Advanced Practice Nursing in the Community
Publication Year: 1998
Subject: Community / Public Health Nursing
In this new text-reference, Dr. Carl Helvie explores the realm of community health care for advanced practice nurses currently working in community care or requiring an awareness and understanding of its salient issues. Simple in its presentation but rigorous in its coverage of related theories and concepts, Advanced Practice Nursing in the Community reviews community health nursing and advanced practice and then presents the Helvie Energy Theory as a guiding framework for the remainder of the volume. This comprehensive volume comprises thoughtful discussions of the economic, environmental, and sociocultural influences on community health, providing a foundation for subsequent chapters on community assessment, analysis, and diagnosis. It examines community intervention, addressing such topics as multilevel community intervention; diffusion and maintenance of community change; mass media and ...
- Front Matter
- Back Matter
- Subject Index
Part I: Overview
Part II: Theoretical Foundations of Community Health Nursing
Part III: Community Assessment
- Chapter 3: Economic Forces Influencing Community Health
- Chapter 4: Environmental Forces Influencing Community Health
- Chapter 5: Social and Cultural Forces Influencing Community Health
- Chapter 6: Community Assessment: Methods, Approaches, Models, and Process
- Chapter 7: Community Analysis and Community Diagnoses
Part IV: Community Planning and Interventions
- Chapter 8: Planning Community Interventions
- Chapter 9: Planning for Diffusion and Maintenance of Community Change
- Chapter 10: Community Interventions: Using Mass Media and the Political Process
- Chapter 11: Community Interventions: Empowerment, Coalition Building, and Involving Citizens, Organizations, and Professionals
- Chapter 12: Community Interventions: Nursing Centers, Mass Clinics, Partnerships, and School Services
- Chapter 13: Applying Interventions in Rural Areas
Part V: Community Evaluation
Copyright © 1998 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Library of Congress Cataloging-in-Publication Data
Main entry under title:
Advanced practice nursing in the community / edited by Carl O. Helvie.
Includes bibliographical references and index.
ISBN 0-7619-0034-9 (cloth: acid-free paper).—ISBN
0-7619-0035-7 (pbk.: acid-free paper)
1. Community health nursing. 2. Public health. I. Helvie, Carl O.
This book is printed on acid-free paper.
04 05 06 07 08 09 10 9 8 7 6 5
Acquiring Editor: Dan Ruth
Editorial Assistant: Jessica L. Crawford
Production Editor: Sanford Robinson
Production Assistant: Denise Santoyo
Copy Editor: Linda Gray
Typesetter/Designer: Rebecca Evans
Indexer: Julie Sherman Grayson
Cover Designer: Ravi Balasuriya
This book is dedicated to Wilfried Kunstmann, Dortmund, Germany, colleague, friend, teacher, thinker, and questioner, and to those students who also questioned and helped me clarify my thoughts.[Page vi]
I am grateful to many individuals who offered assistance in the preparation of this text. To acknowledge them all would be impossible within the limits of this section and the memory of the author. Thus, I apologize for any oversights, which are unintentional.
First, I acknowledge my graduate students in community health nursing who offered comments and stimulating questions over the past years as I taught the course on which this book is based. I am grateful to each of you. I am especially grateful to Chris Elnitsky, currently a doctoral student, and to James Hosack, a White House nurse, who stimulated me to refine the energy theory.
Next, I thank each of the contributors for the case studies and for the chapter on rural nursing. Their experience in applying the concepts in practice has added greatly to the book. In addition, their promptness in submitting the materials facilitated the meeting of deadlines.
I thank each of the reviewers of the original proposal for their comments and confidence in me and the reviewers of the completed manuscript for their valuable comments for refining the manuscript. These have strengthened the book. I thank my chair of nursing, Dr. Brenda S. Nichols, who reviewed and commented on the proposal and who approved a semester's leave from my teaching position for writing the book. Thanks also go to Dean Lindsay Rettie and Vice President for Academic Affairs JoAnn Gora, who also had confidence in me and who approved my leave for writing. I also thank my colleague, Dr. Laurel Garzon, who provided continued support and encouragement.
