Chapter 13: Community Nursing Process

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Welcome back to the Deep Dive.

Today, we are attempting something a little bit dangerous.

Dangerous.

Well, intellectually dangerous because we're asking everyone listening to

sort of dismantle the image of nursing they've probably built up in their heads for years.

Right.

Usually when students start out or even when, you know, the general public thinks of a nurse,

the camera zooms in on a very specific scene.

You're picturing the bedside, the sterile smell, the beeping monitors, the IV drips, the individual patient in the gown.

The acute care model.

It's the default setting for almost everyone.

It's what you see on TV.

Exactly.

But today we're taking a sledgehammer to the hospital walls.

We're stepping out onto the sidewalk, into the high schools, the community centers, the church basements and, well, people's living rooms.

We're moving from the bedside to the curbside.

That's it.

We're trying to figure out what it means to be a nurse when your patient isn't a person in a bed but an entire zip code.

And that is a massive shift.

I mean, it requires a completely different set of eyes.

And to guide us through this landscape, we are doing a deep dive into chapter 13 from Community Health Nursing,

a Canadian perspective, the fifth edition.

Right.

Specifically, we are looking at the chapter titled Community Nursing Process by Lucia Yu.

And I want to be really clear about the mission today.

This isn't just a vocab lesson.

Yeah.

The text poses a really daunting question right at the start, one that I think frankly terrifies a lot of novice nurses.

Oh, absolutely.

It asks, what does caring for a community actually mean?

And maybe more importantly, where do I even begin?

It is daunting.

I mean, think about it.

In a hospital, the system hands you the patient.

They are admitted.

They have a wristband.

They are in bed four.

You know exactly who they are and, you know, why they're there.

The problem is already defined in a way.

It's defined.

But in the community, you have to play detective.

You have to determine who the client even is, where the boundaries are, and why they need you before you can even think about treating anything.

And the stakes for this are getting higher, aren't they?

The text spends some time setting the context of modern healthcare.

We aren't just doing this because it's a nice idea.

We're doing it because the old system is straining.

Oh, it's straining badly.

The reality of modern healthcare is shifting drastically.

The text mentions early hospital discharges.

I mean, we've all heard the stories.

Patients are being sent home quicker and sicker.

Right.

You have major surgery, and you're practically out the door before the anesthesia fully wears off.

Exactly.

So community health nurses or CHNs are dealing with really acute medical problems in the home setting that, you know, maybe 10 or 20 years ago would have been managed in the ICU or on the ward.

That's a huge responsibility.

It is.

But it's not just about the acuity.

The text highlights a massive demographic shift.

We have a rapidly aging population.

We have increasing diversity, and we have the specific critical health needs of indigenous peoples.

So the community itself isn't looking the way it used to either.

Not at all.

And the core philosophy guiding all of this, the North Star for the entire chapter, is primary healthcare.

The goal is health for all.

Health for all.

Not just health for those who can navigate the parking garage at the general hospital, but health for the entire population, regardless of where they live or who they are.

Okay.

So if treat the community, we have to define it first.

Section one of the text is all about defining community.

And I feel like community is one of those words we use so much,

it has almost lost its meaning.

You know, like synergy or wellness.

It can be very vague.

Absolutely.

But the text gives us a really rigid, useful definition to work from.

A community isn't just a place.

It is defined as a group of people who live, learn, work, worship, and play in an environment at a given time.

Live, learn, work, worship, and play.

That's the five W's of community life, essentially.

And they share common characteristics and interests.

But here's the nuance that usually trips people up.

The chapter makes a massive distinction between viewing the community as client versus the community as partner.

Okay, let's stop here because this feels important.

Client versus partner.

To me, client implies a transaction.

I hire you, you fix my problem.

Partner implies we are in it together.

Is that the vibe?

You're very close.

Think of it historically.

The text takes us back to the legends of nursing.

Florence Nightingale and Lillian Wald.

The giants.

The giants, absolutely.

So Florence Nightingale in the Crimean War, cleaning up the sanitation to save soldiers.

