The use of nursing diagnoses for health promotion in community practice

The use of nursing diagnosis contributes to health promotion by helping nurses define and organize knowledge for community practice. When community nurses assess clients' responses to life and health events, clinical judgment frequently requires formulation of both positive and problem-oriented nursing diagnoses. Clinical examples and research findings are used to illustrate the use of nursing diagnoses for health promotion in community practice.     

Computer-aided nursing diagnosis for community health nurses

The computer program described in this article was primarily designed to be an aid in the clinical reasoning process. It is intended to simplify the use of nursing diagnoses in the practice of community health nursing. However, in its present form, this program has value not only for the clinician, but also for nursing students being taught structured techniques for assessment. A more comprehensive approach to nursing care and the routine use of nursing diagnoses in providing that care will be encouraged. This article questions the necessity for community health nurses to use computers in their diagnostic role. In answering this question, evidence has been presented that both describes some of the benefits of using computer technology as it relates to nursing diagnoses, and the results of efforts by nurses who have experimented with this technology in trying to improve their practice. One of the advantages of trying to merge a new technology with a relatively new role for community health nurses is the absence of tradition. There is no traditional methodology or approach for integrating the two. And, there is no one to say that it cannot be done. An approach can be tried, changed if it does not work, and tried again. An opportunity to create a new dimension for professional practice is offered. The answer, therefore, to the opening question is, "Yes--community health nurses should be concerned with using computers in their diagnostic role."     

Environmental Nursing Diagnoses for Aggregates and Community

PURPOSE. To describe the application of group-appropriate methods to derive actual nursing diagnoses for a community.
METHODS. A triangulation method using multiple sources of data, including an environmental survey, fish consumption survey, government reports, publications, and community assessments
FINDINGS. Three priority community environmental nursing diagnoses for aggregates within the community: Knowledge deficit among community residents related to lack of awareness of contaminants in the Anacostia River; "risk for adverse human health effects" among pregnant and nursing women and preschoolers related to consumption of chemically contaminated fish; and knowledge deficit among community residents related to lack of awareness of health effects of consuming chemically contaminated fish.
CONCLUSIONS. The diagnoses serve as the basis for community education and other interventions. The methods are practical and useful for this type of research.
PRACTICE IMPLICATIONS. The nursing profession is experiencing a growing awareness of the close relationship between environmental health and the health of individuals and communities. There is a need for diagnostic labels to describe the responses of aggregates and communities to environmental hazards and conditions.     

Nursing diagnosis: implications for health, with particular concerns for community nursing.

As nursing terminology develops to include positive health/wellness related concepts, the appropriateness of nursing diagnoses is questioned. Nursing diagnoses have the potential to lead community nurses towards a reductionist and simplistic view of the complexities associated with community issues. Concerns and questions are raised in relation to the acceptance of nursing diagnoses in Australian community nursing practice.     

Community Health Nursing Practice and the Roy Adaptation Model

In the current health care environment in the United States, the work performed by community health nurses is increasingly being recognized and valued by society at large. An increased societal emphasis on health promotion and disease prevention has generated many opportunities for community health nurses (CHNs) to stretch their practices from individually-oriented type practice models to more encompassing population-focused type practices. Addressing this trend, the Roy Adaptation Model of nursing has been reconceptualized and expanded to offer a framework for the systematic delivery of nursing care to aggregates in community settings. The purpose of this paper is to describe the current health promotion movement in the United States and discuss the impact of this movement on the practice of community health nursing. In recognition of the importance of theory-based nursing practice and the opportunities that CHNs will have in the health promotion movement, the use of the a specific conceptual model, the reconceptualized Roy Adaptation Model, will be presented as a theoretical framework for community health nursing practice. The nursing process according to Roy is applied to community health nursing and specific attention is paid to the performance of community assessments within the newly defined adaptive modes that relate to collectives: the physical, group identity, role function, and interdependence modes. To date, few references appear in the literature which link the Roy Adaptation Model to community health nursing.     

Applying Critical Theories to Nursing in Communities

Public health realities in the United States indicate that unsafe physical surroundings, oppressive social arrangements, economic impoverishment, and political disenfranchisement threaten the safety and well-being of countless aggregates. To affect change in health-damaging conditions, nurses are urged to join with vulnerable groups, working together to expose oppressive situations and take action. As a guide for such emancipatory practice, the use of critical theories as the conceptual basis for community health nursing is advocated.     

