Community DQ 1
Read chapters 1 and 2 of the class textbook and review the PowerPoint presentations located in all PowerPoints folder, once done answer the following questions.
Review the public health milestones presented in Box 1.1 and identified and discuss what potentials health successes might be cited in the next decade?
Based on the challenges the health care is facing due to the COVID 19 Pandemic, identify and discuss a new role for the nursing profession that will most likely evolve the first half of the 21st century.
Mention and discuss three reasons why you think that comparing healthcare systems between countries is an important approach to serving the healthcare needs of the people.
Mention and discuss how cultural and philosophical factors play an important role in how healthcare systems are developed and supported? Give at least examples.
Instructions
The assignment must be presented in a Times New Romans font (APA required), a minimum of 800 words not to exceeds1000 without counting the first and reference page.
You must be cited and quoted a minimum of 3 evidence-based references excluding the class textbook, electronic references must quote and cited properly and must be from reliable sources such as CDC, FDA, and others.
APA style
Plagiarism FREE
Community/Public Health
Nursing
Promoting the Health of
Populations
SIXTH EDITION
Mary A. Nies, PhD, RN, FAAN,
FAAHB
Dean and Professor School of Nursing, Joint Appointment MPH
Program, Division of Health Sciences, Idaho State University, Pocatello,
Idaho
Melanie McEwen, PhD, RN, CNE,
ANEF
Associate Professor, University of Texas Health Science Center at
Houston, School of Nursing, Houston, Texas
2
Table of Contents
Cover image
Title page
Copyright
Dedication
Author Biographies
Contributors
Reviewers
Preface
Unit 1. Introduction to Community Health
Nursing
Chapter 1. Health: A Community View
Definitions of Health and Community
Determinants of Health and Disease
Indicators of Health and Illness
Definition and Focus of Public Health and Community Health
Preventive Approach to Health
Definition and Focus of Public Health Nursing, Community Health Nursing, and
Community-Based Nursing
Population-Focused Practice and Community/Public Health Nursing Interventions
Community Health Nursing, Managed Care, and Health Reform
Learning Activities
Chapter 2. Historical Factors: Community Health Nursing in
Context
Evolution of Health in Western Populations
3
kindle:embed:0006?mime=image/jpg
Advent of Modern Health Care
Consequences for the Health of Aggregates
Social Changes and Community Health Nursing
Challenges for Community and Public Health Nursing
Summary
Learning Activities
Chapter 3. Thinking Upstream: Nursing Theories and Population-
Focused Nursing Practice
Thinking Upstream: Examining the Root Causes of Poor Health
Historical Perspectives on Nursing Theory
How Theory Provides Direction to Nursing
Microscopic Versus Macroscopic Approaches to the Conceptualization of Community
Health Problems
Assessing a Theorys Scope in Relation to Community Health Nursing
Review of Theoretical Approaches
Healthy People 2020
Summary
Learning Activities
Chapter 4. Health Promotion and Risk Reduction
Health Promotion and Community Health Nursing
Determinants Of Health
Theories in Health Promotion
Risk and Health
The Relationship of Risk to Health and Health Promotion Activities
Summary
Learning Activities
Unit 2. The Art and Science of Community
Health Nursing
Chapter 5. Epidemiology
Use of Epidemiology in Disease Control and Prevention
Calculation of Rates
Concept of Risk
Use of Epidemiology in Disease Prevention
Use of Epidemiology in Health Services
4
Epidemiological Methods
Summary
Learning Activities
Chapter 6. Community Assessment
The Nature of Community
Healthy Communities
Assessing the Community: Sources of Data
Needs Assessment
Diagnosing Health Problems
Summary
Learning Activities
Chapter 7. Community Health Planning, Implementation, and
Evaluation
Overview of Health Planning
Health Planning Model
Health Planning Projects
Health Planning Federal Legislation
Nursing Implications
Summary
Learning Activities
Chapter 8. Community Health Education
Connecting with Everyday Realities
Health Education in the Community
Learning Theories, Principles, and Health Education Models
The Nurses Role in Health Education
Enhancing Communication
Framework for Developing Health Communications
Health Education Resources
Social Media
Summary
Learning Activities
Chapter 9. Case Management
Overview of Case Management
Origins of Case Management
