Chapter 6: Aggregates in the Community

Chapter 6: Aggregates in the Community

Aggregates = Groups with a common characteristic.

Also called target populations.

Basis of Definition

• May be based on:

  • Special interests (e.g., support groups, cultural groups)

  • Geographic locations (e.g., neighborhoods, rural areas)

Key Nursing Role

• Community health nurses must identify aggregates when planning targeted health interventions.

Examples of Aggregates Served

• Individuals across the lifespan (infancy to death)

• Families

• Groups within the community

Management of Care

• Advocacy: Act as a client advocate.

• Case Management: Plan individualized care for client based on needs.

Health Promotion and Maintenance

• Health Promotion/Disease Prevention: Plan and/or participate in community health education.

• Health Screening: Perform health history, health, and risk assessments.

Children (Birth to 12 Years) and Adolescents

Influences on Health

• Income level of caregivers affects child health

  • Low-income = ↑ risk for food insecurity, homelessness, learning difficulties, cognitive delays

• Access to care supported by:

  • Affordable Care Act (ACA)

  • Medicaid

  • Children’s Health Insurance Plan (CHIP)
    (Helps reduce health disparities)

Health Concerns and Leading Causes of Death

Children

• Perinatal conditions & congenital anomalies

• Sudden Unexplained Infant Death (SUID)

• Motor vehicle & other unintentional injuries

• Infant mortality linked to maternal health, socioeconomic status, and access to care

Adolescents

• Motor vehicle & other unintentional injuries

• Homicide

• Suicide

Screening and Preventive Services for Children

Height & weight

Vision & hearing

Dental health

At birth: hemoglobinopathy, phenylalanine level, T4, TSH

Immunization status (per CDC schedules)

Lead exposure

Cholesterol & triglyceride levels

Nutrition assessment

Physical activity assessment

Screening and Preventive Services for Adolescents

Height & weight

Vision & hearing

Dental health

Rubella serology & immunization history

Substance use disorders (including tobacco)

Immunization status

Mental health screenings

Cholesterol & triglyceride levels

Nutrition assessment

Physical activity assessment

National Health Goals (QEBP) for Children

Reductions in:

• Dental caries

• Obesity

• Infant mortality

• Exposure to secondhand smoke

Increases in:

• Newborn blood spot screenings & follow-up testing

• Access to a medical home (SDOH)

• Schools that require health education

• Childhood immunizations

• Use of child safety restraints

• Physical activity

• Number of infants who are breastfed

National Health Goals (QEBP) for Adolescents

Reductions in:

• Violent crimes

• Use of alcohol, marijuana, and illicit drugs

• Deaths related to motor vehicle crashes

• Mental health concerns

Increases in:

• Schools with a breakfast program

• Participation in extracurricular activities

• Wellness checkups

• Physical activity

Community Education for Children

Anticipatory guidance

Breastfeeding

Sleeping positions

Nutrition

Physical activity

Substance use disorders

Dental hygiene & health

Skin protection

Injury prevention (car, fire, water safety, helmet use, poison control, CPR training)

Community Education for Adolescents

Anticipatory guidance

Substance use disorders

Sexual behavior

Nutrition (especially calcium intake for female clients)

Physical activity

Skin protection

Injury prevention (car, fire, firearm safety)

Factors Influencing Health of Adults

Genetic makeup (sex-linked risks for disease)

Environment (influences risk factors)

Societal & cultural expectations (gender influences disease risk and care)

Social determinants of health: major concerns are chronic conditions > infectious diseases

Screening recommendations are general but must consider individual client factors

Note: Despite high U.S. health expenditures, life expectancy is lower than in many other developed countries.

