thinking upstream ch 3

what is thinking upstream

Examining the Root Causes of Poor Health

Historical Perspectives on Nursing Theory

-Florence Nightingale: first nurse to formulate conceptual foundation for nursing practice

-Early nursing theories:Were narrow → didnt consider different fx that affect health of pt, Depicted health situations only for the nurse and patient, Ignored care in context

How Theory Provides Direction to Nursing

- Goals of theory: Improve nursing practice, Guide practice 

- Integrating theory and practice, students focus on factors that are critical to understanding the situation.

Microscopic focus:

oIndividual patient

oConcern is in health problem of interest: approach centers on the individual (e.g., pediatric exposure to lead compounds), Focus is individual children with lead poisoning

macroscopic focus

oCommunity-based approach

- activities for lead exposure include:

•Examine trends of lead poisoning over time

•Estimate percentage of older homes with lead base paint or lead pipes in community

•Locate industrial sources of lead emissions

tension with nurses in community health

o tension between between working on behalf of individuals and working on behalf of population.

oMost often end up caring for the individual or emergency of the day

oLose sight of community—more reactive and not proactive

oNeed to focus on population-based nursing practice

Macroscopic Approach to Solving Community Health Problems

- Examines interfamily and intercommunity themes in health and illness

- Delineates factors in the population that perpetuate the development of illness or foster the development of health

- Emphasizes social, economic, and environmental precursors of illness

- Nursing interventions may include modifying social or environmental variables.

- May involve social or political action

ethical insights

- Nurses have a historical legacy in social justice activities.

-Market Justice: principles people are entitled to end when they acquire them through fair rules of entitlement

- Social justice: principles that all citizens bear equitably in the benefits of and burdens of society →resources equally distributed to everyone in the community

Healthy People 2020 social determinants of health

is designed to identify ways to create social and physical environments that promote good health.

All Americans deserve an equal opportunity to make choices that lead to good health; therefore they must have opportunities to advance in fields such as: (HP 2020)

Education

Child care

Housing

Business

Law

Media

Community planning

Transportation

Agriculture

We must work together to: (HP 2020)

1.Explore how programs, practices, and policies in these areas affect the health of individuals, families, and communities

2.Establish common goals, complementary roles, and ongoing constructive relationships between health sector and other areas

3. Collaborate with federal, state, and local-level partners related to social determinants of health