I also thank members of the leadership group of community health nursing of the American Public Health Association for their encouragement. I am especially grateful to Dr. Caroline White, past chair, Community Health Nursing Section of APHA who provided support and continued encouragement.
Last but not least, I acknowledge Christine S. Smedley, previous sponsoring editor, Sage Publications, for her confidence in offering a contract for the book. I also recognize Mr. Daniel Ruth, my current editor at Sage, for his support and help in obtaining reviews of the manuscript, providing contracts to contributors, and providing other assistance that facilitated the production process and enhanced the quality of the book.[Page xviii]
This book is written for beginning graduate students in community health nursing or for nurses who need a community or aggregate focus in practice. It is the result of needing to use large numbers of articles for teaching graduate students in community health nursing over several years because a text that focused on multiple aspects of the community, aggregates, or both was not available. The text is different from other community health nursing texts and the author's previous community health nursing texts because it has a narrow and in-depth focus on the community and aggregates rather than covering the total field of community health nursing.
Part I presents a book overview and a review of community health nursing concepts. The review covers timely concepts such as generalist versus specialist, community-based and population-focused nursing, and community health nursing or public health nursing, roles, and models. This review is useful for the nurse who has not studied or practiced community health nursing recently.
Part II discusses a theoretical framework for the book. The theory selected to view the community or aggregate is the Helvie energy theory, a systems theory developed around the concept of energy. Models for using this theory in practice are included.
Part III explores community assessment. Chapters 3, 4, and 5 in this section discuss the influence of economic, environmental, and sociocultural forces on the health of the community. Concepts and models related to these topics are presented. Special social and cultural aggregates, such as the homeless and migrant populations and African American, Native American, Asian American, and Latino American populations, are included. In addition, two case studies by community health nursing leaders in practice using the concepts presented for economic and environmental forces influencing health and nursing are presented. Chapters 6 and 7 present concepts and models for community assessment and community analysis. These concepts are applied to a fictitious community, and a nursing leader applies the concepts of community assessment to an actual community.
Part IV covers community planning and interventions. Chapter 8 discusses the planning of community interventions and includes the planning process, concepts of community organization, community change, multilevel models of planning interventions, and other related concepts and models. Chapter 9 explores the planning for diffusion of programs and the maintenance of program changes initiated in the community. A case study by a nursing leader [Page xx]who used diffusion theory in the community to maximize the effects of a program is included. Chapter 10 looks at the first two community- or aggregate-focused interventions and includes concepts and models related to using mass media and the political process to introduce change into a community. Case studies by nursing leaders for these two interventions are included. Chapter 11 presents empowerment, coalition building, and involving professionals and the lay community as community interventions. Models and concepts appropriate to these overall concepts and three case studies by nursing leaders are presented. Chapter 12 discusses concepts of nursing centers, mass immunization clinics, community partnerships, and school nursing as aggregate interventions. A case study by a nursing leader who has developed and implemented a nursing center is included. Chapter 13 discusses the application of these interventions in a rural setting.
Part V introduces community evaluation and presents concepts of outcome variables for measuring community change, components of evaluation, study outcome variables, and other appropriate concepts.
It is the desire of the author that the book will assist the nursing student or practitioner to view the community as the focus of practice. This should be the domain of community health nursing.
