Public Health Nursing Revision

Course Information

• The course is Nursing: HEY442ET-Public Health Nursing-T
• Week designated as REVISION
• Scheduled for Thursdays from 09:00 to 12:50
• The course has a credit/ACTS score of 4
• Examination is Mcqs-based
• The instructor is Dr. Hina Zahoor, reachable via [email protected]
• Instructor's room number is 305
• Office hours are from 9:00 to 5:00
• GBS Link: https://gbs.gelisim.edu.tr/en/lesson-details-5-160-17306-2
• ALMS Link: https://avesis.gelisim.edu.tr/researcher/lesson
• AVESIS Link: https://lms.gelisim.edu.tr/almsp/u/Home/Index

Defining Public Health

• CEA Winslow (1920) defined it as the science and art of preventing disease, prolonging life, and promoting health through organized community effort.
• The Oxford Textbook of Public Health describes it as mobilizing local, state, national, and international resources for healthy living conditions.

Mission of Public Health

• According to Detels & Breslow (2002), health's main goal is to fulfill society's interests by ensuring conditions in which people can maintain health.

Health Policy and Management

• It involves strategically planning, organizing, and administering health systems/services.
• Professionals navigate healthcare complexities for efficient resource allocation, policy development, and quality service delivery.
• Efforts focus on equitable policies, facilities management, and optimizing accessibility and affordability.

Environmental Health

• Focuses on the relationship between the environment and human health.
• Examines air/water quality, sanitation, food safety, and occupational hazards and their impact on the human population.
• Experts work to prevent diseases by reducing risks, advocating for cleaner environments, and implementing policies to safeguard communities from harmful exposures.

Biostatistics

• It uses statistical methods to interpret biological and health-related data.
• It aids in study design, complex health data analysis, and outcome interpretation.
• Statistical models allow researchers to correlate, identify trends, and make informed public health intervention decisions.
• Important for accuracy and reliability, biostatisticians work with epidemiologists/specialists on studies and findings.

Public Health Nursing

• It is a nursing specialty focused on public health.
• Lillian Wald, of the Henry Street Settlement, coined the term.
• Public Health Nurses (PHNs) or community health nurses integrate community involvement and knowledge of the entire population with personal/clinical understandings of health and illness experiences of individuals and families.

Public Health Nurse Responsibilities

• Assessing health trends to identify community-specific health risks.
• Prioritizing health-related interventions for significant benefit.
• Advocating with authorities to improve access to health services in underserved communities.
• Designing/implementing health education campaigns and activities for disease prevention.
• Providing information on local health programs and services for better access to care.
• Providing direct healthcare services to at-risk populations.
• Recording and analyzing medical data.
• Developing relationships with patients and following up.
• Managing community health program budgets.
• Referring people to related services.
• Delivering medical care when needed.

Changing concepts in PH

• From 1880-1920 was the disease control phase
• From 1920-1960 was the health promotion phase
• From 1960-1980 was the social engineering phase
• From 1980 onwards is the health for all phase

Disease Control Phase (1880-1920)

• There was sanitary legislation and sanitary reforms.
• Technical knowledge was less available at the time.
• Aims at controlling man’s physical environment like water supply, and sewage disposal.
• Targeted the control of disease and death in order to improve health.

Health Promotional Phase (1920-1960)

• A goal added to activities was the promotion of health for individuals
• It initiated personal health services: introduction of Mother & Child health services, school health services, Industrial health services, mental health, and rehabilitation services.

Social Engineering Phase (1960-1980)

• Change in the pattern of disease
• Public Health entered in new phase called "social engineering phase"
• Prioritized social and behavioral aspects of disease to lessen chronic diseases burden on society.
• The Concept of Risk Factors came into existence.

Health For All Phase (1981-2000 AD)

• There was a health gap between rich & poor, within & between countries
• Aims to provide provision of health care to all by reducing the inequalities within & between the population so that individuals lead a socially & economically productive life.

Modern Public Life

• The increase in average lifespan during the 20th century is mainly due to public health achievements
  • Vaccination, Infectious Disease Control, Better Safety Policies (motor vehicle and worker safety), Improved family planning, emphasis on safe drinking water
• The focus has shifted towards chronic diseases like cancer, AIDS, diabetes, and heart diseases.

