NCM 113 Community Health Nursing Notes PDF

NCM 113: Community Health Nursing 2 (LEC) NCM 113: Community Health Nursing 2 - Health is a state of complete (Population, Groups and Community as Clients) physical, mental and social Module 1: Com...

NCM 113: Community Health Nursing 2 (LEC) NCM 113: Community Health Nursing 2 - Health is a state of complete (Population, Groups and Community as Clients) physical, mental and social Module 1: Community Health Nursing well-being and not merely the A. DEFINITION absence of disease or infirmity. COMMUNITY HEALTH NURSING ( WHO, 2010) - "Service rendered by a professional - Health is more than a state of well-being. nurse to: - It is a multidimensional reality that communities, groups, includes socioeconomic, families, and individuals at environmental and even political home, factors. in health centers, in clinics, in - Healthere needs to be holistic. schools, and in places of - The nurse in the community foster work interdisciplinary efforts to address for the promotion of health, various core determinants of health. prevention of illness, care of the sick at home, and 3. Nursing as the vehicle or means to rehabilitation. " achieve its aims (Ruth B. Freeman) - Nursing is the art and science of - "Nursing practice in a wide variety caring. of community services and - According to Florence Nightingale consumer advocate areas, and in a (1973), nursing is a means of variety of roles, at times including ensuring that people are placed in independent practice… an optimum condition where Community nursing is certainly not nature can contribute to healing and confined to public health nursing wellness. agencies." (Jacobson, 1975) - "The utilization of the nursing B. PHILOSOPHY AND PRINCIPLES process in the different levels of Philosophy of CHN clientele - individuals, population Community Health nursing is a groups and communities, concerned philosophy of care (Hunt, 2005). with the characterized by: - promotion of health, 1. Collaboration, - prevention of disease and 2. Continuity of care, - disability and rehabilitation." 3. Client and family responsibility (Maglaya, et al) for self-eare, and 4. Preventive health care GOAL: Raise the level of citizenry by helping communities and families to cope Community-based nursing focuses on an with the discontinuities in and threats to individual and is family-centered in health in such a way as to maximize their orientation. potential for high-level wellness" - Nisce, et al Philosophy 2 MAJOR FIELDS OF NURSING IN THE 1. The practice of community and PHILIPPINES public health nursing is anchored on 1. COMMUNITY HEALTH NURSING: the primary of the worth and dignity A. School Health Nursing of man. B. Occupational Health Nursing 2. Respect for people's inherent value C. Community Mental Health Nursing regardless of their background and 2. HOSPITAL NURSING OR beliefs are edified in the universal INSTITUTIONAL NURSING bioethical principles. 3. Responsibility for health rests 3 Basic Concepts of Community and primarily on people and not on Public Health Nursing agencies or professionals. 1. Community as a client 4. The need for the attainment of 2. Health as a goal independence and self-reliance in 3. Nursing as a means or vehicle to health. achieve its aim 5. Health is a shared responsibility and therefore requires collective efforts 1. The community as a client from all sectors. Working with - Community is a collection of people communities requires active who interact with one another and participation of the people. whose common interests or 6. A fundamental commitment of characteristics form the basis for a community and public health nurses sense of unity or belonging is to adhere to the tenets of social (Alexander et al., 2009) justice. This principle speaks of promoting common good and not 2. Health as a goal merely to be fair to all.  NCM 113: Community Health Nursing 2 (LEC) 7. One hallmark of the profession is 3. Ecology oriented having its own code of ethics. 4. Promotes social justice 5. Values consumer involvement Principles of CHN 6. Uses prepayment mechanism The community is the patient in 7. Focuses on preventive service CHN, 8. Offers comprehensive care the family is the unit of care and Four levels of clientele: 3 features of a Community ○ Individual according to Allender et al., 2009; Hunt, 2009 ○ Family, 1. People ○ population group [those who 2. Location share common 3. Social system characteristics, developmental stages and D.THEORETICAL MODEL/ APPROACH common exposure to health problems - eg children, Community Health Nursing Theories elderly. - Nursing theory provides the basis for the community care of the community and family. - Theorists have developed sound CHN principles to guide nurses in providing high quality care. - the client is considered as an ACTIVE partner NOT PASSIVE Health Belief Model recipient of care. - practice is affected by developments Purpose is to predict or explain in health technology, in particular, health behaviors. changes in society, in general. Assumes that preventive health - The goal is achieved through behaviors are taken primarily for the multi-sectoral efforts. purpose of avoiding disease. - Part of the healthcare system and Emphasizes change at the individual the larger human services system. level. Describes the likelihood of taking an Principles of Community and Public action to avoid disease. Health Nursing - Perceived susceptibility, seriousness, and threat of a disease 1. Focus on the community as the unit - Modifying factors (eg.. of care. demographics, knowledge level) 2. Give priority to community needs. - Cues to action (eg, media 3. Work with the community as an campaigns, disease effect on equal partner of the health team. family/friends, recommendations 4. In selecting appropriate activities, from health care professionals) focus on primary prevention. - Perceived benefits minus perceived 5. Promote a healthful physical and barriers to taking action psychosocial environment. 6. Reach out to all who may benefit Milio's framework for prevention from a specific 7. Promote optimum use of resources. Complements the health belief 8. Collaborate with others working in model. the community. Emphasizes change at the community level. C. FEATURES OF CHN Identifies the relationship between health deficits and availability of It is a specialty field of nursing. health- promoting resources. Its practice combines public health Theorizes that behavior changes with nursing. within a large number of people can It is population based. ultimately lead to social change. It emphasizes wellness and other than disease or illness. Pender's Health Promotion Model It includes inter-disciplinary collaboration. Similar to the Health Belief Model. It amplifies the client's responsibility Does not consider health risk as a and self-care. factor that provokes change. Examines factors that affect Characteristics and Features of individual actions to promote and Community and Public Health Nursing protect health. 1. Developmental ○ Personal factors (biological, 2. Multidisciplinary psychological, sociocultural),  NCM 113: Community Health Nursing 2 (LEC) behaviors, abilities, It involves assessing the following self-efficacy community factors： ○ Feelings, benefits, barriers, 1. Social assessment: Determine the and characteristics social problem and needs of a given associated with the action population and identify desired ○ Attitudes of others, and results. competing demands and 2. Epidemiological assessment: preferences Identify the health determinant of the identified problems and set priorities ESSENTIALS OF COMMUNITY NURSING and goals. 1. Determinants of health - factors 3. Ecological assessment: Analyze that influence the client's health. behavior and environmental - Nutrition, stress, education, the determinants that predispose, environment, finances, and social reinforce, and enable the behaviors status/stigma (prejudice). and lifestyles are identified. 