Appendix: Community Assessment Tool[Page 435]Economic SubsystemEmployment Distribution
Number in Community Percentage of Population Employed persons ________________ ________________ Manufacturing ________________ ________________ White-collar ________________ ________________ Wholesale and retail ________________ ________________ Local government ________________ ________________ Federal government ________________ ________________ Unemployed persons ________________ ________________Leading Industries
Name _________________________ Address _________________________
Number of employees ___________ Manager _________________________Family Income[Page 436]Governmental Budget
Community Total in Dollars Percentage of Total Education _______________________ _______________________ Transportation _______________________ _______________________ Welfare _______________________ _______________________ Health _______________________ _______________________ Police _______________________ _______________________ Fire _______________________ _______________________Educational SubsystemNumber of Educational Facilities Public Private Total ______________________ _______________________ Elementary ______________________ _______________________ Junior high ______________________ _______________________ Senior high ______________________ _______________________ Junior college ______________________ _______________________ Colleges ______________________ _______________________ Special schools ______________________ _______________________Health CoverageEducation Level of Population Community State Nation Less than 5 years _________________ _____ ___________ High school graduate _________________ _____ ___________ Some college _________________ _____ ___________ College graduate _________________ _____ ___________ Median school completed _________________ _____ ___________ Currently _________________ _____ ___________[Page 437]Health Manpower Facilities Number Number Graduated Yearly Total __________________ __________________ Medical schools __________________ __________________ Nursing schools __________________ __________________ Dental schools __________________ __________________ Physical therapy __________________ __________________ Social workers __________________ __________________Communications SubsystemNewspapers Name Frequency Circulation __________________________ _______________ _______________ __________________________ _______________ _______________Radio Stations Name Address Audiences (number, kind—young/old, black/white, social class) ____________________ _______________ ____________________ ____________________ _______________ ____________________ ____________________ _______________ ____________________Television Stations Name Address Audiences ____________________ _______________ ____________________ ____________________ _______________ ____________________ ____________________ _______________ ____________________Key Community Leaders/Decision Makers Influencing Subsystem
Name Affiliation ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________
If inadequate, list media as follows with deficits.
Name Deficits ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________Quality Good____________ Poor____________
If poor, list media below with deficits.
Name Deficits ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________
Is there a speakers bureau for health subjects?
List community organizations that have active health programs for the public.Health Materials in Schools
Is health integrated into the school curriculum at all grades?
If no, discuss deficits.__________________________________________
Discuss areas of health covered by grade ___________________________
Is the information adequately covered?
Yes_____________ No_____________[Page 439]Political SubsystemPolitical Parties and Leadership Major party ____________________________________________________ Key leaders ____________________________________________________ Minor party ____________________________________________________ Key leaders ____________________________________________________Major Issues over Last 5 Years that Influence Health Yes No Party Favoring Implemented Housing ______ ______ _________________ _________________ Transportation ______ ______ _________________ _________________ Health facilities ______ ______ _________________ _________________ Water, sewage ______ ______ _________________ _________________ Immunizations ______ ______ _________________ _________________ Fluoridation ______ ______ _________________ _________________ Communications ______ ______ _________________ _________________Recreation SubsystemNumber and Location Total Number Public Private Central _______________ _______________ _______________ North _______________ _______________ _______________ East _______________ _______________ _______________ South _______________ _______________ _______________ West _______________ _______________ _______________Leadership Available During Recreation Area Type of Leadership 1. __________________________ __________________________ 2. __________________________ __________________________ 3. __________________________ __________________________ 4. __________________________ __________________________[Page 440]Hazardous Situations Yes____________ No____________
Describe___________________________________________________________________________________________________________________________________Religious SubsystemReligious Distribution
Community Total Number Percentage of Total Protestant ___________________ ___________________ Catholic ___________________ ___________________ Jewish ___________________ ___________________ Other ___________________ ___________________Key Leaders in Religion (List) Names Phone Number or Address ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________Transportation SubsystemRoutes and Services
Describe major transportation routes.______________________________________
Services available on these routes (buses, trains)______________________________Future Plans
Transportation and health services_________________________________________
Are transportation routes adequate for population getting to health facilities?
If no, discuss specific deficits. ___________________________________________
_____________________________________________________________________[Page 441]Welfare SubsystemAgencies
List agencies, location, area served, and service.
Are these services adequate to meet population needs?
If inadequate, discuss agency and inadequacies.
