The Development of Nursing Diagnoses for Aggregates and Groups

A focus on aggregates, groups, or communities as clients is an important characteristic of community health nursing practice. Community health nurse practitioners have identified population groups as one of five functional components in a typology of community health nursing practice. Questions have been raised, however, as to whether such groups need different forms of nursing diagnoses than those used for individuals. We attempted to use nursing diagnoses in a senior community health nursing course with undergraduate students that included experience working with aggregates or groups. Issues were identified in relation to the scope of the role of nurses in the community, the selection of the client, and the use of a taxonomy.     

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."     

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.     

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.     

Are We Implementing Community Health Promotion in Nursing?

Abstract Promoting the health of communities has been the rallying cry (now renewed) from the nation's top public health officials. Public health nurses have always stressed community health promotion, not only in their work but also in the educating of future public health nurses. Facilitating the shift from focusing primarily upon secondary and tertiary prevention, individual, and disease-oriented processes is a constant challenge, given the current health care and reimbursement systems. The objectives of this paper are: to give a brief historical review of the nation's health objectives, other recent pertinent documents, and early public health nursing's emphases regarding community health promotion; to give a selected overview of recent community health promotion programs implemented by community and public health nurses in nursing education and practice; and to focus on present challenges to nursing in implementing community health promotion.     

Building Community Capacity for Health Promotion: A Challenge for Public Health Nurses

Abstract The centennial celebration of public health nursing is a strong reminder of the tradition and practice of public health nursing's commitment to communities. Partnerships with communities give public health nurses fiduciary responsibility to be actively involved in public health reform to advance health promotion and health protection. Public health nurses must rise to the challenge to build community capacity through facilitating community participation, enhancing community health services, and coordinating public policy to achieve core public health responsibilities of assessment, policy, and assurance. This paper explicates strategies for building community capacity for health promotion.     

Community nurses' health promotion work with older people

AIMS: This paper reports a study describing community nurses' health promotion work with older people aged 50 years and above, and exploring particular health promotion initiatives for older people that would have transferability potential. BACKGROUND: With the ageing of populations worldwide, community nurses in primary healthcare settings have a key contribution to make to the health improvement agenda for older people, yet little is known of the extent of this aspect of their work. METHODS: Questionnaires were sent to 1062 community nurses in six Scottish National Health Service Boards - public health nurses/health visitors, district nurses, general practice nurses, community psychiatric and learning disability nurses and combined duty nurses; 373 (35%) responded, 30 of whom were interviewed by telephone. The data were collected in 2003-2004. FINDINGS: Findings confirmed the wide scope of health promotion, much of which may be embedded and unrecognized. Creative group work showed promise in achieving heath gain for older people, and a range of partnership approaches - interdisciplinary, multidisciplinary and interagency - was evident. Theoretical input and project opportunities within educational programmes had been a catalyst for health promotion initiatives in practice. However, evidence of audit, evaluation, and active involvement of older people in planning health promotion was limited. Funding of health promotion initiatives was vital to sustainability. CONCLUSION: There is merit in making the health promotion work of community nurses more visible through audit and systematic evaluation; promoting the active involvement of older people; strengthening partnership working; and further raising the profile of health in later life within undergraduate and postgraduate community nursing programmes.     

Clinical Competencies for Community Health Nursing

Cost-containment strategies initiated in the early 1980s caused a major shift in site of care delivery for persons needing nursing care. Where once the majority of clients were cared for in the acute-care setting until they were self-sufficient, now most are discharged to the home environment still requiring acute-care nursing interventions as well as community health nursing skills. This rapid shift in practice sites has placed severe strain on community health nursing agencies. Not only are more nurses required to fill the increased demand for services, but the demand comes at a time when we are experiencing a severe nursing shortage. This has forced many agencies to hire acute care nurses who have little or no community health nursing experience. These nurses come to community health nursing expecting to use the same set of skills and knowledge base used in their acute-care practice; however, the skill levels and concepts required for community health nursing are quite different from the acute care setting. Educational preparation has not kept pace with this shift in practice. Consequently, many nurses are not adequately prepared to enter community health nursing. Preparation must include theoretical and experiential components that focus on assessment skills (of the community and individual), decision making, case management, health systems management, teaching, and leadership. Collaborative efforts between community health organizations and educational institutions would seem to be one solution that would ensure adequately prepared nurses for community health nursing. The establishment and maintenance of strong staff-development programs within community health nursing agencies are also required.     

Health-promoting nursing practice: the demise of the nursing process?

Health promotion is gaining widespread recognition throughout the world as the most efficacious practice in achieving health for all In Canada, the philosophy of health promotion is driving both federal and provincial health initiatives Such a philosophy is derived from a human science paradigm and is in direct opposition to the natural science paradigm from which the biomedical approach to health care emerged There now exists a tension between these contrasting paradigms as health care shifts to embrace a health-promotion perspective The nursing process is based in the natural science paradigm and on a biomedical approach to health care In order for nurses to embrace health promotion fully, they must move away from the philosophy of the natural sciences and adopt a human science perspective Such a shift requires a radical transformation in nursing practice as nurses move away from the'top-down'approach of the nursing process and adopt a'bottom-up'approach to health-promoting nursing practice The purpose of this paper is to compare and contrast the nursing process with the principles of health promotion, and to challenge our use of the nursing process in current nursing practice In particular, a framework for health-promoting nursing practice will be provided     

Community health assessment tool: a patterns approach to data collection and diagnosis.

