community health nursing as advocacy copyright ©2008 by pearson education, inc. upper saddle river,...

Community Health Nursingas Advocacy

Copyright ©2008 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.Community Health Nursing, 5/eMary Jo Clark

1CHAPTER

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Definition of Community Health Nursing

• Science and practice of public health

• Systematic use of nursing process

• Promotes health and prevent illness

• Focuses on population groups



Past and Present

• Public health– Environmental sanitation– Control of communicable diseases

• Community health– Health education– Individual behavior change– Actions to change factors that influence health



Community-Based Nursing

• Provides care to individuals (often to those who are ill)

• Delivers care in a community setting



Community-Focused Nursing

• Brings nursing knowledge and expertise to community



Community-Driven Nursing

• Focuses on whole community needs as identified by community members

• Emphasizes community participation to determine needs



Community Health Nursing

• Mission, goals, and expectations– Promote and improve health– Prevent illness and injury– Protect from threats

• Biological• Behavioral• Social• Environmental



Program-focused

• Service delivery system

• Specific health problems

• Specific target populations

• Specialist practice

• Focus on a specific set of services

• More focus on services to groups



Problem Solving in Community Health Nursing



District Nursing

• Originated in England

• Addresses health needs of given geographic segment of the population

• Broad spectrum of services

• Generalist practice

• More services to individuals



Eight Unique Attributes of Community Health Nurses

• Population consciousness

• Orientation to health

• Autonomy

• Creativity



Eight Unique Attributes of Community Health Nurses (continued)

• Continuity

• Collaboration

• Intimacy

• Variability



Advocacy

• Definition

• Nursing advocacy



Community Health Nursing Advocacy

• Definition



Advocacy Models

• Guardian of legal rights

• Preservation of patient values

• Champion of social justice and access to care

• Client empowerment



Advocacy Process

• A recipient of the advocacy

• An advocate

• An adversary

• A consequence for all the participants in the process



Advocacy Process (continued)

• Factors that influence participants in an advocacy situation– Knowledge– Conviction– Emotion



Approaches to Effective Advocacy

• Advocate takes action that is situation- and client-specific

• Use a collaborative and cooperative approach with the adversary

• Educate the advocacy recipient or adversary• Confront the adversary• Request a change• Explain• Enlist the aid of others



Community Health Nurse Functions in the Advocacy Role

• Determine the need for advocacy

• Determine the point at which advocacy is most effective

• Collect facts surrounding the problem

• Present the client’s case to the appropriate decision makers

• Prepare clients to speak for themselves



Standards of Practice

• Essential to a profession



Developed by Quad Council of Public Health Nursing Organizations

• Apply nursing process to community/public health nursing practice

• Incorporate core functions of pubic health



Professional Standards

• Expected levels of professional performance

• Quality of practice

• Education

• Practice evaluation

• Collegiality



Professional Standards (continued)

• Ethics

• Collaboration

• Research

• Resource utilization

• Leadership

• Advocacy



Eight Domains of Competency

• Analytic assessment

• Policy development and program planning

• Communication

• Cultural competence



Eight Domains of Competency (continued)

• Community dimensions of practice

• Basic public health practice

• Financial planning and measurement

• Leadership and systems thinking



Community Health Nursing Roles

• Vary based on specific practice setting

• Focus of activity– Client-oriented roles– Delivery-oriented roles– Population-oriented roles



Focus of Services

• Types and emphasis placed on specific roles vary by practice setting

• Client-oriented roles– Emphasize direct care of specific individuals or

families• Delivery-oriented roles

– Focus on mechanisms of care delivery– Primarily address care delivery to individuals and

families• Population-oriented roles

– Care of communities or populations



Client-Oriented Objectives

• Apply the nursing process

• Assess client needs

• Develop nursing diagnoses

• Plan nursing interventions

• Evaluate nursing care and outcomes



Client-Oriented Roles

• Caregiver

• Educator

• Counselor

• Referral resource

• Role model

• Primary care provider

• Case manager



Caregiver Functions

• Assess client health status

• Derive nursing diagnosis

• Plan nursing intervention

• Implement plan of care

• Perform delegated medical treatments or provide primary care as needed



Caregiver Functions (continued)

