COMMUNITY NURSING Course Reflection PURPOSE The purpose of this assignment is to provide the student an opportunity to reflect

COMMUNITY NURSING Course Reflection

PURPOSE

The purpose of this assignment is to provide the student an opportunity to reflect on selected RN-BSN competencies acquired through the NUR4636 course COMMUNITY NURSING.

COURSE OUTCOMES

This assignment provides documentation of student ability to meet the following course outcomes:

-The students will be able to recognize the different level of prevention and apply them in the community (ACCN Essential I, II, IV, V, VII; QSEN: safety, evidence-based practice, teamwork and collaboration, quality improvement, informatics, and patient-centered care).

-This course will enable the student to place in practice methods of health prevention, promotion and restoration in the communities (ACCN Essential I, II, IV, V, VII; QSEN: safety, evidence-based practice, and teamwork and collaboration, quality improvement, informatics, and patient.

-The students will be able to educate the communities about the different ways to prevent illness and promote health (ACCN Essential I, II, IV, V, VII; QSEN: safety, evidence-based practice, teamwork, and collaboration, quality improvement, informatics, and patient-centered care).

-The student will understand the different tools available to put in place and in the hands of the communities in order to keep them healthy (ACCN Essential I, II, IV, V, VII; QSEN: safety, evidence-based practice, teamwork and collaboration, quality improvement, informatics, and patient-centered care).

REQUIREMENTS

1. Original papers, “NO plagiarism”. The Course Reflection will be graded on quality of self-assessment, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.

2. Follow the directions and grading criteria closely (See Attachment). Any questions about your essay may be posted under the Q & A forum under the Discussions tab.

3. The length of the reflection is to be within three to four pages excluding title page and reference pages.

4. APA format is required with both a title page and reference page. Use the required components of the review as Level 1 headers (upper and lower case, centered):

Note: Introduction – Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63).

a. Course Reflection

b. Conclusion

PREPARING YOUR REFLECTION

The BSN Essentials (AACN, 2008) outline a number of healthcare policy and advocacy competencies for the BSN-prepared nurse. Reflect on the NUR4636 course readings, discussion threads, and applications you have completed across this course and write a reflective essay regarding the extent to which you feel you are now prepared to:

1. Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, including local, state, national, and global healthcare trends.

2. Describe how health care is organized and financed, including the implications of business principles, such as patient and system cost factors.

3. Compare the benefits and limitations of the major forms of reimbursement on the delivery of healthcare services.

4. Examine legislative and regulatory processes relevant to the provision of health care.

5. Describe state and national statutes, rules, and regulations that authorize and define professional nursing practice.

6. Explore the impact of socio-cultural, economic, legal, and political factors influencing healthcare delivery and practice.

7. Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety, and the scope of nursing and other health professionals’ practice.

8. Discuss the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery.

9. Use an ethical framework to evaluate the impact of social policies on health care, especially for vulnerable populations.

10. Articulate, through a nursing perspective, issues concerning healthcare delivery to decision makers within healthcare organizations and other policy arenas.

11. Participate as a nursing professional in political processes and grassroots legislative efforts to influence healthcare policy.

12. Advocate for consumers and the nursing profession.

13. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations.

14. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems.

15. Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations.

16. Use behavioral change techniques to promote health and manage illness.

17. Use evidence¬ based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan.

18. Use information and communication technologies in preventive care.

19. Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions.

20. Assess the health, healthcare, and emergency preparedness needs of a defined population.

21. Use clinical judgment and decision-making skills in appropriate, timely nursing care during disaster, mass casualty, and other emergency situations.

22. Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and the prevention of illness, injury, disability, and premature death.

23. Participate in clinical prevention and population ¬focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity.

24. Advocate for social justice, including a commitment to the health of vulnerable populations and the elimination of health disparities.

25. Use evaluation results to influence the delivery of care, deployment of resources, and to provide input into the development of policies to promote health and prevent disease.” (pp. 20-21, 24-25 SEE ATTACHMENT)

Reference:

American Association of Colleges of Nursing [AACN]. (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author.