Creation of an assessment tool to apply Gordon's functional patterns to the community as a client was a rewarding and stimulating project. Through use of the CHAT, students developed an appreciation of the complexity and inter-relationship of numerous aspects of the community. They completed the nursing process by developing appropriate nursing diagnoses, and planning, implementing, and evaluating a health promotion project. As the students continue to use this tool in the health promotion course, the diagnoses which they generate are being collected. From this accumulated input the plan is to compile a list of common diagnoses which are appropriate to use when the community is the client.     

Knowledge, skills and experiences for community health nursing practice: the perceptions of community nurses, administrators and educators

Nursing in Canada is committed to preparing all new graduates at the baccalaureate level for entry to nursing practice by the year 2000 This goal has major implications for community health nursing education and practice Health care reform is also expected to move care out of the hospital and into the community It was against this backdrop that the researchers mounted a study on the educational preparation needed for graduates to begin to practice community health nursing In this paper, the knowledge, professional and personal skills, and experiences that graduates need to begin community practice are reported The study was carried out within an action-research framework All major groups of stakeholders involved in community health nursing throughout the study province were involved in the project This included nurses and administrators from two public health agencies (provincial and municipal), home care nurses, home health nurses (l e non-governmental visiting nurses), community health centres, provincial health care and nursing consultants, and faculty from two universities In addition to the generation of relevant research findings for use by the educational institutions, the study was initiated to set the stage for future and ongoing interactions between the researchers and community experts to implement the findings from the project Data were collected from 118 participants by means of 27 focus groups of community nurses, administrators and educators Interviews were tape-recorded transcribed and analysed using latent content analysis and constant comparison techniques Findings indicated that qualified nurses from university programmes need a wide range of knowledge, skills and experiences to begin to practice community health nursing Detailed accounts of these requirements are outlined and the implications for practice and education put forward     

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     

Contamination: Nursing Diagnoses with Outcome and Intervention Linkages

PURPOSE: To relate the collaborative processes involved in the evolution of environmental nursing diagnoses and the linkages between two new nursing diagnoses and their associated interventions and outcomes; to describe the environmental health implications of contamination. DATA SOURCES: Published research articles, official reports, textbooks, and collaborative discussion with experts in community and global health. DATA SYNTHESIS: Reflection following review of the literature and collaboration with experts led to the development of a new schema for environmental diagnoses and development of two new diagnoses, allowing for greater clarity and distinction between the contamination diagnoses and risk for poisoning diagnosis. CONCLUSIONS: An environmental nursing diagnosis schema, with its emphasis on contamination, infection, and violence, provides nurses with a holistic framework for making judgments about environmental influences related to individual, family, community, and global health. The diagnoses of Contamination and Risk for Contamination provide necessary language to describe human responses and risk states that may arise following exposure to environmental contaminants. PRACTICE IMPLICATIONS: Development of environmental diagnostic labels and delineation of the linkages to nursing outcomes and interventions will allow nurses to take active roles in identifying environmental components that affect health and planning care that responds to environmental health needs. Greater clarity in the use of language will allow nurses to incorporate environmental concepts appropriately in nursing assessments and improve the accuracy of the diagnostic process and selection of distinct interventions and outcomes. This will result in better outcomes for patients and communities and permit greater accountability of nursing's contribution to environmental health.     

Health Maintenance,Health Promotion: Is There a Difference?

Nurses in community settings are seeing more health care consumers who are medically stable and who are asking for assistance in areas such as exercise, stress reduction, nutrition, and illness and accident prevention. These requests can be characterized as concerns of health maintenance or health promotion. Two nursing diagnoses, altered health maintenance and health-seeking behaviors (specify), enable the practitioner to address these concerns in clinically useful ways. Through case studies and comparative tables, the differences between these two diagnoses is clarified to enable nurses to identify, treat, and evaluate efforts made to enhance health-oriented behaviors.     

Starting from a blank page: discovering and creating community health nursing in post-Soviet Latvia

Nurses discovering the practice and creating the tradition of community health nursing without mentors or forerunners have to learn from the practice itself and from each other. Data in the phenomenologic study of 17 Latvian community health nurses (CHNs) consisted of group and individual interviews and observation of practice with families. The focus of this article is the situated practice of nurses in the new role of primary care CHN, revealed through clinical stories that give voice to nurses in a particular historical and social context. The stories of the nurses in this article provide evidence of a growing ability to practice from a health promotion/prevention focus and engage with families and neighborhoods. The practice is still developing, and at this point nurses are not drawing on experience with families to identify and care for vulnerable populations.