Community Health Nursing: Caring for Populations

Front Cover
Prentice Hall, 2003 - Medical - 822 pages
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This book represents the lessons learned and the progress made in more than 100 years of community health nursing in the United States. The year 1993 marked the 100th anniversary of the founding of the Henry Street Settlement, the acknowledged beginning of modern American community health nursing. Since then, the work of community health nurses has led to better health for individuals, families, and population groups. In this book, I have tried to distill the wisdom of early pioneers and present-day practitioners to guide and direct future generations of community health nurses.

Locally, nationally, and globally, society is in greater need of community health nursing services than at any time since our beginning. Although expected longevity has increased significantly in the last century, quality of life has not kept pace for large segments of the world's population. Previously controlled communicable diseases are resurfacing and new diseases are emerging to threaten the public's health. Malnutrition is a fact of life for many people. Chronic physical and emotional diseases are taking their toll on the lives of large numbers of people. Substance abuse and societal violence are rampant, and more and more frequently environmental conditions do not support health. All of these are problems that community health nurses can and do help to solve.

Community health nurses must have the depth and breadth of knowledge that allows them to work independently and in conjunction with others to improve the health of the world's populations. In part, this improvement occurs through care provided to individuals and families, but it must occur on a larger scale through care provided to communities and population groups.Community Health Nursing: Caring for Populationsprovides community health nurses with the knowledge needed to provide care at all these levels. This knowledge is theoretically and scientifically sound, yet practical and applicable to society's changing demands. This book has been written to give students a strong, balanced foundation for community health nursing.

Community Health Nursing: Caring for Populationsis written for all students in community health nursing courses and provides a thorough introduction to all aspects of the specialty. The book is designed to prepare nurse generalists who can function in any setting, providing care to individuals, families, communities, and population groups.

Each unit in this fourth edition is introduced by the work of Veneta Masson. Her writing reflects some of the realities of day-to-day community health nursing practice. The following dialogue between nurse and client is excerpted from one of Ms. Masson's poems, "Christmas Eve at Maggie's," and portrays the sometimes differing perspectives of nurse and client. Throughout the text the poetry presents other intimate glimpses of individual clients and the profession for students to ponder.

Guess what today is Maggie.
What is today? I prod
tense with expectation
as her fingers tighten
round her empty wallet

Why, I reckon . . . Well, praise the Lord!
It must be the first of the month
and my check come! No, Maggie, it's Christmas Eve.
I came to wish you Merry Christmas.
Sorry.

She fumbles with the stale debris
of yesterday's carry-out sandwich.
That so? she says, wiping the wreath
of crumbs from her mouth.
And here I thought it was the first of the month.

The overall approach of this book is to convey to nursing students at the beginning of the twenty-first century the excitement and challenge of providing nursing care in the community. As we begin a new era of community health nursing, I believe that well-educated community health nurses can provide a focal point for resolution of the global health problems presented above. Early community health nurses changed the face of society, and we can be a strong force in molding the society of the future.

I am convinced that when the bicentennial anniversary of American community health nursing occurs in 2093, community health nurses will be able to look back on the accomplishments of our second century with as much pride as the first.

Organization

This textbook is designed to present general principles of community health nursing and to assist students to apply those principles in practice. It is organized in six units. The first three units address general concepts of community health nursing practice and the last three examine the application of those concepts to specific populations, settings, and community health problems.

Unit Isets the stage for practice by describing the context in which community health nursing occur: Readers are introduced to the concept of populations as recipients of nursing care and to the historical underpinnings and development of community health nursing as an area of specialty practice. Other chapters in this unit address the influences of the health care, political, economic, sociocultural, and environmental contexts that influence the health of populations and the practice of community health nursing.

Unit IIexamines community health nursing as a specialized area of practice, exploring its population focus and the attributes and features that make it unique. Standards for practice and typical roles and functions of community health nurses are also addressed. The second chapter in this unit provides several theoretical perspectives on community health nursing and discusses theoretical models applicable to population groups, as well as individuals and families, as recipients of care.

A unique feature of this textbook is the consistent use of the Dimensions Model of Community Health Nursing to structure the discussion of principles of practice. In Units III through VI, elements of the model are used to examine the processes used in community health nursing practice and the provision of care to selected populations, in specialized settings, and with specific community health problems. A change from the previous edition is the elimination of some redundancy in the use of the model across chapters; however, the model remains as an organizing framework for the chapters in these units, systematizing assessment in terms of the six dimensions of health (addressing relevant biophysical, psychological, physical environmental, sociocultural, behavioral, and health systems considerations) and framing nursing interventions in terms of primary, secondary, and tertiary prevention activities. This consistent approach permits students to readily identify commonalities and differences among processes, populations, settings, and problems.

