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 Culture and Aging

Cross-Cultural Communication

Health-Related Beliefs and Practices

Management of Health Problems: A Cultural Perspective

Management of Health Problems in Culturally Diverse Populations

Role of the Community Health Nurse in Improving Health for Culturally Diverse People

Resources for Minority Health

Summary

Evolve Website

14. Environmental Health

A Critical Theory Approach to Environmental Health

Areas of Environmental Health

Effects of Environmental Hazards

Efforts to Control Environmental Health Problems

Emerging Issues in Environmental Health

Approaching Environmental Health at the Population Level

Critical Environmental Health Nursing Practice

Summary

Evolve Website

15. Health in the Global Community

Population Characteristics

Environmental Factors

Patterns of Health and Disease

International Agencies and Organizations

International Health Care Delivery Systems

Research in International Health

Summary

Evolve Website

Unit 4. Aggregates in the Community

16. Child and Adolescent Health

8
 Issues of Pregnancy and Infancy

Childhood Health Issues

Adolescent Health Issues

Factors Affecting Child and Adolescent Health

Strategies to Improve Child and Adolescent Health

Public Health Programs Targeted to Children and Adolescents

Sharing Responsibility for Improving Child and Adolescent Health

Legal and Ethical Issues in Child and Adolescent Health

Summary

Evolve Website

17. Women’s Health

Major Indicators of Health

Life Expectancy

Social Factors Affecting Women’s Health

Working Women and Home Life

Health Promotion Strategies for Women

Major Legislation Affecting Women’s Health

Health and Social Services to Promote the Health of Women

Levels of Prevention and Women’s Health

Roles of the Community Health Nurse

Research in Women’s Health

Summary

Evolve Website

18. Men’s Health

Men’s Health Status

Use of Medical Care

Theories that Explain Men’s Health

Factors that Impede Men’s Health

Men’s Health Care Needs

Community Health Nursing Services for Men

New Concepts of Community Care

9
 Summary

Evolve Website

19. Senior Health

Concept of Aging

Theories of Aging

Demographic Characteristics

Psychosocial Issues

Physiological Changes

Wellness and Health Promotion

Common Health Concerns

Additional Health Concerns

Elder Safety and Security Needs

Psychosocial Disorders

Spirituality

End-of-Life Issues

Summary

Evolve Website

20. Family Health

Challenges Facing U.S. Families

Understanding Family Nursing

The Changing Family

Approaches to Meeting the Health Needs of Families

Approaches to Family Health

Assessment Tools

Family Health Assessment

Extending Family Health Intervention to Larger Aggregates and Social Action

Applying the Nursing Process

Summary

Evolve Website

Unit 5. Vulnerable Populations

10
21. Populations Affected by Disabilities

Self-Assessment: Perception of Disability

Definitions and Models for Disability

A Historical Context for Disability

Prevalence of Disability

Disability and Public Policy

The Experience of Disability

Health Promotion and Disease Prevention for Pwd

Ethical Issues for People Affected by Disabilities

Summary

Evolve Website

22. Veterans’ Health

Overview of the American Uniformed Services

Veteran Health Risks

Veterans Health Assessment

Interventions for Veteran Health Problems

Summary

Evolve Website

23. Homeless Populations

Definitions, Prevalence, and Demographic Characteristics of Homelessness

Factors that Contribute to Homelessness

Health and Homeless Populations

Health Status of the Homeless Population

Community Public Health Nursing: Care of Homeless Populations

Summary

Evolve Website

24. Rural and Migrant Health

Rural United States

Rural Health

Rural Health Disparities: Context and Composition

11
 Specific Rural Aggregates

Rural Health Care Delivery System

Community-Based Care

Legislation and Programs Affecting Rural Public Health