2. Health indicators 4. Identify administrative and policy - mortality rates, factors that influence implementation - disease prevalence. and match appropriate interventions - levels of physical activity that encourage desired and - obesity, tobacco or other substance expected changes. use] describe the health status of a 5. Implementation of interventions community and serve as targets for the improvement of a community's PROCEED - structure for implementing and health. evaluating the public health program. Health Promotion Model Variables STANDS FOR: 1. Individual characteristics and Policy, experiences Regulatory, and 2. Prior related behavior Organizational 3. Personal Factors Constructs in 4. Behavior-specific cognitions and Educational and affect Environmental 5. Perceived benefits of action Development 6. Perceived barriers to action 7. Perceived self-efficacy It involves the identification of desired 8. Activity-related affect outcomes and program implementation 9. Interpersonal influences 1. Implementation: Design 10. Situational influences intervention, assess availability of 11. Commitment to a plan of action resources, and implement programs. 12. Immediate competing demands and 2. Process Evaluation: Determine if preferences the program is reaching the targeted 13. Health-promoting behavior population and achieving desired goals. Lawrence Green's 3. Impact Evaluation: Evaluate the PRECEDE-PROCEED MODEL change in behavior. 4. Outcome Evaluation: Identify if A comprehensive structure for there is a decrease in the incidence ○ assessing health needs for or prevalence of the identified designing, negative behavior or an increase in ○ implementing, and identified positive behavior. ○ evaluating health promotion and other public health E. DIFFERENT FIELDS programs to meet those 1. School Health Nursing - Promote needs. the health of school personnel and students. It aims to prevent health PRECEDE - Provides the structure for problems that would hinder students' planning a targeted and focused public learning and performance of their health program. developmental task. 2. Occupational Health Nursing - STANDS FOR: Aimed in assisting workers in all Predisposing, occupations to cope with actual and Reinforcing, and potential stresses in relation to their Enabling work and work environment. Constructs in 3. Community Mental Health Nursing Educational - Promotion of mental health and Diagnosis and prevention of mental illness across Evaluation the lifespan and across sectors.  NCM 113: Community Health Nursing 2 (LEC) The services may include: (1) people, 1. Treatment Planning (2) place, 2. Medication Management (3) interaction, and 3. Assessment (4) common characteristics, 4. Counseling interests, or goals. 5. Family Support Combining ideas and concepts, in 6. Education this text, a community is seen as a 7. Group Support - Facilitate services group or collection of locality-based with visiting psychiatrists. Ex. referral individuals, interacting in social units 8. Home Health Care - helps in and sharing common interests, providing nursing care to the characteristics, values, and/or goals. individuals and families in their own place of residence mainly to A. TYPES OF COMMUNITY minimize the effects of illness and disability. Interest - Communities of people 9. Hospice Home Care - specifically who share the same interest or rendered to the terminally ill, passion. intended to provide comfort to Action - Communities of people improve quality of life and provide trying to bring about change. support to the patient and family. Place - Communities of people 10. Faith community nursing - or parish brought together by geographic nursing is the practice of art and boundaries. science and nursing combined with Practice - Communities of people in spiritual care. the same profession or undertake the same activities F. CONCEPT OF THE COMMUNITY A. Types of Communities A community is a group of people (Maurer & Smith, 2009) sharing common geographic boundaries and or common values 1.) Geo-political communities and interest within specific social - are most traditionally recognized or system. imagined when considering the term Communities also vary in terms of community. community dynamics- citizen - are defined or formed by both participation, power and decision natural and man-made boundaries making structures and community and include barangays, collaboration efforts (Allender and municipalities, cities, provinces, Spradley). regions, and nations. Webs of people shaped by - Other commonly recognized relationships, interdependence, geopolitical communities are mutual interests and patterns of congressional districts and interaction (Behringer and Richards). neighborhoods. "a collection of people who interact - may also be called territorial with one another and whose communities. common interest or characteristics 2.) Phenomenological communities form the basis for a sense of unity or - refer to relational, interactive groups, belonging" (Allender et al., 2009). in which the place or setting is more "a group of people who share abstract, and people share a group something in common and interact perspective or identity based in with one another, who may exhibit a culture, values, history, interests, commitment with one another and and goals. shade a geographic boundary" - Examples of phenomenological (Lundy & Janes, 2009); communities include schools, "a group of people who share colleges, and universities; churches, common interests, who interact with and mosques; and various groups or each other, and who function organizations. collectively within a defined social structure to address common B. Characteristics of a Healthy concerns" (Clark, 2008). Community "a locality-based entity, composed of systems of formal organizations A healthy community is one in which reflecting society's institutions, all residents have access to a informal groups and aggregates" quality: (Shuster & Goeppinger, 2008). ○ Education, Maurer and Smith (2009) further ○ Safe and healthy homes, addressed the concept of community ○ Adequate employment, and identified four defining ○ Transportation, attributes:  NCM 113: Community Health Nursing 2 (LEC) ○ Physical activity, and - A group of people is the most ○ Nutrition, in addition to fundamental or essential component quality of a community. ○ Health care. - When a group of people live A healthy community is, in fact, the together and share a common life context of health promotion defined and bind by a strong sense of in the Ottawa Charter (WHO, 1986) community consciousness at that as "the process of enabling people moment a community is formed. to increase control over and to - Hence a group of people is the first improve their health." prerequisite of community. II. The Environment as Component Characteristics of a Healthy Community of Community (Hunt, 1997; Duhl, 2002) - The environment as a component, Shared sense of being a community influences lifestyle in any community based on history and values. setting and it is an indispensable General feeling of empowerment component it cannot be overlooked. and control over matters that III. The Economy/Economic System Existing structures that allow as a Component of the subgroups within the community to Community participate in decision making in - Since communities are made of community matters. people who ultimately interact with Ability to cope with change, solve their physical and social problems, and manage conflicts environment, thus making the within the community through community good for business and acceptable means. employment. Open channels of communication - Many businesses