NUR 150: Community-Based Nursing Mid-term Study Guide

Chapter 1: Community-Oriented Nursing and Community-Based Nursing

 Define Public Health

 Know the three core functions of public health:

o Assessment,
o Policy development and
o Assurance

 Differentiate between the following:

o Community-based nursing,
o Community-oriented nursing,
o community health and public health nursing practice

 Define key terms in Public Health Nursing:

o population/aggregate,
o subpopulation,
o primary, secondary and tertiary prevention

Chapter 2: The History of Public and Community Health and Nursing

 Relate the contributions of the following Nursing Pioneers:

o Florence Nightingale,
o Lillian Wald, and
o Mary Breckinridge

Chapter 3: The U.S. Health and Public Health Care Systems

 Events and trends that influence the status of the health care system.
o Demographic changes
o Health workforce trends
o Technological trends

 Identify current health care system problems associated with cost, quality, and access
to care.

 Organization of the health care system

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o Private or personal care component

o Public health component
 The federal system (DHHS)
 The state system
 The local health department

 Define Primary health care (PHC) and Primary care

Chapter 4: Ethics in Community-Oriented Nursing Practice

 The steps in the ethical decision-making processes.

o Identify the ethical issues and dilemmas.
o Place them within a meaningful context.
o Obtain all relevant facts.
o Reformulate ethical issues and dilemmas, if needed.
o Consider appropriate approaches to actions or options (utilitarianism,
deontology, principlism, virtue ethics, ethic of care, feminist ethics).
o Make decision and take action.
o Evaluate the decision and the action.

 Four situations in which ethical diversity can be judged in relation to cultural

standards:
o Situations that place persons at direct risk for harm, whether psychological or
physical
o Situations in which ethnic cultural standards conflict with professional
standards
o Situations in which the greater community’s values are jeopardized by
specific ethnic values
o Situations in which specific ethnic community customs are annoying but not
problematic for the greater community

 Theories and principles of ethics:

o Autonomy:
o Nonmaleficence
o Beneficence
o Distributive justice

 Discuss the relationship between ethics and Community Health Nursing

 Ethics and public health nursing core functions

o Assessment. Three ethical tenets relate to assessment:
 Competency related to knowledge development, analysis, and
dissemination
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 Virtue ethics or moral character

 Do no harm.
 Policy development. Three ethical tenets relate to policy development:
o An important goal of both policy and ethics is to achieve the public good,
which is part of the concept of citizenship.
o Service to others over self is a necessary condition of a good or right
policy.
o What is ethical is also good policy.
Assurance. Two ethical tenets are related to assurance:
o All persons should receive essential personal health services.
o Providers of public health services should be competent and available.

Chapter 5: Cultural Influences in Nursing in Community Health

 Describe methods for developing cultural competence.

o Cultural awareness
o Cultural knowledge
o Cultural skill
o Engaging in cultural encounters
o Cultural desire

 Strategies used by culturally competent nurses to provide care that reflects the clients’
values are:
o Cultural preservation
o Cultural accommodation
o Cultural repatterning
o Cultural brokering

 Inhibitors to developing cultural competence

o Stereotyping
o Prejudice
o Racism
o Ethnocentrism or cultural prejudice
o Cultural blindness
o Cultural imposition
o Cultural conflict
o Cultural shock

 Differences among cultural groups

o Communication.
o Space.
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o Social organization
o Time perception
o Environmental control
o Biological variations
o Nutrition. Dietary practices
o Socioeconomic factors and culture
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Chapter 6: Environmental Health

Environmental health sciences

o Toxicology is the basic science that studies the health effects associated with
chemical exposures.
o Epidemiology is the science that tries to understand the strength of the association
between exposures and health effects in human populations.