Lillian Wald in the Henry Street settlement in New York, helping impoverished mothers in the tenements.

Now, look at the dynamic there.

They were caring for the community.

The recipient,

the nurse was the expert swooping in to save the day.

The savior model.

I have the knowledge, you have the disease, I will fix you.

Precisely.

That is community as client.

And look, there is a time and a place for that.

In a crisis, you need an expert to take charge.

But the modern view, the one this chapter is really pushing us toward, is community as partner.

Which completely changes the power dynamic.

Completely.

In the partner model, the nurse acknowledges that the expertise too.

They're the experts on their own lives.

So you collaborate with the community.

You work with community leaders, with politicians, with the residents themselves.

You're not just providing a service.

No, you're building capacity so they can help themselves.

You are advocating for equity together.

It's doing with, not just doing for.

It sounds so much more sustainable.

If you, the nurse, eventually leave, the health improvements stay.

That's the ultimate goal.

Now, to be a good partner, you have to know who you are dancing with.

The text breaks down community into three specific types.

It's not always just a neighborhood block.

Right.

And the first one is the most obvious, I think.

Geopolitical communities.

These are the ones defined by lines on a map.

Sometimes they are natural lines, like a group of people living in a valley or on an island.

But usually they are manmade.

Political boundaries.

A school district, a city ward, a province.

Exactly.

So if I'm a public health nurse for the city of Toronto, my community is geopolitical.

My responsibility, my funding, my jurisdiction, it all stops at the city limits.

That's clear cut.

It is.

But the second type is trickier.

The aggregate community.

Aggregate.

That just sounds like concrete to me.

Well, it refers to a collection of people who share common interests, beliefs, culture, or goals, but they might be scattered geographically.

They aren't necessarily neighbors.

Oh, okay.

So like the nursing community, we don't all live in the same building, but we share a profession.

Right.

Or a religious group.

Or more relevant to health, people with a specific condition.

Survivors of breast cancer is an aggregate community.

They share an identity and a very specific set of needs, even if they live miles and miles apart.

And treating an aggregate must be totally different from treating a neighborhood.

You can't just knock on doors.

You can't.

You have to find where they gather, how they communicate.

Which leads us to the third type, which is fascinating and very modern,

the virtual community.

The internet.

The internet.

The text specifically mentions platforms like Twitter, WeChat, and WhatsApp.

It's still wild to me to think of a Twitter feed as a patient.

But think about it.

People find real support there.

They share information, and of course, a lot of misinformation.

They form real bonds.

If you are a nurse trying to promote mental health awareness for teenagers or vaccine info,

that virtual space is a valid community you have to engage with.

You have to go where the people are.

Exactly.

So we've defined the who.

Now let's talk about the what.

What does a community actually do?

The text lists community functions.

Right.

The text argues that for a community to sustain its residents, it has to perform five essential functions.

If you are the nurse detective, you are checking these five boxes to see if the community is, you know, working properly.

Alright, run through them for us.

First, space and infrastructure.

This is the hardware of the community.

Housing, schools, roads, recreation space.

If the library is always closed and the public housing is full of mold, this function is failing.

Okay.

Basic shelter and public space.

Second,

employment and income.

Can people actually survive here?

Is there economic growth?

If everyone has to commute two hours to find a decent job, that's a huge stressor that directly impacts health.

Right.

Stress, exhaustion,

no time for exercise or cooking healthy meals.

Exactly.

Third is security and protection.

This is the obvious stuff like law enforcement and fire services, but also just a general feeling of safety.

Can you walk down the street at night?

Are kids safe playing in the park?

Fourth, participation and socialization.

This is the soft infrastructure.

Do people know their neighbors?

Are there community festivals, church groups, book clubs?

Do people feel like they belong or are they isolated?

And the last one.

Linkages with other systems.

No community is an island.

Does this neighborhood have a bus line to the hospital?

Can the local school board get funding from the provincial government?

If a community is cut off, it withers.