stabilize the and cooperation among the economy and improve the social members of the community. conditions. Equitable and efficient use of IV. Health as a Component of the community resources within the view Community towards sustaining natural sources. - As humans it is the ability of individuals or communities to adapt A healthy city is one that is continually and self manage when facing creating and improving those physical and physical, mental, psychological and social environments and expanding those social changes with environment. community resources that enable people to - Health is an important component of mutually support each other in performing a community. all the functions of life and developing to - The health of the community is a their maximum potential. function of their environment, and It aims to: the people. a. Achieve a good quality of life - A community cannot be described b. Create a health-supportive completely without due reference to environment the health of its members. c. Provide basic sanitation and hygiene V. Quality of life as a Component of needs Community d. Supply access to health care - Quality of life is the general well being of individuals and societies, outlining negative and positive C. Components of a Community features of life. - It observes life satisfaction, including a community is simply a group of everything from physical health, people living together, especially family, education, employment, within a defined geographical wealth, religious beliefs, finance and location, they mostly share norms, the environment. religion, values and identity in - A community is not just a common. geographical location, but it rather a community can be described as a implies physical closeness, and complex whole resulting from the relationships at a particular location combination of: which in turn, adversely or positively ○ The people. improve the quality of life of its ○ The environment. members. ○ The economy. VI. Culture as Component of the ○ Culture Community ○ Health - Culture is defined as the social ○ Quality of life behavior and norms found in human I. People as Components of societies and communities. Community - Some aspects of human behavior, social practices such as culture.  NCM 113: Community Health Nursing 2 (LEC) - The concept of material culture The other factors that influence health as covers the physical expressions of identified by the Charter are rapid and often culture, such as technology, adverse social, economic and demographic architecture and art, whereas their changes that affect the working conditions, material aspects of culture such as learning environments, family patterns, and principles of social organization the culture and social fabric of the -including practices of political communities. organization and social institutions. Poverty A community is a small or large social unit - is the indication of the continuing -a group of people/ who have something in social injustice and failures of a common, such as norms, religion, values, or country's development efforts. identities - The poor have poor health because A community is a social unit made of they do not have the resources to people, cultural traits, described by health afford the basic requisites of health; and Quality of life, located in a defined they do not covered by health geographical location and environment, and insurance; and they do not have the maintains a relatively consistent economic capacity to effectively transact or system. negotiate with the health care system which seems to be more D. Factors affecting health of the responsive to the needs of those community with the necessary financial 1. Characteristics of the Population resources. 2. Location of the Community 3. Social System within the Community Culture - has a positive effect on health. Determinants of Health and Disease - An example is the value that we The health status of a community is Filipinos placed on close family ties associated with several factors: and social relationships. 1. Health care - Families, relatives and friends are a 2. Access major source of financial, emotional, 3. Economic conditions instrumental and social support 4. Social especially during crisis situations. 5. Environmental issues - These relationships contribute to our 6. Cultural practices sense of emotional well-being and mental health. D. 1) Characteristics of the Population - Some people have beliefs and Population is a group of people who practices that adversely affect share common characteristics, health. developmental stage or common exposure to particular environmental Environment factors, and consequently common - The environment plays a direct health problems, issues and influence on the health of the concerns. people. Population "aggregates" with - The state of the world's environment developmental needs and those that is the direct result of the interaction are vulnerable (rural clients, the of a number of factors such as poor, minority populations industrialization, government experiencing health disparities, policies, poverty and an uncaring those with mental health issues) attitude towards the environment Population groups are the usual which contributes to the factors that targets or beneficiaries of social affect the health of the people in the services and health programs. communities. (Allender and Spradley) Politics Social Systems within the - Policies reflects the priorities of community government and the value system of ○ Health system \Family policy makers. system - The health budget is the most ○ Economic system concrete expression of the ○ Educational system government's political will. ○ Religious system - The severely limited health budget is ○ Welfare system also the biggest hindrance to the full ○ Political system implementation of well-meaning ○ Recreational system policies such as health insurance. ○ Legal system ○ Communication system E. ROLES AND ACTIVITIES OF COMMUNITY HEALTH NURSE  NCM 113: Community Health Nursing 2 (LEC) Community Health Nursing focuses on the - Poor health in school-age Nurses’ roles as caregivers, educators, and children advocates for the community: 1. Care provider – CHN provides direct care and health monitoring to individuals, families and communities. 2. Health Educator – Health promotion and disease prevention. 3. Coordinator and Collaborator – facilitating access to services and coordination of care. 4. Advocate – CHN acts as a voice for 1980s - ROLES AND RESPONSIBILITIES OF SCHOOLS REDEFINED the community, involves in health policy development The evolving roles resulted to the expansion 5. Change Agent – Facilitating health of components to: behavior changes and community - health promotion of school mobilization personnel 6. Leader and Manager – in program - School-community projects and planning and management, as well outreach - Nutrition and food safety as supervision of health workers. - Physical education and recreation 7. Researcher – Collects, analyzes - Mental health, counseling and social and interprets health data from the support community. Implementing evidence-based practices. DepEd order no. 43 s.2011U - Directs the 8. Community Organizer – Builds INTEGRATION OF SCHOOL HEALTH community capacity and facilitating NURSING PROGRAM (SHNP) collective action. School based services 9. Counselor – psychosocial support 1. Comprehensive School Health and health counseling Education (grade k-12) - addresses 10. Environmental Health Specialist – the physical ,mental, emotional & Promoting environmental health and social dimensions of health, the doing environmental assessments. HEALTH EDUCATION includes: - Personal health, - Family health, OTHER AREAS OF community public - Consumer health, health nursing - Environmental health, A. SCHOOL NURSING - traditionally it - Sexuality