Community & Public Health Nursing

RUBRIC: DISCUSSION BOARD (30 pts) Criteria Characteristics of initial post Support for initial post Responses to Peers APA format*; Spelling/ Grammar/ Punctuation Meets Expectations 10 to 10 Points • Provided response with rationale. • The post is substantive and reflects careful consideration of the literature. • Examples from the student’s practice/experience are provided to illustrate the discussion concepts. • Addressed all required elements of the discussion prompt. • Well organized and easy to read. 5 to 5 Points • Cited minimum of two references: at least one (1) from required course materials to support rationale AND one (1) from peer-reviewed* references from supplemental materials or independent study on the topic to support responses. • The initial post is a minimum of 200 words excluding references. 10 to 10 Points • Responses to colleagues demonstrated insight and critical review of the colleagues’ posts and stimulate further discussion • Responded to a minimum of two (2) peers and included a minimum of one (1) peer-reviewed* or course materials reference per response. • Responses are a minimum of 100 words and are posted on different days of the discussion period by the due date. 5 to 5 Points • APA format** is used for in-text citations and reference list. • Posts contain grammatically correct sentences without any spelling errors. Levels of Achievement Needs Improvement 3 to 9 Points • Provided response missing either substantive rationale, consideration of the literature, or examples from the student’s practice/experience to illustrate the discussion concepts. • Addresses all or most of required elements. • Somewhat organized, but may be difficult to follow. 2 to 4 Points • Missing one (1) required course reference AND/OR one (1) peer-reviewed reference to validate response. • Post has at least 200 words. 4 to 9 Points Community & Public Health Nursing

• Responses to colleagues are cursory, do not stimulate further discussion and paragraph could have been more substantial. • Responses missing one of the following: o insight/critical review of colleague’s post, o OR respond to at least two peers, o OR a peer reviewed*or course materials reference per response • Responses are a minimum or less than 100 words and posts were on the same date as initial post. 2 to 4 Points • APA format is missing either in-text or at end of the reference list. • Posts contain some grammatically correct sentences with few spelling errors. NOTE: No direct quotes are allowed in the discussion board posts. Unsatisfactory 0 to 2 Points • Provided response with minimal rationale. • Does not demonstrate thought and provides no supporting details or examples. • Provides a general summary of required elements. 0 to 1 Points • Missing 1 or more of the correct type (course or peer-reviewed) or number of references to support response. • Post is less than 200 words or there’s no post. 0 to 3 Points • Responses to colleagues lack critical, in depth thought and do not add value to the discussion. • Responses are missing two or more of the following: o insight/critical review of colleagues’ post o AND/OR response to at least two peers o AND/OR a peer reviewed* reference per response. • Responses are less than 100 words, posted same day as initial post. 0 to 1 Points • Not APA formatted OR APA format of references has errors both in-text and at end of reference list. • Post is grammatically incorrect. *Peer-reviewed references include professional journals (i.e. Nursing Education Perspectives, Journal of Professional Nursing, etc. – see library tab on how to access these from database searches), professional organizations (NLN, CDC, AACN, ADA, etc.) applicable to population and practice area, along with clinical practice guidelines (ECRI Institute https://guidelines.ecri.org). All references must be no older than five years (unless making a specific point using a seminal piece of information) References not acceptable (not inclusive) are UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases. **Since it is difficult to edit the APA reference in the Blackboard discussion area, you can copy and paste APA references from your Word document to the Blackboard discussion area and points will not be deducted because of format changes in spacing. Last updated: 1/31/2020 © 2020 School of Nursing – Ohio University Page 1 of 1 Chapter 3 Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Health Care Today Are we too busy rescuing victims … © Penny Leake Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Health Care Today (Cont.) …to look upstream where the real problems lie? © Penny Leake – McKinlay, 1979 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Microscopic Approach to Solving Community Health Problems    Individual, and sometimes family, response to health and illness Often emphasizes behavioral responses to individual’s illness or lifestyle patterns Nursing interventions are often aimed at modifying individual’s behavior by changing his or her perceptions or belief system Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Macroscopic Approach to Solving Community Health Problems      Community & Public Health Nursing

