Community health nursing approaches

Mrs.Nagamani.T
Asst. Professor
Dept.of Community Health Nursing

 The concept of community is defined as "a group
of people who share some important feature of
their lives and use some common agencies and
institutions."
 The concept of health is defined as "a balanced
state of well-being resulting from harmonious
interactions of body, mind, and spirit."
 The term community health is defined by
meeting the needs of a community by identifying
problems and managing interactions within the
community

 Nurses providing community health services
play key roles in disease and injury
prevention, disability alleviation and health
promotion, as well as managing and providing
care and follow-up across a broad range of
settings.
 Community health nursing promotes and
protects the health of populations through a
combination of knowledge derived from
nursing, social and public health sciences.
CHNs perform this role through several
approaches of practice:

1. Nursing Process Approach
2. Theoritical Approach
3. Epidemiological Approach
4. Problem Solving Approach
5. Evidence based Approach
6. Empowering people to care for
themselves.

 Nursing process is a critical thinking process
that professional nurses use to apply the best
available evidence to caregiving and promoting
human functions and responses to health and
illness (American Nurses Association, 2010).
 Nursing process is a systematic method of
providing care to clients.
 The nursing process is a systematic
method of planning and providing
individualized nursing care.

Nursin
g
proce
ss
Assessme
nt
Plannin
g
Implementatio
n
Evaluatio
n

 Assessment is the systematic and continuous
collection, organization, validation, and
documentation of data (information).
 Collection of data: Data collection is the
process of gathering information about a
client’s health status. It includes the health
history, physical examination, results of
laboratory and diagnostic tests, and material
contributed by other health personnel.

 Types of Data:Two types: subjective data and
objective data.
 1. Subjective data, also referred to as symptoms or
covert data, are clear only to the person affected and
can be described only by that person.
 Itching, pain, and feelings of worry are examples
of subjective data.
 Objective data, also referred to as signs or overt
data, are detectable by an observer or can be
measured or tested against an accepted standard.
They can be seen, heard, felt, or smelled, and they
are obtained by observation or physical examination.
 For example, a discoloration of the skin or a blood
pressure reading is objective data.

 Sources of Data: Sources of data are primary
or secondary.
1. Primary : It is the direct source of
information. The client is the primary source
of data.
2. Secondary: It is the indirect source of
information. All sources other than the client
are considered secondary sources. Family
members, health professionals, records and
reports, laboratory and diagnostic results are
secondary sources.

Methods of data collection: The
methods used to collect data are
observation, interview and examination.
Observation : It is gathering data by
using the senses. Vision, Smell and
Hearing are used.
Interview : An interview is a planned
communication or a conversation
with a purpose.

 There are two approaches to interviewing:
directive and nondirective.
 The directive interview is highly
structured and directly ask the questions.
And the nurse controls the interview.
 A nondirective interview, or rapport
building interview and the nurse allows the
client to control the interview.

Examination : The physical examination
is a systematic data collection method to
detect health problems. To conduct the
examination, the nurse uses techniques of
inspection, palpation, percussion and
auscultation.

 Organization of data: The nurse uses a format
that organizes the assessment data
systematically. This is often referred to as
nursing health history or nursing assessment
form.
 Validation of data:The information gathered
during the assessment is “double-checked”
or verified to confirm that it is accurate and
complete.
 Documentation of data:To complete the
assessment phase, the nurse records client
data. Accurate documentation is essential
and should include all data collected about
the client’s health status.

Diagnosis is the second phase of the
nursing process. In this phase, nurses use
critical thinking skills to interpret
assessment data to identify client
problems.
North American Nursing Diagnosis
Association (NANDA) define or
refine nursing diagnosis.

Anursing diagnosis is:“a clinical
judgment concerning a human response
to health conditions/life processes, or a
vulnerability for that response, by an
individual, family, group, or community.”

 The status of nursing diagnosis are actual,
health promotion and risk.
1. An actual diagnosis is a client problem
that is present at the time of the nursing
assessment.
2. A health promotion diagnosis relates to
clients’ preparedness to improve their
health condition.
3.A risk nursing diagnosis is a clinical
judgement that a problem does not exist, but
the presence of risk factors indicates that a
problem may develop if adequate care is not
given.

