CHN.docx

CHN Theories Nursing theory provides the basis for care of the community and family. Health Belief Model Purpose is to predict or explain health behaviors. Assumes that preventive health behaviors are taken primarily for the purpose of avoiding disease. Emphasizes change at the individual...

CHN Theories Nursing theory provides the basis for care of the community and family. Health Belief Model Purpose is to predict or explain health behaviors. Assumes that preventive health behaviors are taken primarily for the purpose of avoiding disease. Emphasizes change at the individual level. Describes the likelihood of taking an action to avoid disease Perceived susceptibility, seriousness, and threat of a disease Modifying factors (e.g., demographics, knowledge level) V Cues to action (e.g., media campaigns, disease effect on family/friends, recommendations from health care professionals) Perceived benefits minus perceived barriers to acting Milio\'s framework for prevention Complements the health belief model. Emphasizes change at the community level. Identifies relationship between health deficits and availability of health- promoting resources. Theorizes that behavior changes within many people can ultimately lead to social change. Pender\'s Health Promotion Model Like Health Belief Model. Does not consider health risk as a factor that provokes change. Examines factors that affect individual actions to promote and protect health. VI Personal factors (biological, psychological, sociocultural), behaviors, abilities, self- efficacy Feelings, benefits, barriers, and characteristics associated with the action Attitudes of others, and competing demands and preferences ESSENTIALS OF COMMUNITY NURSING 1\. Determinants of health -factors that influence the client\'s health. Nutrition, stress, education, the environment, finances, and social status / stigma (prejudice). 2\. Health indicators (mortality rates, v disease prevalence, levels of physical activity, obesity, tobacco or other substance use) describe the health status of a community and serve as targets for the improvement of a community\'s health. Health Promotion Model Variables 1\. Individual characteristics and experiences 2\. Prior related behavior 3\. Personal factors 4\. Behavior-specific cognitions and affect 5\. Perceived benefits of action 6\. Perceived barriers to action 7\. Perceived self-efficacy 8\. Activity-related affect 9\. Interpersonal influences 10\. Situational influences 11\. Commitment to a plan of action 12\. Immediate competing demands and preferences 13\. Health -promoting behavior PRECEDE - Provides the structure for planning a targeted and focused public health program. Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation It involves assessing the following community factors: 1\. \_ Social assessment: Determine the social problems and needs ot a given population and 2\. \_ Epidemiological assessment: Identify the health determinants of the identified problems and set priorities and goals. 3\. - Ecological assessment: Analyze behavioral and environmental determinants that predispose, reinforce, and enable the behaviors and lifestyles are identified. 4\. Identify administrative and policy factors that influence implementation and match appropriate interventions that encourage desired and expected changes. 5\. al) Implementation of interventions. DIFFERENT FIELDS 1\. School Health Nursing - Promote the health of school personnel and students. It aims to prevent health problems that would hinder students learning and performance of their developmental task. 2\. Occupational Health Nursing -Aimed in assisting workers in all occupation 3\. Community Mental Health Nursing - Promotion of mental health and prevention of mental illness across the lifespan and across sectors. The services may include: 1\. Treatment Planning 2\. Medication Management 3\. Assessment 4\. Counseling 5\. Family Support 6\. Education 7\. Group Support- Facilitate services with visiting psychiatrists. Ex. referral 8\. Home Health Care 9\. Hospice Home Care CONCEPTS OF A COMMUNITY A community is a group of people sharing common geographic boundaries and or common values and interest within specific social system Maurer and Smith (2009) further addressed the concept of community and identified four defining attributes: \(1) people, (2) place, (3) interaction, and (4) common characteristics, interests, or goals. Combining ideas and concepts, in this text, community is seen as group or collection of locality-based individuals, interacting in social units and sharing common interests, characteristics, values, and /or goals. Types of Communities 1.Interest. Communities of people who share the same interest or passion. Action. Communities of people trying to bring about change. Place. Communities of people brought together by geographic boundaries 2\. Practice. Communities of people in the same profession or undertake the same activities. Types of Communities (Maurer & Smith, 2009) 3. Geo-political communities traditionally recognized or imagined when considering the term community. Geopolitical communities are defined or formed by both natural and man-made boundaries and include barangays, municipalities, cities, provinces, communities at congressional namasticisesnameich Borhoodical Geopolitical communities may also be called territorial communities. 