic reaction, you
should never administer CPR.
T___ or F ___

4. A preschool child has arrived at the
Immunization Clinic, having previously
received in infancy, a complete primary series
of DaTP-Polio/Hib. You are informed that the
child is allergic to dust, cats and several foods.
The parents have heard things about autism
and the MMR needle and are reluctant to get
the necessary immunization. What action
would the nurse take regarding the MMR that
is now overdue?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

5. What should be recommended to a 26 yr old
woman who is not immune to rubella?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

6. Who is your target population for the Influenza
Vaccination?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

7. List the 2 major contraindications to influenza
vaccination?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

8. What information should you include when
completing any immunization, and where
would you record it?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

9. Hepatitis B can cause:
a) No symptoms
b) Death
c) Chronic carrier state
d) Cirrhosis
e) All of the above

- 111 -

10. Hepatitis B can be transmitted by exposure to
HBV: (select all that apply)
a) through unprotected sexual contact
b) during the perinatal period
c) via shared needles and other injection drug
paraphernalia
d) via insect bites
e) all of the above

11. The following deals with children with
neurological disorders
a) Children with neurological disorders should
not undergo routine vaccination
T___ or F ___
b) Children with pre-existing seizure disorders
exacerbated by fever may be treated with
prophylactic acetaminophen (15mg/kg) prior
to vaccination
T ___ or F___

12. Cindy, a new mother is breastfeeding her infant
and is due to have a rubella vaccination. She
indicates that she understands the importance
of the vaccine but would like to defer as she id
concerned that it will harm her baby. What
action would be appropriate given Cindys
concerns?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

- 112 -
Answers to Immunization Quiz
Note: Answers are taken from the following source:
Health Canada (2002). Canadian Immunization Guide (6
th
ed.). Ottawa: Health Canada.
The Canadian Immunization Guide Seventh Edition (2006) is available at http://www.phac-
aspc.gc.ca/publicat/cig-gci/index.html

Correct answers are underlined.

1. The term cold chain refers to a system:
a) of distribution for vaccines
b) which ensures that vaccines arrive at
their final destination with their
immunogenic properties intact
c) of storage for vaccines
d) which maintains the temperature of the
vaccine between 2 degrees Celsius and 8
degrees Celsius
e) all of the above

Found in Canadian Immunization Guide (CIG)
(2002) p. 33-37

2. What steps should be maintained to ensure
the cold chain has been maintained?

Manufacturer administration

3. Mona, a 16 year old female. Has just
received a Td booster. She states that she
is feeling faint and is having some difficulty
breathing.
a) She is definitely experiencing an
anaphylactic reaction.
T___ or F X
b) You should have her lie down and
measure her BP, pulse & respirations.
T X or F___
c) Adrenaline is required immediately
T___ or F X .
d) If adrenaline is administered, it should
only be given s/c.
T___ or F X .
e) In the event of an anaphylactic reaction,
you should never administer CPR.
T___ or F X .

S/c or IM 0.01mg/kg (0.5 max) of epi 1:1000 in
opposite limb. S/c for mild treatment and IM
severe Rx. Found in CIG (2002) pg. 16-18.

4. A preschool child has arrived at the
Immunization Clinic, having previously
received in infancy, a complete primary
series of DaTP-Polio/Hib. You are informed
that the child is allergic to dust, cats and
several foods. The parents have heard

things about autism and the MMR needle
and are reluctant to get the necessary
immunization. What action would the nurse
take regarding the MMR that is now overdue?
Ask parents re: previous
immunization history
Give information regarding risk of
disease and risks and benefits of
immunization
Administer vaccine with informed
consent
Review need to return in 4-8 weeks
for 2
nd
MMR
Wait 15 min. to observe for possible
adverse effects. Note: rash possible in
1-2 weeks (pg. 143 re: measles)

Found in CIG (2002), p.7. Explain risk vs benefit

5. What should be recommended to a 26 yr.
Old woman who is not immune to rubella?

determine pregnancy status
avoid pregnancy for 1 month post
immunization
given one dose preferably as MMR

Found in CIG (pg. 204)

6. Who is your target population for the
Influenza Vaccination?
People with increased risk related to
complications (immunosuppressed,
LTC facilities, >65, 6-18yrs on ASA
therapy,)
People capable transmitting to at risk
populations (health care workers,
emergency services, household
contacts of those at high risk)
> 65
people who provide essential
community services

Found in CIG pg. 122-123

7. List the 2 Major contraindications to
Influenza Vaccination?
- 113 -
Anaphylactic reaction to previous
influenza vaccination
Anaphylactic reaction to component of
vaccine (thirmersol, neomycin, eggs)

Not recommended for those <6mos.