So if any of those five are broken,

the patient, the community is sick.

That's a perfect way to put it.

Correct.

And driving those functions are what the text calls the community dynamics, the engines that make it all run.

And there are three of these engines, right?

Yes.

Communication, leadership, and decision -making.

Let's look at communication first.

The text breaks this down in a way I found really interesting.

It's not just do people talk.

It's about the direction of the talk.

Yes.

It visualizes the flow of information, which is a really useful diagnostic tool.

First, you have vertical communication.

So up and down.

Right.

Linking the community to larger powers.

Think of a community group petitioning the mayor for a new stop sign.

That is vertical communication.

They are sending a signal up the chain of command.

And what's horizontal communication?

That's side to side.

Collaboration within the community, the local school talking to the community center, neighbors talking to neighbors over the fence, the business association working together.

Okay.

And then there's a third one, diagonal.

Diagonal is the cross -cutting reinforcement.

It ties the other two together.

It reinforces cohesiveness.

A healthy community has strong flow in all three directions.

If you only have vertical, just a bunch of people complaining to the government, but not talking to each other, you don't really have a community.

You just have a group of angry individuals.

That's a great distinction.

Now, leadership.

This is so crucial for a nurse entering a new area.

The text distinguishes between formal and informal leaders.

And if you miss this distinction, you will fail.

I guarantee it.

Formal leaders are the ones with the titles.

The mayor, the member of parliament, the school board trustee, they have the official authority.

They sign the checks.

But they aren't always the ones the community trusts or listens to.

Exactly.

That's where the informal leaders come in.

These are people with immense influence, but no official title.

It might be the pastor at the big church.

It might be the grandmother who has lived on the block for 50 years and knows everyone's secrets.

It might be a local hero or a well -respected business owner.

The text mentions indigenous elders here too.

Yes.

And that's a critical point.

They hold the cultural authority.

So if you want to run a health program, you might need the formal leader, the band chief, to approve the permit.

But you absolutely need the informal leader, the elder, to tell the people, it's okay.

You can trust this nurse.

This is a good thing for us.

So the smart nurse identifies and builds relationships with both.

You have to.

Which leads directly to the third dynamic.

Decision making.

Formal leaders use policy.

Informal leaders use influence.

You need to leverage both to get things done.

You need the policy and the buy -in.

Okay.

So we know what a community is and how it works.

Now we need a target.

What does a healthy community actually look like?

Section two covers healthy communities and assessment frameworks.

This is interesting because healthy communities is actually a formal movement that started back in the 1980s.

It's not just a generic phrase.

The text has a checklist box titled what constitutes healthy communities.

And it is surprisingly broad.

It is.

I really expected it to say things like low cancer rates or good hospitals.

Me too.

The first time I read it, but it doesn't start there.

It starts with things like a clean, safe physical environment.

Then it lists peace, equity, and

Social justice is a health metric.

According to this text, it's one of the most important ones.

It lists adequate access to food, water, shelter, and income.

But here is the one that really underscores that partner model we talked about.

Broad participation of residents and decision making.

So a top -down authoritarian community with good hospitals still isn't a healthy community.

Not by this definition.

A healthy community is one where people have a voice, where they have agency.

The list also includes a diverse and vital economy and the protection of the natural environment.

It is a holistic, almost ecological view of what makes a place healthy.

To help us wrap our heads around this complexity, the chapter introduces frameworks.

And we really need to spend some time here because these models are the tools the nurse uses to organize all this chaos.

The first one is the big one.

The community as partner model by Vollman Anderson and McFarlane.

This is centerpiece of the chapter, really.

I want listeners to visualize a wheel.

Okay, closing my eyes.

I see a wheel.

At the very center, the hub are the community residents, the people, their demographics, their values, their history.

That is the core.

The core.

Got it.

Now, surrounding them are eight subsystems that make up the tire, if you will.

These are the systems that support the people.

Give me the eight.

Okay.

Physical environment, education, safety and transportation, politics and government, health and social services, communication, economy and recreation.

