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Organizing Frameworks Applied to Community Health Nursing
Organizing Frameworks Applied to Community Health Nursing:
Your text states:" Community health nursing is the specialty area that blends nursing and public health theory into a population-focused practice designed to promote and preserve the health of communities. The focus of community health nursing practice is the community as a whole with nursing care of individuals, families, and groups being provided within the context of promoting and preserving the health of the community as a whole." (Association of Community Health Nursing Educators, l990)
Conceptual models provide a frame of reference for members of a discipline to guide their thinking, observations and interpretations. In those conceptual models with the greatest usefulness in community health nursing, people are seen as being in continuous interaction with a dynamic environment.
Define a.) Conceptual model, b) concepts, c) constructs, d) propositions, and e) theory.
The unique feature of community health nursing is the emphasis on assisting individuals, families, groups, and communities to maintain their highest possible level of health.
Most Nursing models employ the four metaparadigm concepts of the discipline of nursing - person, environment, health and nursing. According to the American Nurses Association the following are the Standards of Community Health Nursing Practice.
Standards of Community Health Nursing Practice
The focus of community health nursing is on the prevention of illness and the promotion and maintenance of health. Nursing activities to achieve these goals include client education, counseling, advocacy and management of care. The goal of population based practice is to enable communities to be healthy. Goal achievement requires a collaborative, interdisciplinary process of assessment, policy development and assurance activities.
The Omaha System Pg. 213
The Omaha System describes and quantifies nursing practice in community settings. It is the only system that was developed by practicing community health nurses for community health nurses. The Omaha System comprises nursing diagnoses, interventions and an outcome rating. Please review the Omaha Classification Scheme and the Omaha Intervention Schemes on pages.
The Neuman Systems Model
Betty Neuman developed the Health Care Systems Model as an organizing framework for students to understand client's needs within a holistic viewpoint (l972). In the Neuman Systems Model the environment is defined as all internal and external influences surrounding an affecting the client system. The client's interaction with the environment is reciprocal. This model links person, environment, health, and nursing. It is an model of an open system in which persons and their environment are in dynamic interaction (l989). For Neuman optimal system stability is the best possible health state when all system variables are in balance within the client system. The major goal of nursing in the Neuman System Model is to keep the client esteem stable through accurate assessment of actual and potential stressors, followed by implementation of appropriate interventions. Three intervention modalities are suggested:
These prevention-as-intervention modalities are used to direct nursing actions. Primary prevention strategies are implemented to strengthen the client's defenses - i.e. might include giving immunizations, supporting positive coping strategies and providing health education programs. Secondary prevention strategies are implemented once health problems have developed, or symptoms have occurred. Early case finding (such as screenings at health fairs) followed by appropriate referrals, counseling about high-risk behaviors, and the use of medications and treatments. Tertiary prevention strategies assist clients in rehabilitation. It provides for readaption, and reeducation. It is initiated after treatment when there is some degree of system stability. The goal is optimal functioning, given the clients health status.
Caplan (l964) developed guiding principles for community mental health, combining Public Health principles with Psychiatric principles. This became "Preventive Psychiatry. Just as in the theoretical frameworks you have just read, Caplan saw the community as the client rather than the individual, and the focus of practice is promoting mental health. Caplan used the terms primary prevention, secondary prevention and tertiary prevention when identifying mental health activities in the community.
In Preventive psychiatry:
Primary Prevention: refers to activities directed at reducing the incidence of mental disorder within a population. Aggregates (population groups) at risk of developing an identified mental disorder and environmental factors that may contribute to that risk are targeted. Population-focused practice refers to the target population to which the intervention is directed . Primary prevention does not seed to prevent a specific person from developing a mental disorder. Rather, it reduces the risk for aggregates within a population through health promotion. Examples of primary prevention would be:
Teaching classes on stress management to factory workers.
Conducting support groups for children moving from a small elementary
School to a large consolidated high school
Secondary Prevention: refers to activities directed at reducing the prevalence of mental disorders by shortening the duration of a sufficient number of established cases (You may want to skip forward to the Epidemiology module for the definitions of incidence and prevalence). This reduction is achieved by encouraging early referrals, decreasing barriers to early diagnosis and providing effective, timely treatment. Examples are:
Staffing a women's crisis center hotline
Screening clients with chronic, debilitating physical illness for depression.
Tertiary Prevention: activities are aimed at reducing the residual defects that are associated with mental disorders. Sometimes this might be referred to as psychiatric rehabilitation services. Examples are:
Medication management groups for Seriously Mentally Ill clients.
Monitoring the effectiveness of aftercare services in community mental health centers.
The services provided in this public health model are based on community needs assessment. Local community mental health centers regularly collect data on the people they serve. This data is used to identify and determine priorities for high-risk aggregates and to design and implement appropriate interventions.
In the Levels of Prevention exercise, there are several mental health related items, so you can apply Caplan's theoretical framework.
Open this link to Betty Neuman's site for more information about her model.
You should now:
E-mail Nancy Jones
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