New Concepts in Public Health

• Public Health 2.0 aims to make public health more accessible and user-driven through participatory technologies.
• Public Health 3.0 challenges the leaders of business, the community, states lawmakers, and federal policymakers to incorporate health into all areas of governance.

Epidemiology - Determinants of Disease

• The primary determinant is the causative agent of a disease or disorder like bacteria, virus or parasite in a communicable disease.
• In a nutritional disorder, the specific nutrient is the primary determinant.
• In an automobile accident, the vehicle is the primary determinant.
• Secondary determinants include multiple factors, like socio-economic factors and the physical environment, influencing the disease.

Types of Epidemiological Studies

• Descriptive studies generate hypotheses and answer what, who, where, and when.
• Analytical studies test the hypotheses and answer why and how.

Descriptive Epidemiology

• Examines the distribution of a disease in a population.
• Observes the basic features of distribution regarding time, place, and person.

Descriptive Studies

• Descriptive studies are used to characterize who, where, or when in relation to the outcome.
• Person: characteristics (age, sex, occupation) of the individuals affected by the outcome
• Place: geography (residence, work, hospital) of the affected individuals
• Time: when events (diagnosis, reporting; testing) occurred

Analitical Studies

• A hypothesis is an educated guess about an association that can be tested with scientific investigation.
• Descriptive analysis is needed when developing hypotheses, Who? What? Where? When?)
• Hypotheses tend to have a narrower focus

Types of Cohort Studies

• Prospective cohort studies group participants according to past/current exposure to determine future outcomes.
• Retrospective cohort studies are conducted when potential exposure/outcomes have already occurred.

Case-Control Studies

• It is a study undertaken is to study rare diseases and multiple exposures related to a single outcome.
• Subjects are selected based on outcome status: case-subjects have the outcome of interest, whereas control-subjects do not have an outcome of interest.

Rules for Competition, Anti-corruption, and Transparency in Turkish Healthcare

• Turkish Criminal Code No. 5237 regulates against bribery and misconduct across all sectors.
• A law prohibits offering any benefit to influence the execution of a legal transaction (Article 252).
• Public officials cannot receive or give gifts related to their duties.
• There is a blacklist of goods/benefits that public officials cannot accept.
• Sector-Specific Rules for Pharmaceutical Companies regulate interactions with healthcare professionals, including congress sponsorship, donations, and materials.
• Pharmaceutical companies must notify value transfers exceeding 10% of the gross minimum wage.

Article 280 of the Turkish Criminal Code: Offenses Against the Court

• Healthcare professionals are legally obligated to report certain crimes encountered during their work.
• Failure to report a crime by covering it or delaying reporting it will result in a prison sentence of up to one year.
• Healthcare professionals include physicians, dentists, pharmacists, midwives, nurses, and other healthcare providers who perform duties that could potentially uncover criminal activity.

Definition of Prevention

• Actions that are geared at eradicating, eliminating, or minimizing the impact of the disease or disability
• Categorised as primary, secondary, and tertiary prevention.

Levels of Prevention: Primordial

• Applied prior to the emergence of risk factors.
• Providing health education achieves it.
• Examples include not starting smoking, preventing childhood obesity by teaching children good eating habits, and making bike ways.

Primary Prevention

• The most important risk factors are already present, but the disease has not yet started
• Health promotion is an important part of this and helps people to lead a healthy lifestyle
• Concept of Health Promotion was adopted in a conference held in Ottawa in Canada in November , 1986 (Ottawa Chapter, November 1986).
• July, 1997 Jakarta declaration was released and conveyed the concept of health promotion.

Health promotion includes

• Health education, environmental modification, nutritional intervention, and lifestyle and behavioral changes

Examples of primary prevention

• Providing safe water and sanitary latrines, controlling insects and Rodents, promoting breastfeeding and small family norms, and improvement in overall socioeconomic status of population, the use of helmets and seat belts to protect against head injuries, Chemoprophylaxis, and Vitamin A prophylaxis

Approaches for Primary Prevention

• The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are established.
• Population mass strategy where intervention is directed at the whole population irrespective of individual risk levels.
• HIgh Risk Strategy to bring preventive care to individuals at special risk. The requires detection of individuals at great risk for the optimum use of clinical methods.