Health Concerns and Leading Causes of Death

Heart disease

Diabetes mellitus

Mental health disorders

Sexually transmitted infections (STIs)

Colorectal cancer (and other cancers as public health concerns)

Stroke

Obesity

Health Concerns and Leading Causes of Death of Females

Reproductive health

• Childbearing

• Menopause

• Preconception counseling

Malignant neoplasms (breast, cervix, ovaries)

Osteoporosis

Health Concerns and Leading Causes of Death of Males

Unintentional injuries

Erectile dysfunction

Malignant neoplasms (prostate, testes)

Screening and Preventive Services for Adults

Height & weight

Dental health

Blood pressure

Cholesterol (ages 45–65)

Fecal occult blood test / sigmoidoscopy (≥45 years)

Immunization status

Diabetes mellitus

HIV/STI

Skin cancer

Nutritional screening (obesity)

Depression screening

Screening and Preventive Services for Females

Pap test

Mammogram & clinical breast exam

Rubella serology & vaccination history (childbearing years)

Screening and Preventive Services for Males

Digital rectal exam

Prostate-specific antigen (PSA) testing

National Health Goals for Adults

Reductions in:

• Bone diseases (e.g., osteoporosis)

• Death from cancer

• Sexual violence

• Incidence of HIV/AIDS

• Fatal & nonfatal injuries

• Unplanned pregnancies

• Excessive alcohol & tobacco use

Increases in:

• Use of both barrier & hormonal contraception

• Pregnant clients receiving early & adequate prenatal care

• Ability to identify warning signs of heart attack & stroke

• Abstinence from alcohol, nicotine, & other substances during pregnancy

Community Education for Adults

Nutrition

STI prevention

Substance use disorders

HIV prevention

Injury prevention (car, fire safety, violence)

Breast & testicular self-examination

Older Adults

Fastest growing aggregate in U.S. population

Proportion of older adults living alone continues to rise → nurses must ensure access to healthcare & assistance (SDOH)

~1/3 of U.S. prescriptions are for older adults

Most have ≥1 chronic condition; many have multiple, with ↑ vulnerability due to aging changes & ↓ recovery ability

Administration on Aging (Older Americans Act): promotes services via states & local nonprofit agencies

Healthy People: has topic areas specific to older adult health

National Health Goals for Older Adults

Reductions in:

• % with moderate to severe functional limitations

• Hospitalizations due to heart failure

• Inappropriate medication use (esp. with disability)

• Hospitalizations due to pressure injuries

• Emergency visits due to falls

Increases in:

• Use of clinical preventive services

• Use of “Welcome to Medicare” benefit

• Public awareness of elder abuse, neglect, exploitation

• Physical activity among adults with reduced physical/cognitive function

• Access to diabetes self-management benefits

• Healthcare professionals with geriatric certifications

Community Education

Community resources & programs

Healthy meals, snacks, nutritional supplements

Exercise

Dental health

Injury prevention

Car & fire safety

Fall prevention

Abuse & mistreatment awareness

Medication safety

A public health nurse is planning an in-service on older adult health. Which of the following information should the nurse include?

a

The percentage of older adults in the population is decreasing.

b

The proportion of older adults who live alone is increasing.

c

Older adults take one-half of all prescription medications.

d

Older adults have a decreased recovery time following injury.

b The proportion of older adults who live alone is increasing.

Since 1990, the likelihood of older adults living alone has grown.

Families

Family as a client = central to community-oriented nursing practice

Families provide emotional, financial, and/or physical support

Nurses help families through assessment, planning, development, and evaluation focused on family issues

Home visits allow nurses to observe the environment, identify barriers, and support risk reduction

Approaches to Family Nursing Care

Family as a Component of Society

• Examines family interactions with institutions (schools, healthcare, finance, congregations)

• Used for population-focused interventions (e.g., immunization campaigns for disadvantaged groups)

Family as a System

• Studies how family member interactions affect overall functioning

• Promotes health by guiding interventions toward family interactions

Family as a Client

• Examines family unit functioning first, then individual needs

• Assesses how family health is influenced by each individual’s reaction to a health event

Family as Context

• Focuses on an individual first, then family next

• Promotes recovery/health of an individual with family as support system

A home health nurse is planning care with a client and their family following a stroke. Match each approach to family nursing care with a strategy for using it to plan care.

Family as a component of society

Family as a system

Family as a client

Family as context

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View the client as the focus of care. with the family members viewed as a source of support for the client.

Ask the family members how their family function overall has changed following the client’s stroke.

Ask individual family members how their life has changed following the client’s stroke.

Examine how the family unit interacts with other parts of society, such as with medical facilities or financial institutions.

Family as a component of society

• Examine how the family unit interacts with other parts of society, such as with medical facilities or financial institutions.

