Chapter One

Elements commonly used to compare and contrast the public health nursing definitions
of health address the inclusion or exclusion of physical, mental, emotional, and spiritual
realms; concepts of wholeness or well-being; perception of health; and social aspects of
role functioning.

Public health efforts focus on prevention and promotion of population health at the
federal, state, and local levels through the provision of community health and personal
health services. The mission of Public Health entitles all people to basic necessities and
accepts collective burdens to make this possible.

The Institute of Medicine has identified three primary functions of public health:
assessment, assurance, and policy development. These functions encompass 10
essential services.

The American Nurses Association definition of public health nursing focuses on care to
individuals, families, and groups within a community, while the American Public Health
Association definition focuses on care to the community as a whole.

Health promotion activities enhance resources directed at improving well-being whereas
disease prevention activities protect people from disease and the effects of disease. The
three levels of prevention widely recognized in public health are primary, secondary, and
tertiary

Healthy People 2020 has four overarching goals: 1) Attain high-quality, longer lives free
of preventable disease, disability, injury, and premature death. 2) Achieve health equity,
eliminate disparities, and improve the health of all groups. 3) Create social and physical
environments that promote good health for all. 4) Promote quality of life, healthy
development, and healthy behaviors across all life stages.

Healthy People 2020 has identified 12 Leading health indicators, 42 topic areas, and1200
objectives aimed at improving the health of all Americans.

The Intervention Wheel contains three important elements: (1) It is population-based; (2)
it contains three levels of practice (community, systems, and individual/family); (3) it
identifies and defines 17 public health interventions.

Key terms; aggregates, community, community health nursing, community-based
nursing, disease prevention ( primary, secondary, tertiary), health, health promotion,
population, population-focused, public health, public health nursing,
Chapter Two

The stages in disease history of humankind include the hunting and gathering stage,
settled villages stage, preindustrial cities stage, industrial cities stage, and present stage.

The nineteenth century saw an increased awareness of the relationship between
unsanitary living conditions and communicable disease and shorter life spans.

Health reform led to improved conditions; however, poorer segments of society continued
to suffer disproportionately.

Public health nursing and community health nursing evolved from home nursing practice,
community organizations, and political interventions on behalf of aggregates.

Increased food production and better nutrition during the nineteenth and early twentieth
centuries contributed to the decline in infectious disease–related deaths. Other factors
included better sanitation through water purification, sewage disposal, improved food
handling, and milk pasteurization.

With improvements in disease control, chronic disease became the greatest threat to
aggregate health.

Aggregate impact on health: Humans created an ecological imbalance by altering their
environments to accommodate growing populations and population density. These
imbalances have had a significant impact on aggregate health.

Community health has been increasingly affected by the tendency throughout history of
people and groups to live in increasingly closer proximity to one another. Increased
interaction has resulted in increases in communicable disease outbreaks and epidemics.

Increases in industrialization and certain technologies have resulted in the development
of environmental pollution, particularly of air and water.

Nursing pioneers such as Nightingale in England and Wald in the United States focused
on health care reforms, home nursing, community empowerment, and nursing education.
They established the groundwork for today's community health nursing.

Contemporary issues continue to include communicable disease concerns,
environmental concerns, societal issues, and the cost of health care.

Key historical public health figures: Jenner, Chadwick, Nightingale, Snow, Lister,
Pasteur, Koch, Shattuck, Wald

Key terms: endemic, epidemic, pandemic, sanitary revolution, stages in disease history
Chapter Three

Downstream interventions focus on correcting the problem after it has occurred while
upstream interventions focus on preventing the problem before it happens.

Orem's Self-Care Deficit Theory of Nursing is based on the assumption that self-care
needs and activities are the primary focus of nursing practice and that nursing is a
response to a sick person's inability to administer self-care.

The Health Belief Model focuses on the individual as the locus of change.

Milio's Framework for Prevention focuses on preventing health problems through a focus
on health choices and proposes a set of six propositions that relate a person's health
choices to society's ability to provide options for healthy choices.

Critical Social Theory uses societal awareness to expose social inequalities that keep
people from reaching their full potential.

Orem's Self-Care Deficit Theory and the Health Belief Model are narrow in scope and
therefore are more appropriate in directing individual intervention, as opposed to
community or aggregate intervention.