education, is defined as: - Mental and emotional health, 1. School health services - Injury prevention and control 2. School health education of disease, 3. A healthy school - Substance abuse and abuse environment both physical 2. Physical education and Activity - and psychosocial aspects this is promoted through a variety of planned physical activities. RA 124, 1947 (Philippines) - an act to 3. Nutrition services provide Medical Inspection of Children 4. School health services Enrolled in Private schools, Colleges, 5. School counseling, psychological universities. and social services - The law stated that, it is the duty of NURSE'S ROLE IN THE the school heads with a total of SCHOOL SETTING >300 enrollment to provide for a I. PRIMARY PREVENTION part-or full time physician for the - Nutrition education annual medical examination of - Immunizations pupils and students. - under the - Safety direct supervision of DOH. - Health education II. SECONDARY PREVENTION WHO ( 1950) Expert Committee on - Screening School Health Services recognized that: - Case finding "effectively, children need good health." - Home visits III. TERTIARY PREVENTION Most common of low school enrolment: - nutritional deficiencies  NCM 113: Community Health Nursing 2 (LEC) - Referral of students for substance 2. Engineering - adaptation of abuse or behavior problems chemical, physical or technological - Prevention of complications and improvements adverse effects 3. Material provision - PPEs to - Faculty & staff monitoring decrease exposure to hazards 4. Supplementation - lab works, health OCCUPATIONAL HEALTH NURSING care Art.23 - United Nations Declaration of Module 2: Health Statistics and Human Rights states that: "Everyone has Epidemiology the right to work, to free choice of A. TOOLS employment, to just and favorable conditions of work." - Tools in measuring and analyzing The government-thru Occupational safety community health problems were and health (OSH) - DOLE - was given the applied to form part of our rule-making and true enforcement powers to assessment tools in diagnosis of implement the stipulations of the Phil community health nursing problems. Constitution and Phil Labor Code thru its Occupational Safety and Health Center 1.) DEMOGRAPHY (OSHC) - is the science which deals with the Aim: promotion and maintenance of the study of the human population's highest degree of physical, mental and size, composition and distribution in social well-being of workers in all space. occupations. Sources of Data OCCUPATIONAL HEALTH NURSING Census - derives its theoretical, conceptual - is defined as an official and and factual framework from a periodic enumeration of multidisciplinary base. population. Demographic, economic and social data are I. Nursing science collected from specified - to provide the context of population group. health care delivery and Sample Survey recognize the needs of - instead of census, individual, family groups and demographic information populations with the collected from a sample of a framework of prevention, given population. health promotion and illness Registration system and injury care management. - are those that collected by II. Medical science the civil registrar's office deal - specific treatment and with recording of vital events management of occupational in the community. Vital health illness and injury events refer to births, deaths, integrated with nursing health marriages, divorce and the surveillance activities. like. Other registration III. Occupational health science systems can also be used to - including toxicology, to describe specific recognize route of exposure, characteristics of the examine relationships population. between chemical exposure in the workplace and acute POPULATION SIZE - refers to the number and latent health effects such of people in a given place or area at a given as burns, cancer, and time. understand dose-response relationship. COMPOSITION - when the population is characterized in relation to certain variables such as age, sex, occupation or educational Occupational health strategies: level. Assessment & control of hazards in the workplace DISTRIBUTION - It shows how people are Health hazards - elements in the workplace distributed in a specific geographic location. that can cause work-related disease How? - risk anticipation and assessment by 2.) HEALTH INDICATORS creating a job-safety analysis. 1. Administrative control - The commonly used measures of health status reflect disease and mortality, rather than health itself.  NCM 113: Community Health Nursing 2 (LEC) - Mortality rate data are widely used to both population and the event in describe the health status of the their specification. population. - Typically period life tables are Leading Causes of Morbidity constructed applying age-specific - Cause Specific Death Rate death rates of a given population for a given year to a hypothetical cohort of 100,000 newborns. 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 Crude Birth Rate beyond exact age 0 (newborns - - a measure of one characteristic of column 5 - Tx) divided by the the natural growth or increase of a number of newborns (100,000) population. Swaroop's index - is the percentage of the deaths aged 50 years or older. - Its inverse represents the Crude Death Rate percentage of untimely deaths - measure of one mortality from all (those who died younger than 50 causes which may result in a years). decrease population. B. PHILIPPINE HEALTH SITUATION 1. Demographic Profile 2. Health Profile Please use this link for this topic https://www.doh.gov.ph/ Infant Mortality Rate C. EPIDEMIOLOGY AND THE NURSE - measures the risk of dying during the 1 year of life. It is a good index of 1.) DEFINITIONS AND RELATED TERMS the general health condition of a community since it reflects the Epidemiology changes in the environment and - the study of the occurrence and medical condition of a community. distribution of health conditions such as disease, death, deformities, or disability in the human population. - It is also concerned with the study of probable factors that influence the Maternal Mortality Rate development of these health - measures the risk of dying from conditions. causes related to pregnancy, childbirth and puerperium. It is an index of the obstetrical care needed USES OF EPIDEMIOLOGY and received by women in a - Study the history of the population community 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 Specific Rate of Mortality incidence, prevalence, disability and - describes more accurately the risk of mortality, to set health problems in exposure of certain classes or perspective and to define their groups to particular diseases. To relative importance and to identify understand the forces of mortality, groups needing special attention. the rates should be made specific - Study the work of health services provided the data are available for with a view of improving them.  