NFDN 2006 - SLO's

NFDN 2006 – SLO’s
UNIT 1: FOUNDATIONS OF COMMUNITY HEALTH
1) Explain the following concepts:

a) Community health nursing: includes community, public, home, occupational, parish,
outpost, and forensic (IE: sexual assault examiners).
i) Umbrella Term: Encompasses other specialities such as public health, home care, and
occupational health.
(1) Includes: community, public health, home health, occupational health, parish,
outpost, and forensic.
ii) Promotes and protects the health of individuals, families, groups, communities, and
populations.
iii) Emphasis on health promotion and disease prevention.
iv) Enhances self-care.
v) Promotes autonomy in decision making.
vi) Trends:
(1) increasing focus on high risk, high acuity & high needs population
(2) community development/mobilization
(3) more acute care in community (early hospital discharge)
(4) change in working conditions for nurses
(5) increasing first contact primary care role
vii) Community: generally defined as a specific population of people, or a place where
people live and work.
(1) people and the relationships that emerge among them as they develop and
commonly share resources (agencies, institutions & a physical environment).
viii) Involves: acute, chronic & palliative care of clients and families. Promotes
nautonomy in decision making.
ix) Functions: involves coordinating care and planning service, programs, and policies
by collaborating with individuals, caregivers, families, other disciplines, communities
and governments.
(1) Combines knowledge of nursing theory, social sciences and public health science.
x) Scope of practice: population focused health promotion, protection, maintenance,
and restoration.
xi) CHN Standards of practice:
(1) Promoting health (Disease prevention, health protection, health maintenance,
restoration, palliation).
(2) Building individual/community capacity
(3) Building relationships
(4) Facilitating access and equity
(5) Demonstrating professional responsibility and accountability.
xii) Works IN the community: providing health care to individuals and families focused
on health promotion and disease prevention.
(1) IE: helping a client in their home – you are working IN the community.
xiii) Works WITH community as a client: because we view the community itself as
the client. Health of the community and community development.
(1) IE: if you are working with school children, you are working WITH the
community.
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xiv) Involves coordinating care and planning services, programs & policies by
collaborating with individuals, caregivers, families, other disciplines, communities &
governments.
xv) History: before 1980 – “Public health nurse” and “Community health nurse” were
interchangeable. They started to change in late 1980’s.
(1) 1930’s: Canadians wants the government to take responsibility for health care.
Poverty was a result of sociopolitical factors.
(2) 1970’s: Lalonde Report: initiated health promotion movement in Canada.
(3) 1978: Alma Ata Declaration: primary health care was defined
(4) 1986: Epp Report:
(5) 1980-1990: shift from illness prevention to health promotion.
(a) Escalating health care costs = reduced funding for health promotion and
disease prevention programs.
(b) Home health care became popular.
(6) 2001: researchers demonstrated that home care for older adults cost less than
institutional care.
(7) 2002: Romanow Report identified home care as the most rapidly growing area of
community health. Part of this is due to early discharges from hospital.
xvi) Canada Health Act:
(1) Universality: cannot be discriminated against.
(2) Accessibility: all insured people have access to health care facilities.
(3) Comprehensiveness: covers all medically necessary procedures.
(4) Portability: can access health care in any province.
(5) Public Administration: cannot be owned and no one makes a profit.
b) Primary health care:
i) Alma Ata WHO (1978): accessibility, health promotion and disease prevention,
public participation, intersectoral collaboration (other agencies), and technology.
ii) Focuses on education, rehab, support, health promotion & disease prevention.
iii) Involves multidisciplinary teams & collaboration with other sectors as well as
secondary (hospital) & tertiary care (Rehab).
iv) 5 principles of primary health care adopted from Alma-Ata:
(1) Equitable distribution of essential health services to all populations.
(2) Increased emphasis on services that are preventative and promotive rather than
curative only.
(3) Maximum individual and community involvement in the planning and
operation of healthcare services.
(4) The integration of health development with social and economic development.
(5) The use of appropriate technology: IE: using diagnostic technology because we
NEED it, not because we have it.
c) Vulnerable Populations: likely to develop health problems as a result of excess risks.
i) Have barriers to access health care services.
ii) Dependent on others for care.
iii) Poverty, older adults, homeless, abused, high risk behaviour, chronic conditions,
severe mental illness, and new immigrants.
d) Health promotion: empower people to improve their own health.
e) Levels of disease prevention:
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i) Primary: Seeks to prevent disease from the beginning.

(1) immunizations, prevent disease from beginning. IE: COPD – Don’t smoke.
ii) Secondary: Seeks to detect disease early in its progression in order to make early
diagnosis and begin treatment.
(1) Early detection (IE: COPD – smokers over 40 should get yearly screening for
lung function).
iii) Tertiary: Begins once a disease has become obvious; aims to interrupt the course of
the disease.
(1) Reduce disability from disease, rehabilitation. IE: COPD – lung rehabilitation.
f) Population health: determining the health of a population using as measurements of
health, the determinants, and health status indicators.
i) Health status indicators: well being, life expectancy, incidence (# of new cases),
and Prevalence rate (# of people that have been living with the disease), mortality
rate, and burden of illness (cost of loss work time, loss of income, and emotional
stress)
g) Public health: includes the study of epidemiology, statistics & assessment.
i) Functions: health protection, promotion, and assessment, public health surveillance,
and injury & disease prevention.
2) Primary care VS. Primary Health Care
3) PRIMARY CARE 4) PRIMARY HEALTH CARE
5) First contact health care system (HCP’s) 8) Comprehensive concept
6) Usually curative focus: treatment, rehab, 9) Wide spectrum services
and preventative measures (immunization, 10) Interdisciplinary teams
smoking cessation, dietary changes). 11) Intersectoral collaboration for health
7) Downstream thinking policy.
12) Includes disease prevention and
community development.
13) Addresses social justice/equity of
resource allocation.
14) Upstream thinking.
15) Explain collaboration in relation to community health and identify significant historical
events that contribute to the development of community health nursing.
a) Collaboration: the commitment of 2 or more parties who set goals to address identified
health concerns.
i) There are 6 basic principles for collaboration:
(1) Client focus
(2) Population health approach
(3) Quality care and services
(4) Access: making sure they can access the care required.
(5) Trust/respect
(6) Communication
b) Population: a collection of people who share one or more personal or environmental
characteristics
c) Aggregates: subpopulation or groups within a population. IE: elders are the aggregates in
an aboriginal population.
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d) Population health: health of a population using the determinants of health and health
status indicators to determine that health.
i) Health status indicators: well-being, life expectancy, incidence & prevalence rate,
mortality rate, burden of illness.
e) Upstream thinking: a “big picture” approach. Considers determinants of health and
other economic, political, and environmental factors.
i) A Macroscopic, population health approach.
ii) Primary prevention perspective
f) Downstream thinking: considers individual health concerns and treatment without
considering the socio-political, economic, and environmental variables.
i) Taking a microscopic, individual curative focus.
ii) Considers individual health concerns and treatments but does not consider the
sociopolitical, economic, and environmental variables.
16) Identify government agencies responsible for managing community health in Canada.
a) Health Canada: safeguards the population health by surveillance, prevention,
legislation, and research. Umbrella agency for:
i) Public Health Agency of Canada (PHAC)
ii) Canadian Institutes of Health Research (CIHR)
iii) Canadian Food Inspection Agency
iv) First Nations & Inuit Health (FNIH)
17) Describe the Canadian Community Health Nursing Standards of Practice.

a) Promoting health (Disease prevention, health protection, health maintenance, restoration,
and palliation).
b) Building individual/community capacity
c) Building relationships
d) Facilitating access & equity.
e) Demonstrating professional responsibility and accountability.
18) Explain the influence of the social determinants of health on health outcomes.
a) LaLonde (1974): human biology, lifestyle, environment, health care organization
b) Epp (1986): challenges to achieving health by reducing inequalities, increasing
prevention, and enhancing coping skills.
c) Ottawa Charter (2006): pre-requisites for health: Peace, shelter, education, food,
income, stable ecosystem, sustainable resources, social justice & equity.
d) Determinants of Health (2004):
i) Income & Social Status (MOST important)
ii) Social support network
iii) Education & literacy
iv) Employment & working conditions
v) Social Environments: communities we interact with: IE: Church groups.
vi) Physical environments
vii) Personal health practices and coping skills
viii) Healthy childhood development
ix) Biology & genetic endowment
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x) Health services (least important because we always have access to health services).
xi) Culture
xii) Gender.
e) Social Determinants of health: the economic and social conditions that shape the health
of individuals, communities, and jurisdictions as a whole.
i) Nurses ensure people have proper distribution of resources that they need so that they
can improve their health.
ii) IE: Social involvement, housing, childhood development, employment, etc.
iii) Recent literature points to the importance of social determinants of health for client
health.
19) Explain the concept of primary health-care and its impacts on community health.
a) Community health nursing expanded due to:
i) Increased demand for cost effectiveness
ii) Decreased hospital stays (Early discharge)
iii) Consumer preference
iv) Technological advances becoming user friendly
v) Proven quality of service
vi) Hospital bed closures.
20) Define population-focused practice.

a) Traditional health care: individual is the focus. Approach is curative or rehab.
b) Population focused health care: group is the focus. Importance given to influence of the
determinants of health.
i) Emphasis is on reducing health inequalities for a defined population or aggregate, as
opposed to individual-level care.
c) Population focused practice:
i) Population focused approach: looks at health promotion, protection, maintenance &
restoration
ii) Looks at the health of the population or aggregates
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21) Identify the nursing roles within community health.

a) Direct care, educator, consultant, facilitator, communicator, coordinator, collaborator,
researcher, social marketer, community developer, and policy formulator.
b) Public health nursing:
i) Goal is to prevent disease & preserve, promote & protect the health of the community
& the population within
ii) Public health has as a primary focus, the health of communities and populations.
iii) “the greatest good for the greatest number”
iv) Policy development – needs to provide leadership in developing policies that support
population health
UNIT 2: COMMUNITY HEALTH NURSING ROLES
1) Purpose & Goals:

a) Elders are the most frequent users
b) All ages can use services.
c) Interventions may include: Injections, catheter insertion, pressure ulcer treatment, home
IV therapy.
d) Fastest growing section is palliative care.
e) Requires professional and non-professional services to safely support home care.
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f) May be seen as an invasion of privacy.
2) Review specialties and roles that are encompassed within community health nursing.
a) Case Co-ordinator: client conferences, increase coordination between services,
continuity of care, and optimal client care and use of resources.
b) Case manager: not always a nurse, enhance continuity, and provide appropriate care.
3) Canadian Nurses Association: advocates for an effective and equitable home care system
calling for:
a) The application of the Canada Health Act principles to home care programs (Coast to
coast).
i) Accessible, publicly funded and administered.
b) The rooting of a national initiative in the principles of Primary health care
c) The granting of priority status to the needs of family caregivers
d) The integration of a health care provider human resource plan.
e) Recommends making home care an essential service for post-acute clients.
4) Define the following nursing specialties and identify examples of practice settings, functions,
and roles of each:
a) Home Health nursing: originally created to provide care after discharge from hospitals.
i) Includes disease prevention, health promotion, episodic illness related services.
ii) Care provided in place of residence.
iii) Main focus is primary prevention.
iv) Practice setting: in home or wherever the client lives.
v) Client population: elders are most frequent users but all ages can use.
(1) Fastest growing section is palliative care.
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vi) Goals:
(1) Health promotion
(2) Maintenance and restoration.
(3) Rehab and restoration to maximum health function.
vii) Functions:
(1) Helps prevent the occurrence of illness & promote client well-being
(2) Client’s have control over and determine their own health care needs
(3) Need active involvement of the client
(4) It is often intermittent health care & therefore we want to facilitate self-care:
(a) activities that individuals initiate and perform on their own behalf in
maintaining life, health and well-being (Orem, 1995)
(5) Contracting: explains what the nurse’s roles are for the client and what the client’s
expectations are from the nurse’s perspective.
(6) Direct functions: physical care, supervision, assessing and teaching, reporting to
physician.
(7) Indirect functions: consulting with others, advocating, documenting, and
obtaining test results.
viii) Roles:
(1) Case Co-ordinator: client conferences, increase coordination between services,
continuity of care, optimal client care and use of resources.
(2) Case manager: not always a nurse, enhance continuity, and provide appropriate
care.
(3) Nurses must be: self-directed, flexible, adaptable, good critical thinking and
assessment skills.
ix) Expansion of home care due to:
(1) Increased demand for cost effectiveness
(2) Decreased hospital stays (early discharge)
(3) Consumer preference
(4) Technological advances becoming user friendly
(5) Proven quality of service
(6) Hospital bed closures
x) Things to remember:
(1) You are a guest in the home
(2) Need permission to visit and provide care
(3) Client has minimal control over lifestyle.
(4) Need to stay non-judgemental
(5) Convey respect
(6) Cleanliness is often compromised so you have to improvise.
(7) Maintain infection control precautions.
(8) ALWAYS be safe – never let the client get between you and exit.
(9) You are allowed to leave if you do not feel safe.
xi) Discharge planning: a process that connects clients and services, to ensure continuity
of care between hospital and community.
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(1) Goal: to prevent health problems from arising following discharge. Prevent
unnecessary hospital readmission.
xii) Referral Process: directing a client to another source of assistance when the client or
CHN is unable to address the client’s issue.
xiii) Practical Nurse: performing skills, documenting care given, observing and
reporting client changes to agency supervisor, calling appropriate person in
emergency situations, and validating & evaluation of services.
b) Public health nursing: promotes and protects health of individuals, families, groups,
communities, and populations.
i) Takes a population health approach. Work within and external to health units.
ii) Settings: health unit, client homes, school settings.
iii) Goal: Achieve a healthy environment.
iv) Main focus: prevention (mostly primary prevention), health surveillance, and at risk
populations.
v) Client: defined as the population, community, aggregate group, family and
individual.
vi) Public Health: community approach to maintain health, prevent disease, and protect
the population.
vii) Roles: advocate, manager, major referral resource, direct primary care giver,
emergency (disaster) nursing, controlling communicable disease, school health and
safety.
(1) Advocate:
(a) Working with clients in the community
(b) Collects, monitors, and analyzes data
(c) Discuss with clients which services are needed
(d) Develops effective plan and implements it.
(e) Assists the client to become more independent.
(2) Manager: Assesses, plans, implements, and evaluates outcomes of clients needs.
Assists clients to identify services needed.
(3) Major referral resource:
(a) Maintains current info available in the community.
(b) Conducts literacy assessment.
(c) Becomes an educator
(d) Provides client and staff with current usable info.
(4) Primary care giver:
(a) Responsible for healthcare needs.
(b) Includes: prenatal services, immunizations, direct observed treatments,
assessment and treatment for STI’s.
(5) Disaster Nursing:
(a) Determine needs and resources required for crisis situations.
(b) Provide education.
(c) Establish mass dispensing clinics.
(d) Conducting communicable disease surveillance.
(6) Communicable Diseases:
(a) Education, prevention, surveillance and outbreak investigations.
(b) Finding infected individuals and notifying contacts.
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viii) Public health nursing: merges knowledge from public health sciences with
professional nursing theories.
ix) Community health nursing: promotes and protects health of individuals, families,
groups, communities, and populations.
(1) Includes: public health nursing, community mental health, home health,
occupational health, school nursing, and correctional nursing.
c) Parish Nursing: nurse with specialized knowledge and who is called to ministry.
i) Started with nurses working in churches to assist with the congregational health.
ii) They do not administer treatments or medications, they only do health teachings and
counselling.
d) Forensic Nursing: new specialty. Works with emergency departments.
i) Deal with collecting samples, history, determining whether assault has occurred.
e) Outpost nurse: work in community health to provide primary health care to clients in
remote areas.
f) Outreach nurse: street nurses. Usually look after marginalized populations like
homeless, drug addicts, etc.
g) Corrections nurse: work in correctional facilities providing care to inmates.
h) Tele-nurse: providing nursing care through the use of a variety of technologies. Could be
via telephone or skype.
i) Primary care network/family care clinics: having all services in one area for the
clients. IE: Physicians, OT, PT, nursing, dietary, pharmacists, etc.
j) Rehabilitation Nursing:
i) Severe Disability:
(1) Unable to perform one or more ADL’s.
(2) Uses an assist device for mobility.
(3) Needs help from another person to accomplish ADLs.
ii) Rehabilitation: the restoration of a person to the fullest physical, mental, social, and
vocational functioning possible.
(1) To help the client achieve an acceptable quality of life with dignity, self-respect &
independence.
(2) Designed for people with physical, mental or emotional disabilities.
(3) Require rehab after a physical or mental illness, injury, or chemical addiction.
(4) Collaborate with PT and OT, speech and language therapists, social services,
physicians, physiatrist, psychologists, prosthetist, sex therapist, client, and family.
iii) Goal: to assist a client in regaining maximal functional status, thereby enhancing
quality of life while promoting independence and self-care. To function
independently or at pre-illness/injury level.
5) Describe the role of the community health nurse in rural settings.