COMMUNITY NURSING Course Reflection NUR4636

Directions and Grading Criteria

Category	Points	%	Description
(Introduction – see note under requirement #4 above)	8	8	Introduces the purpose of the reflection and addresses BSN Essentials (AACN, 2008) pertinent to healthcare policy and advocacy.
You Decide Reflection	80	80	Include a self-assessment regarding learning that you believe represents your skills, knowledge, and integrative abilities to meet the pertinent BSN Essential and sub-competencies (AACN, 2008) as a result of active learning throughout this course. Be sure to use examples from selected readings, threaded discussions, and/or applications to support your assertions to address each of the following sub-competencies: (a) “Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, including local, state, national, and global healthcare trends. (b) Describe how health care is organized and financed, including the implications of business principles, such as patient and system cost factors. (c) Compare the benefits and limitations of the major forms of reimbursement on the delivery of healthcare services. (d) Examine legislative and regulatory processes relevant to the provision of health care. (e) Describe state and national statutes, rules, and regulations that authorize and define professional nursing practice. (f) Explore the impact of sociocultural, economic, legal, and political factors influencing healthcare delivery and practice. (g) Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety, and the scope of nursing and other health professionals’ practice. (h) Discuss the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery. (i) Use an ethical framework to evaluate the impact of social policies on health care, especially for vulnerable populations. (j) Articulate, through a nursing perspective, issues concerning healthcare delivery to decision makers within healthcare organizations and other policy arenas. (k) Participate as a nursing professional in political processes and grassroots legislative efforts to influence healthcare policy. (l) Advocate for consumers and the nursing profession. (m) Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations. (n) Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems. (o) Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. (p) Use behavioral change techniques to promote health and manage illness. (q) Use evidence based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. (r) Use information and communication technologies in preventive care. (s) Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions. (t) Assess the health, healthcare, and emergency preparedness needs of a defined population. (u) Use clinical judgment and decision-making skills in appropriate, timely nursing care during disaster, mass casualty, and other emergency situations. (v) Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and the prevention of illness, injury, disability, and premature death. (w) Participate in clinical prevention and population focused interventions with attention to effectiveness, efficiency, cost-effectiveness, and equity. (x) Advocate for social justice, including a commitment to the health of vulnerable populations and the elimination of health disparities. (y) Use evaluation results to influence the delivery of care, deployment of resources, and to provide input into the development of policies to promote health and prevent disease.” (pp. 20-21, 24-25).
Conclusion	4	4	An effective conclusion identifies the main ideas and major conclusions from the body of your essay. Minor details are left out. Summarize the benefits of the pertinent BSN Essential and sub-competencies (AACN, 2008) pertaining to scholarship for evidence-based practice.
Clarity of writing	6	6	Use of standard English grammar and sentence structure. No spelling errors or typographical errors. Organized around the required components using appropriate headers. Writing should demonstrate original thought without an over-reliance on the works of others.
APA format	2	2	All information taken from another source, even if summarized, must be appropriately cited in the manuscript and listed in the references using APA (6th ed.) format: 1. Document setup 2. Title and reference pages 3. Citations in the text and references.
Total:	100	100	A quality essay will meet or exceed all of the above requirements.

NUR4636 Course Reflection Guidelines.docx 08/21/19

1

Chapter 20

Family Health

Working with Families

Working with families has never been more complex or rewarding than now.

Nurses understand the actual and potential impact that families have in changing the health status of individual family members, communities, and society as a whole.

Families have challenging health care needs that are not usually addressed by the health care system.

How Do You Define a Family?

Definitions of a Family

Historical definitions:

The environment affecting individual clients

Small to large groups of interacting people

A single unit of care with definable boundaries

A unit of care within a specific environment of a community or society

Current theorists:

Two or more individuals who depend on one another for emotional, physical, and economic support. Members of family are self-defined.