So the people are at the core, surrounded by these eight systems.

Right.

And these systems all interact.

If the economy subsystem crashes, it puts immense pressure on the health and social services subsystems.

It's all connected.

But the model gets even deeper.

It incorporates Betty Newman's systems theory.

Right.

And this gives us the concept of lines of defense.

This part sounded bit military to me.

Lines of defense, lines of resistance.

It is a bit military or maybe immunological.

Think of the community as an organism trying to stay healthy and in balance.

Deep inside, protecting the core residents, you have the lines of resistance.

These are the internal strengths.

The community's immune system.

So like strong neighborhood associations or a high rate of volunteerism.

Exactly.

Those are strengths that help it fight off problems from inside.

Now surrounding the community is the normal line of defense.

This is the baseline.

This is the community's normal state of health over time.

For example, maybe the normal unemployment rate is 5%.

Maybe the normal high school graduation rate is 80%.

Maybe the air quality is usually at a certain level.

That's the normal state, the equilibrium.

And then there's the buffer on the outside.

The flexible line of defense.

This is the outer shell.

Think of it like a seawall in a storm.

It's dynamic.

It expands and contracts to protect the community from stressors.

Stressors like what?

A factory closing down.

A factory closing down is a perfect example.

Or a flood.

A flu outbreak.

A spike in hate crimes.

These stressors hit the seawall.

The flexible line of defense.

If the wall is strong, the stressor bounces off.

The community adapts.

What about if it's too weak?

Or if the stressors are too strong, they penetrate.

They break through the seawall and they hit the normal line of defense.

And that's when you see the problems start.

That's when you see the symptoms.

The unemployment rate shoots up past its normal 5%.

Crime spikes.

Homelessness increases.

Disease spreads.

The community is knocked out of its normal state of health.

So the nurse's job?

The nurse's job is to assess how deep the penetration is.

Did it just scratch the paint or did it punch a hole right through to a core?

And then your interventions are designed to patch the wall to strengthen those lines of and help the community get back to its normal state.

That makes it so visual.

I can actually see it.

Okay, the second framework is the epidemiologic framework.

The classic triangle.

Host, environment, agent.

This feels like classic detective work again.

It is.

It's the foundation of public health.

In a disease outbreak, it's simple.

Host.

The person who gets sick.

Environment.

The crowded room or contaminated water source.

Agent.

The virus or bacteria.

But the text suggests using this for social conditions, too.

It uses the example of tuberculosis, but let's try another one, like homelessness.

Okay, great example.

Let's walk through homelessness using the triangle.

Who is the host?

The person experiencing homelessness.

Right.

And what are their characteristics?

They might be dealing with past trauma, mental health issues, or a physical disability.

That's the host.

Now, what is the environment?

A city with really high rent, low vacancy roads, and a lack of affordable housing.

Perfect.

And maybe a weak social safety net.

That's the environment.

Now, the tricky one.

What is the agent?

What's the thing that causes the homelessness?

It could be so many things.

The loss of a job, a sudden eviction notice, an addiction,

fleeing domestic violence.

Exactly.

So by mapping it this way, you see that you can't just treat the host.

You can't fix the person and expect the problem to go away.

You have to change the just by giving the person a pep talk.

You have to fix the housing market and strengthen the social safety net.

Which brings us to the third framework, and this one feels like it flips the script entirely.

Capacity building approaches.

It really does.

It's the glass half full approach.

Traditional nursing and medicine in general is trained to look for problems.

What is broken?

What's the deficit?

Capacity building looks for strengths.

What is working here?

What assets do we have?

It involves something called asset mapping.

I love this concept.

It's so powerful.

Instead of mapping crime hotspots or disease clusters, you map skills, experiences, and physical resources that already exist in the community.

It's a treasure hunt.

The text uses the example of community gardens.

It's a perfect example.

A traditional needs assessment looks at a neighborhood and sees food insecurity, a problem, a deficit.

