Community Health Nursing Principles

• Community Health Nursing (CHN) aims to promote the client's Optimum Level of Functioning (OLOF) through teaching and care delivery according to Jacobson.
• WHO defines it as a special nursing field combining nursing skills, public health knowledge, social assistance, and functions for health promotion, condition improvement, and rehabilitation
• The American Nurses Association (ANA) defines it as a practice synthesizing nursing and public health to promote and preserve population health.
• Community Health Nursing philosophy is a belief system that guides action, providing direction and explaining the "whats," "whys," and "hows" of the profession.
• Margaret Shetland states that CHN philosophy is based on the worth and dignity of a man.

Principles of Community Health Nursing (CHN)

• CHN is based on recognized needs of communities, families, groups, and individuals.
• Community Health Nurses (CHN) must understand the objectives/policies of their agencies.
• In Community Health Nursing, the family is the unit of service.
• CHNs must be accessible to everyone.
• Health teaching is the primary responsibility for CHNs.
• The CHN works as part of a healthcare team.
• CHN services require periodic evaluation.
• CHNs should have access to ongoing staff education.
• CHNs should utilize available community health resources.
• CHNs must use existing active community organizations.
• Accurate recording and reporting is essential in CHN.

Features of CHN

• CHN has a preventive approach to health, focused on populations or aggregates, and is developmental.
• Uses prepayments.
• CHN cares for different levels of clientele.

Different Fields of CHN

• It is considered a broad speciality area with subspecialties.

Public Health Nursing

• Practice generally delivered within official/government agencies.

School Health Nursing

• Aims to promote the health of school personnel and students and prevent health problems that could hinder performance
• Republic Act 124 mandates all schools to provide school clinics for treating minor ailments and emergencies.
• School nurses perform health assessments once a year, with priority given to Grade I enrollees.
• Eight Components of School Health Services are: Health Education, Physical Education Health Services, Nutrition Services, Counselling, psychological and social services Healthy School Environment, Health Promotion for Staff, and Family & Community Involvement.
• Rapid Classroom Inspection: Done after long vacations, between health examinations, or during epidemics
• Visioning Testing - Test visual acuity once a year, at the beginning of the school year.
• Height and Weight Measurement - measured at the beginning and end of the school year, students involved in a rehabilitative supplementary feeding program need to be weighed every quarter.
• Monitors the health status of public school pupils regarding infectious diseases (respiratory tract infections and diarrhea), worm infestations, and dental caries

Occupational Health Nursing

• Defined by the American Association of Occupational Health Nurses (AACHN), it focuses on promoting, preventing, and restoring health in a safe, healthy environment.
• It includes preventing adverse health effects from environmental hazards delivering occupational health and safety programs to clients

Community Mental Health Nursing

• It’s a clinical process using nursing concepts, mental health knowledge, social psychology, community networks, and social sciences.
• It mainly focuses on mental health promotion.

Health Belief Model (HBM)

• It’s a model that was developed in 1958 by social psychologists in the U.S. Public Health Service.
• People must know 'what to do' and 'how to do it' prior to being able to take action.
• Its major limitation is that the burden of action is put solely on the client.

Key Concepts and Definitions of HBM

• Perceived Susceptibility: Belief about the likelihood of getting a condition.
• Perceived Severity: Belief about the seriousness of a condition.
• Perceived Benefits: Belief in the ability of advised action to reduce health risk.
• Perceived Barriers: Belief about real/psychological costs of advised action.
• Cues to Action: Strategies/conditions that activate readiness to act.
• Self-Efficacy: One's confidence in ability to take action to reduce health risks.