 Environmental health assessment. A windshield survey is a helpful first step in

assessment.
o Air
o Water
o Food
o Public right to know
o Risk assessment

 Reducing environmental health risks

o Risk communication: Education is a key primary prevention strategy
 The right information
 To the right people
 At the right time
o Government environmental protection

 Roles for nurses:

o community and public participation,
o individual and population risk assessment,
o risk communication,
o epidemiologic investigations,
o policy development, and
o the education of others

Chapter 9: Epidemiologic Applications

 Define Epidemiology
o Descriptive epidemiology
o Analytic epidemiology

 Basic concepts in epidemiology

o Measures of morbidity and mortality
 Proportion
 Rates
 Incidence and Prevalence
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The epidemiologic triangle

o The agent is a factor that must be present or lacking for a disease or condition to
develop.
o The host is a living species capable of being infected or affected by an agent.
o The environment is everything internal or external to a given host or agent and that
is influenced and influences the host and/or agent.

 The web of causality

 Basic methods in epidemiology

o Descriptive epidemiology
 Person.
 Place
 Time
o Analytic epidemiology
 Cohort studies
 Case-control studies
 Cross-sectional studies
 Ecological studies

Chapter 10: Evidence-Based Practice

Explain how nurses use epidemiology in community health practice. Nurses in the
community are involved in surveillance and monitoring of disease trends and can identify
patterns of disease in a group. Nurses collect, report, analyze, interpret, and communicate
epidemiologic data as part of their daily practice. Nursing documentation on patient
charts and records is an important source of data for epidemiologic reviews.

Barriers to implementing evidence-based practice in nursing

o Misunderstood communication among nursing leaders about the process involved
o Inferior quality of available research evidence
o Inability to assess and use research evidence
o Unwillingness of organizations to fund research and make decisions based on
evidence
o Concern that EBP will lead to a cookbook approach to nursing while ignoring
individual client needs and the nurse’s ability to make clinical decisions
o Lack of resources needed by community-based nursing agencies for its
implementation in the clinical setting, such as time, funding, computer resources,
and knowledge
o Lack of nurses’ necessary skills to identify and evaluate the latest evidence
o Reluctance of nurses to accept the findings
o Nurses’ feelings of being threatened when long-established practices are
questioned
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 Implementing evidence-based practice in nursing: Community-oriented nurses consider EBP

as a process to improve practice and outcomes, and they use evidence to influence policies
that will improve the health of communities. The first step toward implementing EBP in
nursing is recognizing the current status of one’s own practice and believing that care based
on the best evidence will lead to improved client outcomes.

Chapter 11: Using Health Education and Group Process in the Community

 Three domains of learning

o cognitive,
o affective, and
o psychomotor

 Six basic principles that guide the effective educator

o Send a clear message
o Select the learning format
o Create the best learning environment
o Organize learning experiences
o Encourage participatory learning
o Provide evaluation and feedback

 Group concepts. Community groups represent the collective interests, needs, and values
of individuals, linking individuals to the larger social system. Understanding the
community and assessing its health begin by identifying groups and their place in the
community structure. Through community groups, nurses help people identify priority
health needs and capabilities and make valuable community changes.

 Promoting health through group work. Health behavior is influenced by the groups to
which people belong, and people usually consider the responses of others when making
decisions regarding personal welfare.
o Established groups
o Selected membership groups

 Community groups and their contributions to community life. Groups within a

community help identify community problems and are important in managing
interactions within the community and between the community and the larger society.

 Educational issues
o Population considerations
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 Age. Children, adults, and older adults have different learning needs and
responses.
o Pedagogy is a set of learning strategies for children and individuals with little
knowledge about a particular topic.
o Andragogy is a system of learning strategies for adults, older adults, and
individuals with some knowledge about a topic.
o Culture. Education should be related to the cultural background of the client.
Multilinguistic presentation of materials needs to be available to provide
culturally competent health education

 The educational process:

o Identify educational needs.

o Establish educational goals and objectives.

o Select appropriate educational methods

o Implement the educational plan.

o Evaluate the educational process.