Examines interfamily and intercommunity themes in health and illness Delineates factors in the population that perpetuate the development of illness or foster the development of health Emphasizes social, economic, and environmental precursors of illness Nursing interventions may include modifying social or environmental variables May involve social or political action Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Theoretical Approaches  The individual is the focus of change (Microscopic) ➢ ➢  Orem’s self-care deficit theory of nursing The Health Belief Model (HBM) The Upstream View: society is the focus of change (Macroscopic) Milio’s framework for prevention ➢ Critical theoretical perspective ➢ Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Variables and Relationships in the Health Belief Model Figure 3-1 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Critical Interactionism Nurses can use both an upstream and a downstream approach to address health issues through critical interactionism. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Critical Interactionism (Cont.) Issue Downstream Upstream Approach Critical Interactionism Clients: Individual behavior strategies to reduce weight. Health policy changes. Individual strategies with weight loss in conjunction with system changes. Obesity rates Vending machines in Lifestyle changes school with healthier choices. Social marketing at both levels. Bariatric surgery nursing care. School lunch program modifications. Community & Public Health Nursing

Target corporations that profit from obesity. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Critical Interactionism (Cont.) Issue Downstream Upstream Approach Client or Nurse: Workplace violence. Behavior change Address at individual level. organizational factors that promote Workplace workplace programs to violence. reduce violence. What organizational structures perpetuate workplace violence? Critical Interactionism Change needed in knowledge and skills to address issue of workplace violence at both the downstream and upstream level. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Critical Interactionism (Cont.) Issue Nurse: Downstream Upstream Approach Focus on System changes needed. Workplace errors individual: root cause analysis that has individual What system level as focus. factors lead to workplace errors? Change behavior of individual What nurse. organizational structures Reeducation of perpetuate workplace errors? nurse with workplace error. Critical Interactionism A dual approach. Providers need changes in knowledge and skills to address root causes of workplace errors that move from individual to system level. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 By thinking about the root causes of health problems, we begin to understand the importance of directing nursing efforts toward the antecedents of poor health and lost opportunities. The Social Determinants of Health topic area within Healthy People 2020 is designed to identify ways to create social and physical environments that promote good health. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Nursing with the Community Bellack (1998)    The health agenda originates from within the community; it is not imposed by others. A shared vision of health is a challenge because multiple viewpoints are the norm. Success depends on … ➢ ➢ ➢ ➢ Listening Being patient Providing accurate and scientifically sound information Respecting the experiences of community members Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Chapter 4 Health Promotion and Risk Reduction Copyright © 2015, 2011, 2007, 2001, 1997,. 1993 by Saunders, an imprint of Elsevier Inc. Health Promotion Is…   …any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health (Green & Kreuter, 1991) …that which is motivated by the desire to increase well-being and to reach the best possible health potential (Parse, 1990) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Health Protection Is …(Cont.)   … those behaviors in which one engages with the specific intent to prevent disease, detect disease in the early stages, or maximize health within the constraints of disease (Parse, 1990) … an important step in maintaining health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Defining Health   The way health is defined has shifted from a focus on the curative model, to a focus on multidimensional aspects such as the social, cultural, and environmental facets of life and health (Benson, 1996) Health is viewed not only as an important goal, but as a resource for living (WHO, 1986) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Community & Public Health Nursing