Milio's Framework for Prevention

• Nancy Milio created the framework in 1976 to complement Health Belief Model (HBMs).
• It states that health deficits result from lack of or too much critical health resources
• Six Propositions are related to: population health deficits; dictates options; decision-making; select from limited choices; individual choices; alternative health-promoting options.
• Diseases tied to excess afflict affluent societies, diseases from unsafe resources affect the poor.
• The range of available health choices shapes a society's health status.
• National policy is the best way to impact health, not just providing information for individual behavior change.
• Readily available, low cost, health-promoting choices are needed.
• A health imbalance is found between a populations health sustain resources

Nola Pender's Health Promotion Model (HPM)

• Developed in the 1980's and revised in 1996.
• It explores the biophysical factors that influence health promotion activities, but does not include threat as a motivator.
• It focuses on individual characteristics, experiences, behavior-specific cognition/affect, and behavioral outcomes

HPM Details

• Prior related behavior influences subsequent behavior through self-efficacy
• Personal factors include biological, psychological, and sociocultural factors
• Benefits & Barriers to Action: Strong motivators through intrinsic and extrinsic benefits. Unavailability, inconvenience, expense, difficulty or time regarding health behaviors.
• Perceived Self-efficacy: Is a person's belief in their ability to carry out.
• Interpersonal Influences: Feelings/thoughts of others.
• Situational Influences: Perceived options, demand characteristics, aesthetics.
• Commitment to Action: Initiates a behavioral event Competing Demands (low control) & Preferences (high control).
• Alternative behavior immediately before engaging in the planned behavior
• The overall goal is health-promoting behavior and/or outcome.

PRECEDE-PROCEED Model

• PRECEDE was developed Dr. Lawrence Green, stands for Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation, used for community diagnosis.
• PROCEED stands for Policy, Regulatory, and Organizational Constructs in Educational Development, is for implementing and evaluating health programs based on PRECEDE.
• Predisposing factors motivate health behavior. It includes attitudes, beliefs and values
• Enabling factors facilitate/impede health behavior. It includes skills, availability, accessibility and refferals.
• Reinforcing factors is feedback from support persons. This includes support from family, peers, teachers, employers, health care providers

Terminologies

• Aggregate: is the sum or the whole. Community is a part of that whole.
• Geopolitical Community: A community with geographical/ jurisdictional boundaries (e.g. rural municipalities, towns, cities)
• Procedure of systematically acquiring and recording information about the members of a given population.
• Phenomenological Community: A group sharing values, customs, interests, religion or academic interests.

RLE (Related Learning Experience) info related to COPAR

• Ideal COPAR includes 3-6 weeks immersion, duty for 8 hours a day, use custom survey forms, and involves 30-100% of the community.
• Practiced COPAR sometimes has duty for 8 to 16 hours, uses ready-made survey forms, and involves 25-50 families.

Problem Statement

• The problem will only be stated after the survey has been done, tallied and analyzed.
• The problem will come from the survey form and not from the judgement of the healthcare worker.

Organization Building State

• Organization building stage is where strengthen a primary and secondary organization with the proper officers/bylaws
• Primary and secondary leaders are all committed, and members are all coming from the community/non-healthcare
• Implement is where they resolve the "fish rod effect" so that it is sustainable even after assistance ends
• Implement a program lasting through the implementation phase, and something you'll leave to community
• Programs can be non-viable, and need to undergo re-implementation.

Community

• A group sharing characteristics/interests, living together in territory or geographical boundary.
• A place with people under usual conditions.
• Communities may be geopolitical (territorial) or phenomenological (functional).
• Healthy community is where there is a shared community sense, general empowerment, and effective structures can cope with change, and the use of resources is equitable.

Factors Affecting Community Health

• Community: has population, location, and social systems

Population Characteristics

• Population size/density affects healthcare institution size
• Health needs vary by age, gender, occupation, and education
• Influenced by rapid growth, feelings of belonging, education, and social class.

Community Location

• The health of a community can be impacted by natural and man-made elements.
• Land/waterforms shape food sources and occupations
• Disasters play an important role in geography.
• Climate change impacts human health through seasonal diseases.
• The Philippines geographic location is vulnerable given natural hazards.

Social Systems

• They consists of relationships between individuals, groups, and institutions
• Includes family, economics, education, communication, politics, law, religion, recreation, and health
• Roles of CHN follow the following: clinician/care provider, advocate, researcher, leader and educator
• The Minnesota Intervention Wheel shows public health nurses actions to improve health results and outcomes and it includes the responsibilities.