• Introduce other supportive services as needed

• Teach and supervise others• Teach clients self-care• Coordinate health care services• Serve as liaison between client and

system• Evaluate the outcome of nursing

intervention and modify plan



Educator Role

• Assess client’s need for education

• Develop health education plan

• Present health education

• Evaluate outcome of health education



Counseling Role: Choose Viable Solutions to Health Problems

• Assist client to identify and clarify problem• Help identify alternative solutions to problem• Assist client to develop criteria for acceptable

solution • Assist client to evaluate alternative solutions• Evaluate problem-solving process• Point out use of problem-solving process for

future use



Referral Resource: Direct Client to Resources Required to Meet Their Needs

• Obtain information on community resources

• Determine need for and appropriateness of referral

• Make and follow up on the referral



Role Model

• Demonstrate behaviors– Influence health related behaviors– Response to crisis– Treatment of clients– Types of client-focused activities– Display competence



Case Manager

• Identify need for case management

• Assess and identify client health needs

• Design plan of care

• Oversee implementation of care by others

• Evaluate outcome of care



Delivery-Oriented Roles

• Enhance operation of health care delivery system– Coordinator/care manager – Collaborator – Liaison



Coordinator/Care Manager

• Determine who is providing care to client

• Communicate with other providers regarding client situation and needs

• Arrange case conferences as needed

• Assist in development of care networks



Collaborator

• Communicate with other health team members

• Participate in joint decision making

• Participate in joint action to resolve client problems

• Participate in joint activities to evaluate the outcome of care



Liaison

• Serve as initial point of contact between client and agency

• Facilitate communication between client and agency personnel

• Interpret and reinforce provider recommendations

• Serve as client advocate as needed



Population-Oriented Roles

• Promote, maintain, and restore the health of population – Case finder– Leader– Change agent– Policy developer



Population-Oriented Roles (continued)

• Community organizer/mobilizer

• Coalition builder

• Social marketer

• Researcher



Case Finder Role

• Develop knowledge of signs and symptoms of health-related conditions and contributing factors

• Use diagnostic reasoning process to identify potential cases of disease or other health-related conditions

• Carry out investigation of specific cases of disease as needed

• Provide follow-up care to identified cases



Leadership Role

• Identify need for action

• Assess situation and followers to determine appropriate leadership style

• Motivate followers to take action

• Coordinate group member activities in planning and implementing action

• Assist followers to evaluate the effectiveness of action taken



Change Agent

• Plans, controls, and enhances health processes– Recognizes need for change– Makes others aware of need– Motivates others to change– Initiates and directs desired change



Community Mobilizer

• Assists community members to identify health issues of concern

• Participates in data collection relevant to issues of concern

• Mobilizes community members to take action• Assists with coalition development to foster community

action• Assists community members to identify achievable goals• Participates in the development of strategies to

accomplish identified goals• Participates in the implementation of community

strategies to achieve goals



Coalition Builder Creating Temporary/Permanent Alliances

• Functions include– Identify potential coalition members based on

common interest, assets available, etc.– Present potential coalition members with the benefits

to be achieved through alliance– Participate in the delineation of coalition goals– Assist in the development of operating guidelines for

the coalition– Participate in the selection and implementation of

strategies to accomplish coalition goals



Policy Advocate

• Determine need for policy development

• Analyze factors influencing the policy situation

• Identify key decision makers

• Assist in policy formation

• Communicate the proposed policy

• Monitor the progress of policy development



Social Marketer

• Identify the need for societal behavior change• Analyze motivation and perceived benefits and

barriers to the desired change• Identify target markets and their unique features• Develop and test social marketing strategies

appropriate to target markets• Assist with implementation strategies• Evaluate the effectiveness of social marketing

strategies in achieving the desired change



Researcher

• Critically review relevant research

• Apply research findings to practice

• Identify researchable problems

• Design and conduct research

• Collect and analyze data

• Disseminate research findings



Resources

• The Center for Nursing AdvocacyThe Center for Nursing Advocacy seeks to increase public understanding of the central, front-line role nurses play in modern health care. The focus of the Center is to promote more accurate, balanced and frequent media portrayals of nurses and increase the media's use of nurses as expert sources. The Center's ultimate goal is to foster growth in the size and diversity of the nursing profession at a time of critical shortage, strengthen nursing practice, teaching and research, and improve the health care system.

community health nursing as advocacy copyright ©2008 by pearson education, inc. upper saddle river,...

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