– Hanson & Kaakimen (2005)

The family is who they say they are.

– Wright & Leahey (2000)

Inclusive Definitions of Family

“Family” means any person(s) playing a significant role in an individual’s life. This may include person(s) not legally related to the individual. Members of “family” include spouses, domestic partners, and both different-sex and same-sex significant others. “Family” includes a minor patient’s parents, regardless of gender of either parent … without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and others operating in caretaker roles.

– Human Rights Campaign ( 2009)

The Changing Family

Purposes of the family

To meet the needs of society

To meet the needs of individual family members

Examples of different family types

Traditional, nuclear family

Multigenerational family household

Cohabitating families

Single-parent families

Grandparent-headed families

Gay or lesbian families

Unmarried teen mothers

The “Sandwich” Generation

Figure 20-1 From Pew Research Center: Social and Demographic Trends: The Sandwich Generation. http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/. Accessed March 15, 2013.

Why Is It Important for the CHN to Work with Families?

The family is a critical resource.

Any dysfunction in a family unit will affect the members and the unit as a whole.

Case finding can identify a health problem that leads to risks for the entire family.

Nursing care can be improved by providing holistic care to the family and its members.

– Friedman, Bowden, & Jones (2003)

Approaches to Meeting the Health Needs of Families

Moving from the Family to the Community

Moving from the Individual to the Family

Family interviewing

Manners

Therapeutic conversations

Genogram and Ecomap

Therapeutic questions

Commending family or individual strengths

Issues in family interviewing

Many locations, family informant, family health portrait, involvement of children

Intervention in cases of chronic illness

Moving from the Family to the Community

The health of communities is measured by the well-being of its people and families.

Families are components of communities.

Cross-comparison of communities must include health needs as well as resources.

Cross-compare the needs of the families within the community and set priorities.

Delegation of scarce resources is essential.

A double standard in public health is tolerated.

Family Theory Approach

Any “dysfunction” that affects one member will probably affect others and the family as a whole.

The family’s wellness is highly dependent on the role of the family in every aspect of health care.

The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks by emphasizing health promotion, self-care, health education, and family counseling.

Family Theory Approach (Cont.)

Commonalities in risk factors and diseases shared by family members can lead to case finding within family.

Individual is assessed within larger context of family.

Family is vital support system to individual member.

– Friedman (1994)

Systems Theory Approach

The family as a unit interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem).

– Friedman (1998)

Healthy Families

Members interact with each other; listen and communicate repeatedly in many contexts.

Healthy families establish priorities. Members understand that family needs are the priority.

Healthy families affirm, support, and respect each other.

Members engage in flexible role relationships, share power, respond to change, support the growth/autonomy of others, and engage in decision making that affects them.

– DeFrain (1999) and Montalvo (2004)

Healthy Families (Cont.)

The family teaches family and societal values and beliefs and shares a religious core.

Healthy families foster responsibility and value service to others.

Healthy families have a sense of play and humor and share leisure time.

Healthy families have the ability to cope with stress and crisis and grow from problems. They know when to seek help from professionals.

– DeFrain (1999) and Montalvo (2004)

Structural-Functional Conceptual Framework

Internal structure

Family composition, gender, rank order, functional subsystem, and boundaries

External structure

Extended family and larger systems (work, health, welfare)

Context: ethnicity, race, social class, religion, environment

Instrumental functioning (routine ADLs)

Expressive functioning

Emotional, verbal, nonverbal, circular communication; problem solving; roles; influence; beliefs; alliances and coalitions

Developmental Theory

Family life cycle (Duvall & Miller, 1985)

Leaving home

Beginning family through marriage or commitment as a couple relationship

Parenting the first child

Living with adolescent

Launching family (youngest child leaves home)

Middle-age family (remaining marital dyad to retirement)

Aging family (from retirement to death of both spouses)

Family Health Assessment Tools

Genogram

A tool that helps the nurse outline the family's structure

Family health tree

Family’s medical and health histories

Ecomap

Depicts a family’s linkages to their suprasystems

Family Health Assessment Tools

Family Health Assessment

Addresses family characteristics, including structure and process and family environment

Information obtained through interviews with one or more family members, subsystems within the family, or group interviews of more than two members of the family

Additional information obtained through observation of family and their environment

Genogram

Figure 20-2 Redrawn from Genopro Software: Symbols used in genograms, 2009: www.genopro.com.

