COMMUNITY

HEALTH NURSING
NFDN 2006 – Unit 1
Foundations of Community Health
INTRODUCTION
 Pamela Maxey-Schafer BScN, RN
 Instructor since about 2003
 Experience in:
 Emergency Room (US)
 Surgical Unit (US & Canada)
 Office Nurse & Laser Snoring Surgery Assistant
 Immunization (Clinics – Capital Health & Private)
 Assisted Living Nurse (700 clients)
 Teaching – Clinical’s NPRT 1001, 2101-2102, HEAS
Labs, PATH, PHAR, NFDN 1002, 2003, 2005, 2006,
2007, 2008, Academic Advisor & Coordinator of
PNP
CONTACT INFO
 Phone: (780) 644-6388
 Office: B 226
 Pamela.Maxey-Schafer@norquest.ca
 My office hours are-email for specific
appointment
 Best way to reach me is by email
COMMUNITY AS A CONCEPT
 A “community” is generally defined as a
specific population of people, or a place
where people live and work
 We are shifting our focus from individual to
families & communities
 We will look at the definition of community
health nursing, as well as ways in which
community health nurses work with
individuals, families, and the community as a
whole
CANADA HEALTH ACT
5 Principles
 Universality
 Accessibility
 Comprehensiveness of services
 Portability
 Public Administration
HISTORY-IN CANADA
 1930’s
2 significant realizations:
 Canadian’s wanted the government to take
responsibility for health care
 Poverty was a result of sociopolitical factors; not
individual weaknesses
 1970’s-Lalonde Report
o Initiated health promotion movement in Canada
o These were development of first Health determinants
 1978-Alma Ata Declaration
 Primary health care was defined
 1986-Epp Report
HISTORY-IN CANADA
1980-1990s
 Shift in public health strategy from illness prevention
to health promotion
 Escalating health care costs = reduced funding for
health promotion & disease prevention programs
 Home health care became popular

2001
 Researchers demonstrated that home care for older
adults cost less than institutional care
2002
 Romanow Report identified home care as the most
rapidly growing area of community health
 Part of this is due to early discharge
HISTORY OF COMMUNITY
NURSING TERM
 Before 1980, “Public Health nurse” &
“Community Health nurse” were
interchangeable
 Terms started to change in the late 1980s,
early 1990s
 “Community Health nursing” now uses the
broader term that encompasses other
subspecialties such as public health, home
care, occupational health
COMMUNITY HEALTH NURSING
DEFINED
 Is an umbrella term
 promotes & protects the health of
individuals, families, groups, communities &
populations
Community is defined as:
 People & the relationships that emerge
among them as they develop & commonly
share agencies, institutions & a physical
environment
COMMUNITY HEALTH NURSING
An umbrella term which includes
 Community
 Public health
 Home health
 Occupational health
 Parish
 Outpost
 Forensic
COMMUNITY HEALTH NURSE
Functions
 involves coordinating care & planning
services, programs & policies by
collaborating with individuals, caregivers,
families, other disciplines, communities &
governments
 combines knowledge of nursing theory, social
sciences & public health science
COMMUNITY HEALTH NURSE
Works
 “IN” the community
 Providinghealth care to individuals & families
 Focus on health promotion & disease prevention
 Community as a resource
 “WITH” community as a client
 Community itself is the client
 Focus is on health of the community
 Community development
DEFINITIONS
Population
 a collection of people who share one or more
personal or environmental characteristics