 A nursing diagnosis has three components:
(1) The problem and its definition
(2) The etiology
(3) The defining characteristics.
1. The problem statement describes the client’s
health problem.
2. The etiology component of a nursing diagnosis
identifies causes of the health problem.
3. Defining characteristics are the cluster of signs
and symptoms that indicate the presence of
health problem.

 The basic three-part nursing diagnosis
statement is called the PES format and
includes the following:
1. Problem (P): statement of the client’s
health problem (NANDAlabel)
2. Etiology (E): causes of the health problem
3. Signs and symptoms (S): defining
characteristics manifested by the client.

Acute pain related
to abdominal
surgery as
evidenced by patient
discomfort and
pain scale.
Problem Etiology Signs and
symptoms
Pain Surgery of
abdomen
Pain scale
and
discomfort of
patient

 Planning involves decision making and
problem solving.
 It is the process of formulating client goals
and designing the nursing interventions
required to prevent, reduce, or eliminate the
client’s health problems.
TYPES OF PLANNING:
1. Initial Planning
2. Ongoing Planning
3. Discharge Planning

Planning process:
Planning includes;
Setting priorities
Establishing client goals/desired outcomes
Selecting nursing interventions and
activities
Writing individualized nursing interventions
on care plans.

The nurse begin planning by deciding
which nursing diagnosis requires attention
first, which second, and so on.
Nurses frequently use Maslow’s hierarchy
of needs when setting priorities.

Establishing client goals/desired outcomes
After establishing priorities, the nurse set
goals for each nursing diagnosis. Goals
may be short term or long term.

 A nursing intervention is any treatment, that a nurse
performs to improve patient’s health.
TYPES OF NURSING INTERVENTIONS
1. Independent interventions are those activities that
nurses are licensed to initiate on the basis of their
knowledge and skills.
2. Dependent interventions are activities carried out
under the orders or supervision of a licensed
physician.
3. Collaborative interventions are actions the
nurse carries out in collaboration with other
health team members

Implementation consists of doing and
documenting the activities.
The process of implementation includes;
Implementing the nursing interventions
Documenting nursing activities

 Evaluation is a planned, ongoing,
purposeful activity in which the nurse
determines
(a) the client’s progress toward achievement of
goals/outcomes and
(b) the effectiveness of the nursing care plan.
 The evaluation includes;
 Comparing the data with desired
outcomes
 Continuing, modifying, or terminating the nursing
care plan.