4 Healthy People 2020 …   … is the health promotion initiative for the nation. … challenges individuals, communities, and professionals … to take specific steps to ensure that good health, as well as long life, are enjoyed by all. – U.S. Department of Health and Human Services, 2012 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Healthy People 2020 … (Cont.)  Broad goals ➢ ➢ ➢ ➢ Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve high equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Determinants of Health       Biology Behaviors Social environment Physical environment Policies and interventions Access to high-quality health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Figure 4-1 From U.S. Department of Health and Human Services. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Theories in Health Promotion     Pender’s Health Promotion Model (HPM) Health Belief Model (HBM) Transtheoretical Model (TTM) Theory of Reasoned Action (TRA) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Risk and Health   Risk is “the probability that a specific event will occur in a given time frame” (Oleckno, 2002). A risk factor is an exposure that is associated with a disease (Friis & Sellers, 2004). Risk Assessment is a systematic way of distinguishing the risks posed by potentially harmful exposures. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Steps in Risk Assessment     Hazard identification Risk description Exposure assessment Risk estimation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Risk Assessment  Modifiable risks ➢ ➢  Individual has control Examples: smoking, lifestyle, eating habits, activities Nonmodifiable risks ➢ ➢ Individual has little or no control Examples: genetics, gender, age, environmental exposure Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12  Risk Reduction … ➢ ➢  … is a proactive process … enables individuals to react to actual or potential threats to their health Risk communication … ➢ ➢ … is the process of informing the public regarding threats … is affected by perceptions, process, and actions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Tobacco and Health Risk     Leading cause of preventable death Most common in less educated populations and those living below poverty level Most common form of chemical dependency Tobacco in all forms is harmful. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Health Promotion Activities      Look for teachable moments Assess client’s tobacco use Explore willingness to quit Refer to cessation programs Encourage attempts to quit Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Alcohol Consumption and Health     Third leading lifestyle-related cause of death for the nation Short-term use causes acute risks Long-term effects have major impact on health and social issues Influenced by legal drinking age ➢ # 1 used and abused drug among U.S. youth Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Health Promotion Activities (Cont.)      Prevent underage drinking Assist with enforcement of legal drinking age Identify individuals and groups at risk of abuse and dependence Educate adults and youth on dangers of alcohol Requires a community-wide effort to address the problem on several fronts

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Diet and Health     Diet—one of most modifiable risk factors Imbalance of caloric intake and physical activity Complex interplay among metabolism, genetics, behavior, environment, culture, and socioeconomic status Geographic areas, age, ethnicity all influence weight Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Health Promotion Activities (Cont.)    Special populations have different nutritional needs For individualized plans, see http://myplate.gov/ Educate clients about: ➢ Balancing caloric intake and physical activity ➢ Servings vs. portion control ➢ Eating away from home affects “portion distortion” ➢ Using social media and mobile applications to help Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Physical Activity and Health    Physical activity serves both health promotion and disease prevention purposes Leisure activities are influenced by level of education, gender, age, economic level, geography One’s environment plays a significant role in activity level Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Health Promotion Activities (Cont.)    Support and develop “walkable” neighborhoods and cities Determine recommended exercise levels for individuals Visit http://www.cdc.gov/physicalacti vity/data/facts.html Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Sleep and Health     Sleep is an essential component of chronic disease prevention and health promotion Requirements change with age and life circumstances Regulated by waking time and circadian rhythms Hormones during sleep affect memory, blood pressure, and kidney function. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Health Promotion Activities (Cont.)  Sleep assessment is important ➢ ➢  Identify disorders that may affect daily activities Keep sleep log Practice sleep hygiene ➢ ➢ Establish environment that promotes sleep Avoid food and activities that interfere with sleep Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Chapter 6 Community Assessment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Defining the Community  Aggregate of people ➢ ➢  Location in space and time ➢ ➢  The “who” Share personal characteristics and risks The “where” and “when” Physical location frequently delineated by boundaries and influenced by the passage of time Social system ➢ ➢ The “why” and “how” Interrelationships of aggregates fulfilling community functions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Diagram of Assessment Parameters Figure 6-1 Community & Public Health Nursing

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Community Assessment Parameters          Geography Population Environment Industry Education Recreations Religion Communication Transportation          Public services Political organization Community development or planning Disaster programs Health statistics Social problems Health manpower Health professional organizations Community services Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Healthy Communities    A movement to help community members bring about positive health changes Interconnectedness between people and the public and private sectors is essential to make changes. Each community has its unique perspective. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Assessing the Community  Windshield survey ➢ Gain an understanding of environmental layout ➢ Locate possible areas of environmental concern through “sight, sense, and sound” ➢ Gives nurse an opportunity to observe people and their role in the community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Windshield Survey    Community vitality Indicators of social and economic conditions Health resources    Environmental conditions related to health Social functioning Attitudes toward health and health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Assessing the Community (Cont.)  Sources of data: ➢ Census data and other cens … Community & Public Health Nursing