_____________________________________________________________________Population SubsystemPopulation Characteristics
Population at last census_________________________________________________
Population changes over 10-year period_____________________________________
Age distribution _______________________________________________________
_____________________________________________________________________[Page 442]Sex and Race DistributionVital Statistics
Community State Nation Category Current No./Rate 10 Years Ago No./Rate No./Rate Live birth ______________ ______________ ______________ Neonatal death ______________ ______________ ______________ Infant death ______________ ______________ ______________ Maternal death ______________ ______________ ______________ General death ______________ ______________ ______________Social Problems Problem Number Percentage of Total Illegitimate births _____________________ _____________________ Venereal diseases _____________________ _____________________ Syphilis _____________________ _____________________ Gonorrhea _____________________ _____________________ Narcotic users _____________________ _____________________ Suicide _____________________ _____________________ Alcoholism _____________________ _____________________ Health problems _____________________ _____________________Communicable Disease Incidence Disease Current Year 5 Years Ago Diphtheria _____________________ _____________________ [Page 443] Encephalitis _____________________ _____________________ Infectious hepatitis _____________________ _____________________ Influenza _____________________ _____________________ Measles _____________________ _____________________ Tetanus _____________________ _____________________ Tuberculosis _____________________ _____________________ Typhoid _____________________ _____________________ Other _____________________ _____________________Immunization Level for Acute Communicable DiseaseLeading Causes of Death[Page 444]Health SubsystemHealth Personnel
Category Budgeted Positions Percentage Unfilled Physicians ____________________ ____________________ Nurses ____________________ ____________________ Social workers ____________________ ____________________ Psychologists ____________________ ____________________ Aides ____________________ ____________________ Sanitarians ____________________ ____________________ Physical therapists ____________________ ____________________ Other ____________________ ____________________Services Provided
Total number of clients seen in home______________________________________
Percentage of these for home care_________________________________________Types of Services in Home
Category Number of Cases Number of Visits Percentage of Total Cancer _______________ _______________ _______________ Heart disease _______________ _______________ _______________ Diabetes _______________ _______________ _______________ Tuberculosis _______________ _______________ _______________ Venereal disease _______________ _______________ _______________ Other diseases _______________ _______________ _______________ Maternity _______________ _______________ _______________ Infant _______________ _______________ _______________ Preschool _______________ _______________ _______________ School age _______________ _______________ _______________ Adult _______________ _______________ _______________Clinic Services Type Monthly Attendance Purpose ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________School Services Type Monthly Visits to Nurse Purpose ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________[Page 446]Protection
Exchanges With Nonhuman EnvironmentHousing ConditionHousing Complaints (Numbers)
Problem Current Year 5 Years Ago Heating ____________________ ____________________ Lighting ____________________ ____________________ Ventilation ____________________ ____________________ Nuisances ____________________ ____________________ Other ____________________ ____________________[Page 447]SanitationAir Contaminants that are Source of Complaints Smoke Yes ___________ No ____________ Specify:_________ Gases Yes ___________ No ____________ Specify:_________ Odors Yes ___________ No ____________ Specify:_________ Vapors Yes ___________ No ____________ Specify:_________ Pollens Yes ___________ No ____________ Specify:_________ Others Yes ___________ No ____________ Specify:_________Sources of Air Contaminants Industry Yes_________ No_________ Vehicles Yes _________ No_________ Homes Yes _________ No _________ Incinerators Yes __________ No _________ Other (Specify) Yes_________ No_________Water Supply Source Number Percentage Percentage With Adequate Treatment Public _______________ _______________ _______________ Private _______________ _______________ _______________Sewage Disposal Source Number Percentage Percentage With Adequate Treatment Public _______________ _______________ _______________ Private _______________ _______________ _______________Solid Waste Disposal Adequate________________ Inadequate_____________[Page 448]Vector Control Program Program Adequate Inadequate Mosquitoes ___________________ ___________________ Insects ___________________ ___________________ Rodents ___________________ ___________________ Other (Specify) ___________________ ___________________
Food and milk
Food source Adequate Inadequate Restaurants ___________________ ___________________ Stores ___________________ ___________________
Exchanges Beyond the CommunityHealth Threats
If present, describe.____________________________________________________
Programs to reduce threat _______________________________________________
List available sources.