Theories applied in
Community Health
Nursing

• Nightingale’s theory of environment
• Orem’s Self care model
• Neuman’s health care system model
• Roger’s model of the science and unitary man
• Pender’s health promotion model
• Roy’s adaptation model
• Milio’s Framework of prevention
• Salmon White’s Construct for Public health nursing
• Block and Josten’s Ethical Theory of population
focused nursing
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• Born - 12 May 1820
• Founder of mordern nursing.
• The first nursing theorist.
• Also known as "The Lady with the Lamp"
• She explained her environmental theory in her famous book Notes
on Nursing: What it is, What it is not .
• She was the first to propose nursing required specific education and
training.
• Her contribution during Crimean war is well-known.
• She was a statistician, using bar and pie charts, highlighting key
points.
• International Nurses Day, May 12 is observed in respect to her
contribution to Nursing.
• Died - 13 August 1910
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• Natural laws
• Mankind can achieve perfection
• Nursing is a calling
• Nursing is an art and a science
• Nursing is achieved through environmental
alteration
• Nursing requires a specific educational base
• Nursing is distinct and separate from medicine
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• Ventilation and warming
• Light, Noise
• Cleanliness of rooms/walls
• Health of houses
• Bed and bedding
• Personal cleanliness
• Variety
• Chattering hopes and advices
• Taking food. What food?
• Petty management/observation
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Nursing Paradigms
Nursing
• Nursing is different from medicine and the goal of
nursing is to place the patient in the best possible
condition for nature to act.
• Nursing is the "activities that promote health (as
outlined in canons) which occur in any caregiving
situation. They can be done by anyone."
Person
• People are multidimensional, composed of
biological, psychological, social and spiritual
components.
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Nursing Paradigms
Health
• Health is “not only to be well, but to be able to use
well every power we have”.
• Disease is considered as dys-ease or the absence of
comfort.
Environment
• "Poor or difficult environments led to poor health
and disease".
• "Environment could be altered to improve
conditions so that the natural laws would allow
healing to occur."
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• Born 1914 in Baltimore, US
• Earned her diploma at Providence Hospital –
Washington, DC
• 1939 – BSN Ed., Catholic University ofAmerica
• 1945 – MSN Ed., Catholic University ofAmerica
• She worked as a staff nurse, private duty nurse, nurse
educator and administrator and nurse consultant.
• Received honorary Doctor of Science degree in 1976.
• Theory was first published in Nursing: Concepts of
Practice in 1971, second in 1980, in 1995, and 2001.
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• People should be self-reliant and responsible for their
own care and others in their family needing care
• People are distinct individuals
• Nursing is a form of action – interaction between two or
more persons
• Successfully meeting universal and development self-
care requisites is an important component of primary
care prevention and ill health
• A person’s knowledge of potential health problems is
necessary for promoting self-care behaviors
• Self care and dependent care are behaviors learned
within a socio-cultural context
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Nursing – is art, a helping service, and a
technology
• Actions deliberately selected and performed by
nurses to help individuals or groups under their
care to maintain or change conditions in
themselves or their environments
• Encompasses the patient’s perspective of health
condition ,the physician’s perspective , and the
nursing perspective
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• Goal of nursing – to render the patient or
members of his family capable of meeting the
patient’s self care needs
• To maintain a state of health
• To regain normal or near normal state of health
in the event of disease or injury
• To stabilize ,control ,or minimize the effects of
chronic poor health or disability
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• Health – health and healthy are terms used to
describe living things …
• It is when they are structurally and functionally
whole or sound … wholeness or integrity.
.includes that which makes a person
human,…operating in conjunction with
physiological and psychophysiological
mechanisms and a material structure and in
relation to and interacting with other human
beings
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Environment
• environment components are environement factors,
environment elements, conditions, and developed
environment
Human being – has the capacity to reflect,
symbolize and use symbols
• Conceptualized as a total being with universal,
developmental needs and capable of continuous self
care
• A unity that can function biologically, symbolically
and socially
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Nursing client
• A human being who has "health related /health
derived limitations that render him incapable of
continuous self care or dependent care or
limitations that result in ineffective / incomplete
care.
• A human being is the focus of nursing only when
a self –care requisites exceeds self care
capabilities
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Nursing problem
• deficits in universal, developmental, and health
derived or health related conditions
Nursing process
• a system to determine (1)why a person is under
care (2)a plan for care ,(3)the implementation of
care
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• Orem’s general theory of nursing in three related
parts:-
• Theory of self care
• Theory of self care deficit
• Theory of nursing system
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• This theory Includes:
• Self care – practice of activities that individual initiates and
perform on their own behalf in maintaining life ,health and well
being
• Self care agency – is a human ability which is "the ability for
engaging in self care" -conditioned by age developmental state, life
experience sociocultural orientation health and available resources
• Therapeutic self care demand – "totality of self care actions to