4\. Phenomenological communities Phenomenological communities, in the other hand, refer to relational interactive groups, in which the place or setting is more abstract, and people share a group perspective or identity based in culture, values, history, interests, and goals. phenomenological communities include schools, colleges, and universities; churches, and mosques; and various groups or organizations. Characteristics of a Healthy Community A healthy community is one in which all residents have access to a quality 1.education, 2.safe and healthy homes, 3.adequate employment, 4\. transportation, 5.physical activity, and 6.nutrition, in addition to quality 7.health care. Characteristics of a Healthy Community (Hunt, 1997; Duhl, 2002) 1\. Shared sense of being a community based on history and values. 2\. General feeling of empowerment and control over matters that affects the community as whole. 3\. Existing structures that allow subgroups within the community to participate in decision making in community matters. 4\. Ability to cope with change, solve problems, and manage conflicts within the community through acceptable means. 5\. Open channels of communication and cooperation among the members of the community. 6\. Equitable and efficient use of community resources within the view towards sustaining natural sources. A healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources that enable people to mutually support each other in performing all the functions of life and developing to their maximum potential. AIMS: a\. Achieve a good quality of life b\. Create a health-supportive environment c\. Provide basic sanitation and hygiene needs d\. Supply access to health care Components of a Community 1\. O The people. The environment. 2\. The economy. Culture Health Quality of life Sources of Data \> Census is defined as an official and periodic enumeration of population. Demographic, economic and social data are collected from specified population group. \> Sample Survey. instead of census, demographic information collected from a sample of a given population \> Registration system are those that collected by the civil registrar\'s office deal with recording of vital events in the community. Vital events refer to births, deaths, marriages, divorce and the like. Other registration systems can also be used to describe specific characteristics of the population. Population Size Refers to the number of people in a given place or area at a given time. Composition When the population is characterized in relation to certain variables such as age, sex, occupation or educational level. Distribution It shows how people are distributed in a specific geographic location. B. PHILIPPINE HEALTH SITUATION 1\. Demographic Profile 2.Health Profile 2\. HEALTH INDICATORS The commonly used measures ot health status reflects disease and mortality, rather than health itself. Mortality rate data are widely used to describe the health status of population Crude Birth Rate A measure of one characteristic of the natural growth or increase of a population Crude Death Rate A measure of one mortality from all causes which may result in a decrease population. Infant Mortality Rate Measures the risk of dying during the Is year of life. It is a good index of the general health condition of a community since it reflects the changes in the environment and medical condition of a community. Maternal Mortality Rate Measures the risk of dying from causes related to pregnancy, childbirth and puerperium. It is an index of the obstetrical care needed and received by Women in a Community Specific Rate of Mortality Describes more accurately the risk of exposure of certain classes or groups to diseases. 1o understand the forces of mortality, the rates should be made specific provided the data are available for both population and the event in their specification. Leading Causes of Morbidity Cause Specific Death Rate Measures the no. Of deaths in specific cause registered in a a given vear Estimated population as of the same year Life Expectancy is calculated by constructing a life table. A life table incorporates data on age- specific death rates for the population in question, which requires enumeration data for the number of people, and the number of deaths at each age for that population. Life expectancy at birth is the total person-years lived beyond exact age 0 (newborns - column 5 - Tx) divided by the number of newborns (100,000) Swaroop\'s index is the percentage of the deaths aged 50 years or older. Its inverse represents the percentage of untimely deaths (those who died younger than 50 years). B.PHILIPPINE HEALTH SITUATION 1\. Demographic Profile C.EPIDEMIOLOGY AND THE NURSE 1\. Definitions and Related Terms Epidemiology \- the stud ot ot the occurrence and distmbution of health conditions such as disease, death, deformities, or disability on human population. It also concerned with the study of probable factors that influence the development of these health conditions USES OF EPIDEMIOLOGY \> Study the history population and the rise and fall of diseases and changes in their character Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence, \> Study the work of health services with a view of improving them. Operational research shows how community expectations can result in the actual provisions of service. Estimate the risk of disease, accident, detects, and the chances of avoiding them. Identity syndrome by