8. What information should you include when
completing any immunization and where
would you record it?
record info in a permanent record as
well as a client copy of the record
immunization records should not be
archived
Include the following information:
trade name of product
disease(s) against which it protects
date given
site and route of administration
manufacturer
lot number (expiry)
relevant serologic data (e.g. rubella
serologic results)
adverse vaccine events

Found in CIG pg. 40-41

9. Hepatitis B can cause:
a) No symptoms
b) Death
c) Chronic carrier state
d) Cirrhosis
e) All of the above

Found CIG pg. 102

10. Hepatitis B can be transmitted by exposure
to HBV: (select all that apply)
a) through unprotected sexual contact
b) during the perinatal period
c) via shared needles and other injection
drug paraphernalia
d) via insect bites
e) all of the above

11. The following deals with children with
neurological disorders
a) Children with neurological disorders
should not undergo routine vaccination
T___ or F X
b) Children with pre-existing seizure
disorders exacerbated by fever may be
treated with prophylactic acetaminophen
(15mg/kg) prior to vaccination
T X or F___

12. Cindy, a new mother is breastfeeding her
infant and is due to have a rubella
vaccination. She indicates that she
understands the importance of the vaccine
but would like to defer as she id concerned
that it will harm her baby. What action
would be appropriate given Cindys
concerns?
safe
vaccine virus has been detected in
breastmilk and transmission can
occur, no illness has reported in the
infants
risk of disease vs. risk of vaccine
defer if necessary

Found in CIG pg.204

- 114 -
- 115 -
Appendix D: Public Health in the Management of Disasters
& EmergenciesWe are Community Partners in Response

Middlesex-London Health Units professionals
take responsibility of community health both in
disaster and emergency preparedness and
response by:

1. Identifying groups most at risk from
disaster (i.e.: the vulnerable and ill)
2. Using traditional planning principles and
serving as an integral part of the
preparation and the delivery of public
health services during the impact and post
impact phases of the emergency
3. Providing disaster education in advance of
(what to expect in a disaster) and after (how
to deal with the effects) of the event
4. Taking responsibility for the health of a
community following a disaster
5. Using such resources as assessment,
epidemiology and data analysis to make and
implement recommendations for limiting
morbidity and mortality
6. Cooperating, collaborating and participating
with the broadest range of community
agencies to ensure that primary health,
public health, mental health and social
impacts are adequately addressed in
disaster planning
7. Preventing disease by providing health
authorities information on injury
prevention, food and water safety and vector
control
8. Assuring that health services continue post
impact, including acute care, continuity of
care, primary care and emergency care
9. Inspecting evacuation/reception centers
and feeding operations
10. Communicating with government officials
about the public health effects of potential
disasters and providing expert assistance
during and after emergencies
11. Developing and advocate public policies
designed to reduce the public health impact
of potential disasters
12. Collaborating with other health and human
service professionals to rigorously evaluate
intervention outcomes
13. Participating as full partners with
emergency management professionals in
preparedness, response and recovery
14. Staffing public health clinics involved in an
emergency
15. Assuring the ability to respond when
needed
16. Conducting health surveillance, detecting,
identifying and verifying individual cases
through laboratory sciences and to institute
measures to control infectious disease
17. Providing expert assistance to responding to
chemical, biological, radiological or nuclear
hazards
18. Providing public health information
19. Coordinating with other sectors on long-
term consequence management

When disaster strikes, our part includes:
emergency health communications
disease outbreak management
immunization
monitoring of water quality
food safety
home safety
pandemic planning
hazardous materials
air quality
family preparedness
extreme weather response

For more information contact:
Patricia Simone, Manager, MLHU Emergency
Planning
519-663-5317, extension 2371

MLHU - Community Health Certification Guidebook FOR STUDY GROUP USE ONLY

Appendix F: Review Questions

You can found practice review questions on
Community Health Nursing online at:

Minnesota Department of Health:
Section of Public Health Nursing. Wheel
of Public Health Interventions: A
Collection of Getting Behind the Wheel
Stories 2000-2006 (June 2006) retrieved
from
http://www.health.state.mn.us/divs/cf
h/ophp/resources/db.html on October
15, 2009.

Minnesota Department of Health:
Section of Public Health Nursing. Public
Health Nursing Practice for the 21
st

Century: Learning Guide (2000) retrieved
from:http://www.health.state.mn.us/di
vs/cfh/ophp/resources/docs/21stcentu
ry-satellite-learning-guide.pdf on August
10, 2006.

th

ed.). St. Louis, MO: Mosby Retrieved
from
http://coursewareobjects.elsevier.com/o
bjects/elr/Stanhope/community6e/stqu
estions on December 23, 2008.

th

ed.). St. Louis, MO: Mosby Retrieved
from
http://evolve.elsevier.com/staticPages/i
ndex.html October 18 2009.

- 116 -

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