NFDN-2006-Nursing Foundations VI: Community
Nursing-O05-2024 Winter.
What is a Community?
-People and the relationships that emerge among them as they develop
-Commonly shared agencies, institutions or a physical environment
-Geography ( city or town or province)
-Common interests or focus ( children attending a particular school)
What is Community Health Nursing?
-All nurses who work in and with the community
Focus is on the health of the individual & population
-Umbrella term that includes a variety of different practices
Public Health
Home Health
Occupational Health
-Involves direct care, coordinating care & planning services, programs & policies
-Through the collaboration with individuals, caregivers, families, communities &
governments
-Combines knowledge of nursing theory, social sciences & public health science
Populations & Aggregates
1. CHN emphasize population health promotion, disease prevention & health protection
2. Population
Large group of people who share 1 or more personal or environmental characteristics
Example: All high risk children
3. Aggregate
Groups within a population
Example: High risk infants younger than 1 year of age
4. Population Health
Health outcomes of a population
Measured by the determinants of health & health status indicators ( life expectancy)
Historical Roots of CHN
1980-1990s
Shift in public health strategy from illness prevention to health promotion
Escalating health care costs = reduced funding for health promotion & disease
prevention programs
2001
Researchers demonstrated that home care for older adults cost less than institutional
care
2002
Romanow Report identified home care as the most rapidly growing area of community
health
Part of this is due to early discharge
2020
Estimated that two-thirds of all nurses in Canada will be practicing in the community
,Canada Health Act
Enacted in 1984
5 Principles of the Act
=Universality
=Accessibility
=Comprehensiveness of services
=Portability
=Public Administration
Federal Government
Establishes & administers the 5 national principles
Provides financial support to the provinces and territories that legislate, organize &
deliver services
Funds/delivers primary & supplementary services to specific groups (First Nations
people living on reserves)
Health Canada
1. Safeguards the population health by surveillance, prevention,
legislation & research
2. Focus on
Environmental Health
Disease Outbreaks
Drug Products
Food Safety
3. Umbrella Agency for
Public Health Agency of Canada (PHAC)
Canadian Institutes of Health Research (CIHR)
Canadian Food Inspection Agency
First Nations & Inuit Health (FNIH)
Canadian Community Health Nursing Standards of Practice
What is the purpose of the CCHN Standards??
They will become basic practice expectations after 2 years of experience
Seven CCHN Standards
Standard 1: Health Promotion
Standard 2: Prevention and Health Protection
Standard 3: Health Maintenance, Restoration & Palliation
Standard 4: Professional Relationships
Standard 5: Capacity Building
Standard 6: Access and Equity
Standard 7: Professional Responsibility & Accountability
Standard 1: Health Promotion
Encourages families dealing with a chronic illness to participate in regular social
activities
Standard 2: Prevention and Health Protection
Observe high rates of smoking among caregivers & clients, they raise a concerns & a
task group is formed to find a way to address the issue
Standard 3: Health Maintenance, Restoration & Palliation
,Provide ongoing care coordination to individuals & families experiencing poor health
( home visits/ follow up phone calls)
Standard 4: Professional Relationships
Initiate mother to mother groups for women in a specific linguistic group so they can
share resources
Standard 5: Capacity Building
Helps groups & communities gather available resources & support taking action to
address their health issues
Standard 6: Access and Equity
Identifies & facilitates universal and equitable access to available services
Standard 7: Professional Responsibility & Accountability
Documents all activities in a timely & thorough manner ( includes telephone & work with
individuals, families, populations,etc)
Determinants of Health LaLonde 1974
Proposed changes in lifestyles or social & physical environments would likely lead to
more improvements in health
Gave rise to a number of highly successful, proactive health promotion programs
Increased awareness of the health risks associated with certain personal behaviours
and lifestyles
First health determinants: biology, lifestyle, health care & environment
Examples: smoking, alcohol, nutrition & fitness
Determinants of Health Epp 1986
Expanded on the LaLonde Report
Focuses on the broader social, economic & environmental factors that affect health
These factors or determinants of health: income level, education & the physical
environment where one lives and works as important influences on health
Determinants of Health Ottawa Charter 2006
Process of enabling people to increase control over & to improve their health
Core values of equity, participation & empowerment
Pre-requisites for health: peace, shelter, education, food, income, stable ecosystem,
sustainable resources, social justice & equity
Personal Health Practices and Coping Skills
