Approaches to Community Health Nursing PDF

UNIVERSITY OF KIRKUK COLLEGE OF NURSING STAGE: FOUR APPROACHES TO COMMUNITY HEALTH NURSING LECTURER NAME: DR. NAZAR AHMED MAHMOOD Three approaches in community health nursing are: 1. Health promotion. 2. Case management. 3. Community Empower...

UNIVERSITY OF KIRKUK COLLEGE OF NURSING STAGE: FOUR APPROACHES TO COMMUNITY HEALTH NURSING LECTURER NAME: DR. NAZAR AHMED MAHMOOD Three approaches in community health nursing are: 1. Health promotion. 2. Case management. 3. Community Empowerment. 2 Health Promotion 3  Six distinct approaches have been taken to public health over time. These approaches are illustrated in the following table: 4 Health Promotion “Is a process that fosters people’s ability to improve their own health by increasing their control of its determining factors.” (WHO, 1986) Health promotion is more than educating people to change their behavior; it also involves: public policy formation, development of environments that support health, and promotion of community action to create conditions conducive to good health. 5 Models of Health Promotion A number of models have been developed to guide health promotion practice. These include: 1. The Precaution Adopted Process Model 2. The Theory of Reasoned Action. 3. The Health Belief Model 4. Pender's Health Promotion Model 5. The PRECEDE-PEROCEED Model 6. The Health-Illness Continuum Model 7. The Agent-Host-Environment Model 6 1. The Precaution Adopted Process Model The Precaution Adoption Process model is a stage model that describes stages in decisions to adopt or not adopt a health-related behavior (whether or not to take a specific precautionary action). In stage 1, the person is unaware of the health-related issue and the need to adopt any particular health-related behavior. In stage 2, one is aware of the issue but is unengaged by it and is not considering any action. In stage 3, the person is deciding whether or not to act. He or she has considered the possibility of action but has not yet made a decision whether or not to adopt the behavior. This stage may be followed by either stage 4 or stage 5. In stage 4, the person has decided not to act. In stage 5, the person has decided to act but has not yet taken action. In stage 6, they act to engage in the behavior. In stage 7, the behavior becomes a routine part of their lifestyle. 7 8 2. The Theory of Reasoned Action. Is based on two types of beliefs: A. Behavioral beliefs reflect a person’s attitudes toward the expected consequences of the behavior. For example, if you expect that exercise will result in a more desirable figure, and if you value that more desirable shape, you are likely to value, and engage in, exercise. B. Normative beliefs relate to subjective norms influenced by others. In the theory, the intention to act is based on one’s perceptions of others’ attitudes toward the behavior and the value placed on others’ judgments. According to the related Theory of Planned behavior, action is also influenced by perceptions of one’s ability to control behavior. Behavioral beliefs, normative beliefs, and control beliefs all combine to result in behavioral intention, which is the precursor to actual behavior 9 10 Example, If you want to quit smoking (behavioral belief) and perceive that significant others in your life want you to quit (normative belief), but you think stopping smoking will be too difficult (control belief), you will probably not attempt to quit even though your own attitudes and those of people who matter to you support quitting. 11 3. The Health Belief Model − The health belief model is concerned with what people perceive, or believe, to be true about themselves in relation to their health. − Elements of the model include: Individual perceptions of susceptibility and severity, Modifying factors (demographic, sociopsychologic, and structural or environmental variables), Perceptions of benefits and barriers to action, and cues to action. - It's wildly used in research and program development related to health promotion behaviors. This model is based on four premises or beliefs: First, one believes that one is susceptible to, or at risk for, a particular health problem. Second, one believes that the health problem can have serious consequences. Third, one believes that the problem can be prevented. Fourth, that the benefits of action outweigh the costs or barriers 12 13 Example,  You may believe that, never having had chickenpox as a child, you are susceptible to chickenpox (perceived susceptibility).  You also believe that chickenpox may cause serious consequences (perceived severity).  This perception is confirmed when one of your classmates is hospitalized with complications of chickenpox (cue to action).  In addition, you know that varicella immunization will virtually eliminate your risk of developing chickenpox (perceived benefit to action).  Even though you know the possibility of an adverse reaction to the vaccine exists and you have to skip lunch to visit the student health center (perceived costs),  Finally, you decide the benefits outweigh the barriers, and you get immunized. 