Aggregates
 subpopulation
 groups within a population
POPULATION HEALTH
 determining the health of a population using
as measurements of health the determinants
& health status indicators
Health status indicators
 well being, life expectancy, incidence &
prevalence rate, mortality rate, burden of
illness
COMMUNITY HEALTH NURSING
PRACTICE CONSIDERATIONS
 Community health nursing practice: one area
of focus is disease prevention
 Disease prevention is divided into three levels:
 Primary prevention (seeks to prevent disease from
the beginning)
 Secondary prevention (seeks to detect disease early
in its progression in order to make early diagnosis and
begin treatment)
 Tertiary prevention (begins once a disease has
become obvious; aims to interrupt the course of the
disease)
DOWNSTREAM VS UPSTREAM
THINKING
Upstream thinking:
Downstream thinking:
•A macroscopic, “big
 Taking a microscopic picture,” population
individual curative focus health approach
 Considers individual •Primary prevention
health concerns and perspective
treatments but does not •Considers determinants
consider the of health and other
sociopolitical, economic, political, and
economic, and environmental factors
environmental variables •Asks-How could this be
prevented??
COLLABORATING IN
INTERDISCIPLINARY TEAMS
Collaboration
 The commitment of 2 or more parties who set
goals to address identified client health
concerns
 There are six basic principles for collaboration
(CNA)
 Client focus
 Population health approach
 Quality care and services
 Access
 Trust/respect
 Communication
HEALTH CANADA
Safeguards the population health by
surveillance, prevention, legislation, research
As stated in Stanhope (text) Health Canada is
an Umbrella agency for
 Public Health Agency of Canada (PHAC)
 Canadian Institutes of Health Research (CIHR)
 Health Products & Food Branch (HFPB)
 First Nations & Inuit Health Branch (FNIHB)
 Healthy Environment & Consumer Safety
Branch(HECSB)
CANADIAN COMMUNITY HEALTH
NURSING STANDARDS OF PRACTICE
 Promoting health (disease prevention, health
protection, health maintenance, restoration,
palliation)
 Building individual/community capacity
 Building relationships
 Facilitating access & equity
 Demonstrating professional responsibility &
accountability
DETERMINANTS OF HEALTH
 Health Determinants are particularly
important when looking at community health
 As we talk about determinants of health,
think about the ways in which community
health nurses need to think about them when
working in and with communities
DETERMINANTS OF HEALTH
LaLonde 1974
 Human biology, lifestyle, environment,
health care organization
Epp 1986
 Challenges to Achieving Health: reducing
inequalities, increasing prevention,
enhancing coping skills
Ottawa Charter 1986
 Pre-requisites for health: peace, shelter,
education, food, income, stable ecosystem,
sustainable resources, social justice & equity
DETERMINANTS OF HEALTH
 Income & social status
 Social support network
 Education & literacy
 Employment & working conditions
 Social environments
 Physical environments
DETERMINANTS OF HEALTH
 Personal health practices & coping skills
 Healthy childhood development
 Biology & genetic endowment
 Health services
 Culture
 Gender
SOCIAL DETERMINANTS OF
HEALTH
 Definition:
 The economic and social conditions that shape
the health of individuals, communities, and
jurisdictions as a whole

 Recent literature points to the importance of

social determinants of health for client
health.
PRIMARY HEALTH CARE
Alma Ata WHO 1978
 Accessibility
 Health Promotion & Disease Prevention
 Public Participation
 Intersectoral Collaboration
 Technology-appropriate use of health care
resources
PRINCIPLES OF PRIMARY HEALTH CARE

1. Equitable distribution of essential

health services to all populations
2. Increased emphasis on services that are
preventive and promotive rather than
curative only
3. Maximum individual and community
involvement in the planning and
operation of healthcare services
4. The integration of health development
with social and economic development
5. The use of appropriate technology
 PRIMARY CARE VS. PRIMARY HEALTH
CARE
Primary Care
 first contact healthcare
system (health care providers)
 Usually curative focus: treating
disease, rehabilitation, and
preventive measures (e.g.,
immunization, smoking
cessation, dietary changes)
downstream thinking
Primary Health Care
Comprehensive concept
Wide spectrum services
interdisciplinary teams
Intersectoral collaboration for
healthy public policy
Includes disease prevention
and community development
addresses social
justice/equity of resource
allocation
Upstream thinking
PUBLIC HEALTH
 includes the study of epidemiology, statistics
& assessment
Public Health Functions
 Health protection
 Health promotion
 Health assessment
 Public health surveillance
 Injury & disease prevention
PUBLIC HEALTH NURSING
 “the greatest good for the greatest number”
 Summary:
 Public health has as a primary focus the health of
communities and populations
 Goal is to prevent disease and preserve, promote
and protect the health of communities and
populations
POPULATION-FOCUSED
PRACTICE
 Traditional health care:
 The individual is the focus.
 approach is curative or rehabilitative
 Population-focused health care:
 group is the focus
 Importance given to influence of the determinants of
health.
 Emphasis is on reducing health inequalities for a
defined population or aggregate, as opposed to
individual-level care.
POPULATION FOCUSED
PRACTICE
 Population focused approach: looks at health
promotion, protection, maintenance &
restoration
 Looks at the health of the population or
aggregates
COMMUNITY BASED NURSING
 Emphasis on health promotion and disease
prevention
 involves acute, chronic & palliative care of
clients & families
 enhances self care
 promotes autonomy in decision making
COMMUNITY HEALTH NURSING
ROLES
 Advocate  Educator
 Direct care  Facilitator
 Collaborator  Health promoter
 Consultant  Leader
 Counsellor
TRENDS
 increasing focus on high risk, high acuity &
high needs population
 community development/mobilization
 more acute care in community (early hospital
discharge)
 change in working conditions for nurses
 increasing first contact primary care role
NURSING METAPARADIGM
 Consider the 4 parts of the nursing
metaparadigm:
 Nursing
 Health
 Environment
 Client
METAPARADIGM: NURSING
 What do you think would be the major role
of nursing in community health?
 How would practicing nursing in the
community be different from nursing in
hospital?
METAPARADIGM: ENVIRONMENT
 How would we define environment in
community health?

 Why would environment be particularly

important to community health nursing?
METAPARADIGM: CLIENT
 Who is the client in community health?

 What would be different if the nurse was

working with an individual in the community
as opposed to the community itself as a
client?
METAPARADIGM: HEALTH
 How would we define health for
communities? Is it different from health for
individuals?

 Do you think looking at determinants of

health is different when working with
communities as opposed to individual clients
in hospital? Why?