An asset map looks at the same neighborhood and sees an empty lot, which is a physical asset,

and a bunch of retired farmers with gardening skills, which is a human asset.

You combine them and you get a community garden.

So you solve the problem by building on the strengths that were already there, not just by pointing out a deficit.

Exactly.

And you empower the community in the process.

The final model in this section is the big one, the community health promotion model or CHPM.

You can see it in figure 13 .1 in the text.

This one feels like the most holistic of all.

It is.

It combines the Ottawa Charter, which is a key document in global health promotion, with the principles of primary health care.

Its main focus is on the social determinants of health.

And the text has a specific example here about a mother and her children's diet that really struck me.

It's a real challenge to our judgment as health care providers.

It's a crucial scenario for any student to think through.

Imagine a nurse does a home visit and sees a young single mother feeding her children a diet that's very high in carbohydrates, lots of pasta, processed foods, sugary snacks.

The knee -jerk reaction, the judgmental reaction is bad parenting, or at least she needs education.

Right.

The first thought is, I need to teach her about the food groups.

I need to give her a pamphlet.

But the CHPM forces you to stop and look at the determinants of health.

Why is she buying those foods?

Is it because she doesn't know better?

Or is it because she has $20 to feed three kids for three days and a box of pasta is cheap, filling, and easy to make after a long day at a minimum wage job?

It's an income issue, not a knowledge issue.

Exactly.

The determinant of health here is poverty.

If the roux causes poverty, no amount of nutritional pamphlets will fix it.

In fact, giving her a pamphlet might just shame her and damage your therapeutic relationship.

So the intervention isn't a pamphlet.

The intervention, according to this model, is to address the inequity.

It's helping her find a better job, connecting her with a food bank, or advocating for a higher minimum wage.

You have to address the income, not just the behavior.

That is the deep dive perspective right there.

You have to look upstream.

So we have our definitions.

We have our frameworks.

Now we get to the actual work.

Section three, the nursing process assessment.

And just like in the hospital, the nursing process is a cycle.

Assessment, planning, implementation, and evaluation.

It's not linear.

It's a continuous loop,

but it always starts with assessment.

And before you even start asking questions or driving around, the text says you need a plan.

You need a PISO statement.

P -I -S -O.

Yes, P -I -S -O.

It's a mnemonic to keep you focused, to make sure you know why you're there.

P stands for population.

Who are we talking about?

Be specific.

I stands for intervention.

What are we thinking of doing or assessing?

S is setting.

Where are we doing this?

And O is the desired outcome.

What do we hope to change?

So you don't just wander into a neighborhood saying I'm here to help.

No, because that's useless.

You go in with a clear statement.

The text gives a great example.

I am assessing harm reduction strategies, intervention for undergraduate campus students, population at the University of Windsor setting, in order to decrease the rates of risky drinking outcome.

See, that's a plan.

It's measurable.

It's focused.

It gives your work direction.

Okay, so we have our PISO.

Now how do we get the data?

The text lists four types of community assessment.

And the first one is my absolute favorite because it is pure theater of the mind.

The environmental scan or the windshield survey.

This is old school boots on the ground nursing.

You literally get in your car or on the bus or you just walk through a neighborhood and you just observe.

You use your senses.

I want listeners to really picture this.

You are driving slowly through a neighborhood.

The window is down.

You aren't looking at charts or statistics yet.

You are just using your eyes, your ears, your nose.

What are you looking for?

You're looking at the housing.

Are the porches sagging?

Are there bars on the windows?

Are the lawns well kept or overgrown?

That tells you about safety, income levels and social cohesion.

You look at the people who is on the street at 10 o 'clock on a Tuesday morning.

Is it elderly people out for a walk?

Is it unemployed young men hanging out on a corner?

Is it mothers with strollers heading to the park?

That tells you about demographics and employment patterns.

You use your ears too.

Absolutely.

Is it silent and eerie?

Is there constant traffic noise and sirens?

Do you hear kids laughing in a schoolyard or people yelling?

The soundscape is a vital sign of the community.