NCM 113: Community Health Nursing 2 (LEC) - Operational research shows how B. Discernible lesions community expectations can result - changes may be detectable in the actual provisions of service. through sophisticated - Estimate the risk of disease, laboratory tests, during this accident, defects, and the chances period the early signs and of avoiding them.identify syndrome symptoms of disease are by describing the distribution and developing. association of clinical phenomena in C. Advanced disease the population. - anatomical and functional - Complete the clinical picture of changes have produced chronic disease and describe their recognizable signs and natural history. symptoms. - Search for causes of health and disease by comparing the These stages have relevance to the experience of groups that are clearly concept of levels of disease prevention. defined by their composition, inheritance, experiences, behavior LEVELS OF PREVENTION OF HEALTH and environments. PROBLEMS FUNCTION OF EPIDEMIOLOGY NURSE 1. Primary Prevention 1. Implement public health surveillance - It is directed to the healthy 2. Monitor local health personnel population, focusing on conducting disease surveillance prevention of emergence of 3. Conduct and/or assist other health risk factors and removal of personnel in outbreak investigation the risk factors or reduction 4. Assist in the conduct of rapid of their levels (specific surveys, and surveillance during protection) disaster 5. Assist in the conduct of surveys, 2. Secondary Prevention program evaluations, and other - Aims to identify and treat epidemiology studies. existing health problems at 6. Assist in the conduct of training the earliest possible time. course in epidemiology 7. Assist the epidemiologist in 3. Tertiary Prevention preparing the annual report and - Limits disability progression. financial plan Rehabilitation and 8. Responsible for inventory and maintenance of health. maintenance of epidemiology and surveillance unit (ESU) equipment. 3.) EPIDEMIOLOGICAL TRIANGLE 2.) NATURAL LIFE HISTORY OF DISEASE Components of Epidemiological Triangle - Describing the natural history of the disease seeks to identify factors Agent related to the course of a disease - is the intrinsic property of once established in order to microorganism to survive and determine its duration and the multiply in the environment to probability of the various possible produce disease. outcomes such as recovery, death or - Causative agent - is the infectious specific complications. agent or its toxic component that is - Understanding the natural history of transmitted from the source of disease will help institute measures infection to the susceptible body. to prevent pathologic processes from further evolving. Host - is any organism that harbors and Stages of Natural History of Disease provides nourishment for another 1.) Prepathogenesis or susceptibility organism. - in this stage, disease has not developed but factors that Environment favors its occurrence are - is the sum total of all external present conditions and influences that 2.) Pathogenesis - disease has developed affects the development of an and has 3 sub-stages: organism which can be biological, A. Pre-symptomatic disease social and physical. It affects both or early pathogenesis the agent and the host. - an individual has no - For example, the temperature in a symptoms that indicate the given location might affect an presence of illness. agent's ability to thrive, as might the  NCM 113: Community Health Nursing 2 (LEC) quality of drinking water or the - In an observational study, the accessibility of adequate medical subjects are exposed under more facilities. natural conditions. OBSERVATIONAL COHORT STUDY - subjects are enrolled or grouped on the basis of their exposure, then are followed to document occurrence of disease. - Differences in exposure prevalence between the case and control groups allow investigators to conclude that the exposure is Three components of the Environment associated with the disease. 1. Physical environment is composed CROSS-SECTIONAL STUDIES - measure exposure and disease of the inanimate surroundings such status at the same time, and are as the geophysical conditions of the better suited to descriptive climate. epidemiology than causation. 2. Biological environment makes up the living things around us such as APPROACH TO DISEASE AND plants and animal life. DETERMINANTS 3. Socio-economic environment - The present epidemiology approach which maybe in the form of level of is based on the interaction of the economic development of the causative agent and the environment. Essentially, community epidemiology patterns depend upon these factors which influence the 4.) EPIDEMIOLOGICAL PROCESS AND probability of contact between an INVESTIGATION infectious agent and susceptible host. 2 MAIN AREAS OF INVESTIGATION DISEASE DISTRIBUTION 1. The study of the distribution of - The method and technique of diseases epidemiology are desired to detect 2. The search for determinants the cause of a disease in relation to (causes) of disease and it's the characteristic of the person who observed distributions has it or to a factor present in his environment. Since neither DISTRIBUTION population and environment of - Describes the distribution of health different times or places are similar, status in terms of gender, race, these characteristics and factors are geography, time and so on might be called epidemiologic variables. considered in an expansion of the - These variables are studied since discipline of demography to health they determine the individuals and and disease. populations at greatest risk of DETERMINANTS acquiring particular disease, and - Involves explanation of the patterns knowledge of these associations of disease distribution in terms of may have predictive value. causal factors. - For the purpose of analyzing EPIDEMIOLOGICAL STUDIES epidemiology data, it has been found - The purpose of an analytic study in helpful to organize that data epidemiology is to identify and according to the valuables of: quantify the relationship between an exposure and a health outcome. TIME - The hallmark of such a study is the - refers both to the period during presence of at least two groups, one which the cases of disease being of which serves as a comparison studied were exposed to the source group. of infection and the period during CATEGORIES - EXPERIMENTAL which the illness occurred. STUDIES - In an experimental study, the PERSON investigator determines the - refer to the characteristics of the exposure for the study subjects; individual who were exposed and who contacted the infection of the disease in question. OBSERVATIONAL STUDIES PLACE - refers to the features, factor or conditions which existed in or  NCM 113: Community Health Nursing 2 (LEC) described the environment in which - Population the diseases occurred. - the physical and topographical - Urban/ Rural Differences: diseases characteristic spread more rapid in urban areas - Socio-economic and cultural factors than in rural areas primarily because of the greater population. - health and basic social services and - the power structure within the community PATTERNS OF OCCURRENCE AND DISTRIBUTION 1. COLLECTING PRIMARY DATA - The variables of disease as to Primary data - are directly obtained to person, time and place are reflected answer the community diagnosis objectives in distinct patterns of occurrence and A. Observation distribution in a given community. - The following are the characteristic - This method provides an of patterns of disease occurrence; opportunity to check the SPORADIC OCCURRENCE validity or truth of many - Intermittent occurrence of a few verbal statements. isolated and unrelated cases in a - It is an important and useful given locality. method of collecting data - The cases are few and scattered, not related, occur on and off, when informants are unable intermittently to direct supply information. - Rabies occurs sporadically in the B. Survey Philippines, the cases are scattered - Ocular survey or windshield throughout the country, so that the survey walking or driving cases are not related at all to the through the community cases in other areas. appreciating what can be ENDEMIC OCCURRENCE - is the continuous occurrence seen and perceived as the throughout a period of time, of the people go along with their usual number of cases in a given daily lives. locality. C. Informant Interview - Tuberculosis is endemic in all - It involves asking and specific areas of the country. answering questions EPIDEMIC OCCURRENCE following a systematic - is an unusually large number of cases in a relatively short period of