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• Population-focused practice


  Emphasizes health promotion, health protection, and disease prevention. The social determinants of health are highly relevant to population health
• Traditional health care vs Population focused health care

  • Treating an illness
  • The individual is the focus
  • Goal is treating
  • Reduction of health inequities for defined populations/aggregates
  • Shifts the philosophy of blaming (broad holistic approach)
  • Goal is prevention/promotion
• Population


  Collection of people who share one or more personal or environmental characteristic that all reside in a community
• Aggregate


  A group within a population (e.g. school aged children)
• Upstream vs. Downstream thinking

  • Upstream: Primary prevention perspective. MACROSCOPIC health approach
  • Downstream: MICROSCOPIC health approach, individual curative focus
• Standards of practice


  • Health promotion
  • Prevention and health protection
  • Health maintenance, restoration and palliation
  • Professional relationships
  • Health Equity
  • Capacity building
  • Evidence informed practice
  • Professional responsibility and accountability
• CAN collaboration principles


  • Focus on the client
  • Evidence-informed decision making
  • Access
  • A population health approach
  • Social justice and equity
  • Ethics
  • Communication
  • Cultural safety
• Florence Nightingale focused on tracking data and addressing sanitation to impact mortality rates
• William Rathbone wanted to make health care accessible to everyone regardless of factor that get in our way
• Lillian Wald was a dynamic force for social reform, creating widely-adopted models of public health and social service programs
• Eunice Dyke was the first director of public health nursing in Toronto
• Continuity of care


  Making linkages to improve patient health status. Principles and steps of discharge planning and referral are essential
• Health advocacy


  Creating broader awareness of health issues and potential supporting action or change. CHNs collaborate and demonstrate commitment to equity, social justice, and policymaking activities
• Case management


  A strategy to improve accessibility and continuity of patient care. Includes assessment, planning, coordination, delivery, and monitoring of the health services made available to the patient as individual and family
• Challenges of home health nursing

  • Meeting privacy needs of the patient and family and adapting, as needed, to the patient's lifestyle
  • Must practice autonomously, with little structure
  • The home environment lacks many resources typically found in health care institutions
• Factors that continue to challenge public health nurses today

  • Emerging pandemics
  • Reduced funding
  • Climate change disasters
  • Communicable disease
• OHN's scope of practice

  • Worker and workplace assessment and surveillance
  • Primary care
  • Case management
  • Counselling
  • Health promotion and protection
  • Administration and management
  • Research
  • Legal and ethical monitoring
  • Community orientation
• Major public health functions in Ontario

  • Health protection
  • Health promotion
  • Population health assessment
  • Public health surveillance
  • Injury and disease prevention
  • Emergency preparedness and response
• Principles of ethics, equity, social justice, and human rights inform CHN practice, ensuring fairness and equality in health services
• Community health nursing is an umbrella term used to doing nursing specialties and applies to all nurses who work in and with the community. CHNs work in diverse settings and perform a variety of roles
• The CCHN standards comprise 8 standards that are intended to guide and facilitate the practice of CHNs in Canada as they work within the principles of primary health care to promote and preserve the health of populations
• Every public health efforts in Canada were shaped by epidemics that, as part of colonization efforts, devastated indigenous people in Canada, who were introduced to harmful conditions and pathogens. This increasing acceptance of public roles for women permitted community health nursing employment for nurses, which also shaped the evolution of public health in Canada
• CHNs collaborate with many partners using a population health approach to protect and promote health and prevent disease in populations. Team building and collaboration are functions of community development. In collaborating, health care providers should be attentive to options for change and improvement and adjust the plan of care as required
• Steps in evidence informed practice

  • P = population
  • I = intervention
  • C = comparison
  • O = outcomes
• Types of epidemiology


  • Descriptive 'population health assessment'
  • Analytical 'the why and how'
• Common epidemiological measures


  • Mortality: # of deaths due to disease in a population
  • Morbidity: occurrence of disease in a population
  • Incidence rate: # of new cases in a time period
  • Prevalence rate: # of people in population with disease in timeframe
  • Risk: the probability that an event will occur within a specified period
  • Relative risk: incidence rate of disease in exposed pops / incidence in unexposed pops
  • Odds ratio: exposed w disease/unexposed w disease over exposed w/out disease/unexposed w/out disease
• Elements of a community

  • People: community residents
  • Place: geographic and time
  • Function: aims and activities of the community
• Community as a client vs. Community as a partner

  • Community as a client: Provide interventions for total population, CHN is viewed as an expert, Community assessment focusses on use od epidemiological data and disease, occurrences with a focus that is needs defined, Interventions often directed by government protocols, Focus on collective or common good of the population
  • Community as a partner: CHN emphasizes or assets to deal with community-identified health concerns and develop community capacity, CHN works in partnership with the community in approach that is supportive to and meaningful for community members
• Community capacity


  Identifies and works with existing community strengths to promote a positive view of the community. Capacity building helps communities become stronger on the basis of these strengths rather than focusing on their weaknesses
• Windshield survey/virtual community assessment (VCA)

  • Physical environment
  • Health and social services
  • Economy
  • Transportation and safety
• Implementation: Change agent vs. Change partner

  • Change agent: stresses gathering and analyzing facts and implementing programs
  • Change partner: includes enabler-catalyst, teacher of problem-solving skills to address health concerns, and activist advocate
• Group development stages


  • Forming
  • Storming – expressing feelings on issues to focus on
  • Norming – feeling like you're part of the group
  • Performing – sharing ideas in a supportive environment
  • Adjourning – termination and disengagement of the group
• Communicable diseases


  Contagious disease of human or animal origin caused by an infectious agent. Prevention is the main priority.
• Types of communicable diseases

  • Virus
  • Bacteria
  • Parasite
  • Fungi
• Communicable disease prevention and control


  • A program that seeks to reduce the prevalence of a disease to a level at which no longer poses a public health problem
  • Elimination – removal of disease from a large geographical area
  • Eradication – permanent elimination worldwide
• Modes of transmission


  • Vertical – passing of infection from parent to offspring
  • Horizontal – through direct or indirect contact of something that was exposed
• Disease development


  • Infection: entry, development and multiplication of the infectious agent in the susceptible host
  • Disease: one of the possible outcomes of infection
  • Incubation period: time interval between invasion by an infectious agent and first appearance of signs and symptoms of the disease
  • Communicable period: time interval during which an infectious agent my be transferred from an infected person to another person
  • Infection does NOT always turn into disease
  • Endemic: constantly present in a population with relatively low spread
  • Epidemic: sudden increase in cases spreading through a large population
  • Pandemic: sudden increase in cases across several countries, continents or the world
• Surveillance of communicable diseases

  • Surveillance: Systematically collecting, organizing, and analyzing, current, accurate, and complete data for a defined disease condition (Active/passive)
  • Early detection and surveillance: Monitoring trends, Early identification
  • Education and prevention: Community education, Targeted interventions
  • Resource allocation and planning: Resource management, Emergency preparedness
  • Collaboration and communication: Interdisciplinary collaboration, Public communication
• HIV


  Virus that weakens your immune system. Transmitted only through contact with body fluids (blood, semen, rectal and vaginal secretions, breast milk)
• Hepatitis A


  Viral hepatitis often transmitted through fecal-oral route (water, food, sex)