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Community health is a process of health promotion and disease prevention in which community leaders identify community problems and assets, create consensus on goals, take action, and reach goals. Useful theories and models that can be applied to the study of community health include cultural change theories, social change theories, critical theories, community development, diffusion of innovation, ecological models, community participation, community power, and community decision making. The concept of community health incorporates a broad definition of health, one that recognizes the multiple community factors that support and impinge on health. The basic elements of nursing practice incorporated in community health nursing programs are: promotion of healthful living, prevention of health problems, treatment of disorders, rehabilitation, evaluation and research.

Theories and models of Community Nursing Process

  • Nightingale’s Theory of Environment
  • Orem’s Self Care Model
  • Neuman’s Health Care System’s Model
  • Roger’s Model Of The Science Of Unitary Man
  • Parser’s Human Becoming Theory
  • Pender’s Health Promotion Model
  • Roy’s Adaptation Model
  • Milio’s Framework For Prevention
  • Salmon White’s Construct For Public Health Nursing
  • Minnesota Wheel The Public Health Interventions Model
  • Omaha System Model
  • Block and Josten’s Ethical Theory Of Population Focused Nursing
  • Canadian Model For Community

Nightingale’s Theory of Environment

Nightingale’s documents contain her philosophical assumptions and beliefs regarding all elements found in the metaparadigm of nursing.  These can be formed into a conceptual model that has great utility in the practice setting and offers a framework for research conceptualization. (Slanders’ LC, 2010) Nursing is different from medicine and    the goal of nursing is to place the patient  in the best possible condition for nature to act. Nursing is the “activities that promote health (as outlined in canons) which occur in any care giving situation.  They can be done by anyone.”

Neuman’s Health Care System’s Model

The Neuman Systems Model is a unique, open systems-based perspective that provides a unifying focus for approaching a wide range of international health concerns. Being universal in nature, it is open to creative interpretation and is widely used throughout the world as a multidisciplinary, wholistic, and comprehensive guide for excellence in nursing practice, education, research, and administration. Its concepts, processes, and theoretical base are relevant to complement future emerging health care trends and issues ‘Neuman’s systems model is based on the individual’s relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. Betty Neuman is a community health nurse and clinical psychologist who has developed this theory. Her model’s basic central core consists of energy resources (normal temperature range, genetic structure, response pattern, organ strength or weakness, ego structure, and knowns or commonalities) that are surrounded by several lines of resistance, the normal line of defense, and the flexible line of defense. The lines of resistance represent the internal factors that help the patient defend against a stressor, the normal line of defense represents the person’s state of equilibrium, and the flexible line of defense depicts the dynamic nature that can rapidly alter over a short period of time.

The purpose of the nurse is to retain this system’s stability through the three levels of prevention:

  • Primary prevention to protect the normal line and strengthen the flexible line of defense.
  • Secondary prevention to strengthen internal lines of resistance, reducing the reaction, and increasing resistance factors.
  • Tertiary prevention to readapt and stabilize and protect reconstitution or return to wellness following treatment.

Orem’s Theory of Self Care

Each person has a need for self care in order to maintain optimal health and wellness. Each person possesses the ability and responsibility to care for themselves and dependants. Theory is separated into three conceptual theories which include: self care, self care deficit and nursing system.

Martha E. Rogers Science of Unitary Human Beings

Nursing is both a science and art; the uniqueness of nursing, like that of any other science, lies in the phenomenon central to its focus. Nurses long established concern with the people and the world they live is in a natural forerunner of an organized abstract system encompassing people and the environments.

The irreducible nature of individuals is different from the sum of the parts.The integralness of people and the environment that coordinate with a multidimensional universe of open systems points to a new paradigm: the identity of nursing as a science. The purpose of nurses is to promote health and wellbeing for all persons wherever they are.

Parser’s Human Becoming Theory

The theory is structured around three abiding themes: meaning, rhythmicity, and transcendence. The model makes assumptions about man and becoming, as well as three major assumptions about human becoming. The three major assumptions about human becoming are: meaning, rhythmicity, and transcendence.

The Human Becoming Theory makes the following assumptions about man:

  • The human is coexistent while co-constituting rhythmical patterns with the universe.
  • The human is open, freely choosing meaning in a situation, as well as bearing responsibility for decisions made.
  • The human is unitary, continuously co-constituting patterns of relating.
  • The human is transcending multidimensionally with the possibles.