procedure aimed at yielding time. first-hand information from - Bird's flu, there has been no case of the subject of inquiry. bird flu in any area of the country, 1. Face-to-face interview, the occurrence of few cases in a 2. Telephone interview, given area in a given time would 3. Individual interview, constitute a bird's flu epidemic. PANDEMIC OCCURRENCE 4. Group interview - is the simultaneous occurrence of 5. Structured interview, epidemie of the same disease in 6. Unstructured interview several countries. It is another D. Community Forum pattern of occurrence from an E. Focus Group Discussion international perspective. - It is very popular method - Corona Virus has existed and with appropriate in the community different patterns of occurrence in the present as we call it now - to elicit and explore opinions COVID-19. of people, - determine their attitudes and Module 3: Nursing Process in the Care of practices regarding a limited Population Groups and Community set of concept. A. Community Health Assessment Tools THREE IMPORTANT TOOLS IN IDENTIFYING 2. SECONDARY DATA SOURCES COMMUNITY’S HEALTH NEEDS - Data that are obtained by other Demography people which can be used to answer Vital Statistics and the community diagnosis objectives. Epidemiology - Records are written information that are kept in folders. To recognize the health status of the - Data may be obtained by reviewing community these elements are to be those that have been compiled by considered:  NCM 113: Community Health Nursing 2 (LEC) health or non-health agencies, the 4. Cultural factors government or other sources. 5. Health and Illness Patterns Registry of Vital Events Health Records and Report Data about leading causes of illness and Disease Registries deaths and their respective rates of Census Data occurrence. 1. Leading causes of mortality 3. METHODS OF PRESENT COMMUNITY 2. Leading causes of morbidity DATA 3. Leading causes of infant and child 1. Survey questionnaire mortality 2. Form one uses to document the data 4. Leading cause of maternal mortality being collected 5. Leading cause of hospital admission 3. Focus group discussion guide 6. Leading cause of clinic consultation 4. Serves to facilitate the direction and 7. Nutrition status flow of exchange of ideas on specific topics or concepts among the D.) Health Resources participants - Resources that are available in the 5. Key informant interview guide community that essential in the 6. Helps give direction to the person delivery of basic health services doing the interview using a set of 1. Manpower resources prepared questions on a very 2. Material resources specific subject. 7. Observational checklist Problem-Oriented Community Diagnosis - Characterize the biophysical, B. Community Diagnosis psychological, physical 1. TYPES OF COMMUNITY DIAGNOSIS environmental, socio-cultural and Comprehensive Community behavioral as well as system factors Diagnosis relevant to specific problem being Problem-Oriented Community investigated Diagnosis STEPS IN CONDUCTING COMMUNITY Comprehensive Community Diagnosis DIAGNOSIS - Aims to obtain general information 1. Determining the objectives about the community through 2. Defining the study population epidemiologic approach, 3. Determining the data to be collected socio-economic approach, and behavioral approach. SCHEMES IN STATING COMMUNITY DIAGNOSIS A.) Demographic Variables Diagnosis - After analyzing the data, the next Shows the size, composition and step is to make a definitive geographical distribution of the population. statement (diagnosis) identifying Total population and geographical what the problem is or the needs distribution including urban-rural index and are. Nursing diagnosis for population density. communities may be formulated 1. Age and sex composition regarding the following issues: 2. Household size Inaccessible and unavailable 3. Selected vital indicators services 4. Patterns of migration Mortality and morbidity rates 5. Population projections Communicable disease rates Specific populations at risk for B.) Socio-Economic and physical or emotional problems Cultural Variables Health-promotion needs for specific - Socio-economic and cultural factors populations that directly or indirectly affect the Community dysfunction health status of the community. Environmental hazards (ANA 1986) 1. Social indicators 2. Economic indicators Note: 3. Environmental indicators  NCM 113: Community Health Nursing 2 (LEC) The format of the problem statement varies, interventions with communities depending on the philosophy of the agency (Martin, 2005). conducting the assessment. - The Omaha System includes more environmental and community For example, problems or needs factors than are considered in the may be stated simply in NANDA system. epidemiological terms, such as a high rate of adolescent pregnancies, OMAHA SYSTEM whereas in other instances you may - Is research-based, comprehensive be asked to state the problem or practice and documentation need as a nursing diagnostic standardized taxonomy designed to statement. describe client care is a standardized health care North American Nursing Diagnosis terminology consisting of an Association (NANDA) assessment component (Problem - classification system of nursing Classification Scheme), a care diagnoses focused on the physical plan/services component needs of individual clients but was (Intervention Scheme), and an not applicable to the family and evaluation component (Problem community situations faced by Rating Scale for Outcomes). community health nurses. - NANDA classification system has Shuster and Goppingen expanded to include biological, - a locality-based entity, composed of psychological and social needs of systems of formal organizations individuals and families. Because reflecting society's institutions, of ongoing refinement, taxonomy of informal groups and aggregates. nursing diagnoses at present has 11 functional health patterns. Community diagnoses should include - Tools have been developed to these four parts: assess the community using the 1. The problem. functional health pattern typology 2. The population or vulnerable group. (Gikow & Kucharski, 1987; Wright, 1985). 3. The effects of the problem on the -Newer NANDA diagnoses may also population/vulnerable group. apply to communities; examples 4. The indicators of the problem in this include the diagnosis impaired home community. maintenance and impaired social interaction. Categories of Community Health Nursing Omaha System, Omaha Visiting Nurse Problems Association A. Health status problems - and has been used in home care, B. Health resources problems public health, and school health C. Health-related problems practice settings, among others. - Client problems/needs/concerns are C. Planning Community Health organized into four domains: Interventions 1. Physiological, 2. psychosocial, After the problems have been identified, the 3. health-related behaviors, and next task is to prioritize which health 4. environmental. problems can be attended to considering - Each domain may involve actual or available resources, limitations and potential problems or opportunities constraints. for health promotion. - The system includes four categories 1.) PRIORITY SETTING of interventions: teaching, guidance, and counseling; treatments and Criteria: procedures; case management; and A. Nature of the condition/problem surveillance. Although originally B. Magnitude of the problem developed for application with C. Modifiable of the problem individuals or families, users are now D. Preventive potential E. Social applying the problem domains and concern  NCM 113: Community Health Nursing 2 (LEC) Integrated approach which 2.) FORMULATING GOALS AND considers various dimensions of OBJECTIVES health and development. Goal and Objective Setting Comprehensive