Purpose of Case Management
5
Utilization Review and Managed Care
Trends that Influence Case Management
Education and Preparation for Case Managers
Case Manager Services
Case Manager Roles and Characteristics
Case Identification
The Referral Process
Application of Case Management in Community Health
Research in Case Management
International Case Management
Summary
Learning Activities
Unit 3. Factors that Influence the Health of the
Community
Chapter 10. Policy, Politics, Legislation, and Community Health
Nursing
Overview: Nurses Historical and Current Activity in Health Care Policy
Definitions
A Major Paradigm Shift
Structure of the Government of the United States
Overview of Health Policy
Major Legislative Actions and the Health Care System
Public Policy: Blueprint for Governance
The Effective Use of Nurses: A Policy Issue
Nurses Roles in Political Activities
Health Care Reform and Restructuring of the Health Care Industry
Nurses and Leadership in Health Policy Development
Summary
Learning Activities
Chapter 11. The Health Care System
Overview: The Health Care System
Components of the Health Care System
Quality Care
Critical Issues in Health Care Delivery
6
Future of Public Health and the Health Care System
Summary
Learning Activities
Chapter 12. Economics of Health Care
Factors Influencing Health Care Costs
Public Financing of Health Care
Philanthropic Financing of Health Care
Health Care Insurance Plans
Cost Containment
Trends in Health Financing
Health Care Financing Reform
Roles Of the Community Health Nurse in the Economics of Health Care
Best Care at Lower Cost
Summary
Learning Activities
Chapter 13. Cultural Diversity and Community Health Nursing
Cultural Diversity
Transcultural Perspectives on Community Health Nursing
Population Trends
Cultural Perspectives and Healthy People 2020
Transcultural Nursing
Overview of Culture
Culture and Socioeconomic Factors
Culture and Nutrition
Culture and Religion
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
Learning Activities
Chapter 14. Environmental Health
7
A Critical Theory Approach to Environmental Health
Areas of Environmental Health
Effects of Environmental Hazards
Efforts to Control Environmental Health Problems
Emerging Issues in Environment Health
Approaching Environmental Health at the Population Level
Critical Environmental Health Nursing Practice
Summary
Learning Activities
Chapter 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
Health Initiatives Taking Place Throughout the World
Summary
Learning Activities
Unit 4. Aggregates in the Community
Chapter 16. Child and Adolescent Health
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
Learning Activities
Chapter 17. Womens Health
Major Indicators of Health
Social Factors Affecting Womens Health
8
Health Promotion Strategies for Women
Major Legislation Affecting Womens Health
Health and Social Services to Promote the Health of Women
Levels of Prevention and Womens Health
Roles of the Community Health Nurse
Research in Womens Health
Summary
Learning Activities
Chapter 18. Mens Health
Mens Health Status
Use of Medical Care
Theories that Explain Mens Health
Factors that Impede Mens Health
Mens Health Care Needs
Primary Preventive Measures
Secondary Preventive Measures
Tertiary Preventive Measures
Summary
Learning Activities
Chapter 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
Learning Activities
Chapter 20. Family Health
9
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
Learning Activities
Unit 5. Vulnerable Populations
Chapter 21. Populations Affected by Disabilities
Self-Assessment: Responses to Disability
Definitions and Models for Disability
A Historical Context for Disability
Characteristics of Disability
Disability and Public Policy
Costs Associated with Disability
Healthy People 2020 and The Health Needs of People with Disabilities
The Experience of Disability
Strategies for the Community Health Nurse in Caring for People with Disabilities
Ethical Issues for People Affected by Disabilities
Summary
Learning Activities
Chapter 22. Homeless Populations
Definitions, Prevalence, and Demographic Characteristics of Homelessness
Factors that Contribute to Homelessness
Health and Homeless Populations
Health Status of Homeless Population
Community Public Health Nursing: Care of Homeless Populations
Summary
Learning Activities
Chapter 23. Rural and Migrant Health
Rural United States
10
Rural
Rural Health Disparities: Context and Composition
Specific Rural Aggregates
Application of Relevant Theories and Thinking Upstream Concepts to Rural Health