be performed for some duration in order to meet self care requisites
by using valid methods and related sets of operations and actions"
• Self care requisites - action directed towards provision of self
care. 3 categories of self care requisites are-
▫ Universal self care requisites
▫ Developmental self care requisites
▫ Health deviation self care requisites
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• 1. Universal self care requisites Associated with
life processes and the maintenance of the integrity
of human structure and functioning
• Common to all , ADL
• Identifies these requisites as:
▫ Maintenance of sufficient intake of air ,water, food
▫ Provision of care assoc with elimination process
▫ Balance between activity and rest, between solitude
and social interaction
▫ Prevention of hazards to human life well being and
▫ Promotion of human functioning
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2.Developmental self care requisites
• Associated with developmental processes/
derived from a condition…. Or associated with
an event
▫ E.g. adjusting to a new job
▫ adjusting to body changes
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3.Health deviation self care
• Required in conditions of illness, injury, or disease
.these include:--
• Seeking and securing appropriate medical assistance
• Being aware of and attending to the effects and
results of pathologic conditions
• Effectively carrying out medically prescribed
measures
• Modifying self concepts in accepting oneself as being
in a particular state of health and in specific forms of
health care
• Learning to live with effects of pathologic conditions
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• Specifies when nursing is needed
• Nursing is required when an adult (or in the case of
a dependent, the parent) is incapable or limited in
the provision of continuous effective self care. Orem
identifies 5 methods of helping:
▫ Acting for and doing for others
▫ Guiding others
▫ Supporting another
▫ Providing an environment promoting personal
development in relation to meet future demands
▫ Teaching another
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 Describes how the patient’s self care needs will be met by
the nurse , the patient, or both
 Identifies 3 classifications of nursing system to meet the
self care requisites of the patient:-
 Wholly compensatory system
 Partly compensatory system
 Supportive – educative system
 Design and elements of nursing system define
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• Scope of nursing responsibility in health care
situations
• General and specific roles of nurses and patients
• Reasons for nurses’ relationship with patients and
• Orem recognized that specialized technologies are
usually developed by members of the health
profession
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INTRODUCTION
• Theorist - Betty Neuman - born in 1924, in Lowel, Ohio.
• BS in nursing in 1957; MS in Mental Health Public health
consultation, from UCLA in 1966; Ph.D. in clinical
psychology
• Theory was publlished in:
▫ “A Model for Teaching Total Person Approach to Patient
Problems” in Nursing Research - 1972.
▫ "Conceptual Models for Nursing Practice", first edition in
1974, and second edition in 1980.
• Betty Neuman’s system model provides a comprehensive
flexible holistic and system based perspective for
nursing.
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DEVELOPMENT OF THE MODEL
• Neuman’s model was influenced by:
• The philosophy writers deChardin and Cornu
(on wholeness in system).
• Von Bertalanfy, and Lazlo on general system
theory.
• Selye on stress theory.
• Lararus on stress and coping.
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MAJOR CONCEPTS (Neuman, 2002)
Content
• the variables of the person in interaction with
the internal and external environment comprise
the whole client system
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Basic structure/Central core
• The common client survival factors in unique
individual characteristics representing basic
system energy resources.
• The basis structure, or central core, is made up
of the basic survival factors which include:
normal temp. range, genetic structure.- response
pattern. organ strength or weakness, ego
structure.
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• Stability, occurs when the amount of energy that
is available exceeds that being used by the
system.
• A homeostatic body system is constantly in a
dynamic process of input, output, feedback, and
compensation, which leads to a state of balance
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Degree to reaction
• the amount of system instability resulting from
stressor invasion of the normal LOD( Line of
defence)
Entropy
• a process of energy depletion and
disorganization moving the system toward
illness or possible death.
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Flexible LOD
• a protective, accordion like mechanism that
surrounds and protects the normal LOD from
invasion by stressors.
Normal LOD
• It represents what the client has become over
time, or the usual state of wellness. It is
considered dynamic because it can expand or
contract over time.
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Line of Resistance-LOR
• The series of concentric circles that surrounds the
basic structure.
• Protection factors activated when stressors have
penetrated the normal LOD, causing a reaction
symptomatology. E.g. mobilization of WBC and
activation of immune system mechanism
Input- output
• The matter, energy, and information exchanged
between client and environment that is entering or
leaving the system at any point in time.
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Open system
• A system in which there is continuous flow of
input and process, output and feedback. It is a
system of organized complexity where all
elements are in interaction.
Prevention as intervention
• Interventions modes for nursing action and
determinants for entry of both client and nurse
in to health care system.
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Reconstitution
• The return and maintenance of system stability,
following treatment for stressor reaction, which
may result in a higher or lower level of wellness.
Stability
• A state of balance of harmony requiring energy
exchanges as the client adequately copes with
stressors to retain, attain, or maintain an
