[CHN Lec] Lesson 1.docx

**HEALTH AS A HUMAN RIGHT** - \"The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition\" - Dr. Ghebreyesus, WHO Director General (2017) -...

**HEALTH AS A HUMAN RIGHT** - \"The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition\" - Dr. Ghebreyesus, WHO Director General (2017) - \"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services\" (United Nations, UDHR, 1948) United Declaration of Human Rights - No one should be left behind and everyone should be given the health services - \"Health is a fundamental human right indispensable for the exercise of other human rights. Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity. The realization of the right to health may be pursued through numerous, complementary approaches, such as the formulation of health policies, or the implementation of health programmes developed by the WHO or the adoption of specific legal instruments (UN, CESCR, 2000) Covenant on Economic, Social and Cultural Rights. **The right to health consists of interconnected and indispensable components (CESCR, 2000)** - ***Availability*** - Requires that operational public health and channels of service delivery, products and services as well as programs be adequate for all. - ***Accessibility*** - Entails that health facilities, services and goods must be made possible and obtainable to everyone. This includes: a. non-discriminatory b. physically accessible c. economically accessible (affordable) d. accessible information - ***Acceptability*** - Corresponds to respect for the medical ethics, being culturally appropriate and gender sensitive. This clearly define the need for health care centers, products, services and programs to be people-centered, able to accommodate the specific needs of diverse population groups and adheres to the international standards of medical ethics for informed consent and confidentiality. - Ex: vaccines,free check up - ***Quality*** - Implies that the health facilities, commodities and services must be in accordance with scientific and medical standards. Quality health services need to be safe, effective, people-centered, timely, equitable, integrated and efficient **HEALTH AS A HUMAN RIGHT** - \"Health is a fundamental human right and recognized that the obligation of the state is to protect and promote the right of health of all Filipinos\" Article II Section 11 and 15 of the 1987 Philippine Constitution (Republic of the Philippines Official Gazette, 1987). - \"Department of Health (DOH) was established to lead the health sector towards assuring quality health care in promoting and protecting and protecting the health of all Filipinos. - ***Vision:*** \"Filipinos are among the healthiest people in Southeast Asia by 2022, and in Asia by 2040\" (DOH, 2017) **MODELS OF HEALTH** 1. ***Clinical Model*** - Health is the absence of signs and symptoms of disease and illness refers too its presence. This model is the traditional lens of how medical science deals with patients. To illustrate, an adult individual who is not particular with his lifestyle choices will only seek healthcare when chest pain is encountered and begins to suspect a cardiovascular disease. 2. ***Role Performance Model*** - The individual\'s ability to perform societal roles defines what health is in this model. The society is preoccupied with expectations on how one should perform at work, within the family and society. Failure to fulfill these roles means illness. Using this model, an employee who reported for work even if he/she is febrile, may still be considered healthy. 3. ***Adaptive Model*** - Health is a dynamic state. An individual is healthy if he/she was able to adjust positively to social, mental, and physiological changes. Illness exists when the person failed to cope becomes maladaptive to these changes. - Adapt easily and adjust easily to new environment 4. ***Eudaimonistic Model*** - An elevated model of wellness suggests optimal health and illness is reflected by a lack of vitality. This model highlights the interactions between physical, social, psychological, and leads to goal attainments that creates meaning and purpose in life. - Eudaimonism -- state of well-being **DETERMINANTS OF HEALTH AND DISEASE ** 1. ***Biology*** - Is an individual\'s genetic makeup, family history, and any physical and mental health problems developed during life. Heredity plays a part in determining lifespan, state of wellness and the likelihood of developing illness. - eg: Aging, diet, physical activity, injury, violence, or a toxic or infectious agent 2. ***Behaviors*** - The individual\'s responses to stimuli and external conditions. Behaviors interact with biology in a common relationship, as one may influence the other. - eg: Alcoholic/Smoker - Liver Cirrhosis/CVD, Pt. w/ known family hx of Ca regular screening 3. ***Social Environment*** - The social environment has a great impact on the health of individuals, groups, and communities, yet it is complex in nature because of differing cultures and practices. - eg: interactions and relationships with family, friends, coworkers, and others in the community 4. ***Physical Environment*** - It is what is experienced by the senses - what is smelled, seen, touched, heard, and tasted. The physical environment can affect health negatively or positively. - eg: poisonous substance; sanitary environment 5. ***Policies and Interventions*** - Has a profound effect on the health of individuals, groups, and communities. Policies are implemented at local, regional and national levels by many agencies, such as DOH, DepEd, DILG, DOT, and NHA. - eg: policies in smoking in public places, seatbelt and child restraints laws, etc. - DepEd -- school nurse, spread information - DILG -- implementation of rules **Social Determinants of Health (SDH)** - The health status of a community is associated with several factors and is essential for CHN and PHN to understand and recognize the interaction of the factors which may lead to disease, death, and