Rural Health Care Delivery System
Community-Based Care
Legislation and Programs Affecting Rural Public Health
Rural Community Health Nursing
Rural Health Research
New Models of Health Care Delivery for Rural Areas
Summary
Learning Activities
Chapter 24. 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
Learning Activities
Unit 6. Population Health Problems
Chapter 25. 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
11
Prevention of Communicable Diseases
Summary
Learning Activities
Chapter 26. 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
Learning Activities
Chapter 27. Violence
Overview of Violence
History of Violence
Interpersonal Violence
Community Violence
Factors Influencing Violence
Violence from a Public Health Perspective
Prevention of Violence
Summary
Learning Activities
Chapter 28. Natural and Man-Made Disasters
Disaster Definitions
Types of Disasters
Characteristics of Disasters
Disaster Management
Disaster Management Stages
Summary
12
Learning Activities
Unit 7. Community Health Settings
Chapter 29. School Health
History of School Health
School Health Services
School Nursing Practice
School-Based Health Centers
Future Issues Affecting the School Nurse
Summary
Learning Activities
Chapter 30. 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
Learning Activities
Chapter 31. Forensic and Correctional Nursing
Subspecialties of Forensic Nursing
Correctional Nursing
Health Issues in Prison Populations
Mental Health Issues in Correctional Settings
Education and Forensic Nursing
Summary
Learning Activities
Chapter 32. 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
13
The Faith Community Nurse and Spirituality
Issues in Faith Community Nurse Practice
Summary
Learning Activities
Chapter 33. Home Health and Hospice
Home Health Care
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
Formal and Informal Caregivers
Hospice Home Care
Summary
Learning Activities
Index
Special Features
14
Copyright
3251 Riverport Lane
St. Louis, Missouri 63043
COMMUNITY/PUBLIC HEALTH NURSING: PROMOTING THE
HEALTH OF POPULATIONS
ISBN: 978-0-323-18819-7
Copyright 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
imprint of Elsevier Inc.
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
15
http://www.elsevier.com/permissions
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 product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying
on their 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.
Library of Congress Cataloging-in-Publication Data
Community/public health nursing : promoting the health of
populations / [edited by] Mary A. Nies, Melanie McEwen. — Edition
6.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-18819-7 (pbk. : alk. paper)
I. Nies, Mary A. (Mary Albrecht), editor. II. McEwen, Melanie,
editor.
[DNLM: 1. Community Health Nursing. 2. Health Promotion. 3.
Public Health Nursing. WY 106]
16
RT98
610.7343–dc23 2014023359
Director, Traditional Education: Kristin Geen
Senior Content Strategist: Nancy O’Brien
Content Development Specialist: Jennifer Shropshire
Publishing Services Manager: Deborah L. Vogel
Project Manager: John W. Gabbert
Design Direction: Karen Pauls
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
17
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 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, and
encouragement have been my foundation for the past
thirty-five years. I can’t wait to see what happens next!
Melanie McEwen
18
Author Biographies
Mary A. Nies
Mary A. Nies, PhD, RN, FAAN, FAAHB is the Dean and
Professor School of Nursing, Joint Appointment MPH Program,
19
Division of Health Sciences, Idaho State University. Dr. Nies
received her diploma from Bellin School of Nursing in Green Bay,
Wisconsin; her BSN from University of Wisconsin, Madison; her
MSN from Loyola University, Chicago; and her PhD in Public
Health Nursing, Health Services, and Health Promotion Research at
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 populations, especially women. Her research
is involved with physical activity and obesity prevention for
vulnerable populations.
20
Melanie McEwen
Melanie McEwen, PhD, RN, CNE, ANEF is an Associate
Professor at the University of Texas Health Science Center at
Houston 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
at Texas Woman’s University. Dr. McEwen has been a nursing
educator for more than 22 years and is also the co-author of
CommunityBased Nursing: An Introduction (Elsevier, 2009) and co-
author/editor of Theoretical Basis for Nursing (Lippincott, Williams
and Wilkins, 2014).
