NUR 4636C Community Partnered Care
Fall 1999
Health: A Community View
Regina L. Payne, EdD, RN, CWOCN
Anne Nolan, MS, RN, FRCNA
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Health: A Community View
How
do we define health?
 Depends on who is defining it & why
defining it
 And on the unit of analysis: individual,
family, community, aggregate, population
 Are there common characteristics of
health regardless of who or why defining it
& unit of analysis?
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Health: A Community View
Definitions of Health
 Personal
 80 year old female caretaker of husband
 Relative
 Surgeon
 Mexican migrant farm laborer
 Director of Nursing County Health
Department
 School health nurse
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Health: A Community View
Definitions
 WHO, 1986: …extent to which an individual or
group …realize aspirations and satisfy needs …
change or cope with the environment. … Health …
resource for everyday life … not object of living …
positive concept … social and personal … physical
capacities.”
 DON: Health is the extent to which an individual
or group is able, on the one hand, to realize
expectations and satisfy needs, and, on the other
hand, to change or cope with the environment
(WHO, 1984, p.3).
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Health: A Community View
Definition & Focus of Public Health & Community
Health
 What is Public Health?
 Definition: How is Public Health different from
Private Health?
 Focus: Health promotion/education & disease
prevention
 Examples of PH Health Promotion/Education
Activities?
 PH Disease Prevention Activities?
 Primary Prevention
 Secondary Prevention
 Tertiary Prevention
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Health: A Community View
Focus of Public Health &
Community Health
 Focus of Public Health versus
Focus of Nonpublic Health

 National Level:
 Local level:
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Health: A Community View
Focus of Public Health & Community Health
 Focus of Public Health
 COMMUNICABLE DISEASE CONTROL
(Prevention?)
Examples:
 HEALTH EDUCATION (Level of Prevention?)
Examples:
EARLY DIAGNOSIS of DISEASE (Level of
Prevention?
Examples:
SOCIAL PROGRAMMING (Level of Prevention?)
Examples:
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Health: A Community View
Focus of Public Health & Community Health
 Functions of Public Health
 ASSESSMENT: WHAT IS THE HEALTH
STATUS OF THE POPULATION?
 Proxy Measure: Disease
 ASSURANCE: IS CARE AVAILABLE?
 Uninsured Children
 Accidental Deaths
POLICY DEVELOPMENT: LOCAL, STATE, &
FEDERAL
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Health: A Community View
Focus of Public Health & Community Health
 Focus of Community Health
 Health of local communities organized
through partnerships between pubic tax
supported & private agencies: American
Heart Assoc, American Cancer Society,
hospitals, schools, HDs, United Way
agencies, universities
 Examples of partnerships you have been
involved in which focused on the health of a
community
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Health: A Community View
Public Health and Community Health Nursing
 How would you define and ‘level’ each of the
following?
 Community
 Family
 Individual
 Aggregate
 Population
 Group
 Neighborhood

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Health: A Community View
Population Based and Aggregate Based Care
 Population: Large collection individuals with
common personal or environmental
characteristic(s):Give examples:

 Geographic locale:
 Special interest:
 Other characteristics:
Subpopulations-Special groups within populations:
 High risk infants under 1 year age
 Unmarried adolescent mothers
 Grade Schoolers (5-11 year olds)
 Population Based Care: Define:
 CHN Role: Specialist? Generalist? Where would this
person work with populations?
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Health: A Community View
Population Based and Aggregate Based Care
 Aggregate: Group of individuals (smaller than
population) with common personal or
environmental characteristic(s): Example:

 Geographic locale:
 Special interest:
 Other characteristics:
Other aggregate groups:
 High risk infants under 1 year age: Hispanic, RCMA
 Unmarried adolescent mothers: Lee County HD
 Grade Schoolers (5-11 year olds): Rural Lee County
 Aggregate Based Care: Define:
 CHN Role: Specialist? Generalist? Where would this
person work?
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Health: A Community View
Public Health and Community Health Nursing
 Public Health Nursing & Community Health
Nursing
 How does PHN differ from CHN?
 What are the defining characteristics of
each?
 What is their focus of practice for each?
 What are their goals?
 What education and titles do nurses hold
in each sphere?

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Health: A Community View
Preventionistic Approach
Marie is an 8 year old Haitian girl at San Carlos
Park Grade School. You are the school nurse who
has found that Marie has the following needs:
Understands little English; family speaks no
English
Scored at 60th percentile for age/weight on growth
chart
Has head lice, dental caries, & poor hygiene
Identify short term goals & primary, secondary, and
tertiary level coventions for Marie

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Thinking Upstream
Microscopic vs Macroscopic Approaches
 Microscopic Approach to Health Care
 Focus:
 Disease Causation:
 Coventions:
 Macroscopic Approach to Health Care
 Focus:
 Disease Causation:
 Coventions:

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Thinking Upstream
Models for Public Health Planning
 Individual Focus: Thinking Downstream
 Orem: Self Care Deficit Theory
 Health Belief Model
 Societal Focus: Thinking Upstream
 Milio’s Framework for Prevention
 Critical Social Theory
Identify one health problem of a population in
FGCU service region. Formulate coventions using
downstream/upstream approaches. How are these
analogous to microscopic/macroscopic
approaches and individual/societal foci?

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Historical Factors:
Community Health in Context



Identify one highlight of historical
significance in public health for class
discussion (Text, Chapter 2)
Why did you select this event?
Is there a counterpart event today?
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