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A comprehensive
community assessment can lead to

community health programs
such as adolescent smoking prevention, sex education, and proper


Some examples of assessment include

gathering information
on incident rates for identifying and reporting new infections
or diseases, determining adolescent pregnancy rates, and
reporting the number of motor vehicle accidents by teenage drivers


The five-level health services pyramid is an example of how to
provide community-based services within existing health care services
in a community

Primary Care (Health Promotion)
• Prenatal and well-baby care
• Nutrition counseling
• Family planning
• Exercise classes
Preventive Care
• Blood pressure and cancer screening
• Immunizations
• Mental health counseling and crisis prevention
• Community legislation (e.g., seat belts, air bags, bike helmets)
Secondary Acute Care
• Emergency care
• Acute medical-surgical care
• Radiological procedures for acute problems (e.g., x-rays, CT scans)
Tertiary Care
• Intensive care
• Subacute care
Restorative Care
• Cardiovascular and pulmonary rehabilitation
• Sports medicine
• Spinal cord injury programs
• Home care
Continuing Care
• Assisted living
• Psychiatric and older adult day care


public health nursing

focus requires understanding the needs of
a population or a collection of individuals who have one or more
personal or environmental characteristics in common


Community health nursing

is nursing practice in the community,
with the primary focus on the health care of individuals,
families, and groups in a community.


examples of vulnerable populations

Individuals living in poverty, older
adults, people who are homeless, immigrant populations, individuals
in abusive relationships, substance abusers, and people with
severe mental illnesses


populations often have

higher rates of hypertension, diabetes mellitus,
and infectious diseases; decreased outcomes of care; and
shorter life expectancies


Risk factors for abusive relationships

mental health problems, substance abuse, socioeconomic
stressors, and dysfunctional family relationships



Monitor blood pressure and weight; educate about nutrition and antihypertensive drugs; teach stress management
techniques; promote an optimal balance between rest and activity; establish blood pressure screening programs;
assess patient’s current lifestyle and promote lifestyle changes; promote dietary modifications by using techniques
such as a diet diary.



Obtain health history; promote monthly breast self-examinations and annual Papanicolaou (Pap) smears and
mammograms for older women; promote regular physical examinations; encourage smokers to stop smoking; correct
mistaken beliefs about processes of aging; provide emotional support and quality of care during diagnostic and
treatment procedures.



Educate adult about management of activities, correct body mechanics, availability of mechanical appliances, and
adequate rest; promote stress management; counsel and assist family in improving communication, role negotiation,
and use of community resources; teach adult to be cautious of false advertisements that promise a cure for arthritis.


Confusional states

Provide for a protective environment; promote activities that reinforce reality; assist with adequate personal hygiene,
nutrition, and hydration; provide emotional support to the family; recommend applicable community resources such as
adult day care, home care aides, and homemaker services.



Maintain the best possible functioning, protection, and safety; foster human dignity; demonstrate to the primary family
caregiver techniques to dress, feed, and toilet adult; provide frequent encouragement and emotional support to
caregiver; act as an advocate for patient when dealing with respite care and support groups; protect patient’s rights;
provide support to maintain family members’ physical and mental health; maintain family stability; recommend
financial services if needed.


Medication use and abuse

Obtain drug history; educate adult about safe medication storage, the danger of polypharmacy, the risks of drug-drug
and drug-food interactions, and general information about drug (e.g., drug name, purpose, side effects, dosage);
instruct adult about presorting techniques (using small containers with one dose of drug that are labeled with
specific administration times).


In community-based practice, case management
is an important competency

It is the ability
to establish an appropriate plan of care based on assessment
of patients and families and to coordinate needed resources and
services for the patient’s well-being across a continuum of care.


A community-based nurse is also a change

This involves identifying and implementing new and more
effective approaches to problems. You act as a change agent within
a family system or as a mediator for problems within a patient’s
community. You identify any number of problems


Patient Advocate

Your patients often need someone
to help them walk through the system and identify where to go for
services, how to reach individuals with the appropriate authority,
what services to request, and how to follow through with the information
they receive



For example, when your patient is discharged home with
terminal cancer, you collaborate with hospice staff, social workers,
and pastoral care to initiate a plan to support end-of-life care for
the patient and support the family. For collaboration to be effective,
you will need mutual trust and respect for each professional’s abilities
and contributions



As a counselor
you are responsible for providing information, listening objectively,
and being supportive, caring, and trustworthy



Nurse epidemiologists are responsible for community surveillance
for risk factors (e.g., tracking incidence of elevated lead levels
in children and identifying increased fetal and infant mortality rates, increases in adolescent pregnancy, presence of infectious and communicable diseases, and outbreaks of head lice). Nurse epidemiologists
protect the level of health of the community, develop sensitivity to changes in the health status of the community, and
help identify the cause of these changes.


Community assessment

is the systematic
data collection on the population, monitoring the health
status of the population, and making information available about
the health of the community


The community has three components:

structure or
locale, the people, and the social systems. To develop a complete
community assessment, take a careful look at each of the three
components to identify needs for health policy, health programs,
and needed health services


For example, when assessing a patient’s home for safety, you consider
the following:

does the patient have secure locks on doors?
Are windows secure and intact? Is lighting along walkways and
entryways operational?



• Name of community or neighborhood
• Geographical boundaries
• Emergency services
• Water and sanitation
• Housing
• Economic status (e.g., average household income, number of residents on
public assistance)
• Transportation



• Age distribution
• Sex distribution
• Growth trends
• Density
• Education level
• Predominant ethnic groups
• Predominant religious groups


Social System

• Education system
• Government
• Communication system
• Welfare system
• Volunteer programs
• Health system


A community-based nurse is competent

as a caregiver, collaborator,
educator, counselor, change agent, patient advocate, case
manager, and epidemiologist.


A community nurse in a diverse community is working with
health care professionals to provide prenatal care for underemployed
and underinsured South African women. Which
overall goal of Healthy People 2020 does this represent?

Increase life expectancy and quality of life and eliminate
health disparities


The overall
goals of Healthy People 2020

are to increase life expectancy andquality of life and eliminate health disparities through an improved
delivery of health care services


To begin a community assessment the structure and geographical boundaries of the community are identified.

Look at the structures in the community (e.g., schools, churches, types of residences). Next obtain data about the population and the demographics of the community. Who are the residents, what is the age range, and what types of ethnicity are represented? Finally review the social systems in the community. Although the number of schools and churches were obtained when reviewing the community structure, it is important to know what, if any, community services are provided by the schools and churches, including parenting classes, support groups, and play days