optimal level of health thus preserving system
integrity.
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Stressors
• environmental factors, intra (emotion, feeling),
inter (role expectation), and extra personal (job
or finance pressure) in nature, that have
potential for disrupting system stability.
• A stressor is any phenomenon that might
penetrate both the F and N LOD, resulting either
a positive or negative outcome.
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• Wellness is the condition in which all system
parts and subparts are in harmony with the
whole system of the client.
• Illness is a state of insufficiency with disrupting
needs unsatisfied (Neuman, 2002).
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• the primary nursing intervention.
• focuses on keeping stressors and the stress
response from having a detrimental effect on the
body.
• Primary Prevention
▫ occurs before the system reacts to a stressor.
▫ strengthens the person (primary the flexible LOD)
to enable him to better deal with stressors
▫ includes health promotion and maintenance of
wellness.
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• Secondary Prevention
▫ occurs after the system reacts to a stressor and is
provided in terms of existing system.
▫ focuses on preventing damage to the central core by
strengthening the internal lines of resistance and/or
removing the stressor.
• Tertiary Prevention
▫ occurs after the system has been treated through
secondary prevention strategies.
▫ offers support to the client and attempts to add energy
to the system or reduce energy needed in order to
facilitate reconstitution
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PERSON
• Human being is a total person as a client system and the
person is a layered multidimensional being.
• Each layer consists of five person variable or subsystems:
▫ Physiological - Refers of the physicochemical structure
and function of the body.
▫ Psychological - Refers to mental processes and emotions.
▫ Socio-cultural - Refers to relationships and
social/cultural expectations and activities.
▫ Spiritual - Refers to the influence of spiritual beliefs.
▫ Developmental - Refers to those processes related to
development over the lifespan.
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ENVIRONMENT
• "the totality of the internal and external forces
(intrapersonal, interpersonal and extra-personal
stressors) which surround a person and with which
they interact at any given time."
• The internal environment exists within the
client system.
• The external environment exists outside the
client system.
• The created environment is an environment that
is created and developed unconsciously by the client
and is symbolic of system wholeness.
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HEALTH
• Health is equated with wellness.
• “the condition in which all parts and subparts
(variables) are in harmony with the whole of the
client (Neuman, 1995)”.
• The client system moves toward illness and
death when more energy is needed than is
available. The client system moved toward
wellness when more energy is available than is
needed
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NURSING
• a unique profession that is concerned with all of the variables
which influence the response a person might have to a
stressor.
• person is seen as a whole, and it is the task of nursing to
address the whole person.
• Neuman defines nursing as “action which assist individuals,
families and groups to maintain a maximum level of wellness,
and the primary aim is stability of the patient/client system,
through nursing interventions to reduce stressors.’’
• The role of the nurse is seen in terms of degree of reaction to
stressors, and the use of primary, secondary and tertiary
interventions.
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• interrelated concepts
• logically consistent.
• logical sequence
• fairly simple and straightforward in approach.
• easily identifiable definitions
• provided guidelines for nursing education and
practice
• applicable in the practice
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• Mark Salmon White (1982) describes a public
health as an organized societal effort to protect,
promote and restore the health of people and
public health nursing as focused on achieving
and maintaining public health.
• He gave 3 practice priorities i.e.; prevention of
disease and poor health, protection against
disease and external agents and promotion of
health.
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• Nancy Milio a nurse and leader in public health
policy and public health education developed a
framework for prevention that includes concepts of
community-oriented, population focused
care.(1976,1981).
• The basic treatise is that behavioral patterns of
populations and individuals who make up
populations are a result of habitual selection from
limited choices.
• She challenged the common notion that a main
determinant for unhealthful behavioral choice is
lack of knowledge.
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 Governmental and institutional policies, she
said set the range of options for personal
choice making.
 It neglected the role of community health
nursing, examining the determinants of
community health and attempting to
influence those determinants through
public policy.
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• For these 3 general categories of nursing
intervention have also been put forward, they
are
• 1.education directed toward voluntary change in
the attitude and behaviour of the subjects
• 2.engineering directed at managing risk-related
variables
• 3.enforcement directed at mandatory regulation
to achieve better health.
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• Derryl Block and Lavohn Josten, public health
educators proposed this based on intersecting fields
of public health and nursing. They have given 3
essential elements of population focused nursing
that stem from these 2 fields:
• 1.an obligation to population
• 2.the primacy of prevention
• 3.centrality of relationship- based care
• the first two are from public health and the third
element from nursing. Hence it implies to nursing
that relation-based care is very important in
population focused care.
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Epidemiological approach
“ The epidemiological
investigation to health
problems involves the two
basic approaches”

