Study Guide Exam 1 NUR 449

STUDY GUIDE NUR 449-01 released 1-18-2011

EXAM 1 DUE 1-25-2011
VENUE AND TIME: Allyn Hall Rm 259, 12:00- 12:50pm (50mins)
Note: This is just a study guide to help you prepare for your first academic activity (i.e.
Exam) in relation to Community Health Nursing content that we have covered from
January 4th, 2010 to January, 18th, 2011.
Remember, the study guide does not dismiss the fact that you are responsible for the
assigned readings in your syllabus and also information that was discussed in class,
discussions and team/group activities.
Exam: There will be 40 questions.

Things that I want you to know:

Related Overall Course Objectives (from your syllabus):

1. Utilize community nursing concepts, models and theories to analyze the

uniqueness of communities to determine, prioritize and respond to health needs for
a culturally diverse population.
2. Utilize epidemiological models and principles to analyze the appropriate nursing
interventions to provide and improve primary, secondary and tertiary care of
communities.
Week 1:
• Be able to define the following terms: **community/public health nursing,
community, population, aggregate, distributive justice, social justice, geopolitical
& phenomenological communities, healthy communities, health disparity.
o Community health nursing—Term developed in the 1960s to expand the
term "public health nursing" because the term "public health" had become
linked only with nurses employed by governments; a synonym for public
health nursing; a synthesis of nursing and public health.
o Community/public health nursing: The synthesis of public health and the
provision of nursing service to the community or population as a whole.
o Population—A collection of individuals who share one or more personal or
environmental characteristics, the most common of which is geographic
location (Schultz, 1987); the terms "population groups" and "aggregates"
are synonyms for population (Williams, 1977).
o Aggregate—Any number of individuals with at least one common
characteristic.
o Distributive Justice- Ethical concept concerned with the fair provision of
opportunities goods and services to populations of people
o Social Justice- The principle that all persons are entitled to have their
basic human needs met, regardless of differences.
o Geopolitical Community
 Residents of a geopolitical space
• ◦ Between mountains
• ◦ Within city limits
• ◦ In general area (Miami Valley)
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 Group of people living in an environment that supports their major

life goals and meets needs such as food, shelter, & socialization
 Where people live, maintain homes, earn a living, go to
school, raise children, and perform every-day activitiesHealthy
community—A community in which residents are happy with their
choice of location and that exhibits characteristics that would draw
others to the location.
o Phenomenological Community
 Group membership
 Relationships more important than physical location
• ◦ “Place” is a group perspective
• ◦ There is usually a place where the community comes
together
• Otherwise –Aggregate
• Place can be the Internet
 Usually have regular & direct communications
• ◦ Social group – church or club
• ◦ Group with a common link that develops into lasting
community
o Arts community
o Gay/lesbian community
o Business community
o Health disparities—Differences or inequalities of health status, including
differences in life expectancy, mortality, and morbidity. (See also Health
care disparities)
• Be able to determine the role community/public health nurse
o COMMUNITY/PUBLIC HEALTH NURSING
o Care of populations
o ◦ Nursing outside of acute care & institutions
o Takes place in multiple roles & settings
o Client can be person, family, group or the
o whole community/population
o Individual patient decisions are understood
o in context of family & community
o ◦ Care of vulnerable populations, disease
o prevention, investigations, community education.
• Be able to determine nurses’ contribution to public health practice. (i.e. review
public health heroes)
William  1859- British philanthropist
Rathbone
 Established District Nursing which was later known as

census tract
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 Worked with Florence Nightingale to establish public health

principles

◦ Investigation

◦ Reporting

◦ Record keeping

◦ Environmental issues

◦ Teaching and referral

Lemuel  Vital statistics

Shattucks  Environmental sanitation
 Food, drug & communicable disease control
 Well child care, immunization & health education, proposals
on smoke, ETOCH control
 Teaching reform in medical education
 Periodic screening
 Public education
 Supervision of immigration
 L. Shattuck Report: Massachusetts Sanitary Commission

Ada considered to be the first industrial nurse in the United States. Her
Stewart work consisted of home visiting and referral from physicians. The
majority of her patients were obstetrical, but she also cared for
medical and surgical patients. Services to employees, and
townspeople who could not afford any other care, were free.
Jessie  First Black public health nurse who contributed to the
Sleet
Scales development, growth and practice of public health nursing

in New York City during the early twentieth century

 High incidence of tuberculosis among blacks in NY

 Persuaded residents to get treatment for TB

Mary  1925
Breckenri
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dge  Frontier nursing

 Improve health care of rural and inaccessible population in

the Appalachian or eastern region of KY.

Linda  America's First Trained Nurse

Richards
 Established schools of nursing

 Helped provide health promotion services and reduce

illness
Margaret  Nurse, political activist and promote of women’s
Sanger
empowerment)

 Initiated the National Birth Control League in 1913

 Opened first birth control clinic in 1919

 Made contraceptive services and information available to

women after World War II

Charles-  Founded the Yale Department of Public Health within the

Edward
Amory Yale Medical School in 1915
Winslow
 He was professor and chairman of the Department until he

retired in 1945.

 He emphasized a broader perspective on causation,

adopting a more holistic perspective. The department under

his direction was a catalyst for health reform in Connecticut.

He was the first director of Yale's J.B. Pierce Laboratory,

serving from 1932 to 1957.