disability. This includes: - Health care access - Economic conditions - Social and Environmental issues - Cultural practices - SDH are \"***conditions in which people are born, grow, live, work and age; might also be circumstantial elements as such housing, work conditions and access to recreational activities;*** circumstances that influence how an individual will develop sickness, what risk factors they are exposed to, how they access services, and how they utilize the appropriate services; and is shaped by the distribution of money. power, and resources at global, national and local levels\" (SDH, 2008) - SDH may also include ***occupation, circumstances affecting the way in which people work, income, culture, religion, education, racial and gender discrimination*** (Forget and Lebel, 2001) - The social determinants of health do have a significant impact on the health condition of every person. ***These SDH are interrelated, and often cumulatively and indirectly affecting the health of the people*** (Schramme & Ramon,2018) **ONE HEALTH CONCEPT: A Framework for Community and Public Health Nursing** - The human population is confronted with challenges such as the compounding sequence of global change; and the invisible link of humans, domestic animals, livestock and wildlife and their social environment and ecosystem (Zinsstag et al., 2011) - **Emerging infectious diseases (EIDs)** are matter of importance if there is primarily a rapid increase of cases and high incidences of deaths caused by these diseases (Petrosillo, 2019) - EIDs can be bought about by previously undetected or unknown infectious agents, by recognized pathogens affecting new geographical locations or new populace or by re-emerging infective agents whose occurrence of disease had a significant decrease in the past. 60.3% of emerging infection cases had its source from a non- human animal origin (zoonotic pathogens) - The most effective way to act in response to the threats of EIDs is the One Health Approach - recognizing the connection between human, animal and environmental health (Johnson et al., 2019) - The **One Health Concept** calls for a consolidated interaction between human health, veterinary medicine, and public and environmental health professionals, clinicians, researchers, and agencies functioning hand in hand for a worthwhile and sustainable health interventions in addressing worldwide and environmental health challenges) - In the **Philippines**, some of the ***One Health Approach Activities*** are the: - **[NRPCP]** - National Rabies Prevention and Control Program - **[AIPP]** - Avian Influenza Protection Program - **[TB DOTS]** -- Tuberculosis Directly Observed Therapy - **One Health Approach activities** are aware that collaboration and coordination among the different sectors are essential in making any programs geared towards control and eventual elimination of emerging and re- emerging diseases a success (Amurao et al., n.d.). **COMMUNITY HEALTH NURSING** **Key Concepts of Community and Public Health Nursing** - **Three Key Concepts** 1. The community as a client 2. Health as a goal 3. Nursing as the vehicle or means to achieve its aims - ***Community*** - often viewed as a group of people living in a particular area with common beliefs, values, and traditions - Bound by their location, people develop common beliefs and values that eventually evolve as culture. This set of beliefs acquired over time accounts for why people across the globe have similarities and differences. - In the Philippines, the concept of health and illness can be summed up in either presence or absence of signs and symptoms. Without physical manifestations of disease, people tend to cling to the false belief of being healthy. Such mindset breeds a fatal outcome. - Community and Public Health work requires an understanding and respect for culture in the hope of introducing meaningful health information and influencing people to embrace a culture of health **Levels of Clientele** - Providing healthcare in the natural environment of people is a major distinction of public health in contrast with institutional practice. This shows that the nurse in this field must deal with a broad scope of patients in a variety of settings - The Philippine Nursing Law of 2002 (RA 9173) states that \"A person shall be deemed to be practicing nursing within the meaning of this Act when he/she single-handedly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting\". **Four levels of clientele** - Individuals - Families - Groups - Communities **Characteristics and Features of Community and Public Health Nursing** 1. ***Developmental*** - People are imbued with human rights, and this includes right to health. As such, nurses in community/public health work believe that individuals, families, and population groups are primarily [responsible] for their health. 2. ***Multidisciplinary*** - Community and Public Health nurses do not work in a silo and operates not on claiming that solutions are in their hands alone. Rather the nurse fosters [collaboration] with different professionals and sectors from society. 3. ***Ecology-oriented*** - The largest portion of the healthcare delivery system is community-based, and that care is provided in the [natural environment] of people. This means that the setting for community/public health nurses include homes, schools, workplaces, and even prisons and churches. 4. ***Promotes Social Justice*** - Health is a human right, and all people should enjoy [access to healthcare.] This puts the community/public health nurse in a pivotal position to ensure that people regardless of age, sex, creed, or religion enjoy healthcare services in their communities. 