Public and Community Health Nurses

  1. Pubilic Health Nurses and Community Health Nurses:
    the" dimension process of care", how do you use it in your practice?
    I'm studying Community health nursing and am curious how this is applied, if at all.
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  2. 14 Comments

  3. by   hoolahan
    Huh?? Speak English! LOL, just kidding. For those of us who have been out of school for (ahem) awhile, can you refresh my memory what the definition is of this dimension??Thanks
  4. by   SandyB
    hoolahan, I'm so glad to know I'm not speaking English...I feel like I'm not reading English in this book either! Yippee! I'm NOT as crazy as I thought I was...
    OK, here is part of a chap intro
    The Process Dimension in Community Health Nursing
    The systematic processes that community HN emply to promote and safeguard the health of the public include the nursing process as well as the epidemiologic, health education, home visit, case management, change, leadership, groups, and political processes.
    does that help? LOL

    Hey, Love the sheltie...I have 7!!!
  5. by   SandyB
    I can add info on dimension of nursing as a Model. It incorporates the elements of nursing practice employed by the community health nurse. The dimensions included in this category include cognitive, interpersonal, ethical, skill, process and reflective dimensions...

    I suppose if they put it in simple language it would be what we already do but they made it all wordy and theory and ...well, school type confusing stuff!
    Thanks for any input from any of ya all out there!
  6. by   hoolahan
    Originally posted by SandyB
    hoolahan, I'm so glad to know I'm not speaking English...I feel like I'm not reading English in this book either! Yippee! I'm NOT as crazy as I thought I was...

    It's all hooey! Gobbledeegook!!! The secret language that you forget almost the minute you pass your boards!

    The systematic processes that community HN emply to promote and safeguard the health of the public include the nursing process as well as the epidemiologic, health education, home visit, case management, change, leadership, groups, and political processes.

    OMG I am not in my best teacher form tonight, AND this sounds like it came directly from the book I had to use for my BSN program, forget name & author, but iot was a pale yellow background, not Stanhope, but the other "biggie".

    Let's see...
    promote and safeguard the health of the public

    immunizations, educate people about it, work w local health dept to be sure low/no cost program of immunization is available.
    Nursing process? Assess; how do you know there is a problem? Maybe let's say there is an increase in whooping cough being reported in the public elem school system. Speak to school nurse, assess barriers to immunizations (cost, no insurance, cultural or religious barriers?)
    Plan; What will you do about it?
    Speak to public health dept, set-up a health fair, talk to radio stations, maybe start a campaign to promote immunizations, appeal to pharmaceutical co's to donate vaccines for a free clinic.

    Case management: arrange for home vs by nurse to assess parentla understanding of immunzations. mail out flyers w free clinic dates and times, and reminders at key immunization stages in the child's development.

    Impement the plan
    Eval the reults. Did the stats go down for whopping cough the next year? If not what will you do differently next time.


    does that help? LOL No!! I'm spent, that is just how you can take one exmaple of a public or community health problem and take it through the process. I am sure I could do a better job if I were feeling better. Other ideas that could be used are teen smoking, obesity in children, lead poisoning, breast cancer incidence. Lots of things that you can look at in this perspective. If you have the book I am thinking of, you need to read the chapters, or skim them of the different communities to see what kinds of problems can arise in diff communities.

    Hey, Love the sheltie...I have 7!!!
    Then you are the luckiest person I know!!!!!
  7. by   SandyB
    Wow, you do remember it! The book's author is Clark and your examples are similar....but do you use it in practice? Or seen it used? Are there assessment forms or just lots and lots of gov forms and gov paperwork to go around and around with?

    And yep, I'm pretty darn lucky to have 7 wonderful shelties!
  8. by   karbyr
    does it bother anybody else that somebody gets paid a lot more money than us to confuse nurses and student nurses????????lol
  9. by   SandyB
    I dunno if they make a lot more money....but I sure do wish they didn't think it was part of learning to confuse us!
  10. by   flowerchild
    <The Process Dimension in Community Health Nursing
    The systematic processes that community HN emply to promote and safeguard the health of the public include the nursing process as well as the epidemiologic, health education, home visit, case management, change, leadership, groups, and political processes.>

    What a great definition of what I do every day as a public health nurse. The nursing process is used in public health just as it is in hospitals and HHC. A plan of care is developed with the patient and family/CG involvement. I am currently doing tracking of a current outbreak of respiratory illnesses and also GI illnesses in the community. The statistical and anadoctal information is compiled and forwarded to the CDC if warranted. Health education to the community as well as individual patients through handouts and brochures, group classes, as well as one on one pt teaching as any nurse would instruct a patient. If a patients situation has a need for a home visit then we do those too. All of my patients are case managed to the degree that time allows and the patients and family cooperates. Most public health patients mistrust the systems anyway, so they don't make it easy. Many times this only includes a nursing poc but hopefully we get a chance to have a case conference with everyone involved. Change is everywhere. nuff said there. Leadership - I run my own clinic, of course with my assistants total involvement. I could type a lot about the many groups of people that I deal with on a daily basis. Politics play a huge role in what I do, how I do it and wheather or not I do it. Laws are passed on a frequent basis that affect me everyday. The biggest issue is funding. Loose the funding and the clinic is gone. The rumors fly on that one as I post. It's time for me to write the govt powers, again. So far, our cries have been heard and we have successfully saved our funding time and time again. Things are beginning to look a bit worse this year. Might have to actually go to the reps this time. Nothing like using the community to back you though, since they are the voters, get enough of them to stand up for you and they listen even better! Yes, I'd say it's political. Hope this helps you understand a bit better.
  11. by   Jay-Jay
    Did you try posting this in the Home Health forum as well?