a) Rural is generally defined in terms of either the geographic location and population
density, or the distance from OR time needed to commute to an urban center.
b) Approx. 1/5 of the Canadian population resides in rural settings.
c) People in rural areas may experience increased health risks such as:
i) Being overweight or obese
ii) Higher rates of smoking
iii) Higher prevalence of heart disease
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iv) Higher-than-average likelihood of mental illness (especially depression)

v) Higher-than-average incidence of hypertension and arthritis
d) Must be: self-directed, flexible, adaptable, good critical thinking and assessment skills.
e) Rural HCP’s usually live and practice in the same places.
f) A limited number of CHN’s (nurse practitioner’s and PHN’s) may offer a full range of
services for residents in a specified area that may span more than 150km.
g) CHN’s need to have an accurate understanding of rural clients in order to design
community health programs that are available, accessible, and appropriate.
h) Barriers to health care in rural settings:
i) Accessibility: lack of existing health care services, and lack of the necessary
personnel to provide those services.
ii) Affordability: services may not come at a reasonable cost, or a family may have
insufficient resources to purchase them when needed.
iii) Acceptability: a service may be inappropriate or may not be offered in a manner that
corresponds with the values of the target population.
i) Challenges for CHN’s in rural settings:
i) Boundaries between CHNs’ home and work roles may blur because they may
personally know many, if not all, clients—they may never feel like they are “off
duty.”
ii) Expectation that CHN will know something about everything (practice can therefore
be demanding)
iii) Heavy workloads
iv) Professional isolation
v) Limited opportunities for continuing education
6) Identify the role of the practical nurse as it relates to community health nursing.
a) Includes population health promotion, protection, maintenance & restoration.
b) Promotes & protects the health of individuals, families, groups, communities, and
populations.
7) Explain the process of incorporating evidence-informed practice as part of the nursing

process when working with community as client.
a) Evidence-informed practice: Combining the best evidence derived from research with
clinical practice, knowledge and expertise, and unique client expectations, preferences, or
choices when making clinical decisions
i) The application of the best available evidence to improve practice (best practices) and
ensures the practice we are doing is CURRENT.
b) Evidence-informed practice has become central to daily nursing practice.
c) It provides guidance to nurses to help them make the most relevant and individualized
nursing care decisions in their practice.
d) IE: use of handwashing – research has shown that handwashing is the best possible way
to reduce the spread of infections.
e) Underlying principle: High-quality care is based on evidence rather than on tradition or
intuition.
f) Evidence-Informed Practice Process:
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i) Community health nurse need to use best available evidence to make policy
recommendations.
ii) CHNs make clinical observations
iii) Will develop hypothesis of what is happening.
iv) CHN will develop clinical/community question
v) Look at various sources of information research.
vi) What evidence do we choose to use?
vii) What changes do we make? How will we implement the changes?
g) Clinical Practice Guidelines: are developed by a team (often interdisciplinary) of
experts who find and appraise the evidence, draw conclusions, and make
recommendations about best practices.
h) Implementing evidence-informed practice: the CHN must:
i) Recognize the importance of assisting the client with decision making.
ii) Ensure that the evidence is at an appropriate literacy level for each client.
iii) Advise the client of the benefits and risks of an intervention.
iv) Consider client preferences and values in practice decisions.
8) Describe ethical decision-making processes.

a) Ethical Decision making: process of how ethical decisions are made.
i) Identify the issue
ii) Clarify your values – our values, the values of the situation, etc.
iii) Identify all alternatives – look at different steps or processes that we could take.
iv) Determine outcome
v) Place on scale of 1-10
vi) Plan of action
vii) Evaluate
9) Describe ethics as a core function of community health nursing.

a) Ethics: a branch of philosophy that includes a body of knowledge about the moral life
and a process of reflection for determining what persons ought to do, or be.
i) Ethical principles of doing good and preventing harm.
ii) Examines ideal human behavior.
iii) Standards of ethical behavior differ from culture to culture and depend on the value of
the culture and its individuals.
iv) Struggle with the rights of the individual and families vs. the rights of local groups
within the community.
b) Ethical Issues: moral challenges facing our profession.
c) Ethical Dilemma: situation that results in a conflict of 2 or more fundamental values.
Puzzling more issues in which a person takes or chooses not to take a course of action.
d) Ethical Decision making: process of how ethical decisions are made.
e) Deontology (Deontic or Duty-based): the action is right or wrong in itself regardless of
the good that might come from it. (A duty to do something or not do something.
i) IE: pushing someone out of the way of a car, yet they still hit their head and die from
you pushing them.
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f) Consequentialism (Teleology): the right action is the one that produces the greatest
amount of good or the least amount of evil in a given situation.
g) Utilitarianism: maximizing of good and minimizing of harm for the greatest number of
people.
h) Morals: Shared, generational societal norms about what constitutes right or wrong.
Morals stem from values.
i) Values: beliefs about shared worth or importance of what is desired or esteemed within
society. What is important to us?
j) Code of ethics: framework nurses use to guide their professional obligations and actions
within the profession.
i) Canadian Nurses Association: developed a code of ethics. LPN’s and RN’s then
created their own that are decided upon by their licencing bodies.
k) Veracity: telling the truth. Promotes trust in a therapeutic relationship.
i) May be exceptions – where telling the truth may bring about more harm than good
(Ethical Judgement).
(1) IE: working with a pregnant mum and can’t find the heartbeat, do you tell her that
you can’t find it and the baby is dead?
ii) Concerned with values.
iii) Best ethical resolution of issues.
iv) Choice of action feels right for resolution of ethical issue.
l) Ethics theories:
i) Consequentialism (teleology): the right action is the one that produces the greatest
amount of good or the least amount of evil in a given situation.
(1) We are looking at actions that produce the best outcome. Looks at the moral value
of an act that is found in the consequences, NOT in the intentions.
(2) IE: by giving someone pain meds, we are relieving their pain.
ii) Utilitarianism: maximizing of good & minimizing of harm for the greatest number
of people
(1) Used by governing bodies or governments that determine what is best for the
majority of the people.
(2) IE: during disasters, we use this approach to triage based on where the resources
should be used that will help the most people.
iii) Deontology (also called deontic or duty-based): the action is right or wrong in itself
regardless of the good that might come from it (a “duty” to do something or not do
something)
(1) Judges the Morality of an action and makes sure it follows rules and laws.
(2) IE: Not being able to use restraints whenever you want to.
m) Principles:
i) Respect for Autonomy: dignity and respect for individuals, choice, or actions unless
results in harm.
ii) Non-maleficence: DO NO HARM
iii) Beneficence: “We do good” – professionals have an obligation to “do good” for
clients.
n) Distributive justice: fair distribution benefits/burdens in society based on
needs/contributions of members.
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i) Egalitarian: everyone is entitled to equal rights and equal treatment in society.

ii) Libertarian: totally individualistic. The right to private property is most important.
iii) Liberal democratic: a theory that values both liberty and equality.
iv) Communitarianism: maintains that abstract, universal principles are not an adequate
basis for moral decision making.
(1) Virtue effect: to enable persons to flourish as human beings, benevolence,
compassion, trustworthy, and integrity.
(a) IE: asks what virtues we are looking for in the field of nursing.
(2) Ethic of care: a belief on the morality of responsibility in relationships that
emphasize connection and caring.
(a) A CORE VALUE OF NURSING
(3) Feminist ethics: equal rights, etc.
(a) Looks at how actions can affect other people.
o) Practical Nurse Code of Ethics: Measurement Criteria:
i) Adheres to the CLPNA practice standards and CAN code of ethics.
ii) Delivers care in a manner that preserves and protects client autonomy, dignity, and
rights.
iii) Maintains client confidentiality within policy.
iv) Serves as an advocate and assists clients to advocate for themselves.
v) Maintains a therapeutic and professional relationship
vi) Identifies and reports ethical issues.
vii) Reports illegal, incompetent or impaired practices.
p) Code of Ethics:
i) Safe, competent, ethical care
ii) Health and well-being
iii) Choice – respect and promote autonomy.
iv) Dignity of all persons
v) Confidentiality of all info
vi) Justice – equity and fairness for all clients.
vii) Accountability – answerable to practice.
viii) Quality practice environments – safe, supportive, and respectful.
10) Describe advocacy as essential to the professional, leadership role of the community health
nurse.
a) Community Health: address quality of life of individual.
i) Application of information and resources (Finances, effort, votes) to effect systemic
changes that shape the way people in the community live.
ii) IE: advocating for pain meds, or a new bed that prevents skin breakdown.
b) Public Health: address quality of life for aggregates.
i) Intend to reduces death or disability in groups of people.
ii) Involves the use of info and resources to reduce the occurrence or severity of public
health problems.
iii) IE: Advocating for immunizations and vaccinations.
c) Advocacy for LPN’s: principle 2 in code of ethics: Responsibility to clients
i) 2.2: advocate for the client to receive fair and equitable access to needed and
reasonably available health services and resources.
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ii) 2.3: respect and protect client privacy and hold in confidence information disclosed
except in certain narrowly defined exceptions.
d) Conceptual Framework: 3 stages
i) Information stage: gathering info
(1) IE: advocating for laws of bike helmet laws.
ii) Strategy Stage: tactics to disseminate info, identify objectives, and build coalitions.
(1) Determine what you need to advocate for and how you are going to do it.
(2) IE: shared the information and spoke with people in parliament that would assist
them.
iii) Action stage: focus is on implementing the strategies by lobbying, testifying, issuing
press releases, passing laws and voting.
(1) IE: went thru the process to have the bill passed and a law was made to force kids
under 18 to wear a helmet.
e) Ethical principles for effective advocacy:
i) Act in the client’s best interest
ii) Act in accordance with the client’s wishes and instructions.
iii) Keep the client properly informed.
iv) Carry out instructions with diligence and competence.
v) Act impartially and offer frank, independent advice.
vi) Maintain client confidentiality.
f) Advocacy relating to social justice: Nursing Responsibilities
i) Minimize unnecessary/unwanted procedures that may increase suffering.
ii) Health and social conditions that allow persons to live/die with dignity.
iii) Protect communities’ privacy
iv) Help individuals gain access to appropriate health services.
v) Policies/procedures should be consistent with current knowledge/practice.
vi) Fairness and inclusiveness in health resource allocations.
If you ever had a positive TST (Tuberculosis skin test), you can never have another because it
will cause a severe skin reaction (Because it is a live vaccine).
UNIT 3: HEALTH PROMOTION AND DIVERSITY
1) World Health Organization:

a) Major adult health problems: cancer, diabetes, respiratory and cardio disease.
b) Improve health by reducing risk: increase fitness, healthy eating, quit smoking.
2) Primary Health Care:
a) 8 essentials:
i) Education
ii) Safe food supply, adequate nutrition
iii) Safe, adequate water and basic sanitation
iv) Maternal and child care including family planning
v) Immunization
vi) Prevention/control of local/regional endemic diseases.
vii) Appropriate treatment/control of common diseases/injuries.
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viii) Essential drug provision.

b) 5 principles:
i) Equal access to health services
ii) Public participation
iii) Appropriate technology
iv) Intersectoral collaboration
v) Health system reorientation to health promotion and disease/injury prevention.
c) Ottawa Charter: defined health promotion as enabling people to increase control over
and to improve their health (Building capacity).
d) Population Health
i) Promotion: major concepts of Ottawa charter, determinants of health, target and
settings integrates with evidence based decision making to ensure that policies and
programs focus on the right issues, take effective action & produce sound results.
ii) Approach: focus towards improving health outcomes, a sustainable & integrated
health system, increased nutritional growth and productivity and increased social
cohesion. Key Elements:
(1) Address determinants of health
(2) Focus on health of populations
(3) Investing upstream
(4) Evidence based decisions
(5) Multiple strategies implemented
(6) Collaboration
(7) Engage citizens
(8) Increase accountability.
3) Describe how the various definitions of health have influenced the development of health
promotion.
a) Health used to be defined as “Absence of disease.
b) WHO (1947): health is a state of complete physical, mental, and social well-being, and
not merely the absence of disease or infirmity.
c) WHO (1986): positive resource for everyday living that is holistic.
i) Health, as a resource, allows clients to live life to its fullest potential and thus can use
this resource to manage their surroundings.
4) Compare and contrast health promotion, disease prevention, and harm reduction.
a) Health and Wellness Promotion: Process of enabling people to increase control over
the determinants of health and thereby improve their health. Promoting general good
health. Does not seek to prevent specific illnesses.
i) Health promotion: a strategy to improve health.
ii) Good Nutrition: Essential for G&D. Influences disease prevention later in life.
Adolescents are at greater risk.
iii) Accident and Injuries: preventable.
iv) Risk taking behavior high among men – tend to avoid diagnosis and treatment.
v) Older adults living in community longer.
vi) Empower people and give them the resources to make better life choices.
vii) IE: working with an Obese teen:
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(1) We can council teens at an individual level, about importance of eating healthy
and give them info to eat healthy and live healthier.
(2) We can also speak with the school about encouraging healthy eating.
(3) We can also speak with parents to teach them how to make healthy food choices
when preparing food at home and for lunches.
(4) We can then speak with the community where they live and encourage
community activities or physical activities or education programs.
(5) Speak with government about tax incentives for teens taking extra curricular
activities.
viii) Health Promotion strategies:
(1) Ottawa Charter developed concept & components of health promotion
(2) It increased awareness of and expanded determinants of health
(3) Several health promotion strategies identified:
(4) Advocating, enabling, mediating to help communities, groups and individuals to
reach optimal health
(5) This meant a change in roles for health care providers from “being in charge” to
roles of advocate, facilitator, supporter and mediator.
b) Disease Prevention: Involves 3 levels of prevention. Prevents occurrence of disease,

detects and stops disease in those at risk, and reduces negative effects of the disease.
Health education focused on reducing/eliminating health risks and illnesses.
i) Levels of Disease Prevention:
(1) Primary: prevention of problems.
(a) IE: beginning an exercise class to prevent heart disease.
(2) Secondary: screening for problems.
(a) IE: setting up a mobile mammography clinic for women.
(3) Tertiary: rehabilitation and preventing further problems
(a) IE: establishing a cardiac rehab program in the community for post-MI
patients.
c) Harm Reduction: policies or programs that decrease substance use. Abstinence is not a
pre-requisite of being in the programs but it would be the final goal.
i) Goal is to reduce harm from risky behaviours. Often used with concepts such as drug
abuse, sexual health, etc.
ii) IE: using safe injection techniques for IV drug users. Teaching them not to use dirty
needles, or needle exchange programs.
5) Recall how the determinants of health affect health promotion.