Rural Community Health Nursing

New Models Of Health Care Delivery for Rural Areas

Evolve Website

25. Populations Affected by Mental Illness

Overview and History of Community Mental Health: 1960 to the Present Day

Healthy People 2020: Mental Health and Mental Disorders

Factors Influencing Mental Health

Mental Disorders Encountered in Community Settings

Identification and Management of Mental Disorders

Community-Based Mental Health Care

Role of the Community Mental Health Nurse

Summary

Evolve Website

Unit 6. Population Health Problems

26. Communicable Disease

Communicable Disease and Healthy People 2020

Principles of Infection and Infectious Disease Occurrence

Chain of Transmission

Breaking the Chain of Transmission

Public Health Control of Infectious Diseases

Vaccines and Infectious Disease Prevention

Vaccine Needs for Special Groups

Healthy People 2020 Focus on Immunization and Infectious Diseases

Healthy People 2020 Focus on Sexually Transmitted Diseases

Healthy People 2020 Focus on Hiv/Aids

Prevention of Communicable Diseases

12
 Summary

Evolve Website

27. Substance Abuse

Etiology of Substance Abuse

Historical Overview of Alcohol and Illicit Drug Use

Prevalence, Incidence, and Trends

Adolescent Substance Abuse

Conceptualizations of Substance Abuse

Sociocultural and Political Aspects of Substance Abuse

Course of Substance-Related Problems

Legal and Ethical Concerns Related to Substance Abuse

Modes of Intervention

Social Network Involvement

Vulnerable Aggregates

Nursing Perspective on Substance Abuse

Summary

Evolve Website

28. Violence

Overview of Violence

History of Violence

Interpersonal Violence

Community Violence

Factors Influencing Violence

Violence from a Public Health Perspective

Prevention of Violence

Summary

Evolve Website

29. Natural and Manmade Disasters

Disaster Definitions

Types of Disasters

13
 Characteristics of Disasters

Disaster Management

Disaster Management Stages

Recovery Stage

Summary

Evolve Website

Unit 7. Community Health Settings

30. School Health

History of School Health

School Health Services

School Nursing Practice

School-Based Health Centers

Future Issues Affecting the School Nurse

Summary

Evolve Website

31. Occupational Health

Evolution of Occupational Health Nursing

Demographic Trends and Access Issues Related to Occupational Health Care

Occupational Health Nursing Practice and Professionalism

Occupational Health and Prevention Strategies

Skills and Competencies of the Occupational Health Nurse

Impact of Federal Legislation on Occupational Health

Legal Issues in Occupational Health

Multidisciplinary Teamwork

Summary

Evolve Website

32. Forensic and Correctional Nursing

Subspecialties of Forensic Nursing

Correctional Nursing

Health Issues in Prison Populations

14
 Mental Health Issues in Correctional Settings

Education and Forensic Nursing

Summary

Evolve Website

33. Faith Community Nursing

Faith Communities: Role in Health and Wellness

Foundations of Faith Community Nursing

Roles or Functions of the Faith Community Nurse

Education of the Faith Community Nurse

The Faith Community Nurse and Spirituality

Issues in Faith Community Nurse Practice

Summary

Evolve Website

34. Home Health and Hospice

Types of Home Health Agencies

Certified and Noncertified Agencies

Special Home Health Programs

Reimbursement for Home Care

OASIS

Nursing Standards and Educational Preparation of Home Health Nurses

Conducting a Home Visit

Documentation of Home Care

Application of the Nursing Process

Hospice Home Care

Summary

Evolve Website

Index

IBC

15
16
Copyright

3251 Riverport Lane

St. Louis, Missouri 63043

COMMUNITY/PUBLIC HEALTH NURSING: PROMOTING THE HEALTH OF POPULATIONS,

SEVENTH EDITION ISBN: 978-0-323-52894-8

Copyright © 2019 by Elsevier, Inc. All rights reserved.

Chapter 22: Veteran’s Health—Contributions made by Alison C. Sweeney, Angelic Denise

Chaison, and Joanna Lamkin are in public domain.

