Community Nursing Key Concepts

• Community nursing and public health care encompasses key concepts and definitions that guide healthcare practices at the community level.

Key Definitions

• Health: A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity, as defined by the WHO in 1946.
• In community and public health, the term "health" refers to the collective well-being of populations, emphasizing healthcare access, preventive services, and lifestyle factors.
• Community: A group of people sharing common characteristics such as geography, interests, or values.
• In public health, a community includes individuals, families, and groups within a specific location that interact socially, economically, or culturally.
• Mortality: The rate of deaths in a population and an indicator of healthcare system effectiveness in reducing preventable deaths.

Levels of Prevention

• Prevention in health involves avoiding disease before it starts, aligning with the adage "prevention is better than cure."
• Prevention includes plans and measures to prevent the onset of disease or health problems before an undesirable health event occurs.
• Primary prevention aims to prevent diseases or injuries before they occur by reducing exposure to risk factors, enhancing health behaviors, and providing health education.
• Primary prevention examples include vaccination, health promotion programs, and environmental interventions like water sanitation.
• Health promotion examples: Hand washing, healthy diets, exercise, and sex education, and advocating for healthy community policies.
• Specific protection includes activities that protect from disease or disability, such as vaccination/immunization, and workplace safety.
• Secondary prevention focuses on early detection and intervention to halt disease progression or mitigate its impact, like screening programs for cancer, hypertension, and diabetes, and aims to reduce illness severity and complications.
• Secondary prevention consists of measures used once a disease is present to limit its impact on the individual.
• Secondary prevention includes early diagnosis and prompt treatment like mammograms and colonoscopies, and disability limitation.
• Methods of secondary intervention: Administering treatment/medications to limit disability, antihypertensive medications to prevent stroke, and penicillin injection to prevent disability from syphilis.
• Tertiary prevention aims to reduce the impact of an ongoing illness or injury with lasting effects, through rehabilitation and treatment to manage long-term health problems or disabilities, such as cardiac or stroke rehabilitation programs, to improve quality of life.
• Tertiary prevention is aimed at limiting disability, preventing disability from becoming permanent, and rehabilitation following significant illness.
• This level involves health services workers who retrain, re-educate, and rehabilitate people with impairments or disabilities.
• Tertiary level prompt treatment: Speech therapy, physiotherapy, and occupational therapy.

Levels of Healthcare

• Primary Health Care: Is the initial point of contact for individuals seeking healthcare services and includes general health promotion, disease prevention, chronic disease management, maternal and child healthcare, and basic medical treatment.
• Primary healthcare is typically delivered by general practitioners, nurses, and community health workers.
• Secondary Health Care: Involves more specialized medical services, often provided by referral from a primary healthcare provider.
• It includes specialist services like cardiology, dermatology, and psychiatric care, usually delivered in hospitals or clinics with more advanced medical equipment and expertise.
• Tertiary Health Care: Is highly specialized medical care often provided in major hospitals with advanced medical technology and specialist expertise.
• It includes complex treatments like cancer therapy, neurosurgery, and organ transplants, generally for patients with severe or life-threatening conditions.
• The Millennium Development Goals (MDGs), set by the UN in 2000, aimed to improve global health, eradicate poverty, and promote sustainable development by 2015, significantly shaping global health priorities.
• The MDGs highlighted the importance of accessible, equitable health services, particularly in developing regions.
• MDGs Achievements: Reshaped decision making, lifted a billion people out of extreme poverty, reduced hunger, enabled more girls to access education, and protected the planet.
• The MDGs evolved into the Sustainable Development Goals (SDGs), continuing to address global health and social issues with a broader scope including economic and environmental sustainability.

Differences between MDGs and SDGs:

• MDGs involved limited experts, while SDGs involve several partners.
• MDGs focused on 8 goals, while SDGs include 17
• MDGs focused on developing countries, while SDGs expect all countries to contribute.
• MDGs lacked mention of human rights and equity, while SDGs have these deeply rooted.
• MDGs used a baseline date from 1990, while SDGs use 2015.
• MDGs lacked a vision for partnerships, while SDGs build vibrant partnerships.
• MDGs lacked a role for civil society organizations, while SDGs have significant engagement.