Secondary Prevention

• It is the mode of intervention to diagnose the disease early and start treatment.
• The diseases has started but there are no complications
• Examples include Active search for Malaria cases, school health exams, PAP smear, MDT, DOTS, and self breast examination.

Tertiary Prevention

• Occurs when the disease has progressed leading to irreversibility.
• Includes limiting further damages by limiting it or undertaking rehabilitation.
  • Rehabilitation
    • Restoration of function, Restoration of capacity to earn a livelihood, Restoration of the family and social relationship, and restoration of personal dignity and confidence.
    • Types of rehabilitation
      • Vocational: training for job training, counseling
      • Social : helping individual reintegrate into their social environment by building social skills
      • Psychological : mental health therapies that promote emotional well-being.

Health Protection Levels

• Risk-Based Approach – Levels are determined based on the severity of public health threats (e.g., disease spread, environmental hazards, or food safety concerns).
• Preventive and Reactive Measures – Strategies range from basic hygiene practices to strict lockdowns or emergency responses.
• Government and Public Health Guidance – Policies, restrictions, and recommendations vary depending on health levels.

European Air Quality Index & Health Protection Levels

• The European Environment Agency (EEA) monitors and categorizes air pollution level
  • Green = no risk
  • Yellow = sensitive groups may experience minor effects.
  • Orange = health effects for vulnerable individuals; recommendations to limit outdoor activity.
  • Red = Significant health impacts; advisories to stay indoors.
  • Purple = Severe risk, emergency health measures may be required.

Food Safety & Disease Control (ECDC)

• The European Food Safety Authority (EFSA) and ECDC classify outbreaks and contamination risks using different levels: -Routine monitoring = regulated monitoring inspections
  • Increased surveillance = targeted testing for potential contaminations
  • Health Alert = public warnings about food products
  • The emergency Response = recall or contamination and border control measures.

Pandemic Preparedness & Infectious Disease Response (ECDC)

• The ECDC uses a phased approach to disease control:
  • Phase 1 (Interpandemic) is routine screening and vaccination.
  • Phase 2 (Alert Phase) indicates increased monitoring of outbreaks.
  • Phase 3 (Pandemic Phase) indicates full-scale public health interventions (vaccinations and mobility restrictions).
  • Phase 4 (Post-Pandemic) – aims to recovery and reinforcement of health systems.

Health Screening Tests

• Some common sense risks to account for are:
  • Age, gender, past medical history, family medial history and smoking status.

Health Screening Based on Risk Factors

• Advanced age or family history of diseases increase the need for specific screenings like increased risk of diabetes, liver cancer, etc
• Consulting a doctor is importnat

Types of Health Screening Test

• Under Singapore’s 2019 Screening Test Review Committee’s (STRC) guidelines, divided into:
  • Category 1 – Suitable for Everyone in the Population as health screening tests are proven by good and robust evidence to be clinically effective and cost effective for screening everyone in the population.
  • Category 2 – Suitable for Individual-Decision Making with high risk factors .
  • Category 3 – Not Recommended with no evidence or not cost-effective.

Community Identification

• The systematic process of knowing and exploring the defined community for assessing its health status and determining the possible factors affecting the health of the people in the community.
• first step of community health nursing process.

Data Collection Steps

• Uses a descriptive survey approach to gather broad data on community health. Requires careful planning to ensure comprehensive data collection.
• Helps identify health problems, resources, and social structures within the community, and should contain: -Define the Community (Identify the name, address, and type ) -Determine Objectives (Clearly state the purpose ) -Identify Specific Information Sources ( data will be collected from people, records, key informants) -IdentifY Population & Sampling- select respondents if using families or households as sampling units. -Decide on Sample Size & Method- Choose appropriate sampling techniques. -Select Methods & Instruments-Use tools like interview schedules, observation checklists, and community forum guidelines. -Conduct the Survey Plan and execute data collection systematically.

Objectives of Community Communication

• To create awareness about health issues.
• To promote positive health behaviors.
• To influence social norms and attitudes.
• To improve access to health resources and services

Key Principals of Effective Community Communication

• Clarity – Messages should be simple and easy to understand.
• Relevance – Information should be relevant to the community's needs.
• Cultural Sensitivity – Respecting cultural values and beliefs.
• Participation – Engaging community members in discussions.
• Feedback – Encouraging two-way communication.