a. Asking questions
b. Making comparisons

The key information can be approached
through a series of questions
Related to health events
What are the actual and potential health
problems its manifestations and
characteristics?

Which populations are increased at
risk?
When does it happen in terms of day,
month, season etc……….?

Which problems have declined?
Which problems are increasing or have
the risk to increase?

What can be done to reduce the problem
and its consequences?
How can it be prevented in the future?
What action should be taken by the
community to prevent and manage the
problem?

Where and for whom these activities
carried out?
What resources are required in future?
How are the activities to be organized?
What difficulties may arise, and how it
has to overcome?

This approach is to make comparisons and
draw inferences.
Comparison may be made
between different population at a given time
eg. Rural with urban population
between sub group of population
eg. Male with female population
between various periods of observation
eg. Different seasons

Measurement
• Case Counts
• Rates
• Ratios
• Proportions

The case count refers to the
number of cases of a disease or
other health phenomenon being
studied
eg Number of cases of Still births
It Can be useful for allocation of
health resources

The rate measures the occurrence of some
particular event ( development of disease or
the occurrence of death) in a population
during a given period of time.
Expressed as:
Example: Death rate:
x
10n
y
Mid - year population of sameyear
Number of deaths in oneyear
1000

A rate comprises the following
elements- Numerator,
denominator, time specification
and multiplier.
The time specification is usually a
calendar year
The rate is expressed per 1000 or
some other round figure like
100,000.

1. Crude rate: These are actual observation
rates. Eg: Birth rate, Death rate
Crude rates are un standardized rates
2. Specific rate: These are the actual
observed rates due to specific causes
(tuberculosis) occurring in specific groups
(age-sex) during specific time period
(annual, monthly, weekly)

3. Standardized rates: These are obtained
by direct or indirect method of
standardization
Eg: age and sex standardized rates

The ratio is the most fundamental
measurement in epidemiology using
two variables X and Y
Obtained by dividing one quantity by
another with out implying any specific
relationship between numerator and
denominator
Expressed as:
x
o r
y
x ; y

The number of children with
scabies at a certain time
The number of children with
malnutrition at a certain time
Other examples: Sex-ratio,
Doctor-population ratio,
Child-woman ratio

The proportion is a ratio where the
numerator is included in the
denominator
Usually proportions are expressed as a
percentage
Proportion is the part of the whole
Expressed as
Total number of children in same time
The Number of Scabies at atime
100

Numerator: It refers to the number of times
an event has occurred in a population
during specified time period.
It is a component of denominator
Denominator: It may be related to the
population or related to the total event
Related to population: Mid year population
Related to total events: Number of accidents
for 1000 vehicles

• Screening
• Notification
•Evaluation of Health
Services
• Management
• Prevention and control

Evidence: It is something that furnishes
proof or testimony or something legally
submitted to ascertain in the truth of matter.
Evidence based practice: It is systemic
inter connecting of scientifically generated
evidence with the tacit knowledge of the
expert practitioner to achieve a change in a
particular practice for the benefit of a well-
defined client / patient group. (French 1999).

• Evidence based nursing- it is a process by
which nurses make clinical decisions using the
best available research evidence, their clinical
expertise and patient preferences (mulhall,
1998).
• Evidence based medicine or practice- The
conscientious, explicit and judicious use of
current best evidence in making decision
about the care of individual patient. (Dr. David
Sackett, Rosenberg, 1996)

providing• EBP in nursing is
nursing
a way of
care that is guided by the
integration of the best available scientific
expertise. Thisknowledge with nursing
approach requires nurses to critically
assess relevant scientific data or research
evidence and to implement high quality
interventions for their nursing practice.
(NLM PubMed)

• For making sure that each client get the
best possible services.
• Update knowledge and is essential for
lifelong learning.
• Provide clinical judgement.
• Improvement care provided and save lives.

• Provide practicing nurse the evidence based
data to deliver effective care.
• Resolve problem in clinical setting.
• Achieve excellence in care delivery.
• Reduces the variations in nursing care and
assist with efficient and effective decision
making.

• Research evidence has assumed priority over other
sources of evidence in the delivery of evidence based
health care.
• It includes
• Filtered resources- Clinical experts and subject
specialist pose a question and then synthesise evidence
to state conclusion based on available research. These
sources are helpful because the literature has been
searched and results evaluated to provide an answer to
clinical question.
• Unfiltered resources (Primary literature)- It provides
most recent information. E.g MEDLINE, CINHAL etc
provides primary and secondary literature for medicine.

• Clinical experiences- Knowledge through professional
practice and life experiences makes up the second part in
the evidenced based , person-centered care.
• Knowledge from patients- Evidence delivered from pt’s
knowledge of themselves, their bodies and social lives.
• Knowledge from local context-
Audit and performance data
Patient stories and narratives
Knowledge about the culture of the organization &
individuals within it.
Social & professional networks.
Information from feedback
Local & national policy.

• John Hopkins nursing EBP Model- Used as a
framework to guide the synthesis and translation
of evidence into practice. (Newhouse, Dearholt,
Poe, Pugh, & White, 2007).
• There are three phases to the JHNEBP model
1. The identification of an answerable question.
2. A systematic review and synthesis of both
research and non-research evidence.
3. Translation includes implementation of the
practice change as a pilot study, measurement
of outcomes, and dissemination of findings.