Critical Social Theory and Milio's Framework for Prevention are much broader in scope
and can help the community health nurse understand and facilitate community-based
health promotion and protection interventions.

Theory-based practice guides the process of data collection and interpretation and
facilitates appropriate problem diagnoses and planning of interventions for identified
problems.

Key terms: upstream, downstream, microscopic, macroscopic,
Chapter 6

Dimensions describing communities include an aggregate of people, a location in space
and time, and a social system.

Sources of data for assessing a community's health include the following: windshield
surveys, census data, vital statistics, National Center for Health statistics, and local,
regional, and state government reports.

There are 12 steps of a community needs assessment: 1) identify aggregate for
assessment 2) engage community in the planning the assessment 3) identify required
information 4) select method of data gathering 5) develop questionnaires or interview
questions 6) develop procedures for data collection 7) train data collectors 8) arrange for
sample representative of the aggregate 9) conduct the assessment 10) tabulate and
analyze 11) identify needs suggested by data 12) develop action plan

Three approaches to gathering data from the identified aggregate include interviewing
key informants, holding community forums, form focus groups.

The community and aggregate diagnosis consists of four components: the identification
of the health problem or risk, the affected aggregate or community, the etiological or
causal statement, and the evidence or support for the diagnosis.

Epidemiological studies support program planning by establishing the effectiveness of
certain interventions and their specificity for different aggregates.

The community’s ability to respond effectively to changing dynamics and meet the needs
of it’s members indicates productive functioning and a healthy community

Key terms: aggregate, census tracts, community diagnosis, community of solution,
metropolitan statistical area, needs assessment, social system, vital statistics, windshield
survey
Chapter 7

“Community as client” refers to a focus of health care planning and intervention that is
directed to groups, aggregates, organizations, or communities instead of toward
individuals and families.

Using the health planning model, the nurse can assess, diagnose, plan, intervene, and
evaluate an actual or potential health need of a group or aggregate.

The steps of the health planning model are assessment, planning, intervention, and
evaluation.

When identifying prevention levels, the nurse must consider whether the goal is to
prevent a disease or condition, detect a disease or condition, prevent a disease or
condition from worsening, or prevent complications from developing.

After identifying the source of the problem, the nurse should determine the appropriate
system level(s) (subsystem, aggregate system, suprasystem, or all three) for direction of
intervention.

Health planning models in Public Health: PRECEDE-PROCEDE, PATCH, APEX-PH
Program, MAPP Model

Major legislative acts were implemented after World War II to improve access to quality
health care and better health. Health planning Federal Legislation: Hill Burton Act,
Regional Medical Programs, Partnership for Health Program, Certificate of Need,
National Health Planning and Resources Development Act, Patient Protection and
Affordable Care Act

Factors contributing to a failure to control health care costs include public resistance, the
failure of legislation to effect major changes when health care delivery methods are
unchanged, the high costs of technology, and the need for a paradigm shift from an
emphasis on individual medical care to community-based health care that employs
upstream interventions.

Key terms: community as client, health planning, key informant, census tracts,
Chapter 8

Health education refers to “any combination of learning experiences designed to facilitate
voluntary actions conducive to health that people can take on their own, individually or
collectively, as citizens looking after their own health or as decision makers looking after
the health of others and the common good of the community.”

A basic knowledge of various learning theories helps health care workers understand
how individuals, families, and groups learn. There are several broad categories of
learning theories, including cognitive, humanistic, and social learning.

Helpful tips for effective teaching and learning strategies include determining what the
patient wants to know and assessing the reading skill of the patient.

As health educators, community health nurses must realize that cultural and social
definitions of health differ. In addition, the nurse must understand that individuals and
communities must take responsibility for their own health.

Education begins with establishing an atmosphere conducive to learning, whereby a
therapeutic trusting relationship forms the foundation for a healing relationship.

The “Framework for Developing Health Communications” is recommended to create a
variety of health education messages and programs.

Nurses should evaluate health materials for format-layout, type, verbal content, visuals
content, and aesthetic quality before the materials are disseminated to individuals,
families, or the general public.

Nurses should analyze the program and health message for effectiveness and track the
mechanisms using process evaluation.

Key terms: health literacy, health disparities, cognitive theory, social-learning theory,
humanistic theory, community-based participatory methods, community empowerment
CHAPTER 8