5. ***Values Consumer Involvement*** - Patients in community/public health are not merely consumers or end-users of healthcare service. They are considered as [partners in health]. a. Promote health literacy to clients 6. ***Uses Prepayment Mechanism*** - Services provided by public health system are not given for free. It is [funded by taxes of the people]. Hence, healthcare is a basic social service that should be provided by the state to all peoples. - On the field, nurses cannot choose who their patients will be and predict what cases they will deal with. Myriad conditions ranging from infection among children, chronic pain among elderly, and even emergencies like imminent delivery of a pregnant woman are some of the usual cases encountered on a day-to-day basis. 7. ***Focuses on Preventive Service*** - The community are in [constant search of risks] that make people vulnerable to disease and implements interventions to modify and mitigate these vulnerabilities. 8. ***Offers Comprehensive Care*** - Patients in community/public health are not merely consumers or end-users of healthcare service. They are considered as [partners in health.] **Roles of the Community and Public Health Nurse** 1. ***Healthcare Provider*** - Caring is the essence of nursing and has been widely accepted in all settings. The use of the nursing process applied in the natural environment of the client pertains to this role. 2. ***Program Implementer*** - Communicating information to help patients make an informed choice regarding their health is a key activity in public health work. It is hoped that awareness will impact people\'s behavior to achieve health in their own hands. 3. ***Health Educator*** - Nurses working under local government units deliver healthcare to the grassroots. This also requires that programs initiated by the national government thru the Philippine Department of Health (DOH) are executed at all levels 4. ***Community Organizer*** - Working with people in communities and providing them ownership of their healthcare needs and to act collectively on their issues are best captured by this role of the nurse in public health. 5. ***Manager/Leader*** - Community and public health work deals with competing claims specifically on utilization of limited resources. Hence. The nurse employs principles of management to maximize resources effectively and efficiently. 6. ***Researcher/Epidemiologist*** - The nurse is regarded as the health monitor of the community. Together with the rural health midwife, they keep track of illnesses encountered in their areas of jurisdiction and submit reports to health authorities as required by law. 7. ***Client Advocate*** - The community/public health nurse takes a proactive stance in ensuring the right to health of the population he she works with is realized and protected. ***Table 2.1 Summary of Tier 1 Public Health Nursing (PHN) Competencies (Generalist Public Health Nurses)*** - Analytic assessment skills - Policy development/program planning skills - Communication skills - Cultural competency skills - Community dimensions of practice skills - Public Health sciences skills - Financial **PUBLIC HEALTH NURSING** **Standards of Public Health Nursing Practice** - Public health nurses focus on the care of individuals, groups, aggregates, and populations in many settings, including homes, clinics, worksites, and schools. In addition to interviewing clients and assessing individual and family health, public health nurses must be able to assess a population\'s health needs and resources and identify its values. - Public health nurses must also work with the community to identify and implement programs that meet health needs and to evaluate the effectiveness of programs after implementation ***Table 2.2 Public Health Interventions and Definitions*** **Public Health Intervention** - ***Surveillance*** - Describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions - ***Disease and other health event investigation*** - Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures - ***Outreach*** - Locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained - ***Screening*** - Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions - ***Case finding*** - Locates individuals and families with identified risk factors and connects them with resources - ***Referral and follow-up*** - Assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources to prevent or resolve problems or concerns - ***Case management*** - Optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services - ***Delegated functions*** - Carries out direct care tasks under the authority of a health care practitioner as allowed by law - ***Health teaching*** - Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities - ***Counseling*** - Establishes an interpersonal relationship with a community, a system, and a family or individual, with the intention of increasing or enhancing their capacity for self-care and coping - ***Consultation*** - Seeks information and generates optional solutions to perceived problems or issues through interactive problem solving with a community system and family or individual - ***Collaboration*** - Commits two or more persons or organizations to achieve a common goal by enhancing the capacity of one or more of the members to promote and protect health - ***Coalition building*** - Promotes and develops alliances among organizations or constituencies for a common purpose - ***Community organizing*** - Helps community groups to identify common problems or goals, mobilize resources, and develop and implement strategies for realizing the goals they collectively have set - ***Advocacy*** - Pleads someone\'s cause or acts on someone\'s behalf, with a focus on developing the community, system, and individual or family\'s capacity to plead their own cause or act on their own behalf - ***Social marketing*** - Utilizes commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest - ***Policy development and enforcement*** - Places health issues on decision makers\' agendas, acquires a plan of resolution, and determines needed resources, resulting in laws, rules, regulations, ordinances, and policies. Policy enforcement compels others to comply with laws, rules, regulations, ordinances, and policies