Types of Community Communication

• (face-to-face, group discussions)
• Mass Media (radio, television, newspapers)
• Digital Platforms (social media, websites, mobile apps)
• Community Meetings and Forums
• Posters, Pamphlets, and Leaflets

Strategies for Effective Health Education

• Identify Community Needs – Assess health issues specific to the population.
• Use Multiple Communication Channels – Combine different media for outreach.
• Adapt to Literacy Levels – Use visuals, storytelling, and demonstrations.
• Involve the Community – Engage local leaders and stakeholders.
• Evaluate Impact – Measure behavior change and program effectiveness.

Health Educators are responsible for

• Delivering accurate and evidence-based health information.
• Motivating individuals to adopt healthier behaviors.
• Advocating for community health initiatives.
• Developing and implement educational programs.

Barriers to Effective Communication in Health Education

• Language Barriers.
• Cultural Differences.
• Misinformation and Myths.
• Limited Access to Media

Objectives of Family Health Nursing

• Identify health and nursing needs of each family.
• Ensure family’s understanding and acceptance of these needs.
• Plan and provide health services with family participation.
• Empower families to manage their own health independently.
• Support family development and health-related functions.
• Guide families in using community health facilities.
• Educate, counsel, and promote healthy personal and cultural practices.
• Maintain a wholesome physical, psychosocial, and spiritual environment.

Principles of Family Health Nursing

• Provide services without discrimination.
• Conduct periodic health evaluations.
• Maintain proper records and reports.
• Ensure continuous healthcare services.
• Integrate health education and supervision.
• Maintain good interpersonal relationships.
• Engage families in active participation.
• Offer realistic services based on available resources.
• Encourage community health contributions.
• Participate in improving healthcare systems.

Four Approaches to Family Health Nursing

• Family as the Context: Focus on the health of an individual within their family Environment and assesses the family’s role in meeting the individual’s needs.
• Family as the Client: The family as a whole is the focus with attention from each member When Influencing overall family health needs to be adressed
• Family as a System: The family is viewed as an interconnected system where Changes in one member affect all others.
• Family as a Component of Society: The family interacts with broader social Institutions like healthcare, education, and economy. Community health nursing Often applies this perspective.

Elements of Family Nursing Process

• Assessment: Identifying client’s problems.
• Diagnosis: Recognizing needs nurses can address.
• Planning: Creating a care strategy.
• Implementation: Providing nursing care.
• Evaluation: Measuring care success.

Principles of Home Visiting

• Purposeful and well-planned visits.
• Introduce yourself and explain the visit.
• Build trust and good relationships with families.
• Listen actively and provide scientific health education.
• Involve family members in care.
• Evaluate and document the visit.

Home Visiting Purposes

• Provide simple nursing care at home.
• Prevent diseases.
• Promote family health.
• Assess health, socio-economic, and cultural aspects.
• Provide midwifery care (pregnancy, delivery, postpartum).
• Educate about family planning, immunization, and nutrition.
• Deliver basic health services (minor ailments, counseling).
• Strengthen nurse-community relationships.

Advantages Of Home Visits

• Builds interpersonal relationships.
• Nurses can assess patients in their own home.
• Nurse can observe family dynamics and background.
• Can help identify hidden health problems.
• Patients feel more comfortable at home.

Bag Technique

• Keep the nursing bag and equipment clean and organized.
• Place it on a surface away from children/animals.
• Wash hands well before and after handling supplies.
• Use and sterilize only necessary equipment
• Safely dispose of all waste.

Bag Technique Key Steps:

1. Ensure the bag is clean and supplied.
2. Practice good hand hygiene.
3. Select all needed equipment.
4. Prevent contamination of bag.
5. Aseptic techniques should be followed at all times.
6. Safely dispose of waste.
7. Clean and disinfect items to place back in bag. To avoid reuse of disposable items avoid packing them. To avoid infections perform hand hygiene before packing or administering care.

Important Notice

• Since course presentations are private, using the texts and images contained herein on social media or else without permission from the course instructor is against the regulations Law No. 6698.