Community Health Nursing Concepts PDF

COMMUNITY HEALTH NURSING Rosechelle S. Elarco,RN,MAN LEARNING OBJECTIVES:  Explain the concept, theories and principles of community health nursing practice.  Cite the distinguishing features of community health nursing.  Apply the different theoretical models and...

COMMUNITY HEALTH NURSING Rosechelle S. Elarco,RN,MAN LEARNING OBJECTIVES:  Explain the concept, theories and principles of community health nursing practice.  Cite the distinguishing features of community health nursing.  Apply the different theoretical models and approaches to community health nursing practice.  Compare the different fields of community health nursing practice  Define the key concepts of community.  Enumerate the different types of communities  Describe the characteristics of a healthy community and its components.  Identify the factors affecting health of the community.  Demonstrate understanding on the roles and activities of community health nurse.  Determined by geographical boundaries Group of people living in the same place or having a Common values, moral norms and interests particular characteristic in common Its members know and interact with each other and have free communication It functions within a particular organized share common social structure system and common interact with interests and organizations one another characteristics.  Two types of Community Geopolitical Community Phenomenological Community  Barangays  Interactive  Cities, groups/shared groups  Regions based on culture, values, perspective,  Nations interests, history, and goals.  Functions  It provides space for housing, shelter, socialization and recreation.  It provides means and facilities for livelihood  It provides opportunity for employment  It takes care of socialization and education of its members  It provides safety and security for its members by enforcement of norms and legislations formulated by the society.  It provides opportunities for people participation and communication Elements of Community  A sense of membership  Common symbol system  Common values  Common needs  Reciprocal influence  Shared History Healthy Community Feature of Communities  Location: Community Boundaries - This serve to regulate the exchange of energies between the community and its external environment. - Geographical boundaries- mountains, valleys, deserts - Political boundaries – cities, towns, barrios, country, state, nations - Situational boundaries- home, school and work Feature of Communities  Social System - Relationship that community members form with each other. - Interactions within community members - It provides socializations, role fulfillment, goal achievement and member support - It includes economy, education, religion, welfare, politics, recreations, legal system, health care , transportation and communication system Feature of Communities  Population: Families, Culture and Community - individual, families and cultural groups comprising a community contributes to the overall complexion of a community. - Demographics- characteristics of the population Strong Family structure is the basic foundation for strong communities.  Principles and Characteristics of Community and Public Health Nursing 1. Developmental 2. Multidisciplinary 3. Ecology oriented 4. Promotes social justice 5. Values consumer involvement 6. Uses prepayment mechanism 7. Focuses on preventive service  Community Health Nursing is a synthesis of nursing practice and public health practice applied in promoting and preserving the health of populations. (American Nursing Association) General and Comprehensive Not limited to a particular age or diagnostic group. It is continuous and not episodic. The dominant responsibility is to the population as a whole.  COMMUNITY HEALTH NURSING specialized field of nursing practice that renders care to individuals, families and communities, focusing on health promotion and disease prevention through people empowerment. The major goal of community health nursing is to preserve the community's and surrounding populations' health by focusing on health promotion and health maintenance of individuals, families, and groups within the community. The nurse’s actions acknowledge the need for comprehensive health planning, recognize the influences of social and ecological issues, give attention to populations at risk, and utilize dynamic forces that influence change. 3 Basic Concepts of Community and Public Health Nursing 1. The community as a client Community is a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging (Alexander et al., 2009). 2. Health as a goal Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 2010). Health is more than a state of well-being. It is a multidimensional reality that includes socioeconomic, environmental and even political factors. 3 Basic Concepts of Community and Public Health Nursing 3. Nursing as the vehicle or means to achieve its aims Nursing is the art and science of caring. It is a means of ensuring that people are placed in an optimum condition where nature can contribute to healing and wellness.  Dr. Charles-Edward Amory Winslow  Father of Public Health  Public Health is the science and art of: ✓ preventing diseases ✓ prolonging life and promoting health and efficiency through organized community effort ✓ sanitation of environment and control of disease ✓ education of individuals in personal hygiene ✓ organization of medical and nursing services for early diagnosis and preventive treatment of diseases ✓ development of social machinery to ensure for every individual a standard of living adequate for maintenance of health and enable every citizen to realize the birth right of health and longevity Community Health Nursing  The utilization of the nursing process in the different levels of clientele- individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation. - Maglaya, et al Objective of Community Health  To provide needs based on comprehensive services which include the following: a. Promotion and protection of health b. Early diagnosis and treatment and control of further spread of disease c. Control of disability and rehabilitation  The major emphasis in on PRIMARY LEVEL PREVENTION with the active involvement of people. - Safe drinking water - Safe disposal of waste materials - Maintaining general cleanliness - Immunization of children - Traffic control - Good nutrition - Health checkup and mass screening - Early diagnosis and mass treatment - Health education Community Development organized effort of people to improve the conditions of the community life and the capacity of the people for participation, self-direction, and integrated efforts in community affairs in which development is accomplished by the people.  