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1.  Identify and discuss disaster types.

2.  Explain the disaster planning process and nursing participation.

3.  Work on the following case studies;

A.  Case Study # 1

As a county health department nurse, your supervisor has informed you that the local Emergency Management Team is issuing a warning of impending disaster as an F3 tornado is expected to hit your large, metropolitan city within the hour. 

a.  Which emergency measures would you expect to have already been in place?

b.  What are your potential activities during each phase of the emergency management response?

B.  Case Study # 2

A plane crashed while landing on the runway during a snowstorm. The plane was not able to stop in time and slipped off the end of the runway onto a busy interstate highway. Public health nurses were expected to respond to this disaster as well as many first responders. (Learning Objectives: 1, 2, 5)

a.  What are the responsibilities of public health nurses in disaster management?

b.  Public health nurses have been requested to use the START model to assess the cars involved in the plane crash on the highway. What is the START MODEL, and how are numbers assigned to the individuals?

c.  The houses in a two-mile radius around the airport have been requested to evacuate the area because airplane fuel is leaking into the river located directly next to the airport. What guidelines should be considered for individuals requested to evacuate?

d.  When the public health nurses were color coding for prehospital triage, what do red and black color codes mean?

 APA format word document (in-text citations needed).

A minimum of 3 evidence-based references no older than 5 years must be used. 

  A minimum of 800 words not to exceed 1,000 are required without counting the first and last page.  

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Community and Public Health Nursing | 3rd edition EVIDENCE FOR PRACTICE

Rosanna F. DeMarco, PhD, RN, FAAN Chair and Professor Department of Nursing College of Nursing and Health Sciences University of Massachusetts Boston Boston, Massachusetts

Judith Healey-Walsh, PhD, RN Clinical Associate Professor Director of the Undergraduate Program Department of Nursing College of Nursing and Health Sciences University of Massachusetts Boston Boston, Massachusetts

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Vice President and Publisher: Julie K. Stegman Senior Acquisitions Editor: Christina Burns Director of Product Development: Jennifer K. Forestieri Supervisory Development Editor: Greg Nicholl and Staci Wolfson Editorial Coordinator: John Larkin Editorial Assistant: Kate Campbell Production Project Manager: Linda Van Pelt Design Coordinator: Terry Mallon Marketing Manager: Brittany Clements Manufacturing Coordinator: Karin Duffield Prepress Vendor: Aptara, Inc.

3rd Edition

Copyright © 2020 Wolters Kluwer.

Copyright © 2016 Wolters Kluwer. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at shop.lww.com (products and services).

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Printed in China.

Library of Congress Cataloging-in-Publication Data

Names: DeMarco, Rosanna F., author. | Healey-Walsh, Judith, author. | Preceded by (work): Harkness, Gail A. Community and public health nursing. Title: Community and public health nursing : evidence for practice / Rosanna F. DeMarco, Judith Healey-Walsh. Description: 3. | Philadelphia : Wolters Kluwer, [2020] | Preceded by Community and public health nursing / Gail A.

Harkness, Rosanna F. DeMarco. Second edition. [2016]. | Includes bibliographical references and index. Identifiers: LCCN 2018058862 | eISBN 9781975144500 Subjects: | MESH: Community Health Nursing | Public Health Nursing | Evidence-Based Nursing | Nursing Theory | United States Classification: LCC RT98 | NLM WY 108 | DDC 610.73/43—dc23 LC record available at https://lccn.loc.gov/2018058862

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author(s), editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice.

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Contributors

Stephanie M. Chalupka, EdD, RN, PHCNS-BC, FAAOHN, FNAP Associate Dean for Nursing Department of Nursing Worcester State University Worcester Visiting Scientist Environmental and Occupational Medicine and Epidemiology Program Department of Environmental Health Harvard T. H. Chan School of Public Health Boston, Massachusetts (Chapter 9, Planning for Community Change)

Susan K. Chase, EdD, RN, FNAP Professor College of Nursing University of Central Florida Orlando, Florida (Chapter 23, Faith-Oriented Communities and Health Ministries in Faith Communities)