21
Contributors
Carrie Buch, PhD, RN, Associate Professor, Oakland University,
School of Nursing, Rochester, Michigan
Chapter 13: Cultural Diversity and Community Health Nursing
Chapter 33: Home Health and Hospice
Patricia M. Burbank, DNSc, RN, Professor, College of Nursing,
The University of Rhode Island, Kingston, Rhode Island
Chapter 7: Community Health Planning, Implementation, and Evaluation
Holly B. Cassells, PhD, MPH, RN, Professor, School of Nursing
and Health Professions, University of the Incarnate Word, San
Antonio, Texas
Chapter 5: Epidemiology
Chapter 6: Community Assessment
Stacy A. Drake, MSN, MPH, RN, Instructor, The University of
Texas Health Science Center at Houston, School of Nursing,
Houston, Texas
Nellie S. Droes, DNSc, RN, CS, Associate Professor, Emerita,
School of Nursing, East Carolina University , Rivers Building,
Greenville, North Carolina
Chapter 22: Homeless Populations
Anita Finkelman, MSN, RN, Visiting Faculty, School of Nursing,
Bouv College of Health Sciences, Northeastern University, Boston,
Massachusetts
Chapter 10: The Health Care System
Chapter 11: The Health Care System
22
Chapter 12: Economics of Health Care
Susan Givens, RNC-OB, MPH, LCCE, Childbirth Educator,
Mount Carmel St. Anns Hospital, Westerville, Ohio
Chapter 16: Child and Adolescent Health
Lori A. Glenn, DNP, CNM, RN, Assistant Professor, McAuley
School of Nursing, University of Detroit Mercy, Detroit, Michigan,
Nurse Midwife , Hurley Medical Center, Flint, Michigan
Chapter 17: Womens Health
Deanna E. Grimes, DrPH, RN, FAAN, Professor, University of
Texas Health Science Center at Houston, Houston, Texas
Karyn Leavitt Grow, MS, BSN, RN, CCM, Manager, Case
Manager, Sierra Surgery Hospital, Carson City, Nevada
Chapter 9: Case Management
Diane C. Hatton, PhD, RN, Consultant, Reno, Nevada
Chapter 22: Homeless Populations
Jen M. Hurlbut, PhD, MSN, RN, CNE, Associate Professor,
Roseman University of Health Sciences , Henderson, Nevada
Chapter 18: Mens Health
Kim Jardine-Dickerson, RN, MSN, BC, CADC, Assistant
Clinical Professor, Idaho State University, Pocatello, Idaho
Chapter 24: Populations Affected by Mental Illness
Chapter 26: Substance Abuse
Angela Jarrell, PhD, RN, Nurse Consultant, Duquesne
University, Pittsburgh, Pennsylvania
Chapter 31: Forensic and Correctional Nursing
Jean Cozad Lyon, PhD, APN, Hospital Surveyor, The Joint
Commission, Reno, Nevada
Chapter 9: Case Management
Diane Cocozza Martins, PhD, RN, Associate Professor, College
of Nursing, University of Rhode Island, Kingston, Rhode Island
23
Chapter 3: Thinking Upstream: Nursing Theories and Population-Focused
Nursing Practice
Chapter 7: Community Health Planning, Implementation, and Evaluation
Cathy D. Meade, PhD, RN, FAAN, Senior Member and
Professor, Population Science, Health Outcomes & Behavior,
Moffitt Cancer Center, University of South Florida, Tampa, Florida
Chapter 8: Community Health Education
Julie Cowan Novak, DNSc, RN, CPNP, FAANP, Professor and
Vice Dean, Practice and Engagement, Executive Director, UT
Nursing Clinical Enterprise, UTHSCSA Student Health Center and
Employee Health and Wellness Clinic, UT Health Science Center
San Antonio School of Nursing, San Antonio, Texas
Chapter 15: Health in the Global Community
Catherine A. Pourciau, MSN, RN, FNP-C, Family Nurse
Practitioner, Internal Medicine and Pediatric Clinic, Baker,
Louisiana
Chapter 27: Violence
Chapter 29: School Health
Bridgette Crotwell Pullis, PhD, RN, CHPN, Assistant Professor
of Nursing, The University of Texas Health Science Center
Houston School of Nursing, Houston, Texas
Chapter 4: Health Promotion and Risk Reduction
Bonnie Rogers, DrPH, COHN-S, LNCC, Director, NC
Occupational Safety and Health and Education and Research ,
Center and OHN Program, University of North Carolina , School of
Public Health , Chapel Hill, North Carolina
Chapter 30: Occupational Health
Mary Ellen Trail Ross, DrPH, MSN, RN, GCNS-BC, Associate
Professor of Clinical Nursing , Department of Nursing Systems,