And your nose.

Smell is a powerful data point.

Do you smell industrial runoff from nearby factory?

Exhaust fumes?

Or do you smell fresh cut grass and bakery smells?

That tells you about air quality and the types of local businesses.

It's real Sherlock Holmes stuff.

It is.

You observe interactions if you walk into a coffee shop.

Is the vibe tense and quiet or is it friendly and buzzing?

It gives you the pulse of the community before you even look at a single statistic.

I love that.

The second type of assessment is the needs assessment.

This is more formal.

It's about identifying the gap.

The gap between where the community is right now and where it wants to be.

But the text adds a critical warning here.

You must distinguish between needs and wants.

What's the difference?

A need is something essential for health and survival, like safe housing.

A want might be something desirable but not essential, like a new swimming pool.

And you have to match the service to the actual need, not just what you, the nurse, think they need.

Third is problem investigation.

This is reactive.

This is when the alarm bell rings.

There's a sudden measles outbreak or a spike in teen suicides.

You go in specifically to investigate the occurrence and the root cause of that one specific urgent problem.

The fourth type is resource evaluation.

This is checking the inventory.

We have a problem, say a high rate of diabetes, but do we have the tools to fix it?

Are the clinics open at times when working people can actually go?

Are they culturally appropriate?

Is there funding for a community kitchen?

You are assessing the capacity of the system itself.

Okay, so we are out there doing our windshield survey and our resource evaluation.

What specifically are we looking at?

Section four is the data deep dive.

The text lists a dozen components of community assessment.

We can't list them all, but I want to hit some of the heavy hitters.

We have to start with socioeconomic environments.

The text is unequivocal here, and this is probably the single most important takeaway from the chapter.

Income is the most important determinant of health.

Number one, more important than smoking or diet.

More important than almost anything.

Better than genetics, better than lifestyle choices.

The data is overwhelming.

If you are poor, you are more likely to get sick and you will die younger.

Period.

Why?

Why is money so physiological?

It's the cascade effect.

Poverty means chronic stress, constantly worrying about rent and food.

That leads to high cortisol levels, which destroys your heart and your immune system over time.

It means you can't afford fresh, healthy food, so you eat cheap processed food.

It means you live in unsafe housing with mold or lead paint.

It means you can't afford the prescriptions your doctor gives you.

It is the master switch that controls almost everything else.

That's powerful.

Another huge category the text goes into is culture and religion.

It gets very specific about the Canadian context here.

And it has to.

The text states that 21 .9 % of the Canadian population is foreign born.

That's a massive level of diversity.

And culture profoundly impacts health decisions.

The text mentions obvious things like dietary rules or religious restrictions like Jehovah's Witnesses refusing blood transfusions.

But it also touches on some very sensitive cultural friction points, which I thought was brave for a textbook.

It does.

It brings up the controversy over niqabs, the face coverings worn by some Muslim women, and how they have faced ostracization and discrimination.

Now, think about that from a health perspective.

If a woman feels unsafe or judged walking into a clinic because of what she wears, she won't go.

That is a health access issue created by cultural intolerance.

And it also directly mentions Indigenous history.

It explicitly discusses the legacy of residential schools.

This isn't just history.

It's current health data.

The intergenerational trauma from that system creates a deep and understandable mistrust of institutions, including the health care system.

A CHN walking onto a reserve represents the system.

You have to understand that history to even begin to navigate the lack of trust.

Let's talk about population, the demographics at the core of that wheel model.

Big trend highlighted in the text, and you see this in figure 13 .2, is the graying of Canada.

The baby boomers are aging and the population pyramid is becoming more of a rectangle.

Which means what for the health system?

It means the entire system is going to tilt.

We're going to need way more home care and long -term care.

We need to focus on things like fall prevention.

The text notes that 20 to 30 percent of seniors fall every single year.

That is a massive preventable epidemic of broken hips, loss of independence, and hospital admissions.

And one more component I want to touch on is government, politics, law, and safety.