Sabreen A. Darwish, RN, BScN, MScN Second Year PhD Student/Research Assistant College of Nursing and Health Sciences University of Massachusetts Boston, Massachusetts (Chapter 3, Health Policy, Politics, and Reform)

Karen Dawn, RN, DNP, PHCNS, CDE Assistant Professor School of Nursing George Washington University Ashburn, Virginia (Chapter 4, Global Health: A Community Perspective)

Pamela Pershing DiNapoli, PhD, RN, CNL Associate Professor of Nursing and Graduate Programs College of Health and Human Services University of New Hampshire Durham, New Hampshire (Chapter 22, School Health)

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Merrily Evdokimoff, PhD, RN Consultant Clinical Associate Lecturer Department of Nursing University of Massachusetts Boston, Massachusetts (Chapter 20, Community Preparedness: Disaster and Terrorism)

Barbara A. Goldrick, MPH, PhD, RN Epidemiology Consultant Chatham, Massachusetts (Chapter 8, Gathering Evidence for Public Health Practice; Chapter 14, Risk of Infectious and Communicable Diseases; Chapter 15, Emerging Infectious Diseases)

Patricia Goyette, DNP-PHNL, RN Educational Consultant Everett, Massachusetts (Chapter 25, Occupational Health Nursing)

Cheryl L. Hersperger, MS, RN, PHNA-BC, PhD Student Assistant Professor Department of Nursing Worcester State University Worcester, Massachusetts (Chapter 9, Planning for Community Change)

Anahid Kulwicki, PhD, RN, FAAN Dean and Professor School of Nursing Lebanese American University Beirut, Lebanon (Chapter 3, Health Policy, Politics, and Reform)

Carol Susan Lang, DScN, MScN(Ed.), RN Associate Director of Global Initiatives Assistant Professor of Global and Population Health George Washington University School of Nursing Washington, DC

Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN Senior Nurse Scientist and Founder and Director of C.A.R.E Clinic Brigham and Women’s Hospital Boston, Massachusetts (Chapter 16, Violence and Abuse)

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Patricia Lussier-Duynstee, PhD, RN Assistant Dean Assistant Professor School of Nursing MGH Institute of Health Professions Boston, Massachusetts (Chapter 6, Epidemiology: The Science of Prevention; Chapter 7, Describing Health Conditions: Understanding and Using Rates)

Kiara Manosalvas, MA Reseach Assistant II The Following & Mental Health Counselor Teachers College Columbia University Chestnut Hill, Massachusetts (Chapter 16, Violence and Abuse)

Patrice Nicholas, DNSc, DHL (Hon.), MPH, MS, RN, NP-C, FAAN Professor School of Nursing MGH Institute of Health Professions Director, Global Health and Academic Partnerships Brigham and Women’s Hospital Boston, Massachusetts (Chapter 6, Epidemiology: The Science of Prevention; Chapter 7, Describing Health Conditions: Understanding and Using Rates)

Christine Pontus, RN, MS, BSN, COHN-S/CCM Associate Director in Nursing and Occupational Health Massachusetts Nurses Association (MNA) Canton, Massachusetts (Chapter 25, Occupational Health Nursing)

Joyce Pulcini, PhD, RN, PNP-BC, FAAN, FAANP Professor Director of Community and Global Initiatives Chair, Acute and Chronic Care Community School of Nursing George Washington University Washington, DC (Chapter 4, Global Health: A Community Perspective)

Teresa Eliot Roberts, PhD, RN, ANP Clinical Assistant Professor College of Nursing and Health Sciences University of Massachusetts Boston Boston, Massachusetts

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(Chapter 10, Cultural Competence: Awareness, Sensitivity, and Respect)

Judith Shindul-Rothschild, PhD, MSN, RN Associate Professor Connell School of Nursing Boston College Chestnut Hill, Massachusetts (Chapter 17, Substance Use; Chapter 21, Community Mental Health)

Joy Spellman, MSN, RN Director, Center for Public Health Preparedness Mt. Laurel, New Jersey (Chapter 20, Community Preparedness: Disaster and Terrorism)