Family as a system

• Ask individual family members how their life has changed following the client’s stroke.

Family as a client

• Ask the family members how their family function overall has changed following the client’s stroke.

Family as context

• View the client as the focus of care. with the family members viewed as a source of support for the client.

Crisis and Transitions

Family Crisis

• Occurs when family resources are inadequate to cope with a situation.

• Common triggers (transitions):

  • Birth or adoption of a child

  • Death of a family member

  • Child moving out of the home

  • Marriage of a child

  • Major illness

  • Divorce

  • Loss of main family income

Impact of Transitions

• Families must:

  • Change behaviors

  • Make new decisions

  • Reallocate family roles

  • Learn new skills

  • Use new resources

Characteristics of Healthy Families

Communicate well & listen to each other

Provide affirmation & support

Teach respect for others

Create trust

Share play & humor

Interact with one another

Participate in leisure activities together

Share a religious foundation

Respect individual privacy

Share responsibility

Maintain traditions & rituals

Seek help for problems when needed

Family Health Risk Appraisal

Biological Health Risk Assessment

• Genograms: Gather information about family structure, relationships, health/illness patterns.

  • Identify genetic risks (e.g., cancer, heart disease, diabetes mellitus).

  • Genomic information helps with targeted prevention.

• Ecomaps: Visual diagram of family’s relationship with external systems (school, work, church, friends, extended family, health services).

  • Shows family’s role in the community & social supports.

Environmental Risk

• Ecomaps also assess family interactions with groups/organizations.

• Provides information on support network and social risks.

Behavioral Risk

• Gathers info about:

  • Health behaviors

  • Health values

  • Health habits

  • Risk perceptions

• SDOH Example: Economic stability & access to nutritious food.

  • Children: Anemia, poor cognition, anxiety, asthma, poor oral health

  • Adults: Depression, hypertension, hyperlipidemia, sleep disorders

  • Senior Adults: Poor physical health, depression

Genogram (Image)

Ecomap (Image)

A community health nurse is using tools to conduct a family assessment. Sort the following information gathered by the nurse by whether it is more likely to be included in a genogram or an ecomap.

Family history of heart disease

Family involvement in church activities

Ages of everyone in the family

Birth order of children

Occupations of family members

History of family violence

Relationships with neighbors

Schools the children in the family are attending

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Genogram

Ecomap

Genogram

• Family history of heart disease

• Birth order of children

• History of family violence

• Occupations of family members

• Ages of everyone in the family

Ecomap

• Relationships with neighbors

• Schools the children in the family are attending

• Family involvement in church activities

National Health Goals of Families

Reductions in:

• Barriers to access

• Allergens within the home

• Families unable to have/maintain a pregnancy

• Passive smoke exposure

• Household hunger

• Intimate partner violence

Increases in:

• Positive parenting

• Health education from agencies (Head Start, schools, colleges, employment sites, health departments)

• Home testing for radon

• Health insurance coverage

• Individuals with a usual primary care provider

• Family health literacy

A nurse is planning interventions for populations of different age groups in the community. Sort the following educational topics by the population in which it is a major concern.

Dental health

Pneumococcal vaccine

Preconception counseling

Accessing Medicare benefits

Congenital anomalies

Managing osteoporosis

STI Prevention

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School-Age Children

Adults

Older Adults

School-Age Children

• Congenital anomalies

• Dental health

Adults

• STI Prevention

• Preconception counseling

Older Adults

• Pneumococcal vaccine

• Managing osteoporosis

• Accessing Medicare benefits

Genograms vs Ecomaps

“Who’s in the family and their health history” (biological risk)

Purpose: Shows family structure, relationships, and health/illness patterns.

Focus: Biological and hereditary risks (e.g., cancer, heart disease, diabetes).

Use: Identifies genetic tendencies and intergenerational health problems.

Appearance: Family tree diagram with symbols for members, relationships, and medical history.

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“How the family interacts with the outside world” (environmental/social risk)

Purpose: Shows family connections to external systems (school, work, church, friends, healthcare, community).

Focus: Environmental and social supports/stressors.

Use: Identifies resources, stressors, and support networks influencing family functioning.

Appearance: Central family unit connected outward to external groups with lines showing strength/quality of relationships.