a) *****Lalonde (1974): determinants of health were “Biology, environment, and
lifestyle”*****. More were added since then.
b) Policy makers increased their awareness of the importance of health promotion.
c) Previously, medical models prevailed with heavy focus on ILLNESS.
d) WHO (1984) developed 5 principles of health promotion.
e) Ottawa charter of health (1986): increased awareness of and expanded upon the
determinants of health and strategies for health promotion.
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f) Epp Report (1986): proposed a national framework for health promotion and identified 3
national health challenges.
i) Disparities with rich and poor groups.
ii) Increase prevention by reducing and eliminating risks in the environment.
iii) Enhance peoples ability to cope and manage health problems and diseases.
g) Health Promotion Model: 3 dimensional model with interrelating parts that guide
actions to improve health.
i) What?: looks at the health determinants
ii) Who?: looks at the different levels we are working with (Community).
iii) How?: the health promotion strategies that are used to act on the health determinants.
These are 5 strategies from the Ottawa charter
h) Determinants of health: Income and Social Status: most important, Social Support
Groups, Employment and working conditions, Education, Biology and genetic
endowment, Gender, Culture, Physical environment, Social environment, Personal health
practices and coping, Healthy child development, and Health Services.
6) Compare the biomedical, behavioural, and socio-environmental health approaches to

community health nursing.
a) Biomedical: health is determined by biology and genetic endowment.
i) Focus is on screening and identifying biological risk factors.
ii) IE: screening people about hypertension, increasing exercise and eating better.
b) Behavioral: health is determined by health behaviors. From the Lalonde Report.
i) Focus is on individual behaviour change and lifestyle changes to promote health.
ii) IE: increasing physical activity and eating better to decrease obesity which is a cause
of hypertension. Health Education
c) Socio-Environmental: health is determined by multiple sociological and environmental
factors. From the Alma-Ata Conference.
i) States that community participation and inter-sectoral collaboration necessary for
dealing with psychosocial and environmental determines of health.
ii) Health is seen as a resource.
iii) Focus on multi-pronged approach for societal and environmental change.
iv) Used quite a bit in community health.
v) IE: they don’t have enough money to eat healthy foods and fresh foods. They might
not be able to afford to get to appointments, or get memberships to gyms or play
extracurricular activities.
7) Identify health promotion strategies and how, when, and where they would be used.
a) Health Promotion Strategies:
i) Strengthen community action:
(1) Community development
(2) Engaging the community members to participate in health care decisions.
(3) Partnering the identified issues, organize, plan, and work together to make
changes that enhance health by managing effects of the determinants.
(4) IE: Funding for health initiatives such as health healthy food choices in
restaurants.
ii) Creating supportive environments:
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(1) Reciprocal Maintenance – Taking care of each other, our communities, and
environment.
(2) Goals:
(a) Healthy and safe physical environments
(b) Living and working conditions are satisfying
(c) Natural environments and resources conserved.
(3) IE: Creating smoke free workplaces.
iii) Develop personal health skills:
(1) That enhance ability to cope and gain control over health and environment –
Empowerment and involvement.
(a) IE: health education, stress management, healthy eating, early intervention
programs, parenting classes, newborn home visits, literacy support, and job
training.
iv) Reorient Health Services: shift from “treating disease” to considering:
(1) Links between the determinants of health and population health.
(2) Social justice (equity) the individual as a holistic being.
(3) Community based care that is accessible, affordable, acceptable, and appropriate
for the clients.
(4) A greater focus on population health and on health research, and modifications to
professional education.
(5) IE: creating interdisciplinary community health centers.
v) Healthy Public Policy: policy that has a positive effect on or promotes health.
(1) Building healthy public policy: Creating environments that support health and
reduce inequities in health and social policies.
(2) IE: Smoking laws, bike helmet laws, teaching about SIDS, breastfeeding is best,
etc.
8) Compare and contrast the application of risk reduction and capacity-building approaches.
a) Risk Reduction: primary focus on eliminating risk factors. Often focused on reducing
specific risks with a focused approach.
i) Disease prevention strategy.
ii) Reduces or alters health concerns.
iii) Disease detected and treated early.
iv) Most often used with clients with substance abuse.
b) Capacity Building: building on existing skills and strengths. Designed to promote
people’s capacity for health promotion.
i) Specific services, resources and programs that can assist communities, individuals, or
organizations to deal with their health issues.
ii) Involves community members taking action.
iii) Requires social and political support to implement programs.
iv) To build community capacity, CHN’s need to work with community which increases
chance of long term success for programs.
c) Life style approach: health status across the life span.
i) Needs a balance between personal responsibility, social responsibility, and
government responsibility.
ii) Person: Diet, exercise
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iii) Social: socio-economic status, social networks.

iv) Government: Health environments, healthy public policy, reduction in social
inequalities.
9) Explain the community health nurse’s roles and responsibilities in health promotion.
a) Promote health in environmental, political, and social context.
b) CHN’s use the community health nursing process to assess, plan, intervene, and evaluate
their practice on micro and macro levels.
c) Page 140-141.
d) CHNs use many health promotion skills during interactions with their clients when
promoting health.
e) Work in focus groups and prepare funding applications.
10) Identify the effects of diversity on community health nursing.

a) Culture: set of beliefs, values and assumptions about life held by a group of people
generation to generation.
i) Cultural groups can be based on: gender, sexual orientation, geographical location,
physical and mental health challenges, religion, age, race, and ethnicity.
ii) Cultural Characteristics:
(1) Culture is learned based on internalized events/experiences as we grow & develop
(2) Culture is adaptive to environment & technological changes occurring over time
(3) Culture is dynamic – persons respond to changes; culture is not static
(4) Culture is invisible & is only evident by rituals, language, celebrations & attire
(5) Culture is shared in that persons from the same culture identify with the same
values, beliefs, patterns, yet remain individuals
(6) Culture is selective with boundaries identified for desirable, acceptable or
unacceptable behaviours & influences how persons’ view & respond to situations
& issues
(7) Differentiates between outsiders & insiders.
b) Sub-Culture: smaller group variances within a larger group.
c) Diversity: refers to the uniqueness of the client within the cultural context. Focuses on
client assets that build capacity.
d) Multiculturalism: a belief that promotes the recognition of diversity with respect to
ancestry and supports acceptance and belonging.
e) Ethnicity: a shared feeling of peoplehood among a group of individuals. Share similar
cultural patterns that create a common history.
i) Replaced the term “Race” when assigning identity and describing culture.
ii) Personal awareness of certain symbolic elements that bind people together in a social
context.
iii) A social context where race is a biological concept.
iv) Represents the identifying characteristics of culture (Race, religion, national origin).
f) Ethnic Group: a social grouping of people who share a common racial, geographical,
religious, or historical culture.
g) Race: a social classification that relies on physical markers such as skin tone to identify
group membership.
i) Members may be in the same race but a different culture.
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ii) Anywhere from 3-200/300 different races.
11) Explain the importance of culture as a determinant of health.

a) Some cultural groups are at an increased risk for poor health because of marginalization,
stigmatization, and language barriers.
b) nurses need to be more culturally diverse and reflect their client’s beliefs.
c) CNA: nurses require knowledge, skill, attitudes, and personal attributes to provide
culturally competent care.
d) Cultural differences pose fundamental barriers in health care as traditional beliefs can
decrease the use of and compliance with treatment.
12) Explain cultural competence and its implication for community health nursing.
a) Competence: performance that is sufficient and adequate.
b) Cultural Competence: combination of culturally congruent behaviors, practice attitudes
and policies that allow the nurse to work effectively in cross-cultural situations.
i) A set of congruent behaviors, practices, attitudes, and policies that come together in a
system or agency or among professionals enabling effective work to be done in cross
cultural situations.
ii) Being aware of client’s beliefs can help – become less judgemental and more
accepting of differences.
iii) Something that occurs “in the moment”, not a constant thing.
c) Cultural Safety: gaining an understanding of other’s health beliefs and practices in order
that your actions show equality, respect and avoidance of discrimination.
d) Developing Competence:
i) An ongoing life process
ii) Leininger: 2 Principles:
(1) Maintain broad, objective & open attitudes toward individuals and their cultures.
(2) Avoid seeing all individuals as alike.
iii) Awareness of experiences with other cultures.
iv) Promote mutual respect for all differences.
v) Not all nurses reach the same level of development (at the same time or ever).
e) Attributes of cultural competence:
i) Awareness: being aware of different cultures,
ii) Knowledge: gaining some knowledge and learning,
iii) Understanding: recognizing that culture does have an impact on people’s health.
iv) Sensitivity: recognizing the potential for an impact and ensuring that we are not
negating their beliefs, being polite, and being respectful.
v) Interaction: looking at eye contact, touch, use of space, etc. Not all cultures like
certain things.
vi) Proficiency: we understand and demonstrate our knowledge about cultural
differences.
vii) Skill: using that knowledge in the care we are providing.
f) Cultural Competence Terms:
i) Cultural Brokering: to resolve or lessen problems that result from not
understanding.
ii) Immigrant: person coming to a new country to live.
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iii) Interpretation: process by which spoken or signed message from one language to
another is relayed.
iv) Translation: written conversation of one language to another.
g) Culturally Competent CHN’s:
i) Use cultural brokering
ii) Know if there are specific risk factors for a given cultural population
iii) Understand their client’s non-traditional healing practices
iv) Are aware of cultural values, beliefs, and practices to guide them in delivering
culturally appropriate care.
h) Inhibitors of cultural competence:

i) Ethnocentrism: belief that one’s own group determines the standard of behavior for
all other groups to be judges (Own culture superior to all others).
(1) Discrimination is a subtle form of ethnocentrism.
ii) Cultural Blindness: ignore differences between cultures and act as though the
differences do not exist, act as though all people are the same.
iii) Cultural Imposition: imposing one’s own values on others.
(1) IE: nurses imposing western medicine while ignoring non-western treatments like
acupuncture, herbal therapy, spiritual remedies.
iv) Cultural Conflict: misunderstanding of expectations that may arise due to either
partner being unaware of cultural differences. Is a perceived threat.
v) Culture Shock: feeling of helplessness, discomfort and disorientation by individual
in attempting to understand or effectively adapt to another culture group’s different
practices, values, and beliefs.
(1) Anxiety caused by losing familiar sights, sounds, and behaviors.
vi) Stereotyping: Making generalizations about values, beliefs, and behaviors of a
group, ignoring the uniqueness of their individuality.
vii) Prejudice: emotional manifestation of deeply held beliefs about other groups
involving negative attitudes.
viii) Racism: prejudice based on belief that one’s own culture is superior to other
cultural groups. Types of racism include:
(1) Overt Racism: demonstration of attitudes, actions, policies openly illustrate
feeling superiority over groups with intent of harming or damaging.
(2) Systemic Racism (Institutional Racism): policies not equally applied to all
persons.
(3) Cultural Racism: visible minorities treated unfairly or discriminated against.
13) Within a cultural context, apply community health nursing interventions to promote positive
health outcomes for community clients.
a) Cultural Nursing Assessment: a systematic way to identify the beliefs, values,
meanings & behaviors of people while considering their history, life experiences & the
social and physical environments in which they live.
i) Some may be reluctant to acknowledge cultural identity
ii) Acculturation: the process of cultural socialization in which an individual learns a
new culture.
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iii) According to Giger and Davidhizar’s Transcultural Assessment Model, factors to

consider during a cultural assessment include:
(1) Culturally unique individual: what culture are they.
(2) Communication: verbal and non-verbal communication.
(3) Space: the distance we keep between ourselves and them. How do they feel if we
get to close?
(4) Social organization: how their family is organized, does the father figure make
all of the decisions?
(5) Time: some cultures don’t have a strict time schedule and don’t believe in times.
Some may show up late and some may be very specific about what time they need
to be somewhere.
(6) Biological variations: some cultures have food preferences, religious rituals, or
may be prone to different disorders based on their culture or ethnicity.
b) 3 progressive elements:
i) General:
ii) Problem specific
iii) Cultural Details.
c) Categories:
i) Time and space
ii) Rites and Rituals
iii) Culture and Health
iv) Social Roles
v) Language and communication patterns.
d) Cultural Health Care Systems:
i) Popular: informal healing relationships within one’s own social network.
ii) Folk: involves interaction between a person and sacred or secular healer. Most
healers share the same basic values and beliefs and clients.
iii) Professional: HC professionals who are formally education and licensed.
14) Explain ways to promote safety and cultural competence within nurse/client synergy.
a) An awareness of cultural values, beliefs & practices will guide the nurse in planning and
delivering culturally appropriate care.
b) Cultural Variations: response to pain, need for privacy/body exposure, consciousness of
space and time, isolation and quiet, people involved in decision making, hygiene
practices, religious and healing rituals, eye contact, touch.
c) Factors in planning:
i) Language barriers: think in native tongue then translate to English – flash cards,
written words, interpreters.
ii) Defining role relations: is the nurse to use formal or informal approach.
iii) Level of family involvement: how many visitors who make the decisions.
iv) Time orientation: persons orientated or future orientate (white folk, time is money).
v) Illness is a personal experience strongly affected by culture.
d) Interventions:
i) Respect client’s Respect client’s beliefs in folk and traditional remedies
ii) Combine folk lore & standard practices as much as possible. Accept the right to seek
alternative therapies
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iii) Sources of healthcare may include churches, shamans, medicine man, cueranderos,
faith healers
iv) Respect family position & gender distinctions
v) Continuous use of active listening & validation
vi) Client is a person not a culture (cultural safety)
vii) Empowering client
viii) Frame everything in a context the client will understand.
ix) Speak clearly and avoid jargon; English is often the second language
x) Culturally based teaching
xi) Have pamphlet’s in the individual’s native tongue if possible
xii) Remember the different perspectives, decision making
xiii) Use of interpreters
e) Interpretation:
i) The process by which a spoken or written message is translated from one language to
another
ii) literal translation often does not provide appropriate meaning, leads to changes in
meaning, misinterpretations and omissions occur
f) Interpreters:
i) Use an interpreter who has knowledge of health-related terminology.
ii) have a responsibility to communicate effectively with their clients
iii) literacy levels need to be considered in all written & oral communication to clients
iv) communication needs to be in plain language
v) may not understand medical language
vi) may emphasize their personal preferences
vii) Select one with knowledge of health related terminology
viii) Use family members with caution (privacy)
ix) Use community members with caution (confidentiality)
x) Sex of interpreter may be a concern (may require the same gender)
xi) Identify dialect spoken
xii) Verbal to match non-verbal
xiii) We trust the interpreter to say what we say
UNIT 4: COMMUNITY AS CLIENT
1) Community: a social group determined by geographical boundaries and/or common values