 Study Guide Exam 1 NUR 449

 Winslow was also instrumental in founding the Yale School

of Nursing

 Recommended:

◦ Sanitation of environment

◦ Control of communicable infections

Education of the individual- personal hygiene

- Ensure a standard of living to promote the health

and well-being of every individual and the community

◦ Health visitor

Lillian  RN, social activist

Ward  Founder of Henry Street Settlement (1983)

 Established the visiting nurse service for the poor,

immigrant families in NY

 First American public health nursing agency: emphasized

HP/DP principles, eradication of social issues plaguing

immigrants

 Included nurses in schools, tuberculosis programs,

hospitals, factories, child welfare agencies.

Goldmark ◦ Instituted by the medical profession

Report - ◦ Criticized nursing education
1923
 Training and curriculum
 Made recommendations for change
History of: In 1920 the Rockefeller
Foundation funded the Committee for
 Study Guide Exam 1 NUR 449

the Study of Nursing Education, which

included Annie W. Goodrich, M.
Adelaide Nutting, and Lillian Wald, to
study nursing education in the United
States. The report, published in 1923,
is known as the Goldmark Report.
The report concluded that the quality
of existing nursing programs was
inadequate. As a result of the report,
the Rockefeller Foundation funded an
experiment in nursing education which
became the Yale School of Nursing.
 The Yale School of Nursing was the
first autonomous school of nursing
with its own dean, faculty, budget, and
degree meeting the standards of the
University. Education took precedence
over service to a hospital, with training
based on an educational plan rather
than on service needs.

• Be able to identify and describe the core public health professionals and
essential services. (Ch 29 in Maurer)
o Core public health functions
 Assessment of the community
 Assurance that services are provided
 Health policy development
o Core public health essential services
 Preventing epidemics and the spread of disease
 Protecting against environmental hazards
 Preventing injuries
 Promoting and encouraging health behaviors and mental health
 Responding to disasters and assisting communities in recovery
 Ensuring the quality and accessibility of health services

**Become familiar with the scope and practice of public health nursing practice
(will be helpful in understanding the focus of p/c health nursing practice). Go to
 Study Guide Exam 1 NUR 449

this website and review a summary:

http://www.ct.gov/dph/lib/dph/Scope_Standards_PHN.pdf

Scope and Standards of Public Health Nursing Practice

Public Health Nursing is the practice of promoting and protecting the health of
populations using knowledge from nursing, social, and public health sciences. It
is population focused, community-oriented nursing practice. The goal of public
health nursing is the prevention of disease and disability for all people through
the creation of conditions in which people can be healthy.

Tenets (doctrine) of Public Health Nursing

1. Population based assessment, policy development, and assurance
processes are systematic and comprehensive, including:
A. consideration of community capacity
B. personal or lifestyle health practices
C. human biology
D. health services
E. social, economic, physical, and environmental factors as they
affect the population’s health
EXAMPLE: Evaluating health trends and risk factors of population groups and
determining priorities for targeted interventions.

This assessment process includes a review of the needs, strengths, and

expectations of all of the people and is guided by epidemiological methods.
2. All processes must include partnering with representatives of the
people.
This assures that the interpretation of the data, policy decisions, and
planning of intervention strategies reflect the perspectives, priorities, and
values of the people.
EXAMPLE: Working with specific groups to develop public policy and targeted
health promotion and disease prevention activities

3. Primary prevention is given priority. This includes health promotion

and health protection strategies.

4. Intervention strategies are selected to create healthy environmental,

social and economic conditions in which people can thrive.
Public Health Nurses concentrate on interventions aimed at improving
environments to benefit the health of the population. Interventions include
educational, community development, social engineering, as well as policy
development and enforcement strategies. Interventions tend to emerge from the
political or community participation process and result in governmental policies
and laws, administrative rules, and budget priorities.
 Study Guide Exam 1 NUR 449

5. Public Health Nursing practice includes an obligation to actively reach

out to all who might benefit from an intervention or service. Often, those
most likely to benefit are those who are the most marginal recipients

6. The dominant concern and obligation is for the greater good of all the
people, or the population as a whole. Because the unit of care for this
specialty is the population, consideration of what is in the best interest of
the whole takes priority over the best interest of an individual or a group.
Public Health Nurses promote the health of individuals, but this
responsibility is secondary to their obligation to promote the health of the
population.

7. Stewardship and allocation of available resources supports the

maximum population health benefit gain. Provision of information about
cost effectiveness of potential intervention strategies, information about
potential outcomes, and information about potential outcomes of policy
decisions.

8. The health of the people is most effectively promoted and protected

through collaboration with members of other professions and
organizations. Creating conditions in which people can be healthy is very
complex, and resource intensive. PHN’s join with experts from multiple
professions and organizations to improve population health.

Public Health Nurses are distinguished from other nursing specialties by their
adherence to all 8 tenets of public health nursing.

It is not the location of care, but the focus of care that differentiates PHN practice
from other specialty areas of practice.

Standards of Care
Assessment:
Diagnosis
Outcomes Identification
Planning
Assurance
Evaluation

Week 2:
• Understand the following terms: community nursing process, windshield survey,
key informants, surveillance, target population, community as a partner
• Understand the role of the c/public health nurse in the community nursing
process.
Week 3:
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• Understand the following terms: epidemiological triangle, rate, prevalence rate,

incidence, web of causation, herd immunity, communicable diseases (e.g.
chicken pox) , drug resistance, active and passive immunity, communicable
disease investigation, case finding, levels of prevention.
• Understand the above terms and their implications to c/public health nursing
practice.