Ecomap

Figure 20-4 Redrawn from Hartman A: Diagrammatic assessment of family relationships, Soc Casework 59:496, 1978.

Social and Structural Constraints

Identify what prevents families from receiving needed health care or achieving a state of health

Usually based on social and economic causes

Literacy, education, employment

If disadvantaged, often unable to buy health care from private sector

Hours of service, distance and transportation, availability of interpreters, and criteria for receiving services (age, sex, income barriers)

Family Health Interventions

Institutional context of family therapists

Ecological framework: A blend of systems and developmental theory that focus on the interaction and interdependence of families within the context of their environment

Social Network Framework: Involves all connections and ties within a group; social support

Transactional model: A system that focuses on process as opposed to a linear approach

Applying the Nursing Process

Knowledge of self, previous life experiences, and values is crucial in planning home visits

Gather referral information, review assessment forms, and gather intervention tools (e.g., screening materials, supplies) before going to the home

Flexibility is important in working with families

Chapter 21

Populations Affected by Disabilities

Most people whose lives do not end abruptly

will experience disability.

– Nies & McEwen (2015)

Doing a Self-Assessment

What comes to mind when you think of someone with a disability?

Picture yourself as a person with a disability.

Imagine yourself as a nurse with a visible disability, or a client receiving care from a nurse with a disability.

Think about living in a family affected by disability.

What is the experience of living with disability within your community?

Definitions for Disability

Disability is the interaction between individuals with a health condition and personal and environmental factors.

– World Health Organization, 2012

WHO International Classification of Functioning, Disability, and Health

Disability is an umbrella term covering impairments, activity limitations, and participation restrictions (individual level).

An impairment is a problem in body function or structure—activity limitation or participation restriction (micro level).

A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role (macro level).

Table 21-1

Characteristic	Impairment	Disability	Handicap
Definition	Physical deviation from normal structure, function, physical organization, or development	May be objective and measurable	Not objective or measurable; is an experience related to the responses of others
Measurability	Objective and measurable	May be objective and measurable	Not objective or measurable; is an experience related to the responses of others
Illustrations	Spina bifida, spinal cord injury, amputation, and detached retina	Cannot walk unassisted; uses crutches and/or a manual or power wheelchair; blindness	Reflects physical and psychological characteristics of the person, culture, and specific circumstances
Level of analysis	Micro level (e.g., body organ)	Individual level (e.g., person)	Macro level (e.g., societal)

National Agenda for Prevention of Disabilities (NAPD) Model

Figure 21-1 Reprinted with permission from Pope AM, Tarlov AR, editors: Disability in America: toward a national agenda for prevention, Washington, DC, 1991, Institute of Medicine, National Academy Press. Copyright © 1991 by the National Academy of Sciences. Courtesy National Academy Press, Washington, DC.

Quality of Life Issues

Transportation to a needed service

Cost of care

Appointment challenges

Language barriers

Financial issues

Migrant/noninsured issues

Models for Disability

Medical model—a defect in need of cure through medical intervention

Rehabilitation model—a defect to be treated by a rehabilitation professional

Moral model—connected with sin and shame

Disability model—socially constructed

Disability: A Socially Constructed Issue

Disability is a complex, multifaceted, culturally rich concept that cannot be readily defined, explained, or measured (Mont, 2007).

Whether the inability to perform a certain function is seen as disabling depends on socio-environmental barriers (e.g., attitudinal, architectural, sensory, cognitive, and economic), inadequate support services, and other factors (Kaplan, 2009).