Tarah S. Somers, RN, MSN/MPH Senior Regional Director Agency for Toxic Substances and Disease Registry, New England Office US Public Health Service Commissioned Corps Boston, Massachusetts (Chapter 19, Environmental Health)

Patricia Tabloski, PhD, GNP-BC, FGSA, FAAN Associate Professor Connell School of Nursing Boston College Chestnut Hill, Massachusetts (Chapter 24, Palliative and End-of-Life Care)

Aitana Zermeno, BS Research Assistant Connors Center for Women’s Health and Gender Biology Division of Women’s Health Brigham and Women’s Hospital Boston, Massachusetts (Chapter 16, Violence and Abuse)

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Reviewers

Elizabeth Armstrong, DNP, MSN, RN, CNE Assistant Professor School of Nursing University of Bridgeport Bridgeport, Connecticut

Karen Cooper, MS, RN Clinical Assistant Professor Department of Nursing Towson University Towson, Maryland

Teresa E. Darnall, PhD, MSN, RN, CNE Assistant Dean Assistant Professor May School of Nursing and Health Sciences Lees-McRae College Banner Elk, North Carolina

Florence Viveen Dood, DNP, MSN, BSN, RN RN-BSN Program Coordinator Assistant Professor School of Nursing Ferris State University Big Rapids, Michigan

Aimee McDonald, PhD, RN Assistant Professor Department of Nursing William Jewell College Liberty, Missouri

Rita M. Million, PhD, RN, PHNA-BC, COI Nursing Faculty School of Nursing College of Saint Mary Omaha, Nebraska

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Deanna R. Pope, DNP, RN, CNE Professor School of Nursing Marshall University Huntington, West Virginia

Kendra Schmitz, RN, MSN Assistant Professor School of Nursing D’Youville College Buffalo, New York

Kathleen F. Tate, MSN, MBA, CNE, RN Assistant Professor School of Nursing Northwestern State University Natchitoches, Louisiana

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Preface

“If you want to go quickly, go alone. If you want to go far, go together.” African Proverb

“The idea that some lives matter less is the root of all that is wrong in the world.” Paul Farmer

“No matter what people tell you, words and ideas can change the world.” Robin Williams

e are experiencing extraordinary changes in healthcare in this new century; changes that call upon the most creative, analytical, and innovative skills available. While the world has the resources to reduce healthcare disparities and eliminate the differences

in healthcare and health outcomes that exist between various population groups across the globe, accomplishing this is a long-term and complicated task. Improvement in the social structure within which people live, and a redistribution of resources so that all people have access to the basic necessities of life, require an unprecedented global consciousness and political commitment.

Ultimately, reducing health disparities and promoting health equity occur within the local community where people reside. Nurses are by far the largest group of healthcare providers worldwide and, as such, have the ability and responsibility to be change agents and leaders in implementing change in their communities. They can be the primary participants in the development of health policy that specifically addresses the unique needs of their communities. Through implementation and evaluation of culturally appropriate, community-based programs, nurses can use their expertise to remedy the conditions that contribute to health disparities. People need to be assured that their healthcare needs will be assessed and that healthcare is available and accessible.

In the United States, public health has resurged as a national priority. Through Healthy People 2020, national goals have been set to promote a healthy population and address the issue of health disparities. The process of implementing the Healthy People 2020 objectives rests with regional and local practitioners, with nurses having a direct responsibility in the implementation process. The nurse practicing in the community has a central role in providing direct care for the ill as well as promoting and maintaining the health of groups of people, regardless of the circumstances that exist. Today, there are unparalleled challenges to the nurse’s problem-solving skills in carrying out this mission.

Whether caring for the individual or the members of a community, it is essential that nurses incorporate evidence from multiple sources in the analysis and solution of public health issues. Community and Public Health Nursing: Evidence for Practice focuses on evidence-based practice, presenting multiple formats designed to develop the abstract critical thinking skills and complex reasoning abilities necessary for nurses becoming generalists in community and public health nursing. The unique blend of both the nursing process and the epidemiologic process provides a framework for gathering evidence about health problems, analyzing the information, generating diagnoses or hypotheses, planning for resolution, implementing plans of action, and evaluating the results.