approach which - Goals and objectives will serve as strikes at the root of the problem and a guide to the efforts of the nurse address the social determinants of and the people to address the health health problem. - Goal is a desired end. It is directed APPROACHES TO PLANNING HEALTH towards solving the health status PROGRAMS problems that were identified in the Participatory Planning for Community community diagnosis. It states the Health ultimate desire state. For community and health - Objectives are more precise. They development programs and services are considered as planned end point to become relevant, responsive and of all activities and are concerned sustainable, planning should involve with the resolution of the health people's participation. problem itself. They have to be People's participation enables the stated in specific and measurable community to become an integral terms. part of the decision-making and action process (WHO, 1995) and Goals and Objectives will serve to address guarantees the integration of their the health problems. indigenous knowledge and serves A. What is the present health condition as social preparation for the program of the people in the community plan's implementation (WHSMP-PC, B. Why are the people in the 2003) the whole process of community in such condition? engaging the community in planning C. What are the roots of these the process starts by analyzing how problems the nurse looks at the people or the D. What solution will address the community in the scheme of problems? development work. The goal of a program is directed at Planning for sustainable addressing the health problem while the community health development objectives addressed the risk factors. The grounded on health promotion and sub- objectives address the contributing wellness can only be achieved when risk. programs and projects utilize three important approaches (Tuazon et al Goal →corresponds to→ Health Problem 2003). Objective →corresponds to→ Risk factors 1. Community-based approach which empowers the people to address Sub-objective →corresponds to→ Contributing their health needs and problems risk factors 2. Integrated approach which considers various dimensions of 3.) DECIDING ON COMMUNITY HEALTH health and development such as INTERVENTIONS changing lifestyle, changing environment and reorienting health What is planning? care systems - In community health nursing 3. Comprehensive approach which involves the orderly process of strikes at the root of the problem and assessing the health problems and address the social determinants of needs of the community. health Approaches to planning health programs PRECEDE Community-based approach which - it corresponds to the assessment empowers the people to address phase of the model involving social, their health needs and problems. epidemiological, behavioral or environmental, educational or  NCM 113: Community Health Nursing 2 (LEC) ecological and administrative and - Which of the behaviors are policy assessments. due to predisposing factors/ - Since the model examines the which are due enabling different dimensions, it is guaranteed factors or reinforcing factors. a more comprehensive perspective of addressing a health problem. Phase 5 Administrative and Policy - Diagnosis which of the PROCEED factors can be modified - embodies the implementation and through education or through evaluation phase and stands for advocacy. policy, regulatory and organizational construct in educational and STRATEGY AND ACTIVITY SETTING environmental diagnosis. - Defines the strategies and the activities that the nurse and the PLANNING FOR HEALTH PROMOTION community set to achieve in order to realize the goals and objectives. The The Planning Cycle nurse facilitates the community to Situational Analysis gathers health define the strategy or approach in data, tabulates, analyzes, and the health program. interpret data. Identify health problems, set priority. The particular phase of planning cycle Goal and Objective Setting Define involves three activities: program goals and objectives, 1. Designing the health programs or Assign priorities among objectives. services Strategy/ Activity Setting Design 2. Budgeting involve specifying the intervention and programs and requirements of each program in strategies, Ascertain resources, relation to the necessary resources Analyze constraints and limitations and considering constraints that may Evaluation Determine outcomes, hamper implementation of program Specify criteria and standards. and activities 3. Making a time plan or schedule SITUATIONAL ANALYSIS helps the community organize the activities in such a way that time, In this phase of planning cycle the money and efforts are not wasted. nurse together with the community identify and provide explanation to the problems D. Implementing Community Health Interventions Stages in Conducting Situational 1.) IMPORTANCE OF PARTNERSHIP AND Analysis COLLABORATION Phase 1 Social Diagnosis - Working together enables - How the situation affects the organizations to accomplish their quality of life of the goals much quicker because population in its social terms. resources, Skills and views are Phase 2 Epidemiological pooled together. Diagnosis - Determine how the situation 2.) ACTIVITIES INVOLVED IN affects the health of the COLLABORATION AND ADVOCACY population in epidemiological ACTIVITIES INVOLVED IN COLLABORATION terms. Networking Phase 3 Behavioral and coordination Environmental Diagnosis cooperation - What aspects of the problem collaboration can be solved by people coalition or multi- sector adopting new behaviors or collaboration alternative lifestyles / what aspects can be altered by ACTIVITIES INVOLVED IN ADVOCACY changes in the environment. 1. Informing the people about the Phase 4 Educational and rightness of the cause. Organizational Diagnosis  NCM 113: Community Health Nursing 2 (LEC) 2. Thoroughly discussing the people develops confidence to take action the nature of the alternatives. in respect to them and in doing so, 3. Supporting people's right to make extends and develops cooperative choices and act on their choice. and collaborative attitudes and 4. Influencing public opinion. practices in the community (Ross 1967). 3.) COMMUNITY ORGANIZING AND SOCIAL MOBILIZATION A continuous and sustained process of educating the people to understand and - Community organizing is a process develop their critical awareness of their whereby the community members existing condition, working with the people develop the capability to assess their collectively and efficiently on their health needs and problems, plan immediate and long-term problems, and and implement actions to solve their mobilizing the people to develop their problems, put up and sustain capability and readiness to respond and organizational structures which will take action on their immediate needs support and monitor implementation towards solving their long-term problems of health initiatives by the people. (CO: A manual of experience, PCPD). 4.) CORE PRINCIPLES IN COMMUNITY Process ORGANIZING - The sequence of steps whereby Democracy and social welfare; members of a community come Community roots for community together to critically assess to programs; evaluate community conditions and Citizen understanding, support, and work together to improve those participation and professional conditions. service; Structure Co-operation; - Refers to a particular group of Social Welfare Programs; community members that work Adequacy, distribution, and together for a common health and organization of social welfare health related goals. services; and. Emphasis Prevention. 1. Community working to solve its own problem. 5.) GOALS OF COMMUNITY 2. Direction is established internally ORGANIZING and externally. 