“Medicalization” Issues

Nurse needs to differentiate …

A person who has an illness and becomes disabled secondary to the illness

versus …

A person who has a disability, but may not need treatment

“Medicalization” Issues (Cont.)

Nurse’s interaction with PWD and families

Approach on an eye-to-eye level

Listen to understand

Collaborate with the person/family

Make plans and goals that meet the other’s needs and draw on strengths and improve weaknesses

Empower and affirm the worth and knowledge of the person/family with a disability

Promote self-determination and allow choices

Note: PWD = persons with disabilities

Historical Perspectives

Long history of institutionalization/segregation

Often viewed as sick and helpless

In the 20th century, special interest groups emerged to advocate for PWD (e.g., ARC)

Tragedies include Hitler’s euthanasia program

Deinstitutionalization began in 1960s-1970s

Stereotypical images still common in literature and media; these images influence prevailing perceptions of disability

Historical Context for Disability

Early attitudes toward PWD

Set apart from others

Viewed as different or unusual

Documented in carvings and writings

Infanticide or left to die (not in Jewish culture)

Viewed as unclean and/or sinful

Served as entertainers, circus performers, and sideshow exhibitions

Historical Context

18th and 19th century attitudes

No scientific model for understanding and treating

Disability seen as an irreparable condition caused by supernatural agency

Viewed as sick and helpless

Expected to participate in whatever treatment was deemed necessary to cure or perform

Industrial Revolution stimulated a societal need for increased education

If not third-grade level = feeble-minded

Special schools established in early 1800s

Historical Context (Cont.)

20th century attitudes

Special interest groups were formed

First federal vocational rehabilitation legislation passed in early 1920s

Involuntary sterilization of many with intellectual disabilities

ARC (Association for Retarded Children) began to advocate for children with intellectual disabilities—today is Association for Retarded Citizens

ARC is “world’s largest community-based organization of and for people with intellectual and developmental disabilities” (ARC, 2009)

Historical Context (Cont.)

20th century attitudes

One of the most horrendous tragedies under Hitler’s euthanasia or “good death” program

Killed at least 5000 mentally and physically disabled children by starvation or lethal overdoses

Killed 70,274 adults with disabilities by 1941

Over 200,000 people exterminated because they were “unworthy of life”

Deinstitutionalization movement in 1960s and 1970s

Community-based Independent Living Centers established

Historical Context (Cont.)

Contemporary conceptualization

Stereotypical images remain common in literature and media

Population portrayed as a burden to society or from pity/pathos or heroic “supercrip” perspectives

“just as the paralytic cannot clear his mind of his impairment, society will not let him forget it.” (Murphy, 1990, p. 106)

Societal stigma still exists

Teasing or bullying often occurs in schools

Rehabilitation Act of 1973 and American with Disabilities Act of 1990 prohibit “disability harassment”

Characteristics of Disability

Americans with Disabilities Act (ADA) of 1990 and Rehabilitation Act of 1973 defined disability according to limitations in a person’s ability to carry out a major life activity.

Major life activities: ability to breathe, walk, see, hear, speak, work, care for oneself, perform manual tasks, and learn

U.S. Census Bureau (2006) defines disability as long-lasting physical, mental, or emotional condition that creates a limitation or inability to function according to certain criteria.

Examples of Disabilities

Physical disabilities

Sensory disabilities

Intellectual disabilities

Serious emotional disturbances

Learning disabilities

Significant chemical and environmental sensitivities

Health problems

Measurement of Disability

Survey of Income and Program Participation (SIPP)

Functional activities

Activities of daily living (ADLs)

Instrumental activities of daily living (IADLs)

American Community Survey (ACS)

Surveys for disability limitation in six areas that affect function or activity (sensory, physical, mental/emotional, self-care, ability to go outside the home, employment)

Other organizations also collect disability data

Prevalence of Disability

In 2010, approximately 18.7% of civilian noninstitutional population aged 5 years and older had a long-lasting condition or disability.

Of those with a disability, 12.6% had a “severe” disability.

Prevalence var

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