Unit IIIpresents common processes used in community health nursing. In each chapter, the elements of the Dimensions Model are applied to a specific process used by community health nurses. For example, in Chapter 10, students are acquainted with general principles of epidemiology and then apply those principles in the context of the, model to the process of health promotion for individuals, families, and groups of clients. Considerations in each of the six dimensions of health are examined in light of their influence on health promotion. Other processes examined in this unit include the health education, case management, and change, leadership, and group processes.

Unit IVexamines community health nursing care provided to special population groups. In each chapter, students are assisted to apply principles of care to individuals and families, as well as to these populations as aggregates. For example, in Chapter 16, emphasis is placed on community health nursing care for individual children and their families as well as on strategies for improving the health of children as a population group. Similar approaches are taken to the other population groups addressed in the unit: families, communities, women, men, the elderly, and the homeless.

Unit Vpresents community health nursing practice in specialized settings such as the home, school, work, correctional, and disaster settings. Chapter 22, a new chapter in this edition examines the role of the community health nurse in official and voluntary agencies as specialized settings. The local health department is used as an exemplar of official agencies and parish or faith community nursing is the exemplar for community health nursing practice in a voluntary agency. In each of the chapters in the unit, students are guided in the use of the nursing process in the special practice setting. Consideration is given to factors influencing health in each of the six dimensions of health, and nursing interventions at the primary, secondary, and tertiary levels of prevention are discussed.

Unit VIfocuses on community health nursing practice related to common population health problems such as communicable diseases, chronic physical and mental health conditions, substance abuse, and societal violence. Again, students are assisted to apply the nursing process to identify factors contributing to problems in each of these areas and in designing relevant nursing interventions at primary, secondary, and tertiary levels of prevention. Consideration is given to care of individuals and families with these problems as well as to resolving common community health problems at the population level.

NEW FEATURES
  • New Chapter,"Care of Clients in Official and Voluntary Agencies,"includes detailed discussion of parish nursing and its roles and functions as an exemplar of a voluntary health agency. Standards, functions, and services of community/public health nursing serve as a starting point for exploring an official health agency.
  • Cultural Considerationshighlight cultural factors that influence health, health care delivery, and community health nursing practice. Readers are encouraged to examine the effects of their own cultural traditions, as well as those of clients, on health, illness, and nurse-client interactions.
  • Ethical Awarenessintroduces readers to ethical dilemmas faced by community health nurses and assists them to apply principles of ethical decision making.
  • Healthy People 2010: Goals for the Populationprovides a focus for health-related initiatives as well as a snapshot of the current state of health of the U.S. population.
  • Focus on Public Health Aspects of Terrorismincorporates information related to the public health aspects of terrorism. For example, the concept of terrorism and types of terrorist activities and their health effects are introduced in the discussion of global health issues in Chapter 3. Chapter 10 incorporates information on the epidemiology of selected biological weapons. This information is expanded in Chapter 28 and Appendix B, both of which address control of communicable diseases. Finally, terrorist attacks as a form of disaster are addressed in Chapter 27.
HALLMARK FEATURES Chapter Structure

Each chapter ofCommunity Health Nursing: Caring for Populationsincludes:

  • Chapter objectivesthat summarize important points and assist the reader in identifying key issues addressed in the chapter.
  • Key termsthat direct the reader's attention to critical issues addressed in the chapter.
  • Numerous tables and figuresthat highlight important concepts and assist readers in their understanding.
  • Highlightsthat summarize content and assist students to identify major points presented in the text.
  • Assessment Tipsthat provide a series of questions to assist readers in tailoring their nursing assessment to the specific needs of the client population, setting, or health problem addressed in the chapter.
  • Critical Thinking in Researchboxes that stimulate readers to consider research related to chapter topics and to broader their understanding of research principles and methods.
  • Case Studiesthat assist the reader to apply the principles addressed in the chapter to community health nursing practice situations. Each case study is followed by questions designed to promote critical thinking in nursing practice.
  • Testing Your Understandingis a feature that assists readers to evaluate their comprehension of concepts and principles presented in the chapter. These challenging review questions stimulate thought and discussion of important chapter concepts. Each question is I' followed by page references for a quick review of content addressed.
  • Think About Itposes thought-provoking questions to stimulate individual thought or class discussion on issues addressed in the chapter. These questions encourage the reader to go beyond the content presented and to examine related issues and application to their own areas of practice.
  • Referencescontained in each chapter present an up-to-date picture of principles and concepts related to the topic addressed. References provide a balanced view of community health nursing, exploring a variety of issues from several perspectives, and provide a wide range of supplemental material for the interested reader.
  • Full-color photographsserve to bring home to readers the concepts discussed in the chapters while presenting a realistic picture of community health nursing practice.
Appendices

Several of the assessment tools contained in the Appendices of previous editions of the textbook, as well as additional tools previously contained in theCommunity Health Nursing Handbook,have been moved to the companion Web site for the fourth edition. This move was made to permit readers to download immediately usable assessment tools as desired. The remaining appendices present the reader with detailed information that supplements content in the chapters in the book.