and interests. 3 dimensions of community: people, place (geographical), function (IE:
school community, church community, etc.).
a) Functions within a particular social structure and exhibits and creates norms, values, and
social institutions.
b) Members know and interact with one another.
c) Types of communities:
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i) Community of identifiable need: IE: group of menonite women with post-partum

depression.
ii) Community of problem ecology (Pollution):
iii) Community of concern: IE: group of homeless people.
iv) Community of special interest: IE: group of people, like teens or employees, that
have a special interest.
v) Community of viability: IE: communities that are declining or deteriorating.
vi) Resource community:
vii) Community of action capacity: IE: groups looking to create positive change.
viii) Community of political jurisdiction:
ix) Community of solution: IE: groups looking at ways to improve health, like
decreasing hospital admissions.
x) Face to face community:
xi) Neighborhood community: IE: Different areas of a city, like Millwoods.
2) Describe the use of community health assessments as a tool to plan care within communities.
a) Community Health: the process of involving the community in maintaining, promoting,
and protecting its own health and well being.
i) CHN and community seek healthful change together.
ii) Goal: involves a series of health promoting changes.
iii) 3 common characteristics of Community Health: Looks at all three of these to
determine what the community health is.
(1) Status: look at primary and secondary prevention.
(a) Physical component: IE: Morbidity, mortality,
(b) Emotional: mental health, client satisfaction
(c) Social Compnent: crime rates, etc.
(2) Structural: look at health services or population demographic characteristics.
Service and resources focused.
(3) Process: looks at using health promotion. Effective functioning of the
community, community relationships, conflicts, willingness to participate.
b) Community Health Dimensions:
i) Health Status of community: includes:
(1) Physical: often measured by traditional morbidity and mortality rates, life
expectancy indices, and risk factor profiles.
(2) Emotional: measured by client satisfaction and mental health indices.
(3) Social: reflected in crime rates and individual and family functional levels.
ii) Health Structure of community: what is available and how it is used.
(1) Includes community health services and resources and attributes of the
community structure itself, commonly identified as social indicators or correlates
of health.
(2) Hospital, LTC, health units, school health services.
(3) Health providers: dental, medical, nursing, etc.
(4) Use of resources: Bed occupancy or clinic visits.
iii) Process: the process of effective functioning and problem solving abilities.
(1) Asks – How well does the community promote, protect, maintain, and improve its
health.
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(2) Working with NOT working for.

(3) Community conflicts, relationships with society at large,
participation/involvement, and social supports.
3) Describe the application of the community health nursing process.

a) Assessing Community Health: Logical, systematic approach. COMMON
ASSESSMENT APPROACH is the Community Assessment Wheel.
i) Helps to:
(1) Identify community strengths, resources, assets, capacities & opportunities.
(2) Clarify health concerns.
(3) Identify community restraints
(4) Identify the economic, political and Social factors affecting the community.
(5) Identify the determinants of health affecting community health.
b) Healthy communities: multi-sectoral partnerships that utilize community resources to
improve the health of the whole community by development of healthy public policy.
Uses multiple sectors (Government, HCP’s, etc.) to improve the health of the community.
c) Characteristics of health communities:
i) Clean and safe physical environments
ii) Peace, equity, and social justice
iii) Adequate access to food, clean water, shelter, income, safety, work, and recreation for
all
iv) Strong, mutually supportive relationships and networks
v) Wide participation of residents in decision making
vi) Strong cultural and spiritual heritage
vii) Diverse and robust economy
viii) Opportunities for learning and skill development
ix) Access to health services, including public health and preventive programs
d) Assessment Requires:
i) gathering existing data (Age, gender, etc.) and generating missing data (IE: Values,
beliefs, etc.)
ii) Developing a composite data base (Combine the data)
iii) Interpreting the composite database to identify community strengths and health
concerns (makes sense of the data).
iv) Goal is to acquire accurate, usable information about the community.
e) Data Collection (Already existing data): the process of acquiring existing, readily
available info or developing new info about the community and its health.
i) Requires: gathering or compiling existing data. Generating missing data, interpreting
data, and identifying community abilities and health concerns.
ii) Demographic characteristics: age, gender distribution, socioeconomic
characteristics, racial distributions, vital stats, community institutions, and health
personal characteristics.
iii) Geographic characteristics: area boundaries, size of neighborhood, public spaces,
roads.
iv) Socio-economic: occupation, income, education, home rental/ownership.
v) Health, social resources & services: hospitals, clinics, etc.
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f) Data Generation (generating and finding NEW data that doesn’t already exist): the
process of developing data that does not already exist, through interaction with
community members. More difficult to obtain and generally not statistical in nature.
Information included:
i) Knowledge and beliefs, values, sentiments, goals & perceived concerns, norms,
problem solving process, power and leadership, influence structure.
ii) Collected thru interviews or observations.
g) Data Collection Methods:
i) Direct: directly observed by the data collector.
(1) IE: informant interviews, focus groups, and windshield surveys.
ii) Reported data: what is reported to the collector.
(1) IE: secondary analysis of existing data, surveys.
h) Composite Database Analysis: data are analyzed and synthesized and themes are notes.
i) Community health concerns: actual, possible and potential. Identifiable contributing
environmental factors.
ii) Community health strengths: resources available to meet community health
concerns.
iii) Common themes and what resources they have to make changes.
i) Analysis Classification:
i) Demographic characteristics: age, sex, ethnic, and racial groupings.
ii) Geographical: area boundaries, size of neighborhood, public spaces, roads.
iii) Socio-economic: occupation, income, education, home rental/ownership.
iv) Health, social resources & service: hospitals, clinics, etc.
j) Assessment issues: biggest issue is gaining acceptance into a community.
k) Identifying health concerns: each health concern uncovered by data collection and
analysis MUST:
i) Be clearly identified.
ii) State the health risk to the community
iii) Name the affected person/group.
iv) Define the community factors that led to the concern.
l) Planning: Analyzing health concerns: often requires identifying:
i) The direct and indirect factors that contribute to the health concerns.
ii) The outcomes of the health concern.
iii) Relationships among health concerns
iv) To clarify: Identifies the origins and effects and the points of interventions.
m) Community diagnosis: describes a situation and implies an etiology (Reason) and give
evidence to support.
i) Focus on an aggregate or community.
n) Planning: Prioritize health concerns – making a community diagnosis.
i) Setting health concern priorities.
ii) Is the residents and community leadership’s right to participate in discussions that
affect them?
iii) Validation can serve as an important trust building activity in maintaining the
partnership.
iv) Establishing goals and objectives
(1) Goals: a broad statement of desired outcomes.
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(2) Objectives: precise statements indicating the means of achieving the desired
outcomes.
(3) Intervention activities: list all possible interventions and select the most
appropriate.
o) Community Approaches:
i) Community development: improving the health of the community by engaging the
community in working towards community needs.
ii) Community capacity: identifies and works with community strengths to promote a
positive view of the community.
iii) Community building: ensures that partners develop the skills and resources required
to hold programs together.
iv) Asset mapping: capturing community based initiatives such as community
development, strategic planning and organizational development.
(1) 3 approaches: whole assets, storytelling, and heritage.
v) Community Mobilization:
p) Implementation:
i) CHN’s Role:
(1) Content focused (change agent role): stress gathering and analyzing facts and
implementing programs. IE: we have been asked to come in and address a certain
health need.
(2) Process focused (change partner role): include enabler catalyst, teacher or
problem solving skills to address health concerns and activist advocate. IE: We
are working with them and just need help implementing a certain program but
they have already determined what needs to be done to address the health need.
ii) The community health concern and the CHN’s role:
(1) The CHN role depends on the nature of the problem, the community’s decision
making ability and the professional and personal choice. IE: Could be an
educator, facilitator, role model, etc.
iii) The social change process and the CHN’s Role: how receptive the community is to
innovation. Change must fit community’s norms, values and customs.
q) Implementation in practical Terms: TAKE TIME TO:
i) Promote community ownership
ii) Create a unified program that respects the overall goals of the communities.
iii) Maintain a clear focus on the target population and the activities planned.
r) Evaluation: Determining whether we have met our goals.
i) The appraisal of the effects of some organized activity or program.
ii) Begins in the planning phase of community action when goals and measurable
objectives are established and goal attaining activities are identified.
iii) Evaluation needs to be ongoing (formative) and summative.
iv) Outcomes measures answer questions about the results of the intervention.
v) Validate the info you receive.
(1) Return to the sources for confirmation or additional data.
(2) Solicit feedback and check with key resources.
(3) Can be done with Town Hall meetings, focus groups, surveys, and interviews.
vi) Evaluation Process:
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(1) Focus on the evaluation: Identify purpose, consult with stakeholders, and
determine evaluation questions.
(2) Select evaluation methods
(3) Develop measurement tools
(4) Gather and analyze data
(5) Report the evaluation.
4) Explain the concept of community as partner.

a) Community as Client Approach: community assessment emphasizes the use of
epidemiological data and disease occurrence to identify needs. Looks at preventing and
initiating early treatment but uses components of community as being interdependent
(Individual IN that community) and how the community will affect the individual.
i) Community as Client: components of community are interdependent.
(1) Setting of practice is the community & the Unit of care is the individual, family or
group living in the community.
(2) Epidemiology: data collection and disease occurrences.
(3) Disease and Injury Prevention: early intervention – Immunizations and
screening.
(4) Interventions: government policy and legislation, regulations.
b) Community as Partner Approach: the CHN places emphasis on community strengths
or assets to manage community identified health concerns. Works WITH the community,
not just the individual. Community is the UNIT OF CARE.
i) Will utilize community capacity and community development to support the
community to make change.
c) Community as Partner:
i) Evolving respect for public participation in health decision making.
ii) Objective of CHN is to prevent fragmentation of care to the community.
iii) goal is to intervene by either:
(1) Decrease the potential of community system to encounter stressors OR
(2) Limit the impact or effects of stressors on the community through prevention
interventions.
d) CHN practices in the community-uses population health approach.
e) The community is the “unit of care” and a partner:
i) 2 key concepts are Health of Community and Partnership for Community Health
ii) Equal relationship (egalitarian) encourages community involvement, autonomy,
empowerment
iii) Community partners help to develop trust and rapport which assists in the CHN
gaining access to information from the community
iv) Community must believe that health issue exists & that the CHN can help
f) Model: community-as-partner focus: helps organize what type of data we need to collect
and how it should be organized.
g) Conveys an equal relationship between nurse and the community
h) Community assessment wheel: with community in center & 8 subsystems around
(windshield survey)
i) Core: community and people of the community as a whole. The core has to be
maintained to ensure survival of the community.
29
ii) 8 Subsystems: physical environment, health & social services, economics, safety &
transportation, politics & government, communication, education, and recreation.
(1) The subsystems are used to protect the core.
i) Partnership encourages community involvement, autonomy & empowerment
j) Emphasis on community strengths
k) Development of community capacity
l) Community Partnership: a collaboration decision making process participated on by
community members and professionals.
i) IE: locals talking to government agencies to help create a bylaw to ensure sidewalks
are cleared. This helps make them safer.
ii) IE: Apple Schools: working with the school districts to determine which schools
were lower income. They would have a basket full of apples in the office that were
accessible for students to come and eat whenever they needed. They also developed
methods to increase physical activity in the schools. There was funding from
governments and local parents that donated money.
iii) Formal Example: National homeless initiative: Working together to help decrease
homelessness.
iv) Informal Example: working with parents of asthmatic children to help create
policies to reduce pollution.
m) Partnership: the active participation and involvement of the community or its
representatives in healthful change.
i) Members have equal power between them.
ii) They have a common goal.
n) Coalition: 2 or more groups that share a mutual issue or concern and join forces to attain
a common goal.
i) Tend to be more formal.
ii) There is a person in power.
iii) Very similar to partnerships but they are more formal and someone is a leader that
determines their mandate.
o) Effective Partnership Characteristics:
i) Equality in decision making
ii) A shared vision
iii) Integrity
iv) Agreement on specific goals
v) A plan of action to meet the goals.
p) Community Concepts:
i) Sustainability: the maintenance and continuation of established community
programs.
(1) Is more likely to occur when members of the community are partners.
ii) Community competence: linked to community empowerment. Community is able to
use its problem-solving abilities and deal with health issues.
30
(i)Beliefs: Communities and

their people change and grow
best when fully involved and
self powered NOT BY imposed
programs and structures.
(ii) People make up the
core of the community. Social
demographics used to describe
the core. The Core MUST be
maintained to ensure survival of
the community.
(iii) They are surrounded
by 8 subsystems that affect and
are affected by people.
(iv) Lines of resistance:
strengths of a community (solid
line circled around community.
(v) Normal lines of
defence: normal level of
defence reached by the
community (doted lines)
(vi) Flexible lines of
defence: dynamic, rapid changes req’d from the community (dotted lines).
(vii) Stressors: come from within or outside of the community.
(viii) Response of community to stressors is based on weight of stressor
VS. Strengths of community.
(ix)APPENDIX 8 in the book****
5) Apply the nursing process and metaparadigm to planning care for a community.
a) Determinants related to Community: factors that influence the health of populations.
i) Rural: lower levels of education, poorer socioeconomic conditions, less healthy
behaviors, higher mortality rates, stronger sense of community.
ii) Poverty
iii) Populations poorer longer: one parent families, aboriginal, disabilities, visible
minorities.
b) To gain access to the community, the community MUST:
i) Perceive that a need exists and believe the nurse can address the need.
ii) Perceive that its info and contributions are values.
iii) Be assured of confidentiality for non-public info.
iv) Be involved in the beginning in the partnership.
v) Take part in community events, look and listen with interest, visit people in formal
leadership roles, utilize an assessment guide, use peer group support, clarify
community members’ perceptions of health needs, respect peoples right to choose,
and maintain confidentiality.
c) Community Health Nurse may be considered an outsider:
31
i) Gain trust and entry into community