• The Iowa model focuses on organization and
collaboration incorporating conduct and use of
research, along with other types of evidence.
(Titler et al, 2001). It was originated in 1994.
The star point in the model can either be
• A knowledge focused trigger (that emerges from
awareness of innovative research findings
• A problem- focused trigger (that has its root in a
clinical or organizational problem)

 This model examines how to use evidence
to create formal change within
organizations, as well how individual
practitioners can use research on an
informal basis as part of critical thinking and
reflective practice.
The Stetler model of
evidence-based practice based on the
following

2.Other types of evidence and/or non-research-
related information are likely to be combined with
research findings to facilitate decision making or
problem solving.
3.Internal or external factors can influence an
individual's or group's review and use of evidence.
4.Research and evaluation provide probabilistic
information, not absolutes.
5.Lack of knowledge and skills pertaining to research
use and evidence-informed practice can inhibit
appropriate and effective use.

• facilitate critical thinking about the practical
application of research findings
• result in the use of evidence in the context
of daily practice
• Mitigate some of the human errors made in
decision making.

• Lack of value for research in practice
• Difficulty in bringing change
• Lack of administrative support
• Lack of knowledge mentors
• Lack of time for research
• Lack of knowledge about research
• Research reports not easily available
• Complexity of research reports
• Lack of knowledge about EBP

• Provide better information to practitioner
• Enable consistency of care
• Better patient outcome
• Provide client focused care
• Structured process
• Increases confidence in decision-making
• Generalize information
• Contribute to science of nursing
• Provide guidelines for further research
• Helps nurses to provide high quality patient care

• Not enough evidence for EBP
• Time consuming
• Reduced client choice
• Reduced professional judgement/
autonomy
• Supress creativity
• Influence legal proceedings
• Publication bias

Translating research into practice: case study of a community-
based dementia caregiver intervention. (Mittelman MS, Bartels
SJ.)
Evidence from randomized clinical trials has demonstrated the
effectiveness of providing psychosocial interventions for caregivers
to lessen their burden. This case study describes outcomes of the
implementation of an evidence-based intervention in a multisite
program in Minnesota. Consistent with the original randomized
clinical trial of the intervention, assessments of this program showed
decreased depression and distress among caregivers. Some of the
challenges in the community setting included having caregivers
complete the full six counseling sessions and acquiring complete
outcome data. Given the challenges faced in the community setting,
web-based training for providers may be a cost-effective way to
realize the maximum benefits of the intervention for vulnerable
adults with dementia and their families.

Evidence-based nursing care is a lifelong approach to
clinical decision making and excellence in practice.
Evidence-based nursing care is informed by research
findings, clinical expertise, and patients' values, and its
use can improve patients' outcomes. Use of research
evidence in clinical practice is an expected standard
of practice for nurses and health care organizations,
but numerous barriers exist that create a gap between
new knowledge and implementation of that knowledge
to improve patient care. Using the levels of evidence,
nurses can determine the strength of research
studies, assess the findings, and evaluate the
evidence for potential implementation into best
practice.

Empowering people
to care for themselves

Community empowerment refers to the
process of enabling communities to
increase control over their lives.
"Communities" are groups of people that
may or may not be spatially connected, but
who share common interests, concerns or
identities.

 'Empowerment' refers to the process by which
people gain control over the factors and decisions
that shape their lives.
 It is the process by which they increase their
assets and attributes and build capacities to gain
access, partners, networks and/or a voice, in order
to gain control.
 "Enabling" implies that people cannot "be
empowered" by others; they can only empower
themselves by acquiring more of power's different
forms (Laverack, 2008).
 It assumes that people are their own assets, and
the role of the external agent is to catalyse,
facilitate or "accompany" the community in
acquiring power.

 Community empowerment, therefore, is more than the
involvement, participation or engagement of
communities.
 Community empowerment necessarily addresses the
social, cultural, political and economic determinants
that underpin health, and seeks to build partnerships
with other sectors in finding solutions.
 Community empowerment is a process of re-
negotiating power in order to gain more control. It
recognizes that if some people are going to be
empowered, then others will be sharing their existing
power and giving some of it up.

Community health nursing approaches

Community health nursing approaches

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