Personal life choices
social support network
A source of emotional reassurance and provides a safe place for a person to discuss
their problems, which can help them to cope with adversity
social environment
Social or community responses
Income and Social Status
These two factors may be the most important determinants of health
culture
The customs, traditions & the beliefs of the family and community
Employment and Working Conditions
Unemployment, stressful or unsafe work
Biology and Genetic Endowment
Genetic inheritance
, health services
Access and use of services that promote health & prevent disease influence health
Education and Literacy
The degree to which individuals have the capacity to obtain, process & understand
basic health information and services needed to make appropriate health decisions
physical environment
Housing, air quality, water quality, safe houses and transportation systems
gender
Societal characteristics that society ascribes to the two sexes
healthy childhood development
Early childhood development
Social Determinants of Health
Social conditions & broader forces that interact to influence risks to health and affect
how vulnerable or resilient people are to disease or injury
Most Important Social Determinants
Poverty
Economic inequality
Social Status
Stress
Education
Care in early Life
Social determinants of health can predict the health of populations
Identify cardiovascular disease & diabetes the most closely linked to social
determinants
Population Focused Practice
It directs community health nursing practice
Emphasis is on reducing health inequalities of a defined population or aggregate
This is contrast to an individual focused health care
Population health are the health outcomes of a population
Measured by the determinants of health and health status indicators
CHN emphasizes:
Population health promotion
Population disease prevention
Population health protection
Primary Health Care 1978 International Conference on Primary Health Care
Held in Alma, Ata USSRWHO committed to a goal of achieving “health for all” by the
year 2000Alma-Ata is recognized as part of the shift to primary health care
Primary Health Care
=Primary contact between individuals & health care providers
=Formalized way of promoting health
=Addresses social injustice & equity issues
=Includes disease prevention; community development; working in interprofessional
teams
=International strategy for achieving “health of all”
CHN in Primary Health Care
Primary responsibility is health promotion & illness prevention
Nursing-O05-2024 Winter.
What is a Community?
-People and the relationships that emerge among them as they develop
-Commonly shared agencies, institutions or a physical environment
-Geography ( city or town or province)
-Common interests or focus ( children attending a particular school)
What is Community Health Nursing?
-All nurses who work in and with the community
Focus is on the health of the individual & population
-Umbrella term that includes a variety of different practices
Public Health
Home Health
Occupational Health
-Involves direct care, coordinating care & planning services, programs & policies
-Through the collaboration with individuals, caregivers, families, communities &
governments
-Combines knowledge of nursing theory, social sciences & public health science
Populations & Aggregates
1. CHN emphasize population health promotion, disease prevention & health protection
2. Population
Large group of people who share 1 or more personal or environmental characteristics
Example: All high risk children
3. Aggregate
Groups within a population
Example: High risk infants younger than 1 year of age
4. Population Health
Health outcomes of a population
Measured by the determinants of health & health status indicators ( life expectancy)
Historical Roots of CHN
1980-1990s
Shift in public health strategy from illness prevention to health promotion
Escalating health care costs = reduced funding for health promotion & disease
prevention programs
2001
Researchers demonstrated that home care for older adults cost less than institutional
care
2002
Romanow Report identified home care as the most rapidly growing area of community
health
Part of this is due to early discharge
2020
Estimated that two-thirds of all nurses in Canada will be practicing in the community
,Canada Health Act
Enacted in 1984
5 Principles of the Act
=Universality
=Accessibility
=Comprehensiveness of services
=Portability
=Public Administration
Federal Government
Establishes & administers the 5 national principles
Provides financial support to the provinces and territories that legislate, organize &
deliver services
Funds/delivers primary & supplementary services to specific groups (First Nations
people living on reserves)
Health Canada
1. Safeguards the population health by surveillance, prevention,
legislation & research
2. Focus on
Environmental Health
Disease Outbreaks
Drug Products
Food Safety
3. Umbrella Agency for
Public Health Agency of Canada (PHAC)
Canadian Institutes of Health Research (CIHR)
Canadian Food Inspection Agency
First Nations & Inuit Health (FNIH)
Canadian Community Health Nursing Standards of Practice
What is the purpose of the CCHN Standards??