(1) Take part in community events
(2) Look and listen with interest
(3) Visit people in formal leadership positions.
(4) Utilize an assessment guide
(5) Use peer group support
(6) Clarify community member’s perception.
(7) Respect an individual’s right to choose.
(8) Maintain confidentiality.
d) Personal safety in community: inform supervisor of planned visits. Nothing valuable in
car. Call ahead to schedule meetings. Easy exit for you and car.
32
UNIT 5: WORKING WITH VULNERABLE POPULATIONS
1) Define the term “Vulnerable Populations” and describe selected groups in this category.
a) Populations or Aggregates who tolerate a larger “burden” of illness and distress than
others.
b) Higher probability of illness
c) Poor health does not mean that some persons have personal deficiencies, rather it results
from the interacting effects of many internal and external factors.
d) Risks/Predisposing Factors leading to vulnerability:
i) Environment: lead exposure, pollution.
ii) Social: crime, violence.
iii) Personal: diet, exercise.
iv) Genetic: aboriginals are predisposed to diabetes, obesity.
v) Economic: income and social status. IE: people working at minimum wage jobs may
not be able to afford health costs.
vi) Age: IE: elderly populations and very young are at higher risks for vulnerability.
vii) Biological:
e) Web of Causation: the complex interrelationship of many factors, sometimes interacting
in subtle ways to increase or decrease the risk of disease.
i) Web of causation model: analyzes interrelationships among multiple factors that
contribute to the occurrence of a disease or conditions.
f) Resilience: ability to successfully cope when faced with a threat or hardship.
i) Low resilience leads to feelings of hopelessness.
g) Disenfranchisement: a feeling of separation from mainstream society.
i) Lack of emotional connection with any group.
ii) Are often invisible to society as a whole and forgotten in health and social planning.
h) At Risk Populations:
i) Mental Illnesses: 1 in 5 homeless have mental health issues.
(1) Homelessness rapidly becoming one of the leading causes of disability.
(2) Mental health is more than the absence of disease. It contributes to our ability our
goals (mental health commission of Canada).
(3) Good mental health helps us manage stress and protects from mental health issues
ii) Substance Abuse – fast paced life, excessive stress, availability of drug influence,
incidence of abuse.
iii) Disadvantaged children/youth: physical, sexual, emotional abuse, neglect.
iv) Adolescent Sexual Behaviour: pregnant teens, STIs.
v) Violence: includes bullying.
vi) Aboriginal People
2) Describe factors that led to the development of vulnerability in certain populations.

a) Disadvantaged populations:
i) Have fewer resources for health promotion and illness treatment.
ii) Decreased access to health care
iii) Limitations in physical, environmental, personal and social resources.
iv) Poverty, limited social support, infectious diseases, home & workplace hazards.
v) Decreased physical ability to cope with stress.
33
vi) Lack of power, control, victimization, disadvantaged status, disenfranchisement.

b) Predisposing factors: social, economic, financial, age, physiological changes.
c) Poor Neighborhoods:
i) Access to fewer resources.
ii) Differences in quality and level of education.
iii) Higher rates of unemployment.
iv) Lower rates of pay
v) Higher incidence of crime and violence.
vi) Higher number of single parent families.
d) Homelessness: often hard to locate for follow up services.
i) Deliberately hide/refuse to be interviewed or treated.
ii) RISK FACTORS: SEE PAGE 317 (Box 11.1).
(1) Lack of housing, low income, mental health issues, substance abuse, violence,
family conflict, etc.
iii) Intermittent episodes of homelessness, hard to track
iv) Difficult to generalize between urban and rural.
v) Absolute Homelessness: living on street. Chronic homeless. Tend to have substance
abuse issues, mental health or physical disabilities.
vi) Sheltered Homelessness: need to live in emergency shelters occasionally or on a
regular basis.
vii) Hidden homelessness: might be sleeping in cars or at friend’s houses.
(1) (AKA: Temporary Transient Homeless).
viii) Often hard to locate for follow up services.
ix) Deliberately hide/refuse to be interviewed or treated.
x) Social and community factors of homelessness:
(1) Diminishing availability of low cost housing.
(2) Increased unemployment
(3) Substance abuse
(4) Lack of treatment facilities for the mentally ill.
(5) Domestic violence
(6) Often linked to mental illness (1 in 3 homeless are ill).
xi) Effects on Health:
(1) Inability to get adequate rest, exercise and nutrition.
(2) Exposure
(3) Infectious diseases
(4) Acute and chronic illnesses
(5) Infestations
(6) Trauma
(7) Mental health concerns
3) Identify ways in which public policies affect vulnerable populations and can reduce health
inequities in these groups.
a) Public Policy: a course of actions or inaction chosen by public authorities to address a
given problem or interrelated set of problems.
i) Public policies act as a set of guidelines or as a framework for action.
b) Building Healthy Public Policy:
34
i) Advocating for a healthy public policy is a priority strategy for health promotion.
ii) This strategy is the foundation of all other policies.
iii) Nurses need to keep informed as to what policies contributed to health problems &
which help to alleviate and how they can champion public policies.
c) Stages for Assessment:
i) Pre-active: projecting the future health concerns.
ii) Reactive: defining health concerns based on past health concerns identified.
iii) Inactive: define health concerns based on existing status of the health of populations.
iv) Interactive: describe the health concern using both past and present data to predict
future needs.
d) Strategies that can be used to improve health for vulnerable populations:
i) Agenda setting.
ii) Policy formation
iii) Decision making stage
iv) Policy implementation/evaluation.
e) Program planning to affect change:
i) Program: an organized approach to meet the assessed concerns.
ii) Planning process: selecting and carrying out a series of actions to achieve goals.
iii) Goal: Ensure that health services are acceptable, equal, efficient, and effective.
f) 5 key strategies (Ottawa Charter):
i) Strengthening community action.
ii) Creating supportive environments
iii) Developing healthy public policy
iv) Developing personal skills
v) Reorienting health systems.
4) Describe individual and social factors that contribute to vulnerability.

a) Health Concepts:
i) Unemployment negatively impacts mental health and physical working capacity.
ii) Certain immigrants are at increased risk for mental disorders.
iii) Mothers with history of sexual abuse are linked with abusing their children.
iv) Higher suicide rates in rural areas.
v) Older males are more likely to be depressed.
5) Describe strategies that community health nurses can use to improve the health status and
eliminate health inequities of vulnerable populations.
a) Create a trusting environment.
b) Accept and Show respect, compassion, and concern.
c) Work WITH – attempt to understand their life situation and the determinants of health
impact on their wellness.
d) DO NOT make assumptions.
e) Co-ordinate services and providers.
f) Advocate for accessible health services.
g) Focus on prevention: EVERY TIME you see them, do preventative care.
h) Know when to “Walk beside” the client and when to encourage the client to “walk
ahead” and support them.
35
i) Know what resources are available.

j) Develop your own support network.
k) Ability to assess the clients in context and to intervene in ways that restore, maintain or
promote health.
l) Assess living environment, neighborhood surroundings.
m) Assess socio-economic resources.
n) Assess congenital and genetic predisposition.
o) Preventative health needs.
p) Roles: case management, provides comprehensive services, advocacy & develop
policies/programs.
q) CHN’s NEED:
i) Good assessment skills
ii) Current knowledge of available resources
iii) The ability to plan care based on client concerns and receptivity to help.
r) Primary Prevention:
i) Affordable housing
ii) Effective job training
iii) Employer incentives
iv) Preventive health care services
v) Multisystem case management
vi) Birth control, safer sex ed., counselling, parent education.
s) Secondary Prevention:
i) Reducing prevalence or pathological nature of condition, early diagnosis with prompt
treatment to limit the disability.
ii) Supportive housing/emergency housing.
iii) Soup kitchens, meal sites.
iv) Comprehensive physical and mental health services.
t) Tertiary Prevention:
i) Attempt to restore and enhance functioning
ii) Support affordable housing
iii) Promote psychosocial rehabilitation programs
iv) Advocacy for mental illness and homelessness.
6) Reflect upon the effects of poverty on the health and well-being of individuals, families, and
communities.
a) Low-Income Cut-off: GET INFO ON THIS*********
b) Absolute Poverty: somewhat living below the poverty line. No access to resources.
c) Relative poverty: isn’t below the poverty line, but they are having a hard time meeting
their daily needs. Lower standard of living compared to the average person.
i) IE: working poor. They have work but most likely minimum wage.
d) Subjective Poverty: when they believe they don’t have enough resources to meet their
day to day needs, and they may have just enough.
i) IE: the person “feels” like they are not making enough to meet their needs.
7) Describe the health challenges of importance to aboriginal peoples in Canada.

a) Education, income, general health-life expectancy, housing, sense of belonging, access to
health services.
36
b) Stems from marginalization and having their cultures destroyed in the past.
c) Very few aren’t completing high school or going to post-secondary which creates a
decrease in income. This will affect housing, general health, etc.
8) Describe the importance of health challenges within the adolescent population of Canada.
9) Develop nursing interventions based on the nursing metaparadigm for the prevention of
pregnancy concerns that at-risk adolescents might experience.
a) Assess client’s:
i) Living environment
ii) Neighborhood surroundings
iii) Perceptions of their socioeconomic resources
iv) Congenital and genetic predispositions to illness
v) Preventive health needs
vi) Stress
10) Explain the extent of the concern of clients who have mental illness or who are at risk for
mental illness.
a) Affects individuals of all ages, race, culture, gender, SES and educational level.
b) Rapidly becoming one of the leading causes of disability.
c) Mental health is more than the absence of disease it contributes to our ability to achieve
our goals (Mental Health Commission of Canada).
d) Good mental health helps us manage stress and protects from mental health issues.
11) Explain the effect of substance abuse on the community.

12) Discuss the scope of the problem of violence in Canadian communities.
UNIT 6: FAMILY AS CLIENT
1) Explain the importance of family nursing in the community setting.

2) Define family demographics.
a) The study of the structure of families and households and the family related events that
alter the structure through their number, sequencing and timing.
b) Helps CHNs to forecast stresses and developmental changes. Also to identify possible
solutions to family health concerns.
3) Types of families:
a) Nuclear: traditional view – father, mother, kids.
b) Extended: aunts, grandparents.
c) Step/Blended: re-married families with step kids.
d) Lone Parent: single parent.
e) Skip Generation: grandparents caring for children.
f) Living apart together: parents separated OR they are in relationships but living apart.
g) Married/common low without children:
h) Same Sex:
i) Single Person:
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4) Define the following:

a) Family: 2 or more individuals who depend on one another for emotional, physical,
and/or financial support.
i) A set of relationships that the client identifies as family or as a network of individuals
who influence each other’s lives, whether or not they are actual biological or legal
ties.
ii) A family is who they say they are.
b) Family Nursing: specialty area. Family as a client is fundamental. To ensure the success
of the family and its members in adapting to health and illness.
i) Nurses need to recognize family strengths and health concerns (Capacity Building).
ii) Must understand family structure and functioning.
iii) Family affects the health of the individual.
iv) Family health is basic to the community.
v) Within the family, health values, health habits, and health risks are developed,
organized, and performed. (Hopefully we learn health habits at early years).
vi) Individual health behaviours are affected by & acted out within the family, the
community & society.
vii) CHN Responsibilities: help promote health, partner with families to assist with
capacity building, assist families to cope, and collaborate with them to develop useful
interventions.
c) Family Health: difficult to define. A holistic approach.
i) Includes the biological, psychological, sociological, cultural, and spiritual factors.
ii) Dynamic, changing state of well being.
d) Healthy Family: Characteristics:
i) Communicate well and listen to all members.
ii) Members have a sense of trust.
iii) Play together and humour is present.
iv) All members interact with each other and a balance of interactions is noted
v) Has a shared sense of responsibility?
vi) Has traditions, rituals, and shares spirituality.
vii) Opens its boundaries to admit and seek help with problems.
e) Family Hardiness: internal strengths & durability of family unit characterized by sense
of control vs. lack of control or feeling victimized.
f) Family Resiliency: the ability to cope with expected and unexpected stressors.
g) Crisis proof: the ability to integrate the need for stability with the need for growth and
change, flexible.
h) Family Crisis: occurs when the family is not able to cope with an event. Demands of the
situation exceed the family resources.
i) Families cope by using known processes and behaviours.
ii) Attempt to gather resources to deal with demands created by the situation.
iii) 3 factors that determine coping ability:
(1) Understanding of the problem.
(2) Sources of support available
(3) Regular coping mechanisms working
iv) McCubbin’s Resiliency Model of Coping: concept offers a way of looking at
families through their strengths and potential.
38
(1) Resiliency more likely to occur:

(a) Atmosphere of warmth and affection.
(b) Emotional support
(c) Reasonable, clear cut limits
(d) Encourage collaboration among members.
(e) Reinforcing teamwork
(f) Sharing experiences
(g) Referring to support groups.
v) Characteristics of a strong family: in an unexpected crisis:
(1) Clear communication, problem solving ability, commitment to each other, sense
of cohesiveness, and spirituality.
i) Approaches to family nursing:
(1) Family as context: individual in foreground; family in background.
(2) Family as client: family foreground, individual in background.
(3) Family as system: looks at interactions between family members.
(4) Family as component of society: looks at family as a part of general society.
j) Family Caregivers: for older adults or others with disabilities. Over 80 is the fastest
growing age group.
i) Sandwich Generation: generation that is raising kids and taking care of their
parents.
ii) Roles can be:
(1) Formal: they went to school or it is their job.
(2) Informal: family that takes over this role.
iii) Stress, strain & burnout: negative effects of caregiving.
(1) S&S: denial, anger, withdrawal, anxiety, depression, exhaustion, sleeplessness,
emotional reactions, loss of concentration, health concerns.
iv) Teach them TLC:
(1) T: Training in care techniques.
(2) L: leaving the care situation periodically
(3) C: care for themselves.
k) Culture: a set of beliefs, values, and assumptions about life that are widely held by a
group of people. Transmitted across generations.
l) Ethnicity: a shared feeling of people-hood among a group of individuals. The identifying
characteristic of culture.
i) Influenced by education, income level, geographical location and association with
other groups.
ii) Culture and ethnicity impact how families normally interact and react in crisis.
5) Analyze changes in family function and structure.

a) Functional Family: ability to provide autonomy, respond to particular interests & needs
of family members. 5 basic functions:
i) Affective
ii) Socialization and social placement
iii) Reproductive
iv) Economic
v) Health care/health beliefs.
39
b) Dysfunctional Family: seen as bad, noncompliant, resistant, unmotivated.

i) Inhibit clear communication.
ii) Do not provide psychological support.
iii) Are not functioning well.
c) Family Structure: the nature of the relationships between and among family members.
i) The characteristics and demographics (Gender, age, number) of individuals who
make up the family.
ii) Defines the family members: who is in the family, what are relationships between
members, and family conflict.
iii) Wright and Leahey (2005): divided structure into categories and subcategories.
iv) Categories:
(1) Internal: describes who the family is and how they connect to each other.
(a) Are the people who are included in the family and how they are connected.
(b) Not limited to traditional nuclear family.
(c) Important to note any additions or losses to the family
(d) Looking at gender and the expectations for these roles.
(e) Rank order (birth order)
(f) Boundaries.
(2) External: outside groups or things to which the family is connected. Families
relationship with extended family and the larger social system.
(a) External family: relatives not living in the home. Sometimes strengthens or
issues with the extended family can have a significant impact on the family.
(b) Larger Systems (Ecomap): institutions, agencies, school, job, volunteer,
church, friends, neighbors, etc.
(3) Contextual: looks at where that family is at: race, ethnicity, social class,
religion/spirituality, environment.
6) Explain how the determinants of health affect family.

