Community-Based and Community-Focused Nursing, Social Determinants of Health, and Upstream Care

What does the Triangle of Care illustrate?

Continuity of care across different environments: home, community-based sites, and hospital.

What percentage of nurses work in hospitals?

55\% of nurses work in the hospital.

What is the typical career trajectory for new nursing graduates within five years?

Roughly 85-90\% start in hospitals; within five years, about half stay in hospital and half move to community-based or home/primary care settings.

What is the foundation idea behind Social Determinants of Health (SDOH)?

Health outcomes are shaped by context, and people integral to their family and society cannot be separated from their context.

Approximately what percentage of health outcomes are affected by social determinants and context?

Around 70\% of health outcomes are affected by social determinants and context.

List the five domains of SDOH as defined by the U.S. Department of Health and Human Services.

Economic stability, Education and health literacy, Health care access and quality, Housing, Food access and transportation, and Social and community context.

What is the concept of 'upstream work'?

Moving upstream to prevent illness before it begins, rather than only rescuing people after illness occurs (e.g., river rescue analogy).

What are the Healthy People initiatives?

National plans (e.g., Healthy People 2030) that serve as upstream frameworks in the U.S., setting high-priority objectives to improve population health.

What is Value-Based Care (VBC)?

A shift from fee-for-service to value-based, preventive, and population-focused care where providers are rewarded for keeping people healthy and out of the hospital, rather than for hospital admissions or procedures alone.

What is the purpose of SDOH screening in hospitals and clinics?

To identify barriers to care such as food insecurity, income instability, housing, transportation, safety, and social support.

Define health promotion.

Efforts to maintain or improve an already healthy state; upstream to enhance wellness and prevent disease before problems arise.

Define primary health protection (prevention).

Measures that shield the body from specific injuries or diseases (e.g., immunizations, seat belts, helmet laws).

Define secondary health protection.

Early diagnosis and prompt treatment (e.g., screenings, early detection, acute care, emergency care).

Define tertiary health protection.

Long-term rehabilitation and minimizing the effects of disease or disability (e.g., cardiac rehab after a heart event).

Provide an example of secondary health protection.

A school nurse screening students for scoliosis.

Provide an example of primary health protection.

An occupational health nurse teaching safe lifting techniques to prevent back injuries.

Provide an example of health promotion.

A public health nurse promoting a healthy diet and helping establish a community garden.