Challenges to SDGs

• Funding and Resources
• Global Inequality
• Climate Change and Environmental Degradation
• Political Instability and Conflict
• Lack of Data and Monitoring
• Technological Divide
• Global Health Challenges
• Urbanization and Population Growth
• Cultural and Social Barriers
• Private Sector Engagement

Community Defined

• Community health: Health status and health outcomes of a specific group within a shared environment; it encompasses health promotion, disease prevention, and health protection through collective effort.

Types of communities

• Communities can be classified based on various factors, including:
  • Geographical Community: Defined by physical boundaries, such as neighborhoods, towns, or cities, and share common resources and services.
  • Cultural Community: Formed based on shared cultural or ethnic backgrounds, values, traditions, and languages, irrespective of geographic location.
  • Functional Community: Groups sharing common interests, goals, or purposes, like faith-based groups, professional organizations, or educational institutions.
  • Virtual Community: Online groups formed through social media or digital platforms, sharing interests or causes.
• The structure of a community involves its demographic composition, social systems, and resources.

Community Structure

• Demographic Structure: Includes age, gender, ethnicity, and socioeconomic status of the population.
• Social Systems: Include health services, education, legal systems, and social organizations contributing to community functioning and well-being.
• Infrastructure and Resources: Physical structures such as schools, hospitals, transportation systems, and housing, as well as community resources like financial institutions, recreational facilities, and public services.
• Community dynamics refer to the interactions and relationships among community members.
  • Social Interaction: How individuals socially interact, share resources, and support each other.
  • Power and Leadership: The influence of individuals or groups holding authority and making decisions affecting the community.
  • Change and Adaptation: How communities evolve due to internal and external factors like migration, economic shifts, political changes, or health crises, with resilience determined by their ability to adapt.
  • Economic Opportunities: Availability of jobs, financial resources, and programs promoting economic stability and growth.
  • Education: Access to quality education fostering personal and community development.
  • Health Promotion and Prevention: Community-wide efforts promoting healthy lifestyles and preventing diseases.
• Community health assessment is a systematic process of identifying a community's health needs, strengths, and weaknesses through data collection, analysis, and interpretation to guide public health interventions.
• Data collection includes gathering data on various factors affecting health, such as:
  • Demographic data: Age, gender, ethnicity, and socio-economic status.
  • Health data: Morbidity and mortality rates, disease prevalence, access to health services.
  • Environmental data: Quality of housing, access to clean water, air quality.
  • Behavioral data: Lifestyle choices like smoking, alcohol consumption, exercise, and diet.
• Data collection methods include surveys, focus groups, public health records, and interviews with community members; analysis identifies trends, patterns, and disparities in health outcomes.
• A community diagnosis identifies community strengths and weaknesses, as well as opportunities and threats (SWOT analysis), pinpointing areas for health improvement.
• Strengths: Existing resources, social support systems, and strong community leadership.
• Weaknesses: Factors limiting health improvement, such as poor healthcare access, high unemployment, or lack of educational opportunities.
• Opportunities: Potential areas for growth, such as new funding sources, community partnerships, or health promotion initiatives.
• Threats: External challenges like environmental risks, economic downturns, or political instability impacting community health.

Indicators of a Healthy Community Include:

• Psychosocial Indicators:
  • Self-Determination: The community's ability to make decisions and take actions to improve their health outcomes.
  • Community Participation: Involvement of community members in health initiatives, decision-making, and planning.
  • Cultural Expression: Presence of cultural activities fostering identity, mental well-being, and social cohesion.
• Economic Indicators:
  • Viability: The economic strength of the community, including job availability, income levels, and financial stability.
  • Access: Community members' ability to access healthcare, education, housing, and other essential services.
  • Affordability: Whether healthcare services, housing, and other necessities are affordable for most community members.
• Health Indicators:
  • Mortality: The number of deaths, often used as an overall health measure.
  • Morbidity: The rate of disease or illness, indicating the health challenges the population faces.
  • At-Risk Groups: Identification of vulnerable groups like children, the elderly, or low-income populations.
  • Minority Groups: The health status of minority groups, often indicative of disparities in health outcomes related to ethnicity or socioeconomic status.
  • Health Concerns: The most pressing health issues facing the community, like high rates of chronic disease, infectious disease outbreaks, or mental health challenges.
• Conducting a thorough community health assessment and utilizing health indicators allows public health professionals to design targeted interventions addressing community-specific needs, reducing health disparities, and improving overall well-being.