a) Factors that influence: social class, economic stability, racial and ethnic background,
culture, location.
i) IE: inadequate housing and income are linked to substance abuse and physical abuse.
Children who live with family violence have an increased risk of developing
psychological and behavioural problems.
b) Current social trends affecting families:
i) People marrying later
ii) Delayed childbirth
iii) Couples with fewer or no children
iv) More people living alone
v) Tremendous divorce rate (38% IN Canada)
vi) Complex marital roles (More step and blended families)
vii) War!!!!
viii) More single-parent families (greatly increased)
ix) Adolescent pregnancy, more keeping and raising their children
x) Increased numbers of Alternative family forms
xi) Middle generation with children and aging parents
xii) Grandparents responsible for child care (Skip generations)
40
xiii) International = immigration, travelling abroad and staying, illness patterns (aids),
War torn countries
7) Compare and contrast four ways to view family nursing. Theoretical Frameworks
a) Structural-Functional: (IE: Friedman model).
i) views the family as a social system.
ii) Arrangement of members within the family.
iii) Focus is to determine how family patterns are related to other institutions.
iv) Illness of a member results in alteration of the family structure and function.
b) Systems: (IE: CFAM and CFIM).
i) depends on both positive and negative feedback to maintain homeostasis.
ii) Each system has its own characteristics.
iii) All parts depend on one another.
iv) Emphasis is on the whole rather than the individuals.
v) Determines the effects of illness or injury on the entire family.
c) Development: (IE: McGill model)
i) individual and family developmental tasks.
ii) Family lifestyle stages.
iii) Emphasizes how families change over time and focuses on interactions and
relationships among family members.
iv) IE: Single person  dating  married  children  etc.
d) Interactional:
i) a unit of interacting personalities and examines the communication process by which
family members relate to one another.
ii) The ability to predict other family members’ expectations for one’s role enables each
member to have some knowledge of how to react and how other members will react.
8) Explain the Calgary Family Assessment Model (CFAM) and the Calgary Family Intervention
Model (CFIM).
a) Friedmann Family Assessment Model: approaches family from a structure-function
framework. Views family as a subsystem to society (an open social system).
i) Focuses on family’s function & structure & relationships to other social systems.
ii) Enables the CHN to access the family system
(1) As a whole
(2) As a part of the whole of society
(3) As an interaction system.
iii) 6 interview categories:
(1) Identifying data
(2) Developmental family stage and history
(3) Environmental data
(4) Family structure (Communication, power structure, role structure, and family
values).
(5) Family functions (Affective, socialization, health care).
(6) Family coping
b) McGill model of nursing: developmental model of health.
41
i) Explores contextual factors of health work, health potential, style of nursing,

competence in health behavior and health status.
c) Calgary Family Assessment Model (CFAM): a framework for a thorough family
assessment. 3 categories: each category has subcategories which are not all relevant to
all families.
i) Structural Dimension (internal, external, context): the nature of the relationships
between and among family members.
(1) Internal: the people who are all included in the family and how they are
connected to each other.
(a) Composition, gender, sexual orientation, rank order, subsystems (relationships
between the families – parents and siblings), and boundaries.
(2) External: the relationships the family has with people and institutions outside of
the family.
(a) Extended families and larger systems.
(3) Context: the whole situation or background
(a) Ethnicity, race, social class, environment,
and religion.
(4) Assessment tools:
(a) Genogram: a sketch of the family structure
and relevant info about family members.
(i) Age, occupation, school, grade, religion,
ethnicity, current health status.
(b) Ecomap: diagramming the relationships
with other people that the family had contact with
outside the immediate family, relationships
community based systems.
 Ecomap.
ii) Developmental Dimension: stages that

require the family to adjust, adapt, and change
roles. Each stage represents challenges and includes
tasks that need to be completed before the family
successfully moves to the next stage.
(1) Successful Family Characteristics
(Duvall):
(a) Independent home
(b) Satisfactory ways of earning money and
spending money.
(c) Mutually acceptable patterns in the division of labour.
(d) Continuity of mutually satisfactory sexual relationships.
(e) Open system of communication
(f) Workable relationships with relatives
(g) Ways of interacting with the larger community
(h) Competency in child bearing and rearing.
(i) Workable philosophy of life.
(j) Developmental stages of family:
42
(i) Unattached young adult

(ii) Married couple
(iii)Family with young children
(iv)Family with adolescents
(v) Launching children
(vi)Later life.
iii) Functional Dimension: how family members interact and behave towards each other
to achieve identifiable goals.
(1) Instrumental: activities of daily living: Does mum cook and dad do dishes? Etc.
(2) Expressive: communication, problem solving skills, roles, beliefs, spheres of
influence and power that governs members’ interactions.
(3) Expressive communication:
(a) Emotional communication, Verbal communication, Non-verbal, Circular
communication (back and forth)
(b) Problem solving, roles, influences and power, beliefs, alliances and coalitions.
(c) Functional Communication: healthy communication is open, clear, direct,
and congruent. Families develop predictable and repetitive patterns. They
develop rules usually in terms of power, affection, and control.
(d) Dysfunctional: unfounded assumptions about what other members think or
feel without validation. Families develop predictable and repetitive patters.
(4) 4 elements to consider when selecting and designing therapeutic tasks:
(a) Family’s definition of the problem.
(b) Key family characteristics (language, beliefs, strengths).
(c) Unique cooperative response patterns of family members.
(d) Family treatment goals.
(5) 4 dysfunctional ways people communicate under stress:
(a) Placating: agreeing with what is being said despite reservations.
(b) Blaming: attributing responsibility for problems to others and not taking
personal responsibility.
(c) Super reasonable: intellectualizing about problem and leaving out the
emotional component.
(d) Irrelevant: using irrelevant responses instead of dealing directly with the
issue.
(6) Nursing interventions are aimed at:
(a) Goal is to strengthen the family as a functional unit.
(b) Use communication skills to help families solve problems and find external
resources.
(c) Enable the family to accomplish its functions for all members, not just the sick
ones.
(d) Providing emotional support.
(e) Strengthening family functioning.
(f) May include guiding family change.
(7) Family Strengths:
(a) Traits that reside within an individual or family optimism, resilience.
(b) Assets that reside within an individual or a family-finances.
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(c) Capabilities, skills or competencies that an individual or family has developed

(IE: Problem solving skills).
(d) A quality that is more transient in nature than a trait or asset – Motivation.
d) Calgary Family Intervention Model (CFIM): the first nursing family intervention
model. Designed to help facilitate family functioning in the cognitive, affective, and
behavioural domains. Family strengths are identified and reinforced through the use of
commendations.
i) Focuses on promoting and improving family functioning.
ii) Interventions may affect functioning in any or all of the 3 domains.
(a) Cognitive: thinking
(b) Affective: feeling
(c) Behavioral: Doing
iii) Promotes through behavior modification.
iv) Promotes family functioning by: Asking interview questions, offering
commendations, providing info, validating emotional responses, encouraging
narratives, supporting family caregivers, and encouraging respite.
(1) Offering commendations: a statement that emphasizes the strengths or abilities
of the family.
(2) Validating: validation of intense emotions can alleviate feelings of isolation and
loneliness. Validate and reassure families that they will adjust and learn new ways
of coping.
(3) Encourage narratives: the person’s story of how the illness affects their whole
being (emotional, intellectual, social and spiritual). Showing compassion and
offering commendations is usually more therapeutic or helpful than offering
solutions.
(4) Encourage support: encourage listening to each other about concerns and
feelings.
v) Family interviews: may be formal and lengthy or short and casual. They require the
CHN to have:
(1) Perceptual skills: ability to make relevant observations.
(2) Conceptual skills: ability to formulate observations of the entire family and give
meaning to those observations.
(3) Executive skills: the actual therapeutic interventions.
vi) Interview questions: linear. Provide info about the client/family. Explores a family
member’s description or perceptions of a problem.
vii) Circular questions: determines changes that could be made in a client’s life. Helps
the CHN understand relationships between individuals, beliefs, and events and
provide valuable info to help create change.
9) Outline how to promote capacity-building with the family.
10) Outline the important considerations for planning, conducting, and evaluating family home
visits.
a) Family Nursing Assessment: systemic, comprehensive family data collection process.
Used to identify health concerns, family strengths, and resources emphasized.
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i) Gathering Assessment data: provides a way of understanding the client in the social
environment. Need info about coping strategies, communication styles, and
perceptions of their strengths and weaknesses.
ii) Families at risk: marital discord, mental illness, housing conditions, parenting skills,
abuse, neglect. Referrals to professionals is best.
11) Home Visits: the provision of community health nursing care where the individual resides.
MUST BE Clear about the purpose for the visit and that the purpose is understood by the
family.
a) Family may refuse the visit.
b) Safety for the CHN is IMPORTANT.
c) Set up:
i) Date, time, place to meet.
ii) Call, be clear, direct, and state purpose.
iii) Family needing or willing to attend.
iv) Length of meeting
v) Who referred and why
vi) Consider personal safety.
d) Skills required: observing, listening, questioning, probing, prompting.
e) Stages:
i) Engagement: introduction, purpose, establish relationship.
(1) Provide professional identification, have a brief social conversation, describe the
purpose of the visit, describes the nurse’s roles and responsibilities, nurse
determines the client’s expectations, and establish nurse-client relationship.
ii) Assessment: apply CFAM to identify family health concerns. Work with family to
identify mutually agreeable goals and identify solutions.
iii) Intervention: implement nursing interventions using CFIM. Continue to work on
nurse-client relationship.
(1) Knowing community resources.
(2) Empowerment-used to promote and protect health of families by providing info
and encouraging autonomy.
(3) Characteristics of empowered family seeking help: access and control over
resources needed, decision-making and problem-solving abilities, and abilities to
communicate and obtain needed resources.
(4) Start Contracting.
iv) Termination and Evaluation: goals met? Referrals to resources. Review visit with
the family. Evaluate the extent to which goals were met. Plan for future visits if
needed.
v) Post visit documentation: record visit. Once you leave the home, you must record
visit for legal and clinical purposes. Must be current, dates, and signed.
12) Explain caregiving burden and the risks of elder abuse.

a) Caregiver stress: signs include: denial, anger, social withdrawal, anxiety, depression,
exhaustion, sleeplessness, emotional reactions, lack of concentration, health problems.
b) Teach TLC: TRAINING in care techniques, LEAVE the care situation periodically,
CARE for themselves.
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13) Health Risk Appraisal: the process of assessing and analyzing for the presence of specific
risk factors in each category (Cancer, ETOH, MVC).
a) Health Risks: the probability of some event or outcome within a specific period of time.
i) Control of risks is done through disease prevention and health promotion.
ii) Combined effect of several risks has greater influence (Synergy).
iii) Family history
iv) Determinants of health.
v) Family behavioral risks
vi) Society’s influence, social risks: IE: peer pressure can increase risks.
b) Health Risk Reduction: based on the assumption that decreasing the number of risks or
the magnitude of risk will result in a lower probability of an undesired event.
c) Types of risks:
i) voluntary assumed risks (things we choose to do IE: Smoking).
ii) Risks over which scientists debate and are uncertain are more feared (IE: debate
about whether 1 glass of wine is actually good for heart health).
iii) Risks of natural origin (IE Diseases or natural disasters that increase risks).
d) 3 major areas of risk: one risk is often not enough to threaten a family; a combination of
risks may lead to a family crisis.
i) Biological and age related risks: assessed thru genogram.
ii) Environmental risks: social & economic (foremost predictor of health. Assessed
thru Ecomap.
iii) Behavioral risks: health behaviors, values, habits, and risk perceptions are
developed, organized & performed within the family.
e) Risk Appraisal:
i) Behavioural: health behaviours, health values, health habits and risk perceptions are
developed, organized and performed within a family.
ii) Family health values, habits & risk perception: food purchases and prep, sleep
patterns. Setting and monitoring norms for health and health risk behaviors.
Determining when a family member is ill and when health care obtained.
iii) Assessment: patterns for lifestyle components in areas of health promotion, health
protection, and preventative services.
f) Risk Reduction:
i) Biological & Age: 3 generation genogram: identifying gender, age, relationship,
health status and mortality. Basic info about family relationships and patterns of
health and illness.
ii) Family functions: behaviors or activities performed to maintain the integrity of the
family unit and to meet family and individual needs and society’s expectations.
iii) Environmental:
(1) Social risks:
(2) Economic risks: foremost predictor of health.
(3) Assessment by ecomap: family connections with other social units (Relatives,
church, school, and the flow of positive and negative energy.
g) Health promotion with families:
i) Risk assessment is a behavioral approach.
ii) Asset approach is being promoted in use with families.
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(1) Focus on family competencies

(2) Family strengths
iii) CFAM is a family strength based model
iv) Family strengths: resources used by families to promote health-positive behaviors.
14) Interventions: after the assessment, the nurse needs to intervene to help families meet their
needs. Ultimate goal is to help family members discover solutions that reduce or alleviate
suffering.
a) Strategies to meet family’s health needs:
i) Contracting: a strategy aimed at formally involving the family in the nursing process
and jointly defining the roles of both the CHN and family members. Making an
agreement between 2 or more parties.
(1) Involves a shift in responsibility and control toward a shared effort by client and
professional. A working agreement that can be negotiated.
(2) Requires time and effort and willingness for increased responsibility on the part of
the family.
(3) Nurse may have to relinquish some control.
(4) Contracting can give directions and structure to health risk reduction and health
promotion.
(5) 3 phases:
(a) Beginning: mutual data collection, establishment of goals, development of a
plan.
(b) Working: division of responsibilities, setting time limits, implementation of
plan, evaluation, and renegotiation.
(c) Termination: mutual termination of contract.
ii) Empowerment: a process used to promote and protect the health of families,
encourage autonomy, and provide information.
(1) Goal: create a partnership between the CHN and the family characterized by
cooperation and shared responsibility.
iii) CHN:
(1) Must recognize family’s competencies (Strengths) and define an active role
(Partnership).
(2) Families need to feel a sense of personal competence and a desire for and
willingness to take action before active participation occurs.
(3) Characteristics of an empowered family:
(a) Access and control over needed resources
(b) Decision making and problem solving abilities
(c) Ability to communicate and obtain needed resources.
(4) Approach needs to be: positive and focused on competencies, not concerns or
deficits.
(5) Interventions:
(a) Consistent with family cultural norms
(b) Consistent with family perception of health concerns
(c) That promote family behaviors which increase family competencies, decrease
need for outside help.
iv) Community Resources:
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(1) CHN’s help families find resources and learn to use them which includes: sharing
info with them, rehearsing with families questions to ask, preparing materials
needed, making initial contact, and arranging transportation.
(2) CHN needs:
(a) Needs to be familiar with types of services available/offered, any
requirements, and costs.
(b) Locating and using the system often requires skill and patience.
(c) Family should evaluate appropriateness and effectiveness of resources.
15) Evaluation: continuing, revising, or terminating the plan.