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“To every complex question there is a simple answer…and it is wrong.” H. L. Mencken (writer and wit, 1880–1956)

CONTENT ORGANIZATION It is the intention of Community and Public Health Nursing: Evidence for Practice to present the core content of community and public health nursing in a succinct, logically organized, but comprehensive manner. The evidence for practice focus not only includes chapters on epidemiology, biostatistics, and research but also integrates these topics throughout the text. Concrete examples assist students in interpreting and applying statistical data. Healthy People goals and measurable objectives serve as an illustration of the use of rates throughout the text. Additionally, we have added brief learning activities and questions throughout the text to allow students to apply the Healthy People goals to real-life scenarios. Groups with special needs, such as refugees and the homeless, have been addressed in several chapters; however, tangential topics that can be found in adult health and maternal-child health textbooks have been omitted. A chapter on environmental health concerns has been included, along with a chapter on community preparedness for emergencies and disasters. Also, a global perspective has been incorporated into many chapters.

Challenges to critical thinking are presented in multiple places throughout each chapter. Case studies are integrated into the content of each chapter and contain critical thinking questions imbedded in the case study content. Also, a series of critical thinking questions can be found at the end of each chapter. (Please see the description of features below.) Considering the onus presented by Mark Twain: “Be careful about reading health books. You may die of a misprint,” every attempt has been made to present correct, meaningful, and current evidence for practice.

Part One presents the context within which the community or public health nurse practices. An overview of the major drivers of healthcare change leads to a discussion of evolving trends, such as the emphasis on patient/client-centered care, the effects of new technology upon the delivery of care, and the need for people to assume more responsibility for maintaining their health. Community and public health nursing as it presently exists is analyzed and reviewed from a historical base, and issues foreseen for both the present and immediate future are discussed. The nursing competencies necessary for competent community and public health practice are also presented.

A more in-depth discussion of the complex structure, function, and outcomes of public health and healthcare systems follows. National and international perspectives regarding philosophical and political attitudes, social structures, economics, resources, financing mechanisms, and historical contexts are presented, highlighting healthcare organizations and issues in several developed countries. The World Health Organization’s commitment to improving the public’s health in developing countries follows, with an emphasis on refugees and disaster relief. With the burden of disease growing disproportionately in the world, largely due to climate, public policy, socioeconomic conditions, age, and an imbalance in distribution of risk factors, the countries burdened by disease often have the least capacity to institute change. Part One concludes with examination of the indicators of health, health and human rights, factors that affect health globally, and a framework for improving world health.

Part Two provides the frameworks and tools necessary to engage in evidence-based practice focused on the population’s health. Concepts of health literacy, health promotion, disease prevention, and risk reduction are explored, and a variety of conceptual frameworks are presented with a focus on both the epidemiologic and ecologic models. Epidemiology is presented as the science of prevention, and nurses are shown how epidemiologic principles are

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applied in practice, including the use of rates and other statistics as community health indicators. Specific research designs are also explored, including the application of epidemiologic research to practice settings.

Part Three is designed to develop the skills necessary to implement nursing practice effectively in community settings. Since healthcare is in a unique state of transformation, planning for community change is paramount. The health planning process is described, with specific attention given to the social and environmental determinants of change. Lewin’s change theory, force-field analysis, and the effective use of leverage points identified in the force-field analysis demonstrate the change process in action.

Changes directed at decreasing health disparities must be culturally sensitive, client- centered, and community-oriented. A chapter on cultural diversity and values fosters the development of culturally competent practitioners, and the process of cultural health assessment is highlighted. Frameworks of community assessment are presented and various approaches are explored. Management of care and the case management process follows. The role and scope of home care nursing practice and the provision of services is presented along with the challenges inherent with interdisciplinary roles, advances in telehealth, and other home care services.

Although content on family assessment can be found in other texts, it is an integral component of community and public health practice. Therefore, theoretical perspectives of family, and contemporary family configurations and life cycles are explored. Family Systems Nursing and the Calgary Family Assessment and Intervention Model are provided as guides to implementing family nursing practice in the community. Evidence-based maternal-child health home visiting programs and prominent issues related to family caregiving are also highlighted.

