Fluent Essays

Overview This discussion board is aligned with the module objective describe basic concepts/principles of community/public health. As part of the discussion you will: Compare and contrast community health/public health nursing practice with hospital base nursing practice in terms of core functions and essentials services Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts. Post a thoughtful response to at least two (2) other colleagues initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: This is interesting - in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature... and add supportive reference. Avoid comments such as I agree or good comment. Points: 30 Due Dates: Initial Post: Aug 27 by 11:59 p.m. Eastern Standard Time (EST) of the US. Response Post: Sun, Aug 29 by 11:59 p.m. Eastern Standard Time (EST) of the US - (the response posts cannot be done on the same day as the initial post). References: Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references. Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response. Words Limits Initial Post: Minimum 200 words excluding references (approximately one (1) page) Response posts: Minimum 100 words excluding references. Note: Since it is difficult to edit the APA reference in the Blackboard discussion area, you can copy and paste APA references from your Word document to the Blackboard discussion area.  Points will not be deducted because of format changes in spacing. RUBRIC: DISCUSSION BOARD (30 pts) Last updated: 1/31/2020 © 2020 School of Nursing - Ohio University Page 1 of 1 NOTE: No direct quotes are allowed in the discussion board posts. *Peer-reviewed references include professional journals (i.e. Nursing Education Perspectives, Journal of Professional Nursing, etc. – see library tab on how to access these from database searches), professional organizations (NLN, CDC, AACN, ADA, etc.) applicable to population and practice area, along with clinical practice guidelines (ECRI Institute - https://guidelines.ecri.org). All references must be no older than five years (unless making a specific point using a seminal piece of information) References not acceptable (not inclusive) are UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases. **Since it is difficult to edit the APA reference in the Blackboard discussion area, you can copy and paste APA references from your Word document to the Blackboard discussion area and points will not be deducted because of format changes in spacing. Criteria Levels of Achievement Meets Expectations Needs Improvement Unsatisfactory Characteristics of initial post 10 to 10 Points • Provided response with rationale. • The post is substantive and reflects careful consideration of the literature. • Examples from the student’s practice/experience are provided to illustrate the discussion concepts. • Addressed all required elements of the discussion prompt. • Well organized and easy to read. 3 to 9 Points • Provided response missing either substantive rationale, consideration of the literature, or examples from the student’s practice/experience to illustrate the discussion concepts. • Addresses all or most of required elements. • Somewhat organized, but may be difficult to follow. 0 to 2 Points • Provided response with minimal rationale. • Does not demonstrate thought and provides no supporting details or examples. • Provides a general summary of required elements. Support for initial post 5 to 5 Points • Cited minimum of two references: at least one (1) from required course materials to support rationale AND one (1) from peer-reviewed* references from supplemental materials or independent study on the topic to support responses. • The initial post is a minimum of 200 words excluding references. 2 to 4 Points • Missing one (1) required course reference AND/OR one (1) peer-reviewed reference to validate response. • Post has at least 200 words. 0 to 1 Points • Missing 1 or more of the correct type (course or peer-reviewed) or number of references to support response. • Post is less than 200 words or there’s no post. Responses to Peers 10 to 10 Points • Responses to colleagues demonstrated insight and critical review of the colleagues’ posts and stimulate further discussion • Responded to a minimum of two (2) peers and included a minimum of one (1) peer-reviewed* or course materials reference per response. • Responses are a minimum of 100 words and are posted on different days of the discussion period by the due date. 4 to 9 Points • Responses to colleagues are cursory, do not stimulate further discussion and paragraph could have been more substantial. • Responses missing one of the following: o insight/critical review of colleague’s post, o OR respond to at least two peers, o OR a peer reviewed*or course materials reference per response • Responses are a minimum or less than 100 words and posts were on the same date as initial post. 0 to 3 Points • Responses to colleagues lack critical, in depth thought and do not add value to the discussion. • Responses are missing two or more of the following: o insight/critical review of colleagues’ post o AND/OR response to at least two peers o AND/OR a peer reviewed* reference per response. • Responses are less than 100 words, posted same day as initial post. APA format*; Spelling/ Grammar/ Punctuation 5 to 5 Points • APA format** is used for in-text citations and reference list. • Posts contain grammatically correct sentences without any spelling errors. 2 to 4 Points • APA format is missing either in-text or at end of the reference list. • Posts contain some grammatically correct sentences with few spelling errors. 