No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek
permission, further information about the Publisher’s permissions policies and our arrangements
with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency,
can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
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own experience and knowledge of their patients, to make diagnoses, to determine dosages and the
best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.

Previous editions copyrighted 2015, 2011, 2007, 2001, 1997, and 1993.

Library of Congress Cataloging-in-Publication Control Number: 2018944741

17
Content Strategist: Jamie Blum
Senior Content Development Manager: Ellen Wurm-Cutter
Content Development Specialist: John Tomedi
Publishing Services Manager: Julie Eddy
Senior Project Manager: Rachel E. McMullen
Design Direction: Renee Duenow

Printed in Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

18
Dedication

To Phil Yankovich, my husband, companion, and best friend, whose love, caring, and true support
are always there for me. He provides me with the energy I need to pursue my dreams.

To Kara Nies Yankovich, my daughter, for whom I wish a happy and healthy life. Her energy, joy,
and enthusiasm for life give so much to me.

To Earl (who passed away October 15, 2017, at the age of 92) and Lois Nies, my parents, for their
never-ending encouragement and lifelong support. They helped me develop a foundation for
creative thinking, new ideas, and spirited debate.

Mary A. Nies

To my husband, Scott McEwen, whose love, support, inspiration, and encouragement have been
my foundation for more than 40 years. I can’t wait to see what happens next!

Melanie McEwen

19
About the Author

Mary A. Nies
Mary A. Nies, PhD, RN, FAAN, FAAHB, is the Director of Nursing Research and Professor
College of Nursing, Joint Appointment MPH Program, Kasiska Division of Health Sciences, Idaho
State University. Dr. Nies received her diploma from the Bellin School of Nursing in Green Bay,
Wisconsin; her BSN from the University of Wisconsin, Madison; her MSN from Loyola University,
Chicago; and her PhD in Public Health Nursing, Health Services, and Health Promotion Research at

20
the University of Illinois, Chicago. She completed a postdoctoral research fellowship in health
promotion and community health at the University of Michigan, Ann Arbor. She is a fellow of the
American Academy of Nursing and a fellow of the American Academy of Health Behavior. Dr.
Nies co-edited Community Health Nursing: Promoting the Health of Aggregates, which received the
1993 Book of the Year award from the American Journal of Nursing. Her program of research focuses
on the outcomes of health promotion interventions for minority and nonminority populations in the
community. Her research is involved with physical activity and obesity prevention for vulnerable
community populations.

Melanie McEwen
Melanie McEwen, PhD, RN, CNE, ANEF, is a Professor at the University of Texas Health Science
Center at Houston’s Cizik School of Nursing. Dr. McEwen received her BSN from the University of
Texas School of Nursing in Austin; her Master’s in Community and Public Health Nursing from
Louisiana State University Medical Center in New Orleans; and her PhD in Nursing from Texas

21
Woman’s University. Dr. McEwen has been a nursing educator for 30 years and is also the co-
author of Community–Based Nursing: An Introduction (Elsevier, 2009) and co-author/editor of
Theoretical Basis for Nursing (Wolters Kluwer, 2018).

22
Acknowledgments
Community/Public Health Nursing: Promoting the Health of Populations could not have been written
without sharing the experiences, thoughtful critique, and support of many people: individuals,
families, groups, and communities. We give special thanks to everyone who made significant
contributions to this book.
We are indebted to our contributing authors whose inspiration, untiring hours of work, and
persistence have continued to build a new era of community health nursing practice with a focus on
the population level. We thank the community health nursing faculty and students who welcomed
the previous editions of the text and responded to our inquiries with comments and suggestions for
the seventh edition. These people have challenged us to stretch, adapt, and continue to learn
throughout our years of work. We also thank our colleagues in our respective work settings for
their understanding and support during the writing and editing of this edition.
Finally, an enormous “thank you” to John Tomedi of Spring Hollow Press, Elsevier editors Ellen
Wurm-Cutter and Jamie Blum, and project manager Rachel E. McMullen. Their energy, enthusiasm,
encouragement, direction, and patience were essential to this project.
Mary A. Nies, PhD, RN, FAAN, FAAHB
Melanie McEwen, PhD, RN, CNE, ANEF
I would like to express appreciation for the chapter authors who have been with me since the
very first edition of the textbook in 1993, namely:

• Patricia Burbank, Chapter 7: Community Health Planning, Implementation, and Evaluation

• Holly Cassells, Chapter 5: Epidemiology; Chapter 6: Community Assessment
• Susan Givens, Chapter 16: Child and Adolescent Health
• Jean Cozad Lyon, Chapter 9: Case Management

Mary A. Nies, PhD, RN, FAAN, FAAHB

23
Contributors
Cathy R. Arvidson, PhD, FNP-BC, Associate Professor, School of Nursing, Idaho State
University, Pocatello, Idaho

Chapter 10: Policy, Politics, Legislation, and Community Health Nursing

Tonya Bragg-Underwood, DNP, FNP-BC, CNE, Associate Professor, School of Nursing, Western
Kentucky University, Bowling Green, Kentucky
Chapter 20: Family Health
Carrie L. Buch, PhD, BSN, MS, Associate Professor, School of Nursing, Oakland University,
Rochester, Michigan
Chapter 34: Home Health and Hospice
Patricia M. Burbank, DNSc, BS, MS, Associate Dean and Professor, College of Nursing, The
University of Rhode Island, Kingston, Rhode Island
Chapter 7: Community Health Planning, Implementation, and Evaluation
Sarah G. Candler, MD, MPH, Assistant Professor, Baylor College of Medicine, Michael E.
DeBakey Veterans Affairs Medical Center, Houston, Texas

Chapter 22: Veterans’ Health

Holly B. Cassells, PhD, MPH, MN, Professor, School of Nursing and Health Professions,
University of the Incarnate Word, San Antonio, Texas

Chapter 5: Epidemiology
Chapter 6: Community Assessment
Angelic Denise Chaison, PhD, Psychologist, Michael E. DeBakey Veterans Affairs Medical
Center, Assistant Professor, Baylor College of Medicine, Houston, Texas
Chapter 22: Veterans’ Health
Christina N. DesOrmeaux, BSN, MSN, PhD, Community Division Head, Community Nursing,
The University of Texas at Houston Health Science Center, School of Nursing, Houston, Texas

Chapter 13: Cultural Diversity and Community Health Nursing

Chapter 30: School Health
Tina Doyle-Hines, LPC, NCC, U.S. Air Force, Retired, Former Veteran Counselor, UTH Cizik
School of Nursing, Houston, Texas

Chapter 22: Veterans’ Health

Stacy A. Drake, MSN, MPH, RN, Assistant Professor, Nursing Systems, The University of Texas
Health Science Center at Houston, School of Nursing, Houston, Texas

Chapter 32: Forensic and Correctional Nursing

24
Allison P. Edwards, DrPH, MS, RN, CNE
Assistant Professor, Nursing Systems, The University of Texas Health Science Center at Houston,
School of Nursing, Houston, Texas
Board Member, Texas Board of Nursing, Austin, Texas

Chapter 21: Populations Affected by Disabilities

Rola El-Serag, MD, Medical Director Women Veteran’s Program, Michael E. DeBakey Veterans
Affairs Medical Center, Assistant Professor of Medicine, Baylor College of Medicine, Houston,
Texas
Chapter 22: Veterans’ Health
Melissa Domingeaux Ethington, BSN, MSN, PhD, Assistant Professor, Family Health, The
University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas

Chapter 16: Child and Adolescent Health

Ginette G. Ferszt, PhD, RN, PMHCNS-BC, Professor, College of Nursing, University of Rhode
Island, Kingston, Rhode Island
Chapter 28: Violence
Lori A. Glenn, DNP, MS, CNM, RN
Clinical Associate Professor, McAuley School of Nursing, University of Detroit Mercy, Detroit,
Michigan
Nurse Midwife, Mid-Michigan Midwifery, Hurley Medical Center, Flint, Michigan
Chapter 17: Women’s Health
Deanna E. Grimes, DrPH, RN, MSN, FAAN, Suzie Conway Endowed Professor in Nursing,
Nursing Systems, The University of Texas Health Science Center at Houston, School of Nursing,
Houston, Texas
Chapter 26: Communicable Diseases
Karyn Leavitt Grow, MS, BSN, RN
Director of Care Coordination Training, Clinical Development, Caravan Health, Berkeley,
California
Chief Nursing Officer, Manager, Case Management/Preadmission Screening, Sierra Surgery
Hospital, Carson City, Nevada, Reno, Nevada

Chapter 9: Case Management

Jené M. Hurlbut, BSN, MSN, MS, PhD, Professor, Nursing, Roseman University of Health
Sciences, Henderson, Nevada

Chapter 18: Men’s Health

Joanna Lamkin, PhD, Postdoctoral Fellow, Veterans Affairs Health Services Research &
Development, Houston Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center,
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,
Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston,
Texas
Chapter 22: Veterans’ Health
Jean Cozad Lyon, PhD, MSN, Clinical Care Practitioner, ATOP2, HealthInsight, Reno, Nevada
Chapter 9: Case Management

25
Rex Marsau, U.S. Navy, Retired, Former Program Director, U.S. Vets, Houston, Texas
Chapter 22: Veterans’ Health
Diane Cocozza Martins, MEd, MA, PhD, Professor, College of Nursing, University of Rhode
Island, Kingston, Rhode Island
Chapter 3: Thinking Upstream: Nursing Theories and Population-Focused
Nursing Practice
Chapter 7: Community Health Planning, Implementation, and Evaluation
Mary E. McBee, DNP, MSN, BSN, RN, Assistant Professor, Nursing Systems, The University of
Texas Health Science Center at Houston, School of Nursing, Houston, Texas

Chapter 11: The Health Care System

Chapter 12: Economics of Health Care
Melanie McEwen, PhD, RN, CNE, ANEF, Professor, University of Texas Health Science Center
at Houston, Cizik School of Nursing, Houston, Texas

Chapter 1: Health: A Community View

Chapter 2: Historical Factors: Public Health Nursing in Context
Chapter 11: The Health Care System
Chapter 12: Economics of Health Care
Cathy D. Meade, PhD, RN, FAAN
Senior Member, Population Science, Health Outcomes & Behavior, Moffitt Cancer Center
Professor, Oncologic Sciences, University of South Florida, Tampa, Florida
Chapter 8: Community Health Education
Mary A. Nies, PhD, RN, FAAN, FAAHB, Director of Nursing Research and Professor College of
Nursing, Joint Appointment MPH Program, Kasiska Division of Health Sciences, Idaho State
University, Pocatello, Idaho

Chapter 1: Health: A Community View

Chapter 4: Health Promotion and Risk Reduction
Chapter 34: Home Health and Hospice
Julie Cowan Novak, DNSc, RN, CPNP
Executive Director, Neuro Developmental NICU Follow up Clinic, Sharp Mary Birch Hospital for
Women and Newborns, San Diego, California
Professor Emerita, Purdue University, West Lafayette, Indiana

Chapter 15: Health in the Global Community

Bridgette Crotwell Pullis, BSN, MS, PhD, Assistant Professor of Nursing, Director, The
Veterans’ Bachelor of Science in Nursing Program, Nursing Systems, The University of Texas
Health Science Center at Houston, School of Nursing, Houston, Texas

Chapter 4: Health Promotion and Risk Reduction

Chapter 22: Veterans’ Health

26
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