The Human Becoming Theory makes the following assumptions about becoming:

  • Becoming is unitary with human-living-health.
  • Becoming is a rhythmically co-constituting the human-universe process.
  • Becoming is the human’s patterns of relating value priorities.
  • Becoming is an intersubjective process of transcending with the possibles.
  • Becoming is the unitary human’s emerging.

Pender’s Health Promotion Model

Nora J. Pender developed the Health Promotion Model that is proposed as a holistic predictive model of health-promoting behavior for use in research and practice. Health Promotion Model has given health care a new direction. According to her, Health Promotion and Disease Prevention should be the primary focus in health care, and when health promotion and prevention fail to prevent problems, and then care in illness becomes the next priority. She defined 2 concepts: health promotion & health protection.

Roy’s Adaptation Model

This model comprises the four domain concepts of person, health, environment, and nursing and involves a six step nursing process, which includes: assessment of behavior, assessment of stimuli, nursing diagnosis, goal setting, intervention and evaluation. Roy’s goal of nursing is “the promotion of adaptation in each of the four modes, thereby contributing to the person’s health, quality of life and dying with dignity”

Milio’s Framework for Prevention

Nancy Milio developed a framework for prevention that includes concepts of community oriented, population focused care. Behavioral patterns of the populations and individuals who make up populations are a result of habitual selection from limited choices. She challenged the common notion that a main determinant for unhealthful behavioural choice is lack of knowledge. Milio’s framework described a sometimes neglected role of community health nursing to examine the determinants of a community’s health and attempt to influence those determinants through public policy.

Salmon White’s Construct for Public Health Nursing

Marla Salmon, a leader in public health nursing administration, nursing education, and public health policy in the United States, proposed a model to guide community health nursing practice. In Construct for Public Health Nursing, Salmon (1982) described public health as an organized soci­etal effort to protect, promote, and restore the health of peo­ple, and public health nursing as focused on achieving and maintaining public health. The model describes three practice priorities. Not surprisingly, these are prevention of disease and poor health, protection against disease and external agents, and promo­tion of health

Minnesota Wheel the Public Health Interventions Model

Minnesota Department of Health, Division of Community Health Services, Public Health Nursing Section, has devised a model that depicts public health interventions and applications for public health practice. In the form of a wheel, the model shows 17 different interventions within three levels of public health practice: population based community focused practice, systems-focused practice, and individual-focused practice.

Omaha System Model

The Omaha System is a research-based, comprehensive practice and documentation standardized taxonomy or classification designed to document client care from admission to discharge. The hierarchy and terms of the Omaha System are summarized in the Overview, and include an assessment component (Problem Classification Scheme), an intervention component (Intervention Scheme), and an outcomes component (Problem Rating Scale for Outcomes).

Consists of three relational, reliable, and valid components designed to be used together:

  • Problem Classification Scheme (client assessment)
  • Intervention Scheme (care plans and services)
  • Problem Rating Scale for Outcomes (client change/evaluation)

Block and Josten’s Ethical Theory of population focused nursing

Derryl Block and Lavohn Josten, public health educators proposed this based on intersecting fields of public health and nursing. They have given 3 essential elements of population focused nursing that stem from these 2 fields:

  • an obligation to population
  • the primacy of prevention
  • centrality of relationship- based care

The first two are from public health and the third element from nursing. Hence it implies to nursing that relation-based care is very important in population focused care.

HOME HEALTH CONCEPTS 

The home care nurse functions in the home and community, outside the walls of a hospital or other health care facility. The role is more independent and the basic concepts of home health are different from hospital or outpatient nursing.

Roles and Duties of the Home Care Nurse

  • The home care nurse maintains a comprehensive knowledge base of the health of the patient.
  • The home care nurse performs an extensive evaluation of the patient’s medical history, physical condition, psychosocial well-being, living environment, and support systems.
  • The home care nurse functions independently, recommending to the primary or specialty health care provider what services are needed in the home.
  • The home care nurse coordinates the services of other disciplines such as physical therapy, occupational therapy, nutrition, and social work.
  • The home care nurse oversees the entire treatment plan and keeps the health care provider apprised of the patient’s progress or lack of progress toward goals.
  • The home care nurse acts as a liaison between patient, family, caregivers, and the primary health care provider and other members of the health care team.
  • The home care nurse may function as supervisor of home health aides who provide direct daily care for the patient.
  • The home care nurse must honor patient rights as in the hospital

Skills for Home Care Nursing

  • Good rapport building to engage the patient, family, and caregivers in goal attainment.
  • Clear communication to provide effective teaching to family and caregivers, to relate assessment information about the patient to the health care provider, and to share information with the home care team.
  • Cultural competence knowledge and appreciation of the cultural norms being practiced in the home. Cultural practices may affect family structure, communication, and decision making in the home; health beliefs, nutrition, and alternative health practices; and spirituality and religious beliefs.
  • Accurate documentation record keeping in home care is used for reimbursement of nursing services, accreditation and regulatory review, and communication among the home care team.