0 to 1 Points • Not APA formatted OR APA format of references has errors both in-text and at end of reference list. • Post is grammatically incorrect. https://guidelines.ecri.org/ Chapter 3 Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Health Care Today Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Are we too busy rescuing victims … © Penny Leake Health Care Today (Cont.) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 …to look upstream where the real problems lie? – McKinlay, 1979© Penny Leake Microscopic Approach to Solving Community Health Problems  Individual, and sometimes family, response to health and illness  Often emphasizes behavioral responses to individual’s illness or lifestyle patterns  Nursing interventions are often aimed at modifying individual’s behavior by changing his or her perceptions or belief system Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Macroscopic Approach to Solving Community Health Problems  Examines interfamily and intercommunity themes in health and illness  Delineates factors in the population that perpetuate the development of illness or foster the development of health  Emphasizes social, economic, and environmental precursors of illness  Nursing interventions may include modifying social or environmental variables  May involve social or political action Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Theoretical Approaches  The individual is the focus of change (Microscopic)  Orem’s self-care deficit theory of nursing  The Health Belief Model (HBM)  The Upstream View: society is the focus of change (Macroscopic)  Milio’s framework for prevention  Critical theoretical perspective Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Variables and Relationships in the Health Belief Model Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Figure 3-1 Presenter Presentation Notes Redrawn from Rosenstock IM: Historical origins of the health belief model. In Becker MH, editor: The health belief model and personal health behavior, Thorofare, NJ, 1974, Charles B Slack Critical Interactionism Nurses can use both an upstream and a downstream approach to address health issues through critical interactionism. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Critical Interactionism (Cont.) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Issue Downstream Upstream Approach Critical Interactionism Clients: Obesity rates Individual behavior strategies to reduce weight. Lifestyle changes Bariatric surgery nursing care. Health policy changes. Vending machines in school with healthier choices. School lunch program modifications. Target corporations that profit from obesity. Individual strategies with weight loss in conjunction with system changes. Social marketing at both levels. Critical Interactionism (Cont.) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Issue Downstream Upstream Approach Critical Interactionism Client or Nurse: Workplace violence. Behavior change at individual level. Workplace programs to reduce violence. Address organizational factors that promote workplace violence. What organizational structures perpetuate workplace violence? Change needed in knowledge and skills to address issue of workplace violence at both the downstream and upstream level. Critical Interactionism (Cont.) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Issue Downstream Upstream Approach Critical Interactionism Nurse: Workplace errors Focus on individual: root cause analysis that has individual as focus. Change behavior of individual nurse. Reeducation of nurse with workplace error. System changes needed. What system level factors lead to workplace errors? What organizational structures perpetuate workplace errors? A dual approach. Providers need changes in knowledge and skills to address root causes of workplace errors that move from individual to system level. By thinking about the root causes of health problems, we begin to understand the importance of directing nursing efforts toward the antecedents of poor health and lost opportunities. The Social Determinants of Health topic area within Healthy People 2020 is designed to identify ways to create social and physical environments that promote good health. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Nursing with the Community Bellack (1998)  The health agenda originates from within the community; it is not imposed by others.  A shared vision of health is a challenge because multiple viewpoints are the norm.  Success depends on …  Listening  Being patient  Providing accurate and scientifically sound information  Respecting the experiences of community members Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Chapter 3 Health Care Today Health Care Today (Cont.) Microscopic Approach to Solving Community Health Problems Macroscopic Approach to Solving Community Health Problems Theoretical Approaches Variables and Relationships �in the Health Belief Model Critical Interactionism Critical Interactionism (Cont.) Critical Interactionism (Cont.) Critical Interactionism (Cont.) Slide Number 12 Nursing with the Community�Bellack (1998) Chapter 4 Health Promotion and Risk Reduction .Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Health Promotion Is…  …any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health (Green & Kreuter, 1991)  …that which is motivated by the desire to increase well-being and to reach the best possible health potential (Parse, 1990) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Health Protection Is …(Cont.)  … those behaviors in which one engages with the specific intent to prevent disease, detect disease in the early stages, or maximize health within the constraints of disease (Parse, 1990)  … an important step in maintaining health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Defining Health  The way health is defined has shifted from a focus on the curative model, to a focus on multidimensional aspects such as the social, cultural, and environmental facets of life and health (Benson, 1996)  Health is viewed not only as an important goal, but as a resource for living (WHO, 1986) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Healthy People 2020 …  … is the health promotion initiative for the nation.  … challenges individuals, communities, and professionals … to take specific steps to ensure that good health, as well as long life, are enjoyed by all. – U.S. Department of Health and Human Services, 2012 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Healthy People 2020 … (Cont.)  Broad goals  Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.  Achieve high equity, eliminate disparities, and improve the health of all groups.  Create social and physical environments that promote good health for all.  Promote quality of life, healthy development, and healthy behaviors across all life stages. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Determinants of Health  Biology  Behaviors  Social environment  Physical environment  Policies and interventions  Access to high-quality health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Figure 4-1 From U.S. Department of Health and Human Services. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Theories in Health Promotion  Pender’s Health Promotion Model (HPM)  Health Belief Model (HBM)  Transtheoretical Model (TTM)  Theory of Reasoned Action (TRA) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Risk and Health  Risk is “the probability that a specific event will occur in a given time frame” (Oleckno, 2002).  A risk factor is an exposure that is associated with a disease (Friis & Sellers, 2004). Risk Assessment is a systematic way of distinguishing the risks posed by potentially harmful exposures. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Steps in Risk Assessment  Hazard identification  Risk description  Exposure assessment  Risk estimation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Risk Assessment  Modifiable risks  Individual has control  Examples: smoking, lifestyle, eating habits, activities  Nonmodifiable risks  Individual has little or no control  Examples: genetics, gender, age, environmental exposure Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12  Risk Reduction …  … is a proactive process  … enables individuals to react to actual or potential threats to their health  Risk communication …  … is the process of informing the public regarding threats  … is affected by perceptions, process, and actions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Tobacco and Health Risk  Leading cause of preventable death  Most common in less educated populations and those living below poverty level  Most common form of chemical dependency  Tobacco in all forms is harmful. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Health Promotion Activities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15  Look for teachable moments  Assess client’s tobacco use  Explore willingness to quit  Refer to cessation programs  Encourage attempts to quit Alcohol Consumption and Health  Third leading lifestyle-related cause of death for the nation  Short-term use causes acute risks  Long-term effects have major impact on health and social issues  Influenced by legal drinking age  # 1 used and abused drug among U.S. youth Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Health Promotion Activities (Cont.)  Prevent underage drinking  Assist with enforcement of legal drinking age  Identify individuals and groups at risk of abuse and dependence  Educate adults and youth on dangers of alcohol  Requires a community-wide effort to address the problem on several fronts Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Diet and Health  Diet—one of most modifiable risk factors  Imbalance of caloric intake and physical activity  Complex interplay among metabolism, genetics, behavior, environment, culture, and socioeconomic status  Geographic areas, age, ethnicity all influence weight Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Health Promotion Activities (Cont.)  Special populations have different nutritional needs  For individualized plans, see http://myplate.gov/  Educate clients about:  Balancing caloric intake and physical activity  Servings vs. portion control  Eating away from home affects “portion distortion”  Using social media and mobile applications to help Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Physical Activity and Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20  Physical activity serves both health promotion and disease prevention purposes  Leisure activities are influenced by level of education, gender, age, economic level, geography  One’s environment plays a significant role in activity level Health Promotion Activities (Cont.) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21  Support and develop “walkable” neighborhoods and cities  Determine recommended exercise levels for individuals  Visit http://www.cdc.gov/physicalacti vity/data/facts.html Sleep and Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22  Sleep is an essential component of chronic disease prevention and health promotion  Requirements change with age and life circumstances  Regulated by waking time and circadian rhythms  Hormones during sleep affect memory, blood pressure, and kidney function. Health Promotion Activities (Cont.) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23  Sleep assessment is important  Identify disorders that may affect daily activities  Keep sleep log  Practice sleep hygiene  Establish environment that promotes sleep  Avoid food and activities that interfere with sleep Chapter 6 Community Assessment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Defining the Community  Aggregate of people  The “who”  Share personal characteristics and risks  Location in space and time  The “where” and “when”  Physical location frequently delineated by boundaries and influenced by the passage of time  Social system  The “why” and “how”  Interrelationships of aggregates fulfilling community functions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Diagram of Assessment Parameters Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Figure 6-1 Community Assessment Parameters  Geography  Population  Environment  Industry  Education  Recreations  Religion  Communication  Transportation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4  Public services  Political organization  Community development or planning  Disaster programs  Health statistics  Social problems  Health manpower  Health professional organizations  Community services Healthy Communities  A movement to help community members bring about positive health changes  Interconnectedness between people and the public and private sectors is essential to make changes.  Each community has its unique perspective. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Assessing the Community  Windshield survey  Gain an understanding of environmental layout  Locate possible areas of environmental concern through “sight, sense, and sound”  Gives nurse an opportunity to observe people and their role in the community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Windshield Survey  Community vitality  Indicators of social and economic conditions  Health resources Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7  Environmental conditions related to health  Social functioning  Attitudes toward health and health care Assessing the Community (Cont.)  Sources of data:  Census data and other census reports  Vital statistics  NCHS survey data  Local, regional, and state government reports  Locally generated data collection  Analysis of demographic information provides descriptive information about the population Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Assessing the Community (Cont.)  Needs assessment  Used to understand the community’s perspective  Interview key community informants  Use community forums, focus groups, or surveys  12 Steps in a Needs Assessment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Steps in the Needs Assessment Process 1. Identify aggregate for assessment 2. Engage the community in planning the assessment 3. Identify required information 4. Select method of data gathering 5. Develop questionnaires or interview questions 6. Develop procedures for data collection Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Steps in the Needs Assessment Process (Cont.) 7. Train data collectors 8. Arrange for a sample representative of the aggregate 9. Conduct needs assessment 10. Tabulate and analyze data 11. Identify needs suggested by data 12. Develop an action plan Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Nursing Process Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 ● The nursing process can be applied to the community as a client.  Needs assessment  Diagnosing health problems (actual and potential)  Planning  Intervention  Evaluation Format for Community Health Diagnosis Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Figure 6-3 Redrawn from Muecke MA: Community health diagnosis in nursing, Public Health Nurs 1:23-35, 1984. Used with permission of Blackwell Scientific Publications. Epidemiological Studies Used Throughout the Nursing Process  Support planning by establishing effectiveness of certain interventions in specific aggregates  Construct benchmarks to gauge achievement of program objectives  Compare data with other rates  Identify objectives of successful programs  Document effectiveness with epidemiological data Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Chapter 7 Community Health Planning, Implementation, and Evaluation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. The Community as Client Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Figure 7-1 Levels of Community Health Nursing Practice Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Client Example Characteristics Health Assessment Nursing Involvement Individual Lisa McDonald Individual with various needs Individual strengths, problems, and needs Client-nurse interaction Family Moniz family Family system with individual and group needs Individual and family strengths, problems, and needs Interactions with individuals and the family group Group Boy Scout troop Alzheimer’s support group Common interests, problems, and needs Interdependency Group dynamics Fulfillment of goals Group member and leader Population group AIDS patients in a given state Pregnant adolescents in a school district Large, unorganized group with common interests, problems, and needs Assessment of common problems, needs, and vital statistics Application of nursing process to identified needs Organization A workplace A school Organized group in a common location with shared