Public Health Prevention Strategies

Community Health Nursing

• Community health nursing is a synthesis of nursing and public health practices, aimed at promoting and preserving population health.
• Public health is a science and an art focused on preventing disease, prolonging life, and promoting health and efficiency
• Core public health functions include assessment, policy development, and assurance.
• Assessment involves regularly gathering data on health conditions, risks, and resources within a community.
• Policy development uses assessment data to create local and state health policies and allocate resources.
• Assurance focuses on ensuring the availability of necessary health services throughout the community.
• Direct community services are delivered through environmental health services (e.g., protecting from polluted water/food) and personal health care services (e.g., immunizations, family planning, maternal care).
• Community health nursing has essential public health functions such as monitoring health situations and disease prevention and control; developing, planning, and managing health systems; and regulating to ensure public health.
• Essential public health functions also include human resources development and planning within public health; promoting health with social involvement/empowerment and ensuring quality, personal, and population-based health services; and researching, developing, and implementing innovative solutions.
• Preventive approaches to health involve health promotion for well-being and disease preventions to prevent disease.

Levels of Prevention

• Primary prevention: Aims to prevent a health problem before it occurs using general health promotion and specific protection strategies.
  • Examples of primary prevention strategies include promoting good nutrition, providing adequate shelter, and encouraging regular exercise.
• Secondary prevention: Focuses on early detection and prompt intervention during the pathogenesis of a disease. Screening and intervention occur after the problem has begun but before signs and symptoms are obvious.
  • Examples include mammography, blood pressure screening, and newborn screening.
• Tertiary prevention: Aims to prevent the deterioration of a disease state and restore individuals to their optimal level of functioning. Activities focus on reducing the effects of disease/injury and restoring optimal functioning
  • Examples include teaching insulin administration techniques and referring a patient with spinal cord injury to physical/occupational therapy.

Definitions of Health and Community

• Health: A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1958). It involves purposeful, adaptive responses physically, mentally, emotionally, spiritually, and socially (Murray et al., 2009).
• Actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationships with others (Pender et al., 2006). It's also a state of wholeness and optimal functioning of bodily and mental structures (Orem, 2001).
• Community: A collection of people interacting with shared interests or characteristics that lead to a sense of unity and belonging (Allender et al., 2009). A community can be a group having commonalities and interacting; they might also have a commitment towards one another and geographic boundaries (Lundy and Janes, 2009). A locality based entity composed of systems of formal, informal organizations (Shuster and Goeppinger, 2008). Composed of individuals who interact socially, sharing common characteristics, values, interests, and goals (Maurer and Smith, 2009).

Key Concepts

• Geopolitical communities: These are traditionally recognized communities defined by natural or man-made boundaries (e.g., barangays, municipalities, provinces, regions).
• Phenomenological communities: These communities are relational and interactive groups defined by shared perspectives, values, and goals (e.g., schools, colleges, universities, churches).
• Functional communities: Group of people who interact with each other to address specific needs or concerns. (e.g. Gawad Kalinga)
• Population: A group of people sharing common personal characteristics or environmental factors, or that collectively make up a particular geographic area.
• Aggregates: Subgroups or subpopulations sharing common characteristics or concerns (e.g., age groups)

Determinants of Health and Illness

• Social and economic environment
• Physical environment
• Personal characteristics and behaviors (includes income, education, physical environment, and employment)
• Social support networks
• Culture
• Genetics
• Personal behavior and coping skills
• Health services
• Gender

Indicators of Health and Illness

• Life expectancy
• Infant mortality
• Maternal mortality
• Age-adjusted death rates
• Disease incidence rates

Community Health Nursing Practice

• Population-focused approach emphasizing community health interventions and community-based practice to improve the health status of entire communities.
• Assesses the entire population to identify any health differences
• Emphasizes all levels of prevention.

Levels of Clientele

• Individual
• Family
• Group
• Community
• Family: Basic unit of care

Intervention Wheel

• Framework for community and public health nursing.
• Population-based
• 3 levels of practice: Community, Systems, Individual/family
• Identifies public health interventions (17)

Emerging Fields in Community Health Nursing (Philippines)

• Public Health, Occupational Health, and School Health

Home Health and Hospice Care

• Home health care provides nursing care in individuals/family homes minimizing illness related effects.
• Hospice care is a type of home care specifically for terminally ill clients to provide comfort.

EntrepreNurse

• A project to reduce health care costs, maximize employment, and utilize unemployed human resources for public health delivery.

Faith Community Nursing

• This combines spiritual care with nursing.

Competency Standards in Community Health Nursing

• Safe and quality care.
• Knowledge of client's health status
• Sound decision making, comfort and privacy.
• Priority setting based on client needs
• Medication/therapeutic administration
• Use of nursing process
• Management of resources and environment
• Health Education
• Legal responsibility to nurses
• Professional/Personal Development
• Involvement in professional and civic activities
• Quality improvement
• Research
• Records Management
• Communication.

Public Health Nursing in the Philippines

• History of public health initiatives spanning centuries, including early medical dispensaries, water systems, vaccinations.
• Development of formal health programs and structures (e.g. 1901 creation of the Board of Health, 1912 Fajardo Act, RA 1082, Rural Health Act).
• Implementation of the Local Government Code and the Universal Health Care initiative.