14 4. Pender's Health Promotion Model In this Model, behavior is influenced by individual characteristics and behavior- specific cognitions and affect (emotion) that result in a commitment to action. Individual characteristics and experiences include Personal biologic, psychological, and sociocultural factors, including age, gender, strength, self- esteem. Behavior-specific knowledge (cognition) and affect include the belief that there will be a positive outcome from a specific health behavior that one has the skill and competence to engage in health behaviors, and that one is affected by the interpersonal influences of others (especially family, peers, and healthcare providers). 15 16 Factors influencing Health Promotion A number of important factors may influence the health promotion situation: 1. Fatalisms: “the general belief that all events, and in particular, the actions and occurrences that form an individual life, are determined by fate”. Fatalistic beliefs have often been found to be associated with lower rates of participation in health promotion, prevention, and screening activities. 2. Readiness for change: people only engage in change when they are good are ready to do so. The smoker, for example, must be ready to quit smoking. 3. Health literacy: “a person’s ability to read, write, speak, and solve problems at levels needed to function in society”. 4. The attitudes of health professionals toward health promotion: 17 Strategies for Health Promotion Community health nurses use a variety of strategies to foster health promotion at the population level. 1. Health education provides the information and skills required to make effective health-related decisions. 2. Social marketing and the related concepts of branding and tailoring emphasize enhancing people’s motivation to act and reflects the view of personal agency. Motivating people to actually take advantage of opportunities for physical activity present in the community exemplifies social marketing. 3. Legislative action, may mandate health promotion activities, such as motorcycle helmet use, or create conditions conducive to health promotion. 4. The use of community health workers to promote healthy behavior within the population capitalizes on the influence of trusted members of the community. 18 Case Management 19 Case Management "A process of identifying needs for and arranging, coordinating, monitoring, and evaluating quality, cost-effective primary, secondary, and tertiary prevention services to achieve designated health outcomes". Case management is a collaborative process between the case manager and the client and his or her family designed to identify and meet health care needs through quality, cost-effective services. This definition highlights two key elements of case management: quality and cost-effectiveness. Levels of Case Management 1. Individual case management and their family. 2. Population case management: a set of services and interventions that address the health needs of a particular targeted population. Key components of population health management include identification of the population, assessment of population health needs, risk stratification for those most in need of services, engagement and communication, health management interventions, and outcomes measurement. 20 Advantages of Case Management for Clients 1. Better coordination of care 2. Assistance in negotiating a complex health care system 3. Access to acceptable and affordable health care services 4. Attention to multiple health care needs 5. Improved health outcomes 6. Continuity of care and consistent assistance 21 Advantages for Health Care Systems 1. Reduced cost of care 2. Minimization of hospitalization 3. Prevention of re-hospitalization 4. Elimination of service duplication 5. Ease of transfer among agencies 6. Better communication among agencies and providers 7. Increased access to services 8. Decreased paper work 9. Reduced time for authorization of services 22 Community Empowerment 23  Community health nurses act on behalf of individuals, families, and population groups that, for whatever reason, cannot act for themselves. The ultimate outcome of advocacy by population health nurses, however, is the ability of the client to act independently. Community empowerment, is designed to accomplish that outcome “the ability of the client to act independently”, by enabling communities to identify community health problems, and taking steps to resolve them independently of or in concert with health care professionals and others. Community Empowerment: “An enabling process through which individuals or communities take control over their lives or their environment”. 24 25 Community empowerment arises from activities related to: o Community Development: providing a voice in decision making for disadvantaged groups in population. o Community Organizing: groups are helped to recognize common problems or goals. o Community Mobilization: working with groups to provide assessment, interventions, and evaluations. o Community Building: continuous efforts to engage in collective action to create new social capacities, networks for group action and support. Community empowerment results in increased: o Community Competence, the ability of community to engage in effective problem solving. o Community Capacity, abilities, behaviors, values that enable individuals and groups to carry out functions and achieve their objectives. 26