Community Health Diagnosis in Nursing

A review of the historical evolution of the concept of community health diagnosis in nursing identifies sources of ambiguity that have impeded making the goals and values of community health nursing operational. Refinements of meaning in the conceptualization of the community health diagnosis that focus upon the community as the primary level of analysis are suggested. Implications of this reconceptualization of the practice of community health nursing are considered in guidelines for developing community health diagnoses and in an example of the diagnosis of a Mien refugee community's responses to health problems.     

Supporting Breast‐feeding When a Woman Is Homeless

PURPOSE. This case study demonstrates use of standardized nursing languages in the care of new mothers in community settings. DATA SOURCES. The author collected data from clinical practice as an instructor in a baccalaureate nursing program and from the research literature. DATA SYNTHESIS. The appropriate nursing diagnoses, outcomes, and interventions were identified in partnership with the new mother. CONCLUSIONS. This case shows that NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) are useful to direct nursing care in community settings. IMPLICATIONS FOR NURSING. When teaching nursing students in a baccalaureate program, nurse faculty can use NANDA‐I, NOC, and NIC classifications to guide the growing practice of nursing students in community settings.     

Community Analysis: A Collaborative Community Practice Project

Abstract Lack of access to health care is a concern in many communities. A group of representatives from health, social service, other community agencies and nursing education meet regularly to address issues in providing care to homeless, low-income, and uninsured persons in Spokane. Washington. This group's efforts has been hampered by lack of clearly identified factors that adversely affect access to care. One aspect of community analysis performed by this group used a collaborative community practice model. Community diagnoses were determined from information collected from service providers. Community health nursing faculty, as clinical specialists, can play a role in such a collaborative process.     

The DSM-III-R versus nursing diagnosis: a dilemma in interdisciplinary practice

Given the dynamics of the multidisciplinary team and the infancy of nursing diagnoses specific to psychiatric nursing, most nurses prefer using the DSM-III-R to document practice or do not see nursing diagnoses as relevant. The DSM-III-R, first published as the Diagnostic and Statistical Manual in 1952, is specific to the medical care of individuals and oriented toward "cure"; nursing diagnoses, initiated in 1973, are applicable to individuals, families, and groups and address human response to actual or potential health problems. The similarities of these two diagnostic systems include being a guide to practice, evolving as works of political compromise with international import, and serving as communication systems. However, without understanding the differences or similarities between these linguistic systems, nurses opting to use only the DSM-III-R do not contribute to understanding phenomena germane to psychiatric nursing, perpetuate the invisibility of nursing to patient care, and invite turf battles with other professions.     

Correlates of nursing diagnosis quality in public health nursing

The purpose of this study was to identify the relationship between the number and quality of nursing diagnoses generated by public health nurses (PHNs), and the use of different assessment databases (nursing or medical) In addition, the effect of experience with theory-based nursing practice on the number and quality of the diagnoses was examined A convenience sample of 37 PHNs employed in two county health units provided the subjects for this study One agency had implemented theory-based nursing practice, the other had not Analysis of the results revealed that use of a nursing database significantly affected the number of diagnoses generated by PHNs However, the database type did not significantly affect the quality of the diagnoses PHNs' experience with theory-based practice had no significant effect on the number or quality of nursing diagnoses generated by PHNs, irrespective of database     

A Study of the Relationship Between Adolescent Pregnancy and life-Change Events

Given the dynamics of the multidisciplinary team and the infancy of nursing diagnoses specific to psychiatric nursing, most nurses prefer using the DSM-IU-R to document practice or do not see nursing diagnoses as relevant. The DSM-IU-R, first published as the Diagnostic and Statistical Manual in 1952, is specific to the medical care of individuals and oriented toward “cure”; nursing diagnoses, initiated in 1973, are applicable to individuals, families, and groups and address human response to actual or potential health problems. The similarities of these two diagnostic systems include being a guide to practice, evolving as works of political compromise with international import, and serving as communication systems. However, without understanding the differences or similarities between these linguistic systems, nurses opting to use only the DSM-IU-R do not contribute to understanding phenomena germane to psychiatric nursing, perpetuate the invisibility of nursing to patient care, and invite turf battles with other professions.     

Improving Client Outcomes Through Differentiated Practice: A Rural Nursing Center Model

The TriCounty Community Health Center (the Center) was created in 1994 with federal grant monies to increase access and to provide outreach and primary health care services for rural residents. The Center employs a differentiated practice model of nursing care in which all nurses use the nursing process targeted to client systems that match the nurse's level of educational preparation and competence. The model allows nurses to intervene with various client systems, including the individual, family, aggregate, and community. Program outcomes for the Center suggest that using a differentiated nursing practice model for outreach and primary care services appears to have a positive impact on the health of individuals, families, and aggregates in rural settings, using the Omaha Classification System as a framework for evaluation.     