They will become basic practice expectations after 2 years of experience
Seven CCHN Standards
Standard 1: Health Promotion
Standard 2: Prevention and Health Protection
Standard 3: Health Maintenance, Restoration & Palliation
Standard 4: Professional Relationships
Standard 5: Capacity Building
Standard 6: Access and Equity
Standard 7: Professional Responsibility & Accountability
Standard 1: Health Promotion
Encourages families dealing with a chronic illness to participate in regular social
activities
Standard 2: Prevention and Health Protection
Observe high rates of smoking among caregivers & clients, they raise a concerns & a
task group is formed to find a way to address the issue
Standard 3: Health Maintenance, Restoration & Palliation
,Provide ongoing care coordination to individuals & families experiencing poor health
( home visits/ follow up phone calls)
Standard 4: Professional Relationships
Initiate mother to mother groups for women in a specific linguistic group so they can
share resources
Standard 5: Capacity Building
Helps groups & communities gather available resources & support taking action to
address their health issues
Standard 6: Access and Equity
Identifies & facilitates universal and equitable access to available services
Standard 7: Professional Responsibility & Accountability
Documents all activities in a timely & thorough manner ( includes telephone & work with
individuals, families, populations,etc)
Determinants of Health LaLonde 1974
Proposed changes in lifestyles or social & physical environments would likely lead to
more improvements in health
Gave rise to a number of highly successful, proactive health promotion programs
Increased awareness of the health risks associated with certain personal behaviours
and lifestyles
First health determinants: biology, lifestyle, health care & environment
Examples: smoking, alcohol, nutrition & fitness
Determinants of Health Epp 1986
Expanded on the LaLonde Report
Focuses on the broader social, economic & environmental factors that affect health
These factors or determinants of health: income level, education & the physical
environment where one lives and works as important influences on health
Determinants of Health Ottawa Charter 2006
Process of enabling people to increase control over & to improve their health
Core values of equity, participation & empowerment
Pre-requisites for health: peace, shelter, education, food, income, stable ecosystem,
sustainable resources, social justice & equity
Personal Health Practices and Coping Skills
Personal life choices
social support network
A source of emotional reassurance and provides a safe place for a person to discuss
their problems, which can help them to cope with adversity
social environment
Social or community responses
Income and Social Status
These two factors may be the most important determinants of health
culture
The customs, traditions & the beliefs of the family and community
Employment and Working Conditions
Unemployment, stressful or unsafe work
Biology and Genetic Endowment
Genetic inheritance
, health services
Access and use of services that promote health & prevent disease influence health
Education and Literacy
The degree to which individuals have the capacity to obtain, process & understand
basic health information and services needed to make appropriate health decisions
physical environment
Housing, air quality, water quality, safe houses and transportation systems
gender
Societal characteristics that society ascribes to the two sexes
healthy childhood development
Early childhood development
Social Determinants of Health
Social conditions & broader forces that interact to influence risks to health and affect
how vulnerable or resilient people are to disease or injury
Most Important Social Determinants
Poverty
Economic inequality
Social Status
Stress
Education
Care in early Life
Social determinants of health can predict the health of populations
Identify cardiovascular disease & diabetes the most closely linked to social
determinants
Population Focused Practice
It directs community health nursing practice
Emphasis is on reducing health inequalities of a defined population or aggregate
This is contrast to an individual focused health care
Population health are the health outcomes of a population
Measured by the determinants of health and health status indicators
CHN emphasizes:
Population health promotion
Population disease prevention
Population health protection
Primary Health Care 1978 International Conference on Primary Health Care
Held in Alma, Ata USSRWHO committed to a goal of achieving “health for all” by the
year 2000Alma-Ata is recognized as part of the shift to primary health care
Primary Health Care
=Primary contact between individuals & health care providers
=Formalized way of promoting health
=Addresses social injustice & equity issues
=Includes disease prevention; community development; working in interprofessional
teams
=International strategy for achieving “health of all”
CHN in Primary Health Care
Primary responsibility is health promotion & illness prevention