governance and goals Relationship of goals, structure, communication, patterns of organization to its strengths, problems and needs Consultant and/or employee application of nursing process to identified needs Community Italian neighborhood Anytown, USA An aggregate of people in a common location with organized social systems Analysis of systems, strengths, characteristics, problems, and needs Community leader, participant, and health care provider Health Planning Model Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Figure 7-2 Hogue (1985) Steps in the Health Planning Model  Assessment  Meet with group leaders of aggregate to clarify mutual expectations  Determine sociodemographic characteristics  Interview a key informant  Consider both positive and negative factors  Compare the aggregate with the “norm”  Research potential problems  Identify health problems and needs  Prioritize the identified problems and needs to create an effective plan Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Four Types of Needs to Assess  Expressed needs  Demand for services and the market behavior of the targeted population  Normative needs  Lack, deficit, or inadequacy of services determined by health professionals  Perceived needs  Wants and desires expressed by audience  Relative needs  Gap showing health disparities between advantaged and disadvantaged population Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Factors for Determining Priorities  Aggregates preferences  Number of individuals affected by the health problem  Severity of the health need or problem  Availability of potential solutions  Practical considerations such as skills, time, and available resources  May use Maslow’s hierarchy of needs or levels of prevention to further refine priorities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Community Involvement Is Essential “Start where the people are!”  Five spheres of empowerment  Interpersonal (personal empowerment)  Intragroup (small group development)  Intergroup (community)  Interorganizational (coalition building)  Political action – Labonte (1994) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Steps in the Health Planning Model (Cont.)  Planning  Determine the intervention levels • Subsystem, aggregate system, and/or suprasystem  Plan interventions for each system level • Primary, secondary, or tertiary levels of prevention  Validate the practicality of the planned interventions according to available resources • Personal, aggregate, and suprasystem Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Development of Goals and Objectives  Goals—where we want to be  Objectives—steps needed to get there  Measurable  Specific measures  Instructions to guide population  Used to measure outcomes Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Steps in the Health Planning Model (Cont.)  Intervention  Often the most enjoyable stage for the nurse and the clients  Implementation should follow the initial plan  Should include a variety of strategies  Prepare for unexpected problems Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Interventions by Type of Aggregate and System Level Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Project Type of Aggregate System Level for Intervention Rehabilitation group Group Subsystem and aggregate system Textile industry Organization Aggregate system and suprasystem Crime watch Group, organization, and population group Aggregate system and suprasystem Bilingual students (case study) Community Aggregate system and suprasystem Steps in the Health Planning Model (Cont.)  Evaluation  Include the participant’s verbal or written feedback and the nurse’s detailed analysis  Reflect on each previous stage to determine the plan’s strengths and weaknesses  Evaluate both formative (process) and summative (product/outcome) aspects  Communicate follow-up recommendations Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Importance of Each Step in the Nursing Process  Aggregate assessments must be thorough.  Should elicit answers to key questions about the aggregate’s health and demographic profile  Should compare this information with similar aggregates presented in the literature  The nurse must complete careful planning and set goals that the nurse and the aggregate accept.  Mutual planning is very important.  Interventions must include aggregate participation and must meet the mutual goals.  Evaluation must include process and product evaluation and aggregate input. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 PRECEDE-PROCEED Model Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Federal Legislation Affecting Health Planning  Hill-Burton Act  Regional Medical Programs (RMP)  Partnership for Health Program (PHP)  Certificate of Need (CON)  National Health Planning and Resources Development Act Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Comprehensive Health Reform  Patient Protection and Affordable Care Act (2010)  Preventive services based on evidence-based recommendations  National strategy to improve the nation’s health  CMMS innovation center  National quality improvement strategy for services and population health  Improved access to care  Reduction in the growth of Medicare spending  National workforce strategy Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Nurses’ Role  Work collaboratively with health planners to improve aggregate health  Fuse technology with knowledge of health care needs and skills  Become directly involved in the planning process  Engage in aggregate-level projects Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18