University of Texas Health Science Center, Houston, Texas
Chapter 19: Senior Health
Diane Santa Maria, MSN, RN, APHN-BC, Clinical Faculty,
24
University of Texas School of Nursing, Houston, Texas
Chapter 14: Environmental Health
Beverly Siegrist, EdD, MS, RN, CNE, Professor, Department of
Nursing, Western Kentucky University, Bowling Green, Kentucky
Chapter 20: Family Health
Chapter 32: Faith Community Nursing
Edith B. Summerlin, PhD, MSN, BSN, RN, CNS, Assistant
Professor, University of Texas Health Science Center at Houston ,
School of Nursing, Houston, Texas
Chapter 19: Senior Health
Chapter 28: Natural and Man-made Disasters
Patricia L. Thomas, PhD, RN, Director, Nursing Practice &
Research , Trinity Health, Livonia, Michigan
Chapter 23: Rural and Migrant Health
Meredith Troutman-Jordan, PhD, PMHCNS-BC, Associate
Professor, University of North Carolina at Charlotte , College of
Health and Human Services, School of Nursing, Charlotte, North
Carolina
Chapter 21: Populations Affected by Disabilities
Elaine Vallette, DrPH, RN, Dean, Nursing and Allied Health,
Baton Rouge Community College, Baton Rouge, Louisiana
Chapter 27: Violence
Chapter 29: School Health
Lori Wightman, MSN, DNP, RN, NEA-BC, Chief Nursing
Officer, Mercy Hospital Grayling, Grayling, Michigan
Chapter 23: Rural and Migrant Health
ANCILLARY AUTHORS
Joanna E. Cain, BSN, BA, RN, President and Founder, Auctorial
Pursuits, Inc., Atlanta, Georgia
NCLEX Review Questions
25
TEACH for RN-Case Studies
Penny Leake, PhD, RN, Professor Emerita of Nursing, Luther
College, Decorah, Iowa
PowerPoint Slides
Tiffany M. Smith, MSN, RN, PhD student/Graduate Assistant,
Roseman University of Health Sciences, University of Nevada , Las
Vegas, Nevada
Case Studies
Anna K. Wehling Weepie, DNP, RN, CNE, COI, Assistant Dean,
Undergraduate Nursing and Professor, Allen College, Waterloo,
Iowa
Test Bank
26
Reviewers
Edna M. Billingsley, MSN, RN, PMHN-C, CLNC,
GNP, Assistant Professor of Nursing , Bethel University ,
McKenzie, Tennessee
Barbara Broome, RN, MSN, PhD, FAAN, Associate Dean and
Chair Community/Mental Health Nursing, Professor, University of
South Alabama College of Nursing , Mobile, Alabama
Stephanie Chalupka, EdD, RN, PCHCNS-BC,
FAAOHN, Associate Dean for Nursing, Worcester State
University, Worcester, Massachusetts
Colleen L. Ciano, MSN, RN, PhD (c), Instructor of Nursing, The
Pennsylvania State University, Middletown, Pennsylvania
Connie Cooper, EdD, RN, CNE, Assistant Professor, Bellarmine
University, Louisville, Kentucky
Michelle T. Dang, PhD, RN, APHN-BC, Assistant Professor,
California State University, Sacramento, Sacramento, California
Lisa Garsman, MS, FNP-BC, Director BSN Program, Saint Peters
University, Jersey City, New Jersey
Scharmaine Lawson-Baker, DNP, FNP-BC,
FAANP, CEO/Founder, Advanced Clinical Consultants, New
Orleans, Louisiana
Lisa M. LeBlanc, RN, BSN, Instructor of Nursing, Wisconsin
Lutheran College, Milwaukee, Wisconsin
Patricia S. Martin, RN, MSN, Assistant Professor, University of
Louisville, Louisville, Kentucky
27
Nancy N. Menzel, PhD, RN, PHCNS-BC, CPH, Associate
Professor, Nursing, University of Nevada, Las Vegas , Las Vegas,
Nevada
Lynn M. Miskovich, DNP, ANP-BC, APRN, Associate Professor
of Nursing , Purdue University Calumet, Hammond, Indiana
Patti Moss, MSN, RN, Assistant Professor, Nursing, Lamar
University, Beaumont, Texas
Jill M. Nocella, MSN, RN, Professor of Nursing, William
Paterson University, Wayne, New Jersey
Vicky L. ONeil, DNP, APRN, FNP-BC, Associate Professor,
Dixie State College of Utah, St. George, Utah
Laura Opton, MSN, RN, CNE, Second Degree BSN Program
Director, Texas Tech University Health Sciences Center, Lubbock,
Texas
Susan Palmer, MSN, RN, Lecturer, Fairleigh Dickinson
University, Teaneck, New Jersey
Fay Parpart, MS, RN, ANP-BC, Assistant Clinical Professor,
Virginia Commonwealth University, Richmond, Virginia
Keevia Porter, DNP, MSN, NP-C, RN, Assistant Professor
BSN/MSN Programs, University of Tennessee Health Science
