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This revolutionary book is the first of its kind designed to provide nurses the tactics and tools to help them approach public health nursing through the tapestry of culture and community instead of the individual. By looking through the clarifying lenses of anthropology, economics, political science, sociology, and epidemiology, and other soft and hard sciences, the authors show a clear and powerful connection to health of the larger community and the health of individuals. Once this connection is made, the health care team--of which the public health nurse is uniquely positioned to lead--can focus energies and funding on affecting change and affecting health. Intentionally, Healthy Places, Healthy People de-emphasizes the care of individuals and families, not because it is not important, but rather to introduce students to a kind of nursing practice--focused on health rather than disease, on communities rather than individuals, and on strengths as well as failings. Two chapters are devoted exclusively to community and cultural assessment, with a quick and easy-to-use assessment approach laid out in sidebar boxes throughout these chapters. It is ideal for undergraduate and graduate nursing students and practicing nurses who are not familiar with population-based culturally sensitive care. The author team of Melanie Dreher, Dolores Shapiro and Micheline Asselin together have a powerful command of a wide range of issues in community health nursing, including a strong grounding in practice issues, public health policy, anthropology, and scholarship. A Teaching Guide is available to instructors who adopt the book for use in their courses as a free downloadable PDF file. Contact the publisher at 1.888.654.4968 to arrange for your teaching guide.
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This is a book about community health practice. Although nursing takes nourishment from many disciplines, the two that have most informed this book are anthropology and epidemiology. Healthy Places, Healthy People places nurses at the center of the health team, solving problems and monitoring, designing, planning, and directing the care of whole populations. It speaks to the responsibility of nurses to shape the future of healthcare. Some may regard this as an idealistic approach to public or community health nursing and argue there are few places in which we practice in the manner recommended here. We regard this as an asset rather than a shortcoming. Leaders and educators have an obligation to teach not only what is, but also what can and should be. They have a responsibility to not only assist nursing graduates to take positions in the existing healthcare system, but also to have the vision and ability to forge new roles, negotiate more effective healthcare systems, and ultimately to create healthier communities. The fact that there are few places in which true community health nursing is being practiced should not discourage us; it should energize us. This book takes an unabashedly idealistic perspective about these goals. At the same time, however, the authors have tried to be painstakingly realistic about the strategies for achieving them. Impractical tactics and failed results only serve to discourage nurses and eventually to make them stop trying.
Healthy communities are fundamental to healthy populations and the object of community practice intervention. But when confronted with the magnitude and complexity of the community-client, community health nurses often retreat to the interventions with which they are most familiar—specifically, personal health services. Thus in spite of almost two decades of critique (Butterfield, 1990; Dreher, 1982; Drevdahl, 1995; Kang, 1995), community health nursing continues to locate advocacy at the individual and family level. In their historical reluctance to move beyond personal health services, community health nurses have become "community assessors but personal interveners, creating a paradox in which improving a community’s health is accomplished through action aimed at individual behaviors rather than at the larger social and political vehicles" (Drevdahl, p. 13).
Flu immunizations, family planning clinics, nutritional counseling, smoking cessation, and prostate cancer screening are important and necessary public health activities. They are not sufficient, however, to build community capacity, i.e., a thriving, productive citizenry, residing in a healthy social and physical environment; nor are they sufficient to meet the two primary goals of Healthy People 2010—to eliminate health disparities and extend the quality and years of healthy life (U.S. Department of Health and Human Services, 2001). To accomplish the broad, far-reaching changes that will build sustainable, healthy places and populations, community advocacy must include large-scale social action (Atwood, Colditz, & Kawachi, 1997; Milio, 1975).
It is usually the case that the thorniest public health problems are those most deeply embedded in the traditions and structures of a community’s culture. The growing epidemic of obese and overweight people, for example, is amazingly resistant to standard interventions. So in spite of public education, recreational facilities, nutritional disclosure on packaged food, and peer-support programs, not to mention any number of diets, behavior modification programs, hypnosis, and surgical interventions, the rate of obesity continues to grow, creating a national public health problem that has effectively reduced the quality and years of healthy life.
For most public health problems, there is no shortage of plans and projects. The debates over fluoridation, speed limits, cigarette advertisements, immunization, family planning, and gun control all demonstrate the significance of culture-bound values in shaping public health policy. The dilemmas encountered in advocating for healthy communities are attributable not to the lack of solutions, but rather to the difficulty in implementing those solutions within a complex community culture.From the Author:
In this book, we offer a public-health improvement strategy that can be applied to any community at any time. It is about assessment, analysis, and action to build community capacity. Readers will learn how to view and interpret community strength, as well as vulnerability, and to formulate and implement interventions. This culturally grounded community perspective permits nurses to anticipate and plan for a healthy future. It is one large exercise in critical thinking.
Engaging in a practice that has the potential to improve the health of individuals, families, whole communities, and even nations for generations to come is a momentous undertaking. It is certainly as challenging, demanding, and exciting as working in an intensive care unit, an emergency room, or in labor and delivery. We hope this book conveys the personal gratification and fulfillment that can be derived from a career with almost limitless possibilities for fundamental and far-reaching social change.
Melanie Dreher, PhD, RN, FAAN, Dolores Shapiro, PhD, RN, Micheline Asselin, MPA,MSN,RN,CHPN
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