____________________________________________________________________SOURCE: Community Health Nursing: Theory and Practice by Carl O. Helvie. Copyright 1991, by Springer Publishing Co. Used by permission.
About the Author
About the Contributors[Page 471]
Jacqueline Agnew, PhD, is Associate Professor of Environmental Health Sciences and Director of the Occupational Health Nursing Program at the Johns Hopkins School of Hygiene and Public Health in Baltimore, Maryland. She is Deputy Director of the Johns Hopkins Educational Resource Center, funded by the National Institute for Occupational Safety and Health (NIOSH) to prepare occupational health professionals. Her research focuses on occupational stress, ergonomic factors in the workplace, and the interactive effects of work exposures and age on the health of older workers. She is a member of the NIOSH Board of Scientific Counselors and also serves on the Workers’ Family Protection Task Force.
Janie Canty-Mitchell earned a diploma in nursing from Lincoln Hospital School of Nursing, Durham, North Carolina, a BSN degree from Florida State University, and MSN and PhD degrees from the University of Miami. She was awarded a 2-year postdoctoral research fellowship at Indiana University School of Nursing in 1994. Her work in community health nursing spans 17 years, including work as a public health nurse, supervisor of public health nursing, assistant community health nursing director, and community health nursing university professor. Her nursing research has centered on stress, caring, and hope in inner-city adolescents. She was awarded a grant from the Agency for Health Care Policy and Research to conduct her dissertation research. She is a member of Sigma Theta Tau Nursing Sorority, the American Public Health Association, and the Midwest Nursing Research Society. She has numerous experiences working with youth and voluntary agencies in inner cities.
Barrie Carveth, RN, MSN, FNP, is former Instructor of Nursing at the University of Virginia and is case manager, Westhaven Nursing Clinic, Charlottesville, Virginia.
Jeri W. Dunkin received her PhD in nursing at the University of Texas, Austin, in 1988. She spent several years with the University of North Dakota, where she was director of the graduate Rural Health Nursing Specialization in the College of Nursing. At the same time, she served as chair of the Nursing Research Division at the University of North Dakota Rural Health Research Center. She is currently the Coordinator for the Center of Nursing Research, Medical College of Georgia School Nursing.[Page 472]
Christine Elnitsky is a doctoral student in urban health services at Old Dominion University in Norfolk, Virginia. She holds an MSN (community health nurse specialist) and a BSN from Old Dominion University. Her nursing education began with a vocational nursing program at Harris Hospital School of Nursing in Fort Worth, Texas. Her 20 years of nursing experience in community health and hospital nursing includes clinical, administration, teaching, and research activities. She participates in research and is published in the areas of health care delivery systems, outcomes, chronic illness, health policy, and older adults.
Sandra L. Ferketich, PhD, RN, FAAN, currently Professor at the University of Arizona College of Nursing, received a BSN from the University of New Mexico, an MS from Indiana University, and a PhD from the University of Arizona. She recently completed a year of analyzing health policy as a Fellow with the Institute of Medicine. Her publications and research have been on research methods, instrumentation, maternal role attainment, family functioning, childbearing, and nursing interventions with homeless persons on preventive therapy for tuberculosis and rural communities in partnership with community health nurses and lay health workers.
Sharon Garrett earned a BSN degree from the University of Wisconsin—Madison and is currently an MSN candidate at Indiana University School of Nursing—Indianapolis. She has been involved in diverse communities in a professional and volunteer capacity for more than 25 years. Her professional experience includes work as a staff nurse and head nurse at a major hospital, home health nurse, health services coordinator for a Head Start program, an instructor for a continuing education program, and a research and teaching assistant. Her accomplishments include developing a health curriculum for a Head Start program, coordinating a community bloodmobile, and cochairing a community television telethon that focused on alcohol and drug abuse. She received a good citizen award from a Wisconsin city for her community contributions. She has worked extensively with young adolescents and parents.