This brings us full circle back to the idea of policy as health.

The text talks about smoke -free bylaws, seatbelt laws, zoning laws that prevent fast food joints from opening right next to a high school.

These are powerful medical interventions that happen in city hall, not in a hospital.

That is a mountain of data to collect.

Section 5 asks the critical question, how do we collect it all without drowning?

The text says you have two basic buckets for your data.

Quantitative, the hard numbers, the facts and figures.

Census data, Statistics Canada reports, disease rates.

And then you have qualitative, the stories, the opinions, the lived experiences.

The text mentions surveys, which are great for getting a snapshot of numbers, but it also talks about community forums.

Town halls, yeah.

But there is a huge warning label attached to them in the text.

Who shows up to a town hall at 7 p .m.

on a Tuesday night?

People who are motivated, usually people who are angry about something.

Exactly, the loud minority.

You might sit there and think the whole town is furious about a bike lane when really it's just 10 very loud, very organized people.

The text warns nurses not to mistake the loud voices for the representative ones.

So how do you get the real story, the nuanced story?

One of the best ways is through focus groups.

You gather a small curated group of people, maybe 6 to 12 people who share a similar characteristic, like new mothers or caregivers for elderly parents.

And because it's a small, safe group, you can dig really deep into their

Now, this section pivots to something called the population health approach.

And there is a case study here that I think defines the whole episode.

It's figure 13 .3, the slum area drawing.

This is a classic exercise in perspective taking.

The text shows a simple drawing of a rundown urban neighborhood.

There are broken windows, trash all over the streets, stray dogs, that kind of thing.

And the nurse, with her professional training, looks at that picture and sees.

Sanitation risks, injury risks from the broken glass,

risk of rabies from the dogs.

Her first instinct is we need to clean up the trash.

We need animal control.

But the exercise asked is a different question.

What does health mean to the people living here?

Exactly.

And if you ask the resident in that drawing, they might say health to me means having a job or health means getting the drug dealers off the corner so my kids are safe and I can finally sleep at night.

They don't care about the trash on the street.

That's not their priority.

So if the nurse comes in with a big community cleanup campaign, it will fail.

It will completely fail because it doesn't address the community's stated priority.

You have to see the world through their eyes first.

That is the essence of the partnership model, which leads us directly into section six, risk diagnosis and planning.

We have the data.

We understand the community's priorities.

How do we write it down in a way that's useful?

In the hospital, you have a medical diagnosis, pneumonia.

In the community, you have a community nursing diagnosis and there's a very specific formula for writing one.

I love a good formula.

It makes things clear.

It does.

The formula is aggregate plus response plus etiology plus characteristics.

Okay, let's break that down.

Aggregate is the who.

Right.

The population group.

Response is the health issue, the problem or the potential.

Etiology is the related to part, the root cause and characteristics is the as evidenced by the proof, the data.

Okay, let's play a game.

I'll give you the scenario from table 13 .2 in the text.

You break it down.

First, a wellness diagnosis.

The population is high school students.

That's the aggregate.

They seem ready and open to learning about health.

Okay, that's the response.

It's a positive one.

Potential for healthy lifestyles.

Why?

Because they keep asking their teachers questions about it.

That's the etiology.

It's related to a desire to learn.

And we know this because the school just launched a big new health curriculum.

And that's the characteristics.

It's evidenced by the school's integrated health curriculum.

So the full diagnosis is high school students aggregate have a potential for healthy lifestyles response related to their desire to learn etiology as evidenced by the integrated curriculum characteristics.

That makes perfect sense.

Okay, let's do a harder one.

A grim one from the table.

The population is first nation reserve peoples aggregate.

The health issue is a high rate of suicide response risk for suicide.

Why the text points to a lack of resources, high stress and intergenerational trauma etiology related to inadequate resources and high levels of psychosocial stress and the proof, the horrifying statistics characteristics evidenced by suicide rates that are 4 .3 times higher than the national average.

Writing it out that way is so powerful because it forces you to link the tragedy, the response to the cause, the etiology.