3. Development and implementation of - Community organizing is the a specific project is less important process by which people come than the development of the capacity together to identify common of the community to establish the problems or goals, mobilize project. resources, and, in other ways, 4. Consciousness raising involves develop and implement strategies perceiving health and medical care for reaching the objectives they want within the total structure of society. to accomplish. understanding of the community. Gaining an The target of copar is a program that understanding of the community. empowers and helps and educate a poor community to be Self Reliance. 6.) COMMUNITY ORGANIZING To convert community to stand on his own. PARTICIPATORY RESEARCH COPAR stands for Community IMPORTANCE Organizing Participatory Action Research 1. COPAR is an important tool for - A social development approach that community development and people aims to transform the apathetic, empowerment as this helps the individualistic and voiceless poor community workers to generate into a dynamic, participatory and community participation in politically responsive community. development activities. - A process by which a community identifies its needs and objectives,  NCM 113: Community Health Nursing 2 (LEC) 2. COPAR prepares people/clients to - Do the same process as in selecting eventually take over the a municipality. management of a - Consult key informants and development.programs in the future. residents. 3. COPAR maximizes community - Coordinate with local government participation and involvement; and NGOs for future activities. community resources are mobilized F. Choosing Final Community for community services. - Conduct informal interviews with community residents and key PRINCIPLES informants. 1. People especially the most - Determine the need of the program oppressed, exploited and deprived in the community. sectors are open to change, have - Take note of political development. the capacity to change and are able - Develop community profiles for to bring about change. secondary data. 2. COPAR should be based on the - Develop survey tools. interest of the poorest sector of the - Pay courtesy call to community community. leaders. 3. COPAR should lead to a self-reliant - Choose foster families based on community and society. guidelines G. Identifying Host Family PHASES OF COPAR - House is strategically located in the community. 1.) Pre-Entry Phase - Should not belong to the rich - Is the initial phase of the organizing segment. process where the community - Respected by both formal and organizer looks for communities to informal leaders. serve and help. - Neighbors are not hesitant to enter Activities include: the house. A. Preparation of the Institution - No member of the host family should - Train faculty and students in COPAR be moving out in the community. - Formulate plans for institutionalizing COPAR. 2.) Entry Phase - Revise/enrich curriculum and - sometimes called the social immersion program. preparation phase. - Coordinate participants of other - Is crucial in determining which departments. strategies for organizing would suit B. Site Selection the chosen community. - Initial networking with local - Success of the activities depend on government. how much the community organizers - Conduct preliminary special have integrated with the community. investigation. - Make a long/short list of potential 3.) Organization-building Phase communities. - Entails the formation of more formal - Do ocular survey of listed structure and the inclusion of more communities formal procedure of planning, C. Criteria for Initial Site Selection implementing, and evaluating - Must have a population of 100-200 community-wise activities. families. - It is at this phase where the - Economically depressed. No strong organized leaders or groups are resistance from the community. being given training (formal, - No serious peace and order informal, OJT) to develop their style problem. in managing their own - No similar group or organization concerns/programs. holding the same program. D. Identifying Potential Municipalities 4.) Sustenance and Strengthening Phase - Make long/short list of potential - Occurs when the community municipalities organization has already been E. Identifying Potential Community established and the community  NCM 113: Community Health Nursing 2 (LEC) members are already actively - measures the immediate effects of participating in community-wide the program and determines undertakings. whether the objectives of the - At this point, the different program were met. committees setup in the 3. Outcome evaluation organization-building phase are - measures the long-term effects of already expected to be functioning the program and determines if it by way of planning, implementing meets the goal of the program. and evaluating their own programs, with the guidance from the COMMUNITY ORGANIZING community-wide organization. PARTICIPATORY ACTION RESEARCH (COPAR) 5.) Monitoring and Evaluating Introduction Community Health Programs 1. Designing and Implementing COPAR or Community Organizing Evaluation Participatory Action Research - Phase of planning cycle that - is a vital part of public health determines whether the program is nursing. COPAR aims to transform relevant, effective, efficient and the apathetic, individualistic and adequate. voiceless poor into a dynamic, - It is concerned with finding out the participatory and politically specific input, process and responsive community. output/outcome indicators. - Involves two processes, observation WHAT IS COPAR? and measurement. The nurse - A social development approach that observes, then compares the aims to transform the apathetic, observed data with some criterion individualistic and voiceless poor standard or indicators of good into a dynamic, participatory and performance. politically responsive community. 6.) Development on Evaluation Plan DEFINITION - It is a process by which we judge the - A collective, participatory, worth or value of something transformative, liberative, sustained (Suchman, 1967). and systematic process of building - Evaluation involves two processes people's organizations by mobilizing namely observation and and enhancing the capabilities and measurement. resources of the people for the - There are two approaches of resolution of their issues and evaluating a program. concerns towards effecting change A. Qualitative methods of evaluation in their existing oppressive and - determine the meaning and exploitative conditions (1994 National experience of the program for the Rural Conference). people involved and interpret the - A continuous and sustained process effects that may be observed. of educating the people to B. Quantitative methods understand and develop their critical - measure and score changes awareness of their existing occurring as a result of the program. condition, working with the people - Such measurements are collectively and efficiently on their systematically made using immediate and long-term problems, pre-selected instruments to detect and mobilizing the people to develop expected changes. their capability and readiness to respond and take action on their An evaluation may look into three immediate needs towards solving aspects of program their long-term problems (CO: A 1. Process evaluation manual of experience, PCPD) - measures the activities of the program, its quality and who it is PROCESS reaching out. The sequence of steps whereby members 2. Impact evaluation of a community come together:  NCM 113: Community Health Nursing 2 (LEC) to critically assess D.) COPAR IS GROUP - CENTERED to evaluate community conditions - And not leader centered. Leaders work together to improve those are identified, emerge and are conditions. tested through action rather