HOME HEALTH PRACTICE

The nursing process is carried out in home care as it is in other nursing settings. Patient interactions are structured differently than in the hospital because the nurse will interact with the patient for a limited time. Major concerns of the home care nurse are patient teaching, infection control, and maintenance of safety.

Common Nursing Diagnosis Found in Community Health

  • Deficit knowledge of treatment
  • Risk for falls
  • Risk for infection

NO

NURSING DIAGNOSE

NURSING OUTCOME

INTERVENTION

EVALUATION

1

Deficit knowledge of treatment Increasing knowledge of family about treatment
  • Teach the directed toward the patient, family, caregivers, and involved significant others.
  • Teaching the considered skilled and therefore reimbursable. Topics may include:
    • Disease process, Pathophysiology, and signs and symptoms to monitor treatment.
    • Administration of inject able medication or complex regimen of oral medications.
    • Diabetic management for a newly diagnosed diabetic.
    • Wound or ostomy care.
    • Catheterization.
    • Gastrostomy and enteral feedings.
    • Management of peripheral or central I.V. catheters.
    • Use of adaptive devices for carrying out activities of daily living and ambulation.
    • Transfer techniques and body alignment.
    • Preparation and maintenance of therapeutic diet.

 

  • Evaluated and removed or compensated for barriers to learning
  • Plan the teaching include the three domains of learning:
    • Cognitive sharing facts and information
    • Affective address the patient’s feelings about the disease and treatment
    • Psychomotor  performance of desired behavior or steps in a procedure
  • Make a documentation of patient teaching specific and include the degree of patient competence of the procedure.
  • Take several teaching plans sessions to implement successfully.
Knowledge of treatment sufficient

2

Risk for falls Ensuring Safety
  • Continually assess safety in the home, particularly if the patient is very ill and the care plan is complex.
  • Assess for environmental safety issues cluttered spaces, stairs, throw rugs, slippery floors, poor lighting.
  • Assess for patient’s personal safety issues sensory deficits, weakness, and problems with eating or swallowing.
  • Assess safety in the bathroom handrails, bath mat, raised toilet seat, water temperature.
  • Assess safety in the kitchen proper refrigeration of food, ability to shop for and cook meals, oven safety.
  • Be alert for abuse and neglect, especially of children, dependent elders, and women.
  • Check equipment for electrical and fire safety and that it is being used properly.
  • Be continually cognizant of your own safety get directions, travel during daylight hours, wear seat belts, do not enter suspicious areas without an escort, be alert to your surroundings.

 

Patient safety

3

Risk for infection Infection Control
  • Assess and maintain a clean environment.
    • Make sure that clean or sterile supplies are readily available when needed.
    • Make sure that contaminated supplies are disposed of promptly and properly.
      • Needles should be disposed of in a sharps container (usually kept in the home), which can be disposed of through the home health agency or the patient’s pharmacy.
      • Supplies, such as dressings, gloves, and catheters, should be securely bagged and disposed of in small amounts through the regular trash collection at the patient’s home. However, biohazard waste disposal may be necessary in some cases
  • Be aware of all methods of transmission of infection and implement and teach preventive practices.
  • Perform ongoing assessment for signs and symptoms of infection, and teach the patient, family, and caregivers what to look for.
  • Be aware of community-acquired infections that may be prevalent in certain populations, such as tuberculosis, human immunodeficiency virus infection, hepatitis, and sexually transmitted diseases.
    • Teach preventive practices.
    • Encourage and institute screening programs.
    • Report infections according to the local public health department policy.
  • Encourage and provide vaccination for the patient and household contacts for influenza, pneumococcal pneumonia, hepatitis B, and others as appropriate.

 

Infection not appear

Reference:

http://www.neumansystemsmodel.org/
http://en.wikipedia.org/wiki/Neuman_systems_model
http://currentnursing.com/nursing_theory/Florence_Nightingale_theory.html
http://en.wikipedia.org/wiki/Martha_E._Rogers
http://nursing-theory.org/theories-and-models/parse-human-becoming-theory.php
http://nursingtheories.blogspot.com/2008/07/health-promotion-model-heuristic-device.html
http://www.omahasystem.org/overview.html

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