Part Four presents the common challenges in community and public health nursing. The chapter addressing the risk of infectious and communicable diseases explores outbreak investigation with analysis of data experience provided by the case studies. Public health surveillance, the risk of common foodborne and waterborne illnesses, and sexually transmitted diseases are followed by a discussion of factors that influence the emergence/reemergence of infectious diseases, examples of recent outbreaks, and means of prevention and control.

The challenge presented by violence in the community is presented with an emphasis on intimate partner violence and the role of the healthcare provider. Because of the cultural variations in substance use disorder, multifaceted approaches to the problem are discussed with the recommendation that evidence-based prevention and treatment protocols for substance use disorder are incorporated by community health nurses in all practice settings. Meeting the healthcare needs of vulnerable and underserved populations is another challenge. Health priorities for people who live in rural areas; are gay, lesbian, bisexual, or transgender; are homeless; or live in correctional institutions are reviewed.

The issues of access to quality care, chronic disease management, interaction with health personnel, and health promotion in hard-to-reach populations among these populations are also presented.

The environmental chapter demonstrates how to assess contaminants in the community by creation of an exposure pathway. The health effects of the exposure pathway can then be ascertained. Individual assessment of contaminant exposures, interventions, and evaluations are also explored, ending with a focus on maintaining healthy communities. The final chapter in Part Four presents the issue of community preparedness. The types of disasters along with classification of agents are described, disaster management outlined, and the public health response explained. The role and responsibility of nurses in disasters and characteristics of the field response complete the content.

Part Five describes five common specialty practices within community and public health nursing. All have frameworks that define practice and reflect the competencies necessary for competent practice in a variety of community settings. These include application of the

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principles of practice to community mental health, school health, faith-oriented communities, palliative care, and occupational health nursing.

Features Found in Each Chapter

CHAPTER HIGHLIGHTS Brief outline of the content and direction of the chapter

OBJECTIVES Observable changes expected following completion of the chapter

KEY TERMS Essential concepts and terminology required for comprehension of chapter content

CASE STUDIES

Vignettes presented throughout the content of each chapter, designed to stimulate critical thinking and analytic skills

Evidence for Practice

Examples of objective evidence obtained from research studies that provide direction for practice

Practice Point

Highlighting of essential facts relevant to practice

Student Reflection

Student stories of their own experience and reflections

KEY CONCEPTS Summary of important concepts presented in the chapter

CRITICAL THINKING QUESTIONS

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Problems requiring critical analysis that combines research, context, and judgment

COMMUNITY RESOURCES List of resources that support the content of selected chapters

I didn’t fail the test, I just found 100 ways to do it wrong. Benjamin Franklin

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Acknowledgments

It is difficult to embark on the development of a new textbook without the support of colleagues, family, and friends. A special thanks belongs to our contributors, both returning and new, who were willing to share their expertise by writing chapters filled with the passion and commitment to community and public health. In addition, we are thankful for the invaluable experiences we obtained from our community and public health work that interfaced and informed the production of this book. Those experiences ranged from developing interventions with and for women living with HIV/AIDS in Boston, to implementing community-based programs that addressed the health needs of diverse populations, to teaching students about the social determinants of health, and to assuming leadership roles on local boards that are responsible for the health of our local communities. Our editorial coordinator, John Larkin, was very helpful in answering questions, calming frustrations, and solving problems. Greg Nicholl, our development editor, provided the consistency found throughout the chapters. Thank you all for helping us create this unique approach to community and public health nursing!

Rosanna F. DeMarco Judith Healey-Walsh

A Special Thanks in Memoriam to Dr. Gail A. Harkness, DPH, FAAN The first and second editions of this textbook were led by the efforts of Dr. Gail Harkness. Gail was a mentor and friend. While she is no longer with us to help support, guide, and enliven this newest edition, we wanted to take time to honor her memory and produce this edition in her honor.