describing the distribution and association of clinical phenomena in the population FUNCTION OF THE EPIDEMIOLOGY NURSE 1\. Implement public health surveillance Natural Life History of Disease Describing the natural history of the disease seeks to identify factors related to the course ot a disease once established in order to determine its duration and the probability of the various possible outcomes such as recovery, death or specific complications. Understanding the natural history of disease will help institute measure to prevent pathologic processes from further evolving. Stages of Natural History of Disease 1\. Prepathogenesis or susceptibility \- in this stage, disease has not developed but factors that favors its occurrence are present 2\. Pathogenesis- disease has developed and has 3 sub- stages: A. Pre- symptomatic disease or early pathogenesis - individual has no symptoms that indicate presence of illness A. Pre- symptomatic disease or early pathogenesis - individual has no symptoms that indicate presence of illness. B. Discernible lesions - changes maybe detectable through sophisticated laboratory test, during this period the early signs and symptoms of disease are developing C. Advanced disease - anatomical and functional changes have produced recognizable signs and symptoms These stages have relevance to the concept of levels of disease prevention. 3\. Epidemiological Triangle Components of Epidemiological Triangle Agent is the intrinsic property of microorganism to survive and multiply in the environment to produce disease Causative agent is the infectious agent or its toxic component that is transmitted from the source of infection to the susceptible body Host is any organism that harbors and provides nourishment for another organism. Environment is the sum total of all external condition and influences that affects the development of an organism which can be biological, social and physical. It affects both the agent and the host. Three components of the Environment 1\. Physical environment is composed of the inanimate surroundings such as the geophysical conditions of the climate. 2\. Biological environment makes up the living things around us such as plants and animal life. 120 YEARS OF 3.. Socio-economic environment which maybe in the form of level of economic development of the community. o IG 4\. Epidemiological Process and Investigation 2 MAIN AREAS OF INVESTIGATION The study of the distribution of diseases The search for determinants (causes) of disease and it\'s observed distributions DISTRIBUTION Describes the distribution of health status in terms of gender, race, geography, time and so on might be considered in an expansion of the discipline of demography to health and disease. DETERMINANTS Involves explanation of the patterns of disease distribution in terms ot causal ractors. EPIDEMIOLOGICAL STUDIES The purpose of an analytic study in epidemiology is to identify and quantify the relationship between an exposure and a health outcome. The hallmark of such a study is the presence of at least two groups, one ot which serves as a comparison group. CATEGORIES EXPERIMENTAL STUDIES In an experimental study, the investigator determines the exposure for the study subjects; OBSERVATIONAL STUDIES in an observational study, the subjects are exposed under more natural conditions. between the exposed and unexposed groups lead investigators to conclude that exposure is associated with disease Observational case-control study, sublects are enrolled according to whether they have the disease or not, then are questioned or tested to determine their prior exposure. Differences in exposure prevalence between the case and control groups allow investigators to conclude that the exposure is associated with the disease Cross-sectional studies measure exposure and disease status at the same time, and are better suited to descriptive epidemiology than causation. Approach to disease and Determinants The present epidemiology approach is based on the interaction of thecausative agent and the environment. Essentially, epidemiology patterns depend upon these factors which influence the probability of contact between an infectious agent and susceptible host. Disease distribution The method and technique of epidemiology are desired to detect the cause of a disease in relation to the characteristic of the person who has it or to a factor present in his environment. Since neither population and environment of different times or places are similar, these characteristics and factors are called epidemiologic variables. TIME refers both to the period during which the cases of disease being studied were exposed to the source of infection and the period during which the illness PERSON refer to the characteristics of the individual who were exposed and who contacted the infection of the disease in question. PLACE refers to the features, factor or conditions which existed in or described the environment in which the diseases occurred Urban/ Rural Differences: diseases spread more rapid in urban areas than in rural areas primarily because of the greater population. Patterns of Occurrences and Distribution The variables of disease as to person, time and place are reflected in distinct patterns of occurrence and distribution in given community. The following are the characteristic of patterns of disease occurrence; SPORADIC OCCURRENCE Intermittent occurrence of