COMPREHENSIVE TEACHING AND LEARNING PACKAGE Companion Web Site

The companion Web site for the fourth edition of the textbook contains a variety of supplemental information and assessment tools that will be of immediate use to readers. The Web site includes the following new features:
http://www.prenhall.com/clark

  • Chapter outlines:Detailed chapter outlines assist readers to organize their learning of chapter content and to easily refer back to important portions of the chapter.


  • Chapter objectives:Chapter objectives assist readers in identifying key concepts contained in each chapter.


  • Key terms:A list of key terms and audio glossary from the text are included to assist students to grasp basic concepts of community health nursing.


  • Multiple-choice questions:Multiple-choice review questions are provided for each chapter to assist readers to evaluate their comprehension of chapter content. Answers and rationale are provided for questions posed.


  • Challenge Your Knowledge:TheChallenge Your Knowledgefeature presents readers with thought-provoking short essay questions that test and expand comprehension of important concepts presented in each chapter. These questions assist students in the application of principles of community health nursing in practice.


  • Expanding Your Perspective:This feature presents summaries of full-text articles that assist readers to examine a topic in more depth or additional2ase studies that promote the application of theoretical principles to practice. Links to several full-text research articles are provided related to selected chapters in the text. These articles present research studies related to the content in relevant chapters. Each article summary is followed by questions that assist the reader to evaluate the study and the applicability of findings to community health nursing practice in their own locations.

    Case studies assist readers in applying principles presented in the chapter to actual community health nursing practice. Each case study is followed by questions to stimulate thought on the part of the reader; potential answers to these questions are provided.


  • Assessment tools:Assessment tools provided on the Web site include those previously included in the appendices to the text as well as several additional tools from theCommunity Health Nursing Handbook.Some new assessment tools are included as well. Tools are based on a consistent assessment format and address considerations in each of the six dimensions of health (biophysical, psychological, physical environmental, sociocultural, behavioral, and health system) as they affect the health status of specific population groups or in specific settings.


  • Web links:Web links are provided to additional sources of information related to chapter topics.


  • Information updates:This feature provides periodic updates on information that changes more frequently than a textbook can be revised (for example, immunization schedules, new epidemiologic information for selected conditions). Updated incidence and prevalence maps for selected conditions are also included.
INSTRUCTOR'S RESOURCE CD-ROM

TheInstructor's Resource CD-ROMincludes the following features:

  • Detailed chapter outlinesthat pinpoint the main issues discussed in each chapter.
  • Learning objectivesthat provide instructors with student goals for each chapter.
  • Key termsand definitions provided in the core text.
  • PowerPoint slidesfor each chapter that can be use to structure class presentations.
  • Suggested teaching strategiesthat actively involve students and help bring community health nursing practice to life.
  • Discussion topicsthat will evoke active student participation in the classroom. The topics presented can also be used for out-of-class activities by students.
  • Answers to case study questionspresented in the text that allow for their use as examinations or for class discussion.
  • Test questionsin multiple-choice format that test students' grasp of content provided in each chapter. Answers and rationale are also provided.
  • Discussion guidesfor theCritical Thinking in Research, Cultural Considerations,andEthical Awarenessfeatures that allow faculty members to make the most effective use of these features to expand students' knowledge and understanding.

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Contents

Homeless Clients
4
CHAPTER
21
Defining Populations as a Focus for Care
35
Copyright

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About the author (2003)

Mary Jo Clark, PhD, RN, PHN has been practicing and teaching community health nursing for 40 years. After completing her BSN degree at the University of San Francisco, she received her introduction to global community health nursing as a U.S. Peace Corps Volunteer in Vita, India, a rural town with a population of about 3,000. Returning to the United States, Dr. Clark employed her cross-cultural expertise as a Public Health Nurses in the Los Angeles County Department of Health Services. In 1973, she became a pediatric nurse practitioner, and later began teaching community health nursing at East Tennessee State University. She completed a masters degree in community health nursing at Texas Women's University and a PhD in nursing at the University of Texas at Austin. Moving with her Army nurse husband to Augusta, Georgia, she taught graduate and undergraduate community health at the Medical College of Georgia. For the past 20 years, Dr. Clark has taught at baccalaureate, masters, and doctoral levels at the University of San Diego, Hahn School of Nursing and Health Science. In addition to her full-time teaching and writing, Dr. Clark has maintained an active community health nursing practice. She is well known in the community health nursing field and has provided consultation and made presentations across the country and overseas. Her many and varied experiences in community health nursing in the United States and abroad form the core of the material presented in this book.

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