a) Begins on the planning phase, when goals and measurable objectives are established. It is
an ongoing process.
b) Evaluation is crucial to determine whether the client’s condition or well-being improved.
c) Involves 2 components:
i) Examining a condition or situation.
ii) Judging whether change has occurred.
d) May include:
i) An estimation of the effectiveness of the nursing care
ii) The quality of nurse-family interactions
iii) Changes in the family that may require modifications or termination of the care plan.
iv) Families response.
e) Evaluation Questions:
i) To what extent have goals been met?
ii) What changes need to be made?
iii) Were health concerns resolved?
iv) Were identified risks reduced?
v) Which interventions have been effective or ineffective?
f) The nurse applies critical thinking skills and clinical judgement when evaluating the
outcomes of goals set with families.
g) When an outcome is not achieved, the nurse and the family work together to determine
the barriers.
16) Lifestyle: a resources for quality of life and coping; a broad concept that includes not only
diet, alcohol consumption, and exercise, but also the social conditions in communities and
determinants of health such as socioeconomic status and social networks.
17) Child and Adolescent Health:

a) 2 major roles of CHN’s within child health:
i) Provision of direct services to children and their families: Assessment, management
of care, education and counselling.
ii) Assessment of the community and the establishment of programs to ensure a healthy
environment for its children.
b) Obesity is a problem: Promote activity and nutrition.
c) Injuries and accidents: most common cause of preventable disease, disability, and death.
18) Adult health:
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a) Women’s health: breast self-exam, reproductive health, menopause, cardiovascular

disease, diabetes, mental illness, and cancer.
b) Men’s health: testicular cancer, high risk-taking behaviors.
19) Older Adults health: chronic illness, mobility, memory loss, medication use, elder abuse.
a) Aging: total of all changes that occur in a person with the passing of time.
b) Ageism: term that denotes discrimination toward older people because of their age.
c) Gerontology: a study of the processes of growing old with a focus on what is normal and
successful aging
d) Gerontological nursing: specialty of nursing in older populations.
UNIT 7: COMMUNICABLE DISEASE CONTROL
1) Define epidemiology.
a) Epidemiology: the study of the distribution and factors that determine the health-related
states or events in a population, as well as the use of this information to control health
problems.
i) Investigates the distribution or the patterns of health events in population and the
determinants or factors that influence those populations.
ii) FOCUSES ON POPULATION
iii) Understanding the factors that contribute to health and disease
iv) The development of health promotion and disease prevention measures.
v) The detection and characterization of emerging infectious agents.
vi) The evaluation of health services and policies.
vii) The practice of nursing in public health.
viii) Differs from clinical medicine in that it studies populations.
(1) Monitors the health of the population
(2) Identifies determinants of health and disease in the communities.
(3) Investigations and evaluates interventions to prevent disease and maintain health.
b) Goal of epidemiology: To identify and understand the causal factors & mechanisms of
disease, disability & injuries so that effective interventions can be implemented to
prevent the occurrence of adverse processes before they begin or before they progress
c) Study of populations in order to: monitor the health of the population, identify the
determinants of health and disease in communities, and investigate and evaluate
interventions to prevent disease and maintain health.
d) CHN: uses epidemiology principles and techniques to deal with factors that affect
individuals, families, and population groups that cannot be easily controlled in the
community.
e) Morbidity- the occurrence of disease in a population, includes incidents and prevalence
f) Mortality- the number of death in a population
g) Ratio- can be used to calculate an approximation of risk
h) Cohort- group of individuals with similar characteristics
i) Incidence rate: the number of new cases or events
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j) Prevalence rate: the number of individuals living with a given disease or condition.
k) Distribution- patterns of health events in populations and the determinates (factors) that
influence the patterns
l) Population at risk- those for whom there is a finite probability of experiencing the event
m) High risk population- persons who because of exposure, lifestyle, family history or
other factors are at greater risk for disease
n) Point epidemic- time and space related pattern which is important in infectious disease
o) Descriptive Epidemiology
i) Looks at the health outcomes in terms of who, what, when, where and why
p) Analytical Epidemiology
i) Looks at the origins of causes (etiology) of the disease and deals with determinate of
health in terms of how and why
ii) Determinates may be individual, relations, social, communal or environmental
q) Methods in Epidemiology:
i) Routine collected data (Census)
ii) Data collection for other purpose.
iii) Original data for specific studies.
r) Types of studies:
i) Descriptive (Observational)
ii) Analytical (Observational)
iii) Ecological
iv) Experimental/Intervention Studies (Clinical trials).
s) Sensitivity: frequency of true positives
t) Specificity: frequency of true negatives.
u) Basic Concepts:
i) Distribution of health status & events in the community
ii) Individuals differ in their probability or risk of disease
iii) Primary concern is HOW they differ
iv) A higher number of cases may simply be the result of a larger population or the result
of a longer period of observation
v) Any description of disease pattern should take into account the size of the population
at risk
vi) We look at the number of cases (numerator), the number of persons at risk
(denominator) and the amount of time observed
vii) Using ratios/proportions and rates (measure of frequency) instead of simple counts of
cases correctly identifies population at risk
v) Demography: science of human populations. Statistical description of population.
i) Characteristics: age, gender, marital status, geographical distribution, cultural,
political and socioeconomic factors, determinants, consequences of population
change.
ii) Can help identify populations at risk.
iii) Can provide info for primary prevention.
iv) Use of vital statistics and census data to track disease trends and other trends like:
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(1) Infant mortality

(2) C-section rates
(3) Pregnancy complication rates
(4) General mortality from disease/injuries
2) Identify the steps of the epidemiological process.

a) Endemic: usual rate of occurrence in a given population. Constantly present in a given
geographical area or population.
b) Epidemic: an outbreak that exceeds the endemic rate (increased number of cases).
Occurrence of disease in a community or region that is greater than normally expected.
c) Pandemic: pandemic rate of occurrence and movement of occurrence geographically. A
worldwide epidemic affecting large populations.
d) Consists of several steps:
i) Define the outcome (Disease, accidents, injuries, and wellness).
ii) Describe the distribution/problem (Who, where, when, what).
iii) Search for patterns
iv) Look for factors that explain the pattern or risk.
v) Implement control plan
vi) Evaluate the results/plan.
e) Focus is on populations, NOT individuals.
f) Scientific disciplines:
i) Biology: to better understand disease processes.
ii) Biostatistics: the current raw info available.
iii) Geographic information science: map disease patterns.
iv) Social Science: to better understand risk factors.
g) Goal: interventions to prevent disease by looking at the context in which is occurring
(Risk factors, health determinants).
h) Sources of Data: data for epidemiological studies commonly come from 3 categories:
i) Routinely collected data such as census data, vital statistics records, and health
surveillance data.
ii) Data collected for other purposes, such as medical, health department, and insurance
records.
iii) Original data collected for specific epidemiological studies.
3) Epidemiological Approaches:
a) Epidemiological triangle: any change in one of the sides cause disequilibrium.
i) Three sides: any changes in one of these can influence occurrence of disease by
increasing or decreasing client’s risk for disease.
(1) HOST (susceptible host): living person (animal) capable of being infected by an
agent. 4 factors influence the spread of disease:
(a) Resistance: a
(b) Immunity: a
(c) Herd Immunity: if a majority of people are vaccinated, they will protect the
ones that are not immunized.
(d) Infectiousness: looks at how fast the disease will spread.
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(2) AGENT (pathogenic organism): something that must be present/lacking for a

disease to develop. 4 main categories of infectious agents:
(a) Bacteria, fungi, parasites, and viruses.
(3) ENVIRONMENT (vector for disease transmition): all that is internal or
external to the host & agent.
(a) 3 environmental factors:
(i) Everything external to the human host.
(ii) Environmental factors and the transmission of infectious agent from an
infected host to a susceptible host.
(iii)Changing environmental factors can reduce communicable disease risk.
(b) Modes of transmission:
(i) Vertical: transferred from mother to child.
(ii) Horizontal: direct/indirect contact, common vehicle, airborne, and vector
bourne.
b) Person, place & time model: a
c) Web of causation: complex interaction of many factors. Examinations of the
relationships among all components.
i) Illustrates the complex interactions of factors, characteristics, and exposures that
increase (or decrease) the risk of disease.
4) Describe the levels of prevention.

a) Natural History of disease: refers to the progression of the disease process from onset to
recovery. This process is related to the 3 levels of prevention.
(1) Pre-pathogenesis: susceptibility to disease
(2) Pathogenesis: from the preclinical stage to death, disability, or recovery.
b) Primary Prevention: interventions to prevent the occurrence of disease, injury or
disability. Prevention of problems-broad efforts.
i) Environmental protection: basic station, food safety, home and workplace safety, air
quality control.
ii) Specific protection against disease or injury: Immunizations, proper seat belt use.
iii) IE: beginning an exercise class for adults to prevent heart disease, immunizations.
c) Secondary Prevention: interventions designed to increase the probability of an early
diagnosis so that treatment is likely to result in a cure.
i) Health screenings, mammograms, pap tests, colonoscopy.
ii) IE: setting up mobile mammography clinics for women at risk for Breast Ca.
iii) Goal is to identify people at risk for disease.
iv) Screening is not a diagnostic test.
v) Aim is early detection and treatment.
d) Tertiary Prevention: interventions aimed at minimizing disability and rehabilitation
from disease, injury or disability.
i) Physical and occupational therapy, rehabilitation.
ii) IE: establishing a cardiac rehab program in the community for post-MI patients.
5) Compare and contrast reliability and validity.

a) Reliability: refers to consistency or ability of a test to be repeated. Results are consistent
across time.
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i) 3 major sources of error can affect reliability:

(1) Variation in the trait being measured
(2) Observer variation.
(3) Inconsistency in the instrument.
ii) Interater:
iii) Intrarater:
b) Validity: test measure what it is supposed to measure. Refers to whether a measure is
measuring what we think it is. Measured by sensitivity and specificity.
i) Sensitivity: quantifies how accurately the test identifies those with a condition.
(1) Represents the proportion of persons with the disease whom the test correctly
identifies as positive (true positives).
(2) High sensitivity is needed when early treatment is crucial and when identification
of all cases is important.
ii) Specificity: how accurately the test identifies those without the condition.
6) Explain how community health nurses use epidemiology in their nursing process.
a) CHN’s use morbidity and mortality rate when planning and assessing.
b) Use epidemiology to identify extent of health concern, health threats, unhealthy
behaviors in their community.
c) CHN’s members of interdisciplinary teams that analyze health and disease so that they
can develop appropriate prevention programs.
d) Use current evidence.
e) CHN’s constantly involved in monitoring disease trends.
f) Documentation always important.
g) Lots of studies and stats to call upon for assistant (Stats Canada).
7) Describe the past and current effects and threats of infectious diseases on society.
a) Historical Perspectives:
i) 1900 – Communicable disease were leading cause of death in Canada
ii) By 2000, we saw improvements and an end to epidemics
b) Infection: injurious contamination of body or parts of body by bacteria, viruses, fungi,
protozoa, or by the toxin they may produce. Can
be local or generalized and spread throughout the
body.
i) Once infectious agent enters the host, it
begins to proliferate and reacts with defence
mechanisms of body S&S of infection.
ii) Infection control interventions: isolation
precautions, health teaching, management,
supports, health care resources.
iii) Examples of infectious diseases: HIV,
AIDS, West Nile Virus, Anthrax, Avian flu,
H1N1, Hantavirus, Necrotizing Fasciitis.
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8) Identify the determinants of health that affect communicable diseases, infectious diseases,
and STI’s.
a) Determinants of health: there are associations between the determinants of health and
communicable diseases, infections, and STI’s:
i) Low Income is linked to increased rates of STD’s.
ii) Low Literacy levels are barriers to receiving effective care for STD’s.
9) Provide examples of infectious disease control interventions.

a) Prevention and Control of communicable diseases: seek to reduce the prevalence of a
disease to a level at which it no longer poses a public health problem.
i) Elimination: removal of the disease from a large geographical area (Country or
region).
ii) Eradication: permanent elimination of a disease worldwide.
b) STI Treatment:
i) Treatment is disease-specific
ii) Often have 1-dose regimens OR may have a course of medication
iii) IMPORTANT that they finish ALL the medication if it’s a course
iv) “Test of cure” not generally done unless woman is pregnant
c) Common Immunizations:
i) Chickenpox (varicella)
ii) MMR (measles, mumps, rubella/German measles)
iii) DTaP (diphtheria, tetanus, acellular pertussis)
iv) Polio
v) Pneumococcus (S. pneumoniae)
vi) Meningococcus (N. meningitidis)
vii) HIB (Haemophilus influenzae type b)
viii) Influenza
ix) Shingles
x) Hep B
xi) HPV (human papillomavirus)
xii) There are also some immunizations that are reserved for travel and/or high-risk
communities: Hep A, BCG (TB), rabies, typhoid, traveller’s diarrhea, Japanese
encephalitis, etc.
d) Immunization administration:
i) Informed consent is ESSENTIAL
ii) Given SC (live vaccines) OR IM (inactive), occasionally oral
iii) Contraindications:
(1) Acute illness with fever in last 24 hours
(2) Vaccine or component allergy (ask about eggs)
(3) Live vaccines are contraindicated in immunocompromised clients
iv) Side effects:
(1) Fever, fatigue, irritability, rash (varicella & MMR), small painless lump at
injection site (vaccines with aluminum), pain at injection site
(2) More severe side effects (e.g. anaphylaxis) are atypical and MUST be reported
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e) Vaccine Safety:
i) Many concerns have been raised about the safety and effectiveness of vaccines
ii) Informed consent is required for all vaccines
iii) The link between MMR and autism has been largely disproven
iv) Parents should be advised to wait 15 minutes before leaving (in case of anaphylaxis)
and to call if severe side effects
v) Continuous monitoring occurs for vaccines.
f) Vaccine preventable diseases: vaccines are one of the most effective methods of
preventing and controlling diseases.
i) Diseases such as polio, diphtheria, pertussis, and measles are controlled by vaccines.
ii) Influenza (Flu): a viral respiratory infection often distinguishable from the common
cold or other respiratory diseases.
(1) 3 types of influenza viruses: A, B, and C: B and C are stable, A is constantly
changing.
iii) Smallpox: considered eradicated from the world since 1979. Last death from small
pox occurred in 1977.
g) Non-Vaccine Preventable Diseases: IE: TB
h) Disease Development:
i) Infection: the entry, development, and multiplication of the infectious agent in the
susceptible host.
ii) Disease: one outcome of infection.
iii) Incubation period: a
iv) Communicable period: a
10) Surveillance: systematically collecting, organizing, and analyzing current, accurate, and
complete data for a defined disease condition.
11) Communicable Disease Tracing:
i) The provincial Public Health Act provides a list of diseases that require notification
ii) Any doctor who diagnoses an individual with a reportable disease is legally required
to report it to Public Health; any nurse or midwife who suspects someone has a
particular disease is also obligated to report it
iii) Public Health then conducts a follow-up to determine who has been exposed and
offer them prophylaxis if available
12) Reportable Disease:
i) Most diseases reportable under the Public Health Act are vaccine-preventable, STIs,
and exotic illnesses (e.g. viral hemorrhagic fevers, plague, leprosy, cholera, etc.)
ii) A few are considered possible biological warfare agents (e.g. anthrax, smallpox)
iii) The Alberta government has policies & procedures for handling communicable
disease follow-up
13) Communicable Disease Follow-Up:
i) First, Public Health gets notification that someone has been diagnosed
ii) Next, PHNs contact the individual(s) affected and ask for a complete list of all
contacts
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iii) Finally, PHNs contact exposed individuals and recommend they come in for testing
and/or prophylaxis
iv) All contract tracing is confidential
v) There are specific guidelines for each particular disease
14) Population Health Risks:
i) Some diseases (West Nile is an example) require IMMEDIATE notification of the
Medical Officer of Health
ii) Sometimes outbreaks of illnesses have led to an increase in public health programs
aimed at prophylaxis
(1) Mumps outbreak a few years ago led to a vaccination campaign for college
students
15) STI Contact Tracing:
i) STIs represent a specific area of communicable disease follow-up that must be treated
delicately
ii) STIs often present asymptomatically
iii) It is important for sexual health nurses to indicate that what’s important is not
figuring out who’s responsible, but getting everyone tested & treated
16) Sexually Transmitted Infections:
a) Can be spread by direct and indirect modes of transmission from host to host.
b) Can be virus, bacterium, parasite, or fungus.
c) If untreated, they are often fatal.
17) Role of CHN in prevention:
a) Primary Prevention: activities to help people healthy before onset of disease. Assess for
risky behaviors. Community outreach. Provide education.
b) Secondary Prevention: screening for diseases, follow up with contracts to prevent
spread. Recommend for those with high-risk behavior to be tested for HIV. Provide
counselling for persons with both negative and positive results.
c) Tertiary prevention: apply to many of the chronic STI’s and TB clients. Manage
symptoms. Psychosocial supports. Directly observed therapy for TB medication
monitoring to prevent antibiotic resistance in community.
UNIT 8: ENVIRONMENTAL HEALTH AND DISASTER MANAGEMENT
1) Explain how the environment, as a determinant of health, influences human health and
disease.
a) Environmental Health: the achievement of health and wellness and the prevention of
illness and injury from the exposure to physical or psychosocial environmental hazards.
b) Toxicology: basic science that studies the health effects associated with chemical
exposure.
c) Poisons: toxic substances that cause injury, illness, or death.
d) Epidemiology: The science that helps us understand the association between exposures
and health effects.
e) Pollution sources: are characterized as point or nonpoint sources:
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i) A pollutant from a point source is released into the environment from a single site
(IE: a smokestack).
ii) A pollutant from a nonpoint source is more diffuse (IE: Traffic, fertilizer, or
pesticide runoff into waterways, or animal waste from food production).
f) Climate Change: an environmental issue and is affected by air pollution.
i) Sink: any process, activity, or mechanism that removes a greenhouse gas, aerosol, or
precursor of a greenhouse gas from the atmosphere.
g) Environmental Scan: assess both the internal and external environments and is
frequently used by researchers to assess population health issues; by organizations to
develop, evaluate, and revise programs; and by policy makers to address social,
economic, technological, and political issues.
h) Environmental epidemiology: seeks to clarify the relationships between physical,
chemical and biological and human health.
i) The study of the effects of health on physical, chemical, and biological factors in the
environment.
i) Surveillance: systemic & ongoing observation and collection of data concerning disease
occurrence.
j) Concepts of biology – Environmental Principles:
i) Everything is connected to everything else.
ii) Everything has to go somewhere.
iii) The solution to pollution is dilution
iv) Today’s solution may be tomorrow’s problem.
2) Explain the role of the community health nurse in environmental health.