A Complementary View of Nursing Diagnosis

A review of the various definitions of nursing diagnoses in the literature demonstrated a potential for use of positive, negative, or neutral terms. The majority of examples used a negative term, however, which reflected an actual or potential problem. A dual approach to nursing diagnosis allows for consideration of client strengths as well as weaknesses. A framework for positive diagnoses is proposed and examples are given. Such diagnoses may be particularly useful for community health nurses working in health supervision or health maintenance.     

An Experience in Health Planning for Baccalaureate Nursing Students

A model was developed, using the nursing process, that has been incorporated into a health planning project for a community health nursing course. It is used to assist students to view larger aggregates as the client and to gain knowledge and experience in health planning. Examples of completed projects are presented. Evaluation of the projects by students, faculty, and aggregates supports the use of the model as a framework for nursing intervention within a community for the improvement of client health.     

EXPLORING THE EXPANDED PRACTICE ROLES OF COMMUNITY MENTAL HEALTH NURSES

Significant changes to the delivery of mental health services have resulted in the expansion of the community mental health nursing role. This qualitative study was undertaken to explore the extent to which community mental health nurses are currently engaged in expanded forms of practice. Focus groups were undertaken with community mental health nurses (n = 27) from metropolitan and rural Victoria, Australia. Thematic analysis identified the following major themes: reported practice, consumers as beneficiaries of expanded practice, risk of harm and litigation, and barriers to expanded practice. The findings emphasize the need for significant changes in current legislation if expanded practice for nurses is to become a reality.     

A Model of Community-Focused Nursing

Theoretically, the focus of community health nursing is the community; however, the nature of the practice has not been well documented. The purpose of this study was to develop a community-focused model by identifying appropriate behaviors and activities for staff-level community health nurses. A list of suggested behaviors and activities was compiled by means of brainstorming sessions and sent to a sample of community health nursing administrators, educators, and staff nurses in Michigan. Responses were analyzed using nonmetric multidimensional scaling techniques to uncover and define the primary underlying dimensions of perceived community-focused practice of community health nursing. Three specific regions were identified and labeled: (1) client-oriented services; (2) aggregate needs identification; and (3) aggregate planning and intervention. These regions (concepts) have been illustrated graphically in a proposed model for community focused nursing entitled the S-C model. In addition, discrepancies among the three respondent groups were identified.     

Exploring the expanded practice roles of community mental health nurses

Significant changes to the delivery of mental health services have resulted in the expansion of the community mental health nursing role. This qualitative study was undertaken to explore the extent to which community mental health nurses are currently engaged in expanded forms of practice. Focus groups were undertaken with community mental health nurses (n = 27) from metropolitan and rural Victoria, Australia. Thematic analysis identified the following major themes: reported practice, consumers as beneficiaries of expanded practice, risk of harm and litigation, and barriers to expanded practice. The findings emphasize the need for significant changes in current legislation if expanded practice for nurses is to become a reality.     

Aggregate/Community-Centered Undergraduate Community Health Nursing Clinical Experience

Abstract Debate continues about the appropriateness of clinical experiences targeting aggregates in undergraduate community health nursing education. This paper describes a practical model to teach, through experience, the concepts of aggregate/community-centered practice at the baccalaureate level. As a voluntary alternative to the usual community assessment paper, groups of students worked in partnership with community groups to define health needs and to address one need. Sequential student groups focused the assessment and implemented a plan. The required time for each project varied. One project is described to illustrate the model. While independent community-centered practice is not expected of the B.S.N. graduate, the model described here develops comprehension of the concepts and process of such practice.     

Use of Nursing Diagnosis With Population Groups

The authors report findings of a study done to examine the use of nursing diagnosis by community health nurses ( n = 15) and students ( n = 20) who worked with population groups. Results of the analysis of the open-ended questionnaires and student assignments indicate that many of the diagnoses, both wellness and deficit, could be classified in relation to the concepts present in published classification systems. Issues raised by the study about the use of nursing diagnosis with population groups include: incorporating wellness diagnoses in the NANDA Taxonomy, identifying when a group diagnosis is appropriate, determining whether to give priority to a behavioral or an environmental focus, and selecting the level of abstraction.