a few isolated and unrelated cases in a given locality. The cases are few and scattered, not related, occur on and off, intermittently Rabies occurs sporadically in the Philippines, he cases are scattered throughout the country, so that the cases are not related at all to the cases in other areas. ENDEMIC OCCURRENCE is the continuous occurrence throughout a period of time, of the usual number of cases in a given locality. Tuberculosis is endemic in all specific areas of the country. EPIDEMIC OCCURRENCE is of unusually large number of cases in a relatively short period of time. Bird\'s flu, there has been no case in any area of the country, the occurrence of few cases in a given area in a oven time would constitute a hird\'s flu epidemic PANDEMIC OCCURRENCE is the simultaneous occurrence of epidemic of the same disease in several countries. It is another pattern of occurrence from an international perspective. Corona Virus has been existed and with different pattern of occurrence in the present as we call it now COVID- A. Community Health Assessment Tools Three Important tools in identifying community\'s health needs. Demography Vital Statistics and Epidemiology To recognize the health status of the community these elements are to be considered: Population the physical and topographical characteristic Socio- economic and cultural factors health and basic social services and the power structure within the community 1\. Collecting primary data Primary data are directly obtained to answer the community diagnosis objectives A Observation - This method provides an opportunity to check the validity or truth of many verbal statements. It is an important and useful method of collecting data when informants are unable to directly supply information. B. Survey- Ocular survey or windshield survey walking or driving through community appreciating what can be seen and perceived as the people go along with their daily lives. C. Informant Interview- It involves asking and answering questions following a systematic procedure aimed at yielding firsthand information from the subject of inquiry. Face-to-face interview, Telephone interview D. Community Forum Individual interview E. Focus Group Discussion- It is very popular method appropriate in the community to elicit and explore opinions of people, determine their attitudes and practices regarding a limited set of concept 2\. Secondary Data Sources Data that are obtained by other people which can be used to answer the community diagnosis Records are written information that are kept in folders. Data may be obtained by reviewing those that have been compiled by health or non-health agencies the government or other sources 3.Methods of present Community Data 1\. Survey questionnaire \- Form one uses to document the data being collected 2\. Focus group discussion guide \- Serves to facilitate the direction and flow of exchange of ideas on specific topics or concepts among the participants 3\. Key informant interview guide \- Helps give direction to the person doing the interview using a set of prepared questions on a very specific subject. 4\. Observational checklist B. Community Diagnosis 1\. Types of Community Diagnosis Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis § Comprehensive Community Diagnosis Aims to obtain general information about the community through epidemiologic approach, socio-economic approach, and behavioral approach \* Problem-Oriented Community Diagnosis- Characterize the biophysical, psychological, physical environmental, socio-cultural and behavioral as well as system factors relevant to specific problem being investigated. A. Demographic Variables Shows the size, composition and geographical distribution of the population. Total population and geographical distribution including urban-rural index and population density 1\. Age and sex composition 2\. Household size 3\. Selected vital indicators 4\. Patterns of migration 5\. Population projections B. Socio-Economic and Cultural Variables SocIO-economic and cultural factors that directly or indirectly aftect the health status of the community. 1\. Social indicators 2\. Economic indicators 3\. Environmental indicators 4\. Cultural factors 5\. Health and Illness Patterns Data about leading causes of illness and deaths and their respective rates of occurrence 1\. Leading causes of mortality 2\. Leading causes of morbidity 3\. Leading causes of infant and child mortality 4\. Leading cause of maternal mortality 5\. Leading cause of hospital admission 6\. Leading cause of clinic consultation 7\. Nutrition status Health Resources Resources that are available in the community that essential in the delivery of basic health services 1\. Manpower resources 2\. Material resources Steps in Conducting Community Diagnosis 1\. Determining the objectives 2\. Defining the study population 3\. Determining the data to be collected Schemes in Stating Community Diagnosis Diagnosis After analyzing the data, the next step is to make a definitive statement (diagnosis) identifying what the problem is or the needs are. Nursing diagnoses for communities may be formulated regarding the following issues: Inaccessible and unavailable services Mortality and morbidity rates Communicable disease rates Specific populations at risk for physical or emotional problems Health-promotion needs for specific populations Community dysfunction Environmental hazards (ANA, 1986)