a) Promoting Healthy Environments:
i) Socio-economic approach
ii) An understanding of the determinants of health continually evolving
iii) Ottawa Charter supported this approach
(1) Placed the responsibility of health on society
(2) Strategies
(a) Building healthy public policy
(b) Creating supportive environments
(c) Strengthening community action
(d) Developing personal skills
(e) Reorienting health services
b) Environmental Health Indicators: measure the relationship between environment and
health.
i) Canadian Environmental Sustainability indicators (CESI) include air quality,
greenhouse gas emissions, and water quality.
ii) Environment Canada: enforce the Canadian Environmental Protection Act. They
oversee prevention of pollution and protection of the environment and human health.
c) Determinants of Health: Environment: Physical and psychosocial environment are
determinants of health.
i) Physical environment: air pollution, contaminated drinking water, etc.
ii) Psychosocial environment: long hours and heavy demands at work.
57
d) CHM:
i) Understand the risks
ii) Know public health laws
iii) Work with community to coordinate services
iv) Educate (explain relationship between harm & health)
v) Community involvement & public participation
vi) Individual & population risk assessment
vii) Epidemiological investigations
viii) Policy development
e) Risks:
i) Reducing environmental health risks
(1) Education
(2) Primary, secondary, and tertiary prevention
ii) Risk Management assessment
(1) Reduce, reuse, recycle, and recover.
f) Communicable Diseases
i) Aim is to reduce the incidence and prevalence of a disease to a level at which it is no
longer a major problem
ii) Infectiousness: A measure of the potential ability of an infected host to transmit the
infection to other hosts
(1) Eg. TB- smear positive or smear negative
iii) Reduction of risk: Alter the environmental factors
iv) Primary Prevention: Avoidance of the disease, Prevention before disease affects
community, Health promotion, Immunizations, Education, counselling
(1) IE: Counsel women about reducing exposure to environmental hazards.
v) Secondary Prevention:
(1) Screening for early detection of diseases to ensure early treatment which may
alter outcome and transmission of disease
(2) Teaching, counselling
(3) prevent re-infection
(4) manage symptoms & prevent spread
(5) contact partners with STI’s
vi) Tertiary Prevention:
(1) Managing symptoms & psychosocial support for chronic issues
(2) Directly observed therapy (TB)
(3) Management of AIDS at home
(4) Rehabilitation
(5) Regular surveillance
vii) Multi-system Approach:
(1) Improving host resistance
(2) Improving safety of the environment.
(3) Improving public health systems.
(4) Facilitating social and political changes to ensure health for all.
58
3) Apply the nursing process and nursing metaparadigm to the practice of environmental health.
a) Environmental Health Assessment: assessment ranges from individual to community
health assessments to partnering in a specific environmental site assessment. Windshield
assessments are best. Environmental hazards have the greatest impact on air, water, and
food sources in the environment which can then impact health.
i) Referral: resources may vary in communities; a starting point is environmental
epidemiology or toxicology unit of the local health department.
ii) Air: indoor (IE: mold or dust, mice) and outdoor (smog, exhaust, fires) air quality.
iii) Water: its necessary for all forms of life and for the production of food.
iv) Food: most food borne illnesses can be avoided by good food prep practices.
b) Environmental Exposure History:
i) Should identify current and past exposures
ii) Have a preliminary goal of reducing or eliminating current exposures
iii) Have a long-term goal of reducing adverse health effects.
iv) Acronym: IPREPARE*** Look this up***
c) Risk Assessment: a qualitative and quantitative evaluation of the risk posed to human
health of the environment by the actual or potential presence or use of specific pollutants.
i) Precautionary principle: government policy incorporates this principle, that when
there is doubt action should be on the side of caution.
ii) IE: When BPA was in water bottles, there was lots of talk about how it was
carcinogenic. The government stepped in and made public announcements to stop
using the products until they could be changed.
d) Risk Communication:
i) CHN’s can work as risk communicators – they will counsel or inform areas of safe
drinking water, hand washing techniques, food prep, and communicable diseases.
ii) Risk: chance that a specific health problem will develop in a client because of
exposure to certain factors.
(1) Reducing environmental health risks: Education and prevention.
(2) Risk management: selecting and implementing a strategy to reduce risks.
(3) 4 R’s for reducing environmental pollution: reduce, reuse, recycle, recover.
e) Interventions: education and advocacy.
i) Education: IE: Explaining the relationship between harmful environmental
exposures and human health OR guiding the community toward risk reduction based
on both individual behavior changes and community-wide approaches.
ii) Advocacy: they can advocate for environmental health by:
(1) Writing letters to newspapers, informing of local issues.
(2) Providing info at community gatherings, formal hearings, and professional
nursing forums.
(3) Serving on environmental health issues committees or government health
commissions.
(4) Volunteering to serve on municipal, provincial, territorial, or federal
environmental health commissions.
(5) Reading, listening, and asking questions.
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4) Explain the various types of disasters and their effects on people and their communities.
a) Disasters: an event that occurs suddenly or unexpectedly.
i) Most cannot be fully prevented.
ii) Adequate preparation is usually not possible.
iii) They disrupt normal functioning and create vulnerability.
b) Types of disasters: natural or man-made.
c) SARS (Severe Acute Respiratory Syndrome):
i) Started off in Asia but rapidly became a global threat.
ii) Infection control was not adequate because of a lack of availability of PPE
iii) It became a catalyst to implement change in prep for future disease outbreaks.
iv) Canadian Response to SARS:
(1) Public Health Agency of Canada (PHAC) was established.
(2) Influenza pandemic management was increased.
(3) Disease surveillance was increased.
(4) National Health Emergency Response Teams were created by PHAC.
d) Natural Disasters: increased in danger due to urbanization and overcrowding.
i) Many people live in vulnerable areas like tornado, hurricane, or tsunami-prone areas.
ii) One of the major problems in developing countries is the large number of people
living in danger areas and lack of resources to respond adequately to natural disasters.
iii) Local Examples: Alberta Flooding in 2013, Slave Lake Fire in 2011.
e) Human-Made Disasters: caused by humans. Increased due to overcrowding and human
development.
i) Examples: school shootings.
5) Describe the phases of disaster management/planning: Canada has developed an

emergency management framework that includes an all-hazards approach to dealing with
natural and human hazards and disasters.
a) Prevention and mitigation:
i) Prevention: goal is to prepare for a possible disaster and look for ways to mitigate
the damage. CHN’s help by advocating for safer environments.
ii) Mitigation: attempting to limit the severity of a potential disaster. CHN’s help by
identifying vulnerable populations and lobbying governments to work on improving
environments.
iii) IE: we can’t completely prevent deaths of homeless during winter but we can
mitigate deaths by giving them access to resources they need.
b) Preparedness: a readiness to respond to and manage a disaster situation and the
consequences. Realistic, simple plans are necessary. Education and planning.
i) Collaboration across multiple sectors is necessary.
(1) Personal: families and individuals should be prepared for any type of natural or
human disaster.
(2) Professional: CHN’s may be asked to respond to a disaster situation.
(3) Community: it is important for all disaster workers to work together with clearly
defined roles to set up their community disaster plan before a disaster occurs.
ii) Influenza Pandemic Preparedness: an example of how preparedness helped to
mitigate the impact of a disease.
60
(1) The government stockpiled vaccines and antiviral drugs for individuals affected
by acute influenza.
(2) Influenza triage centers, staffed by nurses, NPs, and physicians.
(3) CHN’s educated the general public and provided assistance thru vaccine programs
and clinics.
(4) Multisectoral collaboration was evident thru the use of mass media campaigns to
educate people about the flu on a national scale.
iii) Preparedness (CHN ROLE):
(1) Review the community’s disaster history.
(2) Consider how past disasters have affected health care delivery.
(3) Understand how particular organizations fit into the disaster plan.
(4) Educate community members about disaster preparedness.
(5) Help initiate or update disaster plans.
(6) Organize disaster drills.
(7) Be ready to provide updated records of vulnerable populations within a
community.
c) Response: the actual implementation of the disaster plan in the community.
i) Responses may differ depending on the type, cause, magnitude, location, and duration
of the disaster, as well as the amount of warning.
ii) Includes caring for the psychological needs of the individuals affected.
iii) People respond in different ways:
(1) Adults: typical stress response like fear, anxiety, anger, insomnia, headaches,
guilt, irritability, and nausea.
(2) Children: nightmares, school-related problems, regression.
iv) CHN’s: involved in a number of ways.
(1) Triaging people
(2) Helping set up shelters for affected individuals.
(3) Surveillance of people with reporting:
(a) Care of individuals with acute illnesses.
(b) Care and monitoring of chronic illnesses
(c) Care and monitoring of psychosocial needs.
d) Recovery: Focus is to rebuild the community as best as possible.
i) Both Retrogressive and Progressive changes:
(1) Rebuild the community back to its original level of functioning.
(2) Evaluate the response to disaster management and focus on methods that could be
taken to improve the management of future disasters.
(3) Check for environmental health hazards that may have occurred as a result of the
disaster.
6) Disaster Nursing Process: disaster management is very similar to the nursing process:
a) Assessment: Prevention and mitigation
b) Diagnosis: prevention and mitigation
c) Planning: Disaster planning
d) Implementation: response
e) Evaluation: recovery.
7) Describe pandemic preparedness.
61

NFDN 2006 - SLO's

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NFDN 2006 - SLO's

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NFDN 2006 – SLO’s

UNIT 1: FOUNDATIONS OF COMMUNITY HEALTH

1) Explain the following concepts:

i) Primary: Seeks to prevent disease from the beginning.

17) Describe the Canadian Community Health Nursing Standards of Practice.

20) Define population-focused practice.

21) Identify the nursing roles within community health.

UNIT 2: COMMUNITY HEALTH NURSING ROLES

1) Purpose & Goals:

f) May be seen as an invasion of privacy.

5) Describe the role of the community health nurse in rural settings.

iv) Higher-than-average likelihood of mental illness (especially depression)

7) Explain the process of incorporating evidence-informed practice as part of the nursing

8) Describe ethical decision-making processes.

9) Describe ethics as a core function of community health nursing.

i) Egalitarian: everyone is entitled to equal rights and equal treatment in society.

UNIT 3: HEALTH PROMOTION AND DIVERSITY

1) World Health Organization:

viii) Essential drug provision.

b) Disease Prevention: Involves 3 levels of prevention. Prevents occurrence of disease,

5) Recall how the determinants of health affect health promotion.

6) Compare the biomedical, behavioural, and socio-environmental health approaches to

iii) Social: socio-economic status, social networks.

10) Identify the effects of diversity on community health nursing.

ii) Anywhere from 3-200/300 different races.

11) Explain the importance of culture as a determinant of health.

h) Inhibitors of cultural competence:

iii) According to Giger and Davidhizar’s Transcultural Assessment Model, factors to

UNIT 4: COMMUNITY AS CLIENT

1) Community: a social group determined by geographical boundaries and/or common values

i) Community of identifiable need: IE: group of menonite women with post-partum

(2) Working with NOT working for.

3) Describe the application of the community health nursing process.

4) Explain the concept of community as partner.

(i)Beliefs: Communities and

i) Gain trust and entry into community

UNIT 5: WORKING WITH VULNERABLE POPULATIONS

2) Describe factors that led to the development of vulnerability in certain populations.

vi) Lack of power, control, victimization, disadvantaged status, disenfranchisement.

4) Describe individual and social factors that contribute to vulnerability.

i) Know what resources are available.

7) Describe the health challenges of importance to aboriginal peoples in Canada.

11) Explain the effect of substance abuse on the community.

UNIT 6: FAMILY AS CLIENT

1) Explain the importance of family nursing in the community setting.

4) Define the following:

(1) Resiliency more likely to occur:

5) Analyze changes in family function and structure.

b) Dysfunctional Family: seen as bad, noncompliant, resistant, unmotivated.

6) Explain how the determinants of health affect family.

i) Explores contextual factors of health work, health potential, style of nursing,

ii) Developmental Dimension: stages that

(i) Unattached young adult

(c) Capabilities, skills or competencies that an individual or family has developed

9) Outline how to promote capacity-building with the family.

12) Explain caregiving burden and the risks of elder abuse.

(1) Focus on family competencies

15) Evaluation: continuing, revising, or terminating the plan.

17) Child and Adolescent Health:

18) Adult health:

a) Women’s health: breast self-exam, reproductive health, menopause, cardiovascular

UNIT 7: COMMUNICABLE DISEASE CONTROL

(1) Infant mortality