Gail was such an intelligent, warm, and wise public health expert who was most passionate about population health and epidemiology, and particularly infectious diseases past, present, and evolving. She was a prolific writer and teacher. When I met her, she reached out to me, asking if I could help her with her vision of a community health and public health textbook for nursing

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students that was affordable and succinct and did not just “rattle on” with facts but situated public health ideas in the context of evidence, student stories, and current disease prevention and health promotion innovations. She brought to my mentorship opportunity her global experiences from the UK (University of Leeds) to Japan (Osaka), as well as her own local work on a town Board of Health in Massachusetts. Gail loved public health research and the evidence it yielded to inform policy decisions toward all our health. She was a graduate of the University of Rochester (undergraduate and graduate programs) in Nursing and received her Doctorate in Public Health from the University of Illinois, School of Public Health in Epidemiology and Biometry (the application of statistical analysis to biologic data).

More than being an epidemiologist, she loved the opportunity as an academician to teach nursing students at all levels to be as passionate about public health as she was. She was a professor emerita from University of Connecticut. We know her family and friends miss Gail very much, but her energy and spirit will always be in this textbook.

Rosanna F. DeMarco

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Contents

PART ONE The Context of Community and Public Health Nursing

Chapter 1 Public Health Nursing: Present, Past, and Future Healthcare Changes in the 21st Century Public Health Nursing Today Roots of Public Health Nursing Challenges for Public Health Nursing in the 21st Century

Chapter 2 Public Health Systems Importance of Understanding How Public Health Systems are Organized Structure of Public Healthcare in the United States Functions of Public Health in the United States Trends in Public Health in the United States Healthcare Systems in Selected Developed Nations Public Health Commitments to the World: International Public Health and Developing Countries

Chapter 3 Health Policy, Politics, and Reform Healthcare Policy and the Political Process Healthcare Finances and Cost–Benefit Access to Care and Health Insurance Healthcare Workforce Diversity Nursing’s Role in Shaping Healthcare Policy Advocacy Activities of Professional Nursing Organizations Current Situation of Nursing Political Involvement: Challenges and Barriers Quality of Care Information Management Equity in Healthcare Access and Quality Community-Based Services Associated With Healthcare Reform Ethical Consideration Health Advocacy and Healthcare Reform Overview of the ACA Prior to the End of Obama Presidency Health Services Research Conclusion

Chapter 4 Global Health: A Community Perspective Definitions of Health Global Health Concepts Women, Poverty, and Health Sustainable Development Goals Other Factors That Affect Global Health Role of Nurses

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PART TWO Evidence-Based Practice and Population Health

Chapter 5 Frameworks for Health Promotion, Disease Prevention, and Risk Reduction Introduction Health Promotion, Disease Prevention, and Risk Reduction as Core Activities of Public Health Healthy People Initiatives Road Maps to Health Promotion Behavior Models Use of the Ecologic Model: Evidence for Health Promotion Intervention Health Promotion and Secondary/Tertiary Prevention for Women Living With HIV/AIDS Health Literacy Health Literacy and Health Education Health Literacy and Health Promotion Role of Nurses

Chapter 6 Epidemiology: The Science of Prevention Defining Epidemiology Development of Epidemiology as a Science Epidemiologic Models Applying Epidemiologic Principles in Practice

Chapter 7 Describing Health Conditions: Understanding and Using Rates Understanding and Using Rates Specific Rates: Describing by Person, Place, and Time Types of Incidence Rates Sensitivity and Specificity Use of Rates in Descriptive Research Studies

Chapter 8 Gathering Evidence for Public Health Practice Observational Studies Intervention (Experimental) Studies

PART THREE Implementing Nursing Practice in Community Settings

Chapter 9 Planning for Community Change Health Planning Community Assessment Systems Theory Working With the Community Social Ecologic Model Health Impact Pyramid Multilevel Interventions Social Determinants of Health Change Theory Planning Community-Level Interventions Collaboration and Teamwork Evaluating Community-Level Interventions

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Funding Community-Level Intervention Programs Social Marketing Nurse-Managed Health Centers

Chapter 10 Cultural Competence: Awareness, Sensitivity, and Respect Culture and Nursing Western Biomedicine as “Cultured” Aspects of Culture Directly Affecting Health and …