Chapter 12: Community Assessment and Evaluation

 Define Community
 The goal of community-oriented practice is community health. Common characteristics
include:
o status,
o structure, and
o process
 Most changes aimed at improving community health involve partnerships between health
care providers and community residents. Community partnership is crucial because
community members and professionals who are active participants have a vested interest
in the success of efforts to improve the health of their community

 Assessing community health. Community assessment is the process of critically thinking

about the community and involves getting to know and understand the community client
as partner. Community assessment helps to identify community needs, clarify problems,
and identify strengths and resources
o Data gathering
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o Data generation
o Database analysis

 Identifying community problems The community problem consists of the following:

o Clear identification of the specific problem faced by the community
o Specifying the persons in the community affected by the problem
o The factors that led to the problem

 Planning for community health

o Problem analysis and prioritization
o Establishing goals and objectives
o Identifying intervention activities

 Implementing for community health. This phase includes the work and activities aimed at
achieving the goals and objectives

 Evaluating intervention for community health. Evaluation is the appraisal of the effects of
some organized activity or program. It begins in the planning phase of community action
when goals and measurable objectives are established and goal-attaining activities are
identified.

Chapter 14: Disaster Management

Definition of disaster

Prevention: Prevention activities may include: heightened inspections; improved

surveillance and security operations; public health and agricultural surveillance and
testing processes; immunizations, isolation, or quarantine.

Preparedness. Preparedness is advance preparation to cope with a disaster. It includes:

o Personal preparedness
o Professional preparedness
o Community knowledge and plans used to prevent or alleviate a disaster.
Nurses have key roles in disaster preparedness to facilitate preparation in the community
and in the workplace.
o initiate or update the agency’s disaster plans,
o provide educational programs and materials regarding disasters specific to the area,
and organize disaster drills.
o advocating for a safe environment and assessing for and reporting environmental
health hazards.
o Nurses should also understand what the available community resources will be
after a disaster strikes and how the community will work together.
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Response is organized actions taken to deal with a disaster. The primary agencies involved
in disaster response include:
o The Federal Emergency Management Agency (FEMA): The level of disaster
determines FEMA response. FEMA’s assistance is not needed in many small
disasters, such as single-family home fires. In these cases, the American Red
Cross and other voluntary agencies assist victims.
o American Red Cross
o the Salvation Army
o many church denominations, and other voluntary organizations
o
The American Red Cross has three ways a disaster can be classified:
o disaster type,
o disaster level, and
o disaster scope.

Response to bioterrorism. Biological or chemical terrorist attacks require a very different

response. The five components to a comprehensive response to outbreaks of illness are
the following:
o Detecting the outbreak
o Determining the cause
o Identifying factors that place people at risk
o 4Implementing measures to control the outbreak
o Informing the medical and public communities about treatments, health
consequences, and preventive measures
How communities are affected by disasters. The effects of disasters upon people depend on
several things:
o type, cause, and location of the disaster;
o magnitude and extent of damage;
o duration; and
o amount of warning provided

The role of the nurse in disaster response depends a great deal on the nurse’s past
experience, role in community preparedness, specialized training, and special interest.
Although nurses in community health have expertise in community assessment, case
finding and referring, prevention, health education, surveillance, and working with
aggregates, those skills will be set aside to deal with life-threatening problems first.

Triage: the process of separating casualties and allocating treatment based on the victim’s
potential for survival. Categories:

o Red
o Yellow
o Green
o Black
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Recovery is the stage of a disaster when all involved agencies pull together to restore the
economic and civic life of a community. The role of the nurse in disaster recovery is
varied. Flexibility is essential in the recovery operation. Nurses also need to observe for
environmental health hazards during the recovery phase, such as faulty housing
structures, lack of water or electricity, or disease-carrying animals. Case finding and
referral are critical during the recovery phase and may continue for a long time.