Key actions in the Intervention Wheel:

• Surveillance, disease/health event investigation, outreach, screening, case-finding, referral/follow-up, case management, delegated functions, health teaching, counselling, consultation, collaboration, coalition building, and community organizing.

Philippine Health Situation and Demographics Overview:

• These factors impact health status in communities.
• They can be assessed by urban migration
• The median age in the Philippines as of 2017 was 24.3.
• The projection for the Philippines Population as of 2017, based on the 2015 Census Authority is 104.9 Million.

Philippine Demographic Trends:

• The ageing index is the proportion of older people, which most countries will consider a rate of 7% for their population over 65.
• Population growth declined by almost half, from 2.7 to 1.5 in the same period.
• The overall age dependency ratio trend declined at 28%.
• In 2017, the Population rose to 352 persons per sq. km doubling from the 1980 rate.
• Roughly 45 million people of over 71.6 million aged 15 and over millions were in the labor force.
• The average household has a size of just 4.4, that accounts for nearly 23 million.
• Major cities will always change but mostly include: Manila, Davao and Cebu.

Philippine Vital Statistics Overview:

• The most recent birth statistics indicated 1,132,640 to 321,039 marriages and 447,735 deaths, according to vital statistics.
• There also are 16 registered live births in the Philippines per 1000 Population.

Philippine Birth Trends:

• In 2017, registered live births numbered 1,700,618 equivalent with CBR 16 births per 1000
• Births have declined by ~5% in the last half-decade to 2012
• Factors include Lifestyle changes associated with affluence.
• National Demographic health Survey (NDHS, 2017) showed a total fertility decline to 2.7 children per woman.
• There are more males (888k) born than females (812k) a sex ratio of 109:100.
• An average of almost approximately 3 or 4 newborns.
• Mostly, births in the country medically attendants except for those in ARMM.
• 40% use planning 14% Traditional and 45% not Using.
• Mother's mean age at first birth is 23.
• More illegitimate rates are caused than any other recorded in the countries.

Mortality In the Philippines

• Mortality rate decline has generally been consistently done since 2015

Top Causes of Death in the Philippines:

Ischemic Heart Disease, Malignant Neoplasms, and Pneumonia. The Philippine is prone to more or different diseases more than others. The number of deaths in the month increase. The leading cause of morbidity here is Pneumonia. The Philippines also struggle with Malaria, TB and HIV, which according to data has generally had an unstable trend.

Terminologies

• Statistics are obtained in statistics.
• People that are from or tallies people.
• Distribution has location

Morbidity, Endemic and Outbreaks:

The Leading causes of morbidity in 2005 were Acquired infections and Pneumonia, bronchitis. Emerging infectious diseases such as the Severe acute respiratory syndrome (SARS).

• Obesity has a prevalence rate in 2016 of 6.4%, while Maternal deaths stand at a rate of 121/100 and a rate of 22% for children.
• HIV or AIDS has increased slowly in the Philippines that mostly accounts for 0.1% of the populations, where over 70k live with HIV/AIDS.

Concepts of Demography

• From Greek: Study/description of people' statistics/diseases

Important terms relating to its Concept/definition

• Population size: The number of people at a certain given time.
• Population composition: Characteristics such as age, gender/sex, occupation.
• Distribution: Specific geographic location.

Mathematical Tools

• It is a series of investigations of how populations respond to changes.
• Population: is a collection of persons alive at a specified point in time. Age and sex of pyramid
• Population pyramids are a way to visualize the make-up of a population. Sex ratio = number of males/ number of women * 100

Population Size Related Data

• Population Census is usually conducted by the government and attempts to count every person in a country.
• Sample Size: The data are gathered from a number of people in the general Population.
• Registration System: Records every Vital Event.

Components of the Population

Population growth: Age AND Sex

The Equation Relative: Pt is population size and Po is census. Natural Inc: Birthrate in a rate.

Health Indicators

• It are numerical records by community to identify the growth & helps with the improvement of the community. Vital Stats: Health, Marriage/death sickness through health indicators. Provides health & statistics. Statistics like the following: The Number and population CDR = Numbers of Death, and years per pop.