Community Health Development (CHD)  Process of putting in the hands of community members the power to make effective health decisions and to influence the management of available health resources so that they can start to address their own health concerns  Active players: community leaders, barangay health workers, community volunteer health workers, and people in the community Mission:  Cooperation  Self help  Voluntary participation  PHILOSOPHY AND PRINCIPLES PHILOSOPHY: health is a fundamental human right and that communities are the focus of care, aiming to improve their overall health and well-being. 1. The practice of community and public health nursing is anchored on the primary of worth and dignity of man. 2. Respect for people’s inherent value regardless of their background and beliefs are edified in the universal bioethical principles. 3. Responsibility for health rests primarily on people and not on agencies or professionals. 4. The need for the attainment of independence and self-reliance in health. 5. Health is a shared responsibility and therefore requires collective efforts from all sectors. Working with communities requires active participation of the people. 6. A fundamental commitment of community and public health nurses is to adhere to the tenets of social justice. This principle speaks of promoting common good and not merely to be fair to all. 7. One hallmark of the profession is having its own code of ethics.  Principles of Community and Public Health Nursing 1. CHN is based on the recognized needs of communities, families, groups, and individuals. 2. The CH nurse must fully understand the objectives and policies of the agencies she represents. 3. In CHN, the family is the unit of service. 4. CHN must be available to all. 5. Health teaching is the PRIMARY responsibility of the CH nurses. 6. The CH nurse works as a member of the health team. 7. There must be provision for periodic evaluation of CHN services 8. Opportunities for continuing staff education programs for nurses must be provided by the agency. 9. The CH nurse makes use of available community health resources 10. The CH nurse utilizes the already existing active organization in the community 11. There should be accurate recording and reporting in CHN 12. Evidence-Based Practice THEORETICAL MODELS/ APPROACHES  The Health Belief Model (HBM)  The HBM was initially proposed in 1958 and developed by a group of social psychologists to explain why the public failed to participate in screening for tuberculosis (Hochbaum, 1958).  It is the one of the most widely used conceptual framework in health behavior to be able to explain behavior change and maintenance of behavior change and to guide health promotion interventions.  The Health Belief Model (HBM) is one of the first theories of HEALTH BEHAVIOR. It provides the basis for the practice of HEALTH EDUCATION and HEALTH PROMOTION People will not change their health behaviors unless they believe that they are at risk. BEHAVIORAL HEALTH THEORY a combination of: INTERPERSONAL HEALTH-RELATED BEHAVIORS  The Health Belief Model (HBM) ✓ Used to develop preventative health program ✓ Design appropriate intervention program HBM is a popular model applied in nursing, especially in issues focusing on patient compliance and preventive health care practices. ❖ It helps to explain the impact of an individuals perception and attitude towards a disease. ❖ How perception and attitudes impacted their health related decision making. The Health Belief Model (HBM)  The health belief model proposes that a person's health-related behavior depends on the person's perception of four critical areas:  the severity of a potential illness  the person's susceptibility to that illness  the benefits of taking a preventive action  the barriers to taking that action. The model suggests that a person is more likely to engage in a health-promoting behavior if they: Believe they are susceptible to a health problem. Understand the severity of the condition if untreated. Recognize the benefits of taking action. Identify ways to overcome barriers to taking action. Are motivated by cues to action and feel confident in their self-efficacy.  The model postulates that health-seeking behavior is influenced by a person’s perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat.  HBM addresses the relationship between a person’s beliefs and behaviors. It provides a way to understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies.  THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL Perceived Susceptibility: refers to a person’s perception that a health problem is personally relevant or that a diagnosis of illness is accurate. Example: "I am at risk of developing diabetes because I have a family history." Perceived severity: one recognizes personal susceptibility, action will not occur unless the individual perceives the severity to be high enough to have serious organic or social complications. Example: "If I get diabetes, it will significantly affect my quality of life and may lead to complications like blindness." Perceived benefits: refers to the patient’s belief that a given treatment will cure the illness or help to prevent it. Example: "Eating a healthy diet and exercising regularly can help prevent diabetes."  THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL Perceived Costs: refers to the complexity, duration, and accessibility and accessibility of the treatment. Example: "The treatment for my condition is long, expensive, and difficult to access in my area. Motivation: includes the desire to comply with a treatment and the belief that people should do what. Example: "I want to follow the doctor’s advice to manage my blood pressure because I believe it’s my responsibility to stay healthy for my family.