    Just a suggestion....

    And sorry, I have NOTHING to contribute to the above! Been out of school too long, i guess!
  12. by   flowerchild
    <The dimensions included in this category include cognitive, interpersonal, ethical, skill, process and reflective dimensions...>

    <Are there assessment forms or just lots and lots of gov forms and gov paperwork to go around and around with?>

    The paperwork is there, but much of it is reviewing/evaluating and updating current items already in place. I chart as much as I need to cya and that's about it. Once the care plan is in place, the docs orders on file, the charting and nursing care (includes skills) is very focused. My hands used to hurt from all the writting in HHC, I don't have that problem anymore. Forms are my buddies, they make things easier. The content is sometimes governed but usually only when we are dong something that has to do with a public health issue that the gov't is mandating us to do. We always like to compile accurate stats for the govt b/c that is how our funding is based. The higher the population with a specific problem, the more money we get next year to help us promote that program. See/search: "Healthy People 2000" program as an example.
  13. by   WashYaHands
    As a community health nurse I use all of these dimensions and they are all intertwined. The nursing process in community health is assessment, diagnosis, planning, implementation and evaluation. The assessment aspect is assessing a population or aggregate population and all of the facets of the community in which people interact (history, demographics, ethnicity, values and belifs, physical environment, health and social services, economy, transportation, safety (police, fire, EMS, crime rates), politics, government structure, communication (how do people communicate and get news, education (levels, schools), recreation (leisure activities, exercise). An important compenent in assessing a community is speaking with the residents to find out what they perceive their needs are. For example, after doing a community assessment on a small community where I live one thing that I found that the crime rate was high and that people were fearful of being burglarized. So, one of the community diagnosis was, "Stress and anxiety of being criminally burglarized related to increased episodes of thefts and burglaries as evidenced by police crime statistics of past four years and personal testimony of residents, especially the elderly." My plan was to increase street and business lighting as well as offer a public awareness program on home and personal security. This requires leadership and working with the local government and police to implement the plan (politics) It also helps if you learn how to write grants . Once they were convinced of the need, it was implemented (not this simple, but you get the point). The local sheriff department helped with home visits of elderly folks to identify security issues in the home. Also, they helped with personal and property safety workshops (health education). We also enlisted volunteers from the fire department to help the elderly install additional safety devices in their homes. So, after the plans are implemented the community health nurse goes back after a time and evaluates whether or not the interventions decreased the crime rate and assessed the concerns of the people related to this issue.
    The epidemiological dimension is identify incidence and prevalence of specific illness/disease/adverse events and attempt to find a causal relationship. Once you establish a causal relationship and risk factors, preventive and public programs can be developed to educate the public and/or takes steps to prevent occurences. One example of this is the American Academy of Pediatrics public awareness campaign of "Back to sleep" for infants to decrease the incidence of SIDS. Infant sleep position is not the only risk factor for SIDS, but this campaign made an impact in the incidence and prevalence of this tragic event. It was epidemiology that did (and still is) identifying risk factors for SIDS. These are just some small examples, hope this helps. Sorry for such a long post.

    Linda
  14. by   hoolahan
    Yes that Clark book was my best friend in my BSN program, and another great book is the Edleman et al one, sorry, I gave the whole of it to a friend for her studies.

    Great insights flowerchild! In home health we have lots of paperwork, starting with The OASIS, )each letter stands for something, I forget what at this moment) but it is a 32 page assessment form, but just like anyform, you learn how to ask the oepn-ended questions so that you can get a lot of info for the answers just by asking one good question.

    I remember when I did some infection control nursing there were some forms to send to CDC as flowerchild said for statistical purposes.

    Do I use this in practice? Yes. I was doing disease management for a Medicaid insurance company, and I did compile data for stats, case manage, do educational presentations, and flowerchild is right, most fear or are suspicious of your motives.

    So yes, I do use the processes, but I never think of it as "Gee, I think I'll implement my Dimensions moddel and focus on the cognitive domain." I just do it. I do think in a nursing process way all the time, just b/c it is a very logical approach to solve many problems, not just for nursing issues. It becomes second nature.

    I will admit, gobbledeegook or not, what I learned in that program did make me a better home health nurse. I wish I could deny it but I can't, so it is good for something, I just wish the terminology weren't so.....bewildering!

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