It forces you to acknowledge the root cause.

You can't just treat the suicide risk with a crisis hotline.

You have to treat the inadequate resources and the systemic stress.

The diagnosis points you toward the upstream solution.

So we have a diagnosis.

We have a plan.

Now, section seven, how do we get the community to actually do it?

Because remember, we are partners.

We can't just write a prescription and order them to be healthy.

No, you can't.

So you use participatory tools.

These are tools designed to make the community the boss to put them in the driver's seat.

Tool number one is the community needs matrix, which you can see in table 13 .3.

This is pure democracy in action.

It's so simple and so effective.

You create a grid.

Down the side, you list all the potential health problems, nutrition, accidents, smoking, mental health, whatever comes up in your assessment.

Then you get the community members themselves to vote on how concerned they are about each issue.

In the text example, the nurse might look at the data and think nutrition is the big killer.

But when the community votes, they rate accidents as their number one fear.

Maybe because there was a recent car crash involving a kid on their street.

Exactly.

Their experience tells them accidents are the biggest threat.

So what do you do as the nurse?

You work on accidents.

You respect their vote.

You have to.

That builds trust.

You work with them to get a crosswalk or a lower speed limit.

And then later, once you've proven you're a true partner, maybe you can bring up the conversation about nutrition.

Tool number two, community mapping.

We talked about asset mapping, but you can also map illness.

Figure 13 .4 in the chapter shows a map of Anabifida cases.

By putting pins on a map, you might suddenly see that they all cluster around a certain factory or a particular water source.

It turns the community into data visualizers and citizen scientists.

And the ultimate goal of all this is community mobilization.

This is when the community takes the ball and runs with it.

When the health initiative takes on a life of its own.

And the text gives the ultimate Canadian example of this.

Terry Fox.

Terry Fox.

It started as one person's vision.

A young man with an amputated leg dipping his artificial foot in the Atlantic Ocean in St.

John's, Newfoundland.

He wanted to run across Canada for cancer research.

He didn't have a government grant.

He didn't have a huge organization behind him at first.

No, it was as grassroots as it gets.

Just him and a friend in a van.

But his vision, his determination, it mobilized the entire nation.

People came out to the highways and small towns to cheer him on.

They became a movement.

That is the holy grail of community health.

When the community owns the health goal so deeply that they move mountains to achieve it.

So inspiring.

And it brings us to the final section of the chapter, section eight, the role of the CHM.

After everything we've talked about, you can see that the nurse has to wear so many different hats.

They're an advocate, a leader, a collaborator, a researcher, an educator.

But the text really emphasizes the ethical responsibility of the role.

This is where we end.

And it's maybe the most challenging part of the chapter.

The text explicitly says,

advocating for social justice and equity is not extra credit.

It is not political.

It is a core part of the job.

So things like fighting for a living wage or for more affordable housing or fighting against racism and discrimination.

The text argues that is nursing work in this context because those are the systemic issues.

The root causes that are making your patients sick in the first place.

You can't separate health from

very heavy responsibility.

It is, but it's the only way to actually create health rather than just treating sickness over and over again.

So as we sign off, I want to leave you with that provocative thought we hinted at in the beginning.

If we truly, truly treated the community as a partner,

if we really accepted that zoning laws and income levels and transit access are fundamental medical issues, how would that change our politics?

It would mean that every city council meeting is a health meeting.

Every budget debate is a health debate.

You wouldn't just have the minister of health worried about health.

You'd have the minister of transportation and the minister of finance understanding their role in population well -being.

If we prioritized health for all in our city planning, in our economic policies,

maybe we wouldn't need to build so many hospitals in the first place.

That is the dream of community health nursing.

That is the dream vision.

A huge thank you to Lucia Yu and the authors of Community Health Nursing, a Canadian perspective for this incredible roadmap.

And thank you to you, the listener, for sticking with us on this very deep dive.

Thank you.

This has been the Last Minute Lecture Team.

We'll see you next time.