Center, College of Nursing , Memphis, Tennessee
Cynthia Portman, MSN, RN, Assistant Clinical Professor in
Nursing, Department of Nursing and Rehab Sciences, Angelo State
University, San Angelo, Texas
Joann Sands, ANP-BC, MSN, RN, Clinical Instructor, The State
University of New York University at Buffalo, Buffalo, New York
Charlotte Sortedahl, DNP, MPH, MS, BSN, RN, Assistant
Professor, University of Wisconsin Eau Claire, Eau Claire,
Wisconsin
Marnie Lynn Sperling, DMD, MSN, RN, FN-CSA, Assistant
Professor, Nursing, Caldwell College , Caldwell, New Jersey
28
Debbie Sweeney, RN, DNSc, Associate Professor, Nursing,
Baptist College of Health Sciences, Memphis, Tennessee
Virginia Teel, DHSc, RN, Assistant Professor, Nursing, College
of Coastal Georgia, Brunswick, Georgia
Julie B. Willardson, DNP, FNP-C, Assistant Professor of
Nursing, Roseman University of Health Sciences, College of
Nursing, South Jordan, Utah
29
Preface
More money is spent per capita for health care in the United States
than in any other country ($8400 in 2010). However, many countries
have far better indices of health, including traditional indicators
such as infant mortality rates and longevity for both men and
women than does the United States. The United States is one of the
few industrialized countries in the world that lacks a program of
national health services or national health insurance. Although the
United States spent 17.9% of its gross domestic product on health
care expenditures in 2010, a record high of $2.6 trillion, before full
implementation of the Affordable Care Act, nearly 18.0% of the
population had no health care coverage.
The greater the proportion of money put into health care
expenditures in the United States, the less money there is to
improve education, jobs, housing, and nutrition. Over the years, the
greatest improvements in the health of the population have been
achieved through advances in public health using organized
community efforts, such as improvements in sanitation,
immunizations, and food quality and quantity. The greatest
determinants of health are still equated with factors in the
community, such as education, employment, housing, and
nutrition. Although access to health care services and individual
behavioral changes are important, they are only components of the
larger determinants of health, such as social and physical
environments.
30
Upstream Focus
The traditional focus of many health care professionals, known as a
downstream focus, has been to deliver health care services to ill
people and to encourage needed behavioral change at the
individual level. The focus of public/community health nursing has
traditionally been on health promotion and illness prevention by
working with individuals and families within the community. A
shift is needed to an upstream focus, which includes working with
aggregates and communities in activities such as organizing and
setting health policy. This focus will help aggregates and
communities work to create options for healthier environments
with essential components of health, including adequate education,
housing, employment, and nutrition and provide choices that allow
people to make behavioral changes, live and work in safe
environments, and access equitable and comprehensive health care.
Grounded in the tenets of public health nursing and the practice
of public health nurses such as Lillian Wald, this sixth edition of
Community/Public Health Nursing: Promoting the Health of Populations
builds on the earlier works by highlighting an aggregate focus in
addition to the traditional areas of family and community health,
and thus promotes upstream thinking. The primary focus is on the
promotion of the health of aggregates. This approach includes the
family as a population and addresses the needs of other aggregates
or population subgroups. It conceptualizes the individual as a
member of the family and as a member of other aggregates,
including organizations and institutions. Furthe