“ Modifying factors: include personality variables, patient satisfaction, and socio- demographic factors. Example: "As an elderly person with limited income, I feel accessing healthcare is more difficult compared to younger people with better resources."  MILIO'S FRAMEWORK FOR PREVENTION  Nancy Milio developed a framework for prevention that includes concepts of community – oriented, population- focused care.  Behavioral patterns of the populations-and individuals who make up populations – are a result of habitual selection from limited choices.  Health Deficits occur when there is an imbalance between a community’s health needs and its health sustaining resources.  The framework focuses on the relationship between individual health behaviors and the broader socio- environmental factors that influence these behaviors. It emphasizes prevention at the community and population levels rather than solely focusing on individual responsibility.  She challenged the common notion that a main determinant for unhealthful behavioral choice is LACK OF KNOWLEDGE 1. Health-Directed Behavior- Individual health behaviors are shaped not just by personal choices but also by available resources and environmental influences. 2. Choices are Limited by Resources Individuals may have limited health-promoting options due to constraints such as: Economic factors (e.g., poverty, unemployment). Social factors (e.g., education, cultural norms). Environmental factors (e.g., lack of access to healthcare or clean water). 3. Population-Level Interventions The framework highlights the importance of policy changes and community-based interventions to improve health. Strategies should address structural barriers and promote equity in health opportunities. 4. Health-deficit: A lack of resources and opportunities for healthy living. Health-surplus: Environments that promote and sustain health. Principles of Milio’s Framework 1. Health behaviors result from available choices influenced by social, economic, and environmental factors. 2. Changing health patterns requires altering societal norms and resource allocation. 3. Policy-level interventions are essential to provide individuals with healthier choices. 4. Prevention is more effective when implemented at the population level.  LEVELS OF PREVENTION MODEL  This model, advocated by Leavell and Clark in 1975, influenced both public health practice and ambulatory care delivery worldwide.  This model suggests that the natural history of any disease exists on a continuum, with health at one end and advanced disease at the other.  The model delineates three levels of the application of preventive measures that can be used to promote health and arrest the disease process at different points along the continuum  The goal is to maintain a healthy state and to prevent disease or injury.  HEALTH PROMOTION MODEL  The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was designed to be a “complementary counterpart to models of health protection.”  It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client’s level of well being.  The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health.  HEALTH PROMOTION MODEL  Health-promoting behaviors.  The model emphasizes proactive approaches to health and focuses on factors influencing health behaviors rather than simply preventing diseases. It encourages individuals to strive for optimal well- being through personal and environmental change. Assumptions of Nola Pender's Health Promotion Model  Individuals seek to regulate their behavior actively.  Individuals interact with their environment, which can be transformed to support health behaviors.  Health professionals play an important role in influencing individuals toward health promotion.  Self-initiated change of behavior is key to achieving better health.  Health Education  Care Plans  Community Health Promotion  Behavior Changes in Chronic Illness PRECEDE- PROCEED MODEL Lawrence Green’s PRECEDE-PROCEED Model  is a comprehensive framework developed for planning and evaluating health promotion and public health programs.  It emphasizes a systematic, evidence-based approach to behavior and environment change. DESIGNING, IMPLEMENTING AND EVALUATION of public health programs  PRECEDE The model PRECEDE is an acronym for Predisposing Reinforcing Enabling Constructs in Educational Diagnosis and Evaluation.  Phases of PRECEDE  Social Assessment determining the social problems and needs of a given population and identify desired results.  Epidemiological Assessment Identify health determinants of the identified problems and set priorities of goals  Ecological Assessment Analyze behavioral and environmental determinants that predispose, reinforce and enable the behaviors and lifestyle Identify behaviors (e.g., lack of exercise) and environmental factors (e.g., lack of parks) contributing to the problem.  Phases of PRECEDE ❑ Educational and Ecological Assessment: Analyze the factors influencing behavior change. These include: 1. Predisposing factors: Knowledge, attitudes, beliefs, values, and perceptions influencing behavior. 1. Example: Lack of awareness of the benefits of physical activity. 2. Reinforcing factors: Positive or negative feedback that encourages or discourages behavior. 1. Example: Praise from peers or family for adopting healthy behaviors. 3. Enabling factors: Factors that facilitate behavior change, such as resources, skills, or access. 1. Example: Availability of exercise facilities or affordable healthy food. ❑ Administrative and Policy Assessment Assess policies, resources, and organizational factors that can support program implementation. Example: Budget allocation for community health education programs.  PROCEDE MODEL Policy Regulatory and Organizational Constructs in Educational and Environmental Development  Involves the identification of desired outcomes and program implementation  IMPLEMENTING AND EVALUATION of Public Health Programs  IMPLEMENTATION Design intervention, assess the availability of resources, and implement the program. Example: Launching exercise classes or nutritional education in communities.  PROCESS EVALUATION determines if the program reaching the targeted population and achieving desired goals. Example: Checking attendance in health education sessions.  IMPACT EVALUATION Evaluate the change in behavior  OUTCOME EVALUATION identify if there is a decrease in the incidence or prevalence of