Laurel S. Garzon, PhD, is Associate Professor in the Advanced Perinatal/Neonatal Graduate Program at Old Dominion University School of Nursing in Norfolk, Virginia. She has participated in community empowerment projects involving women's health and adolescent parents. She is a graduate of the University of North Carolina at Chapel Hill, the University of Virginia, and the Catholic University of America.
Doris Glick, RN, PhD, is Associate Professor of Nursing and Director, Primary Care Nursing Center, the University of Virginia.
Bethany Hall-Long, PhD, RNC, is Assistant Professor in the College of Nursing at the University of Delaware. Her areas of undergraduate and graduate didactic and clinical teaching are community health nursing, health policy, and nursing theory. She has worked as a nurse educator, manager, recruiter, and clinician in a variety of acute care and public health settings. Her areas of scholarship and clinical expertise arc community health nursing, community development, [Page 473]health policy, and multicultural women's health. She is a member of numerous professional and civic organizations.
Clare Houseman, PhD, RN, CS, is the Health Services Concentration Area Director for the PhD in Urban Services Program at Old Dominion University. She is also a Certified Clinical Nurse Specialist in Adult Psychiatric and Mental Health Nursing and maintains a part-time psychotherapy practice. She was a member of the HB1024 task force and at one point chaired the group. She also served as a consultant to the Virginia State Board of Nursing regarding the credentialing of clinical nurse specialists in the state. She is editor and author of a text titled Psychiatric Certification Review Guide for the Generalist and Clinical Specialist in Adult, Child, and Adolescent Mental Health Nursing (1994).
Kathleen M. May, DNSc, RN, currently Associate Professor at the University of Arizona College of Nursing, received a BSN from Saint John College of Cleveland, an MS from the University of Colorado, and a DNSc from the University of California, San Francisco. She has practiced nursing in hospital settings, home health, and public health. Her publications and research have been on community health nursing and nursing interventions with homeless persons on preventive therapy for tuberculosis, older rural elderly receiving health peer teaching on health promotion, and rural communities in partnership with community health nurses and lay health workers.
Sonda Riedesel Oppewal, PhD, is Associate Professor in the College of Nursing at East Tennessee State University in Johnson City, Tennessee. She teaches community health nursing and is Project Director of a federally funded school-based health center located in a rural high school. Her current research interests include adolescent health, rural health, and the diffusion of innovations.
Anna L. Pratt, RN, MSN, is currently Nursing Supervisor with the Virginia Beach Department of Public Health. A graduate of Hartwick College (1970, BSN) and the University of Rhode Island (1978, MSNEd), she has practiced community health nursing for 26 years. Her experience includes traditional home-based nursing care as well as various services provided in a public health clinic setting. Currently, she supervises a self-directed team of public health nurses and health educators whose focus is to provide health promotion and risk reduction education to residents in a wide variety of community settings. She also has adjunct faculty status with Old Dominion University's School of Nursing and is an active volunteer with the American Cancer Society in Virginia Beach, serving on its executive board of directors.
Angela B. Savage, RN, BSN, is currently Nurse Manager with the Virginia Beach Department of Public Health. A graduate of the University of Virginia (1969, BSN), she has 27 years of experience in community health nursing. She has provided home-based nursing care as well as maternal and child health and communicable disease services in public health clinics. Her career in middle- and upper-level management in public health spans more than 20 years. She is on the board of directors of a private, community-based clinic that provides free primary care to indigent residents of the city.[Page 474]
Sherry Weinstein, MN, CPNP, is former Instructor of Nursing at the University of Virginia and school nurse practitioner, Greene County (Virginia) School Health Cottage.
Cynthia Westley, RN, MSN, ANP, is Instructor of Nursing at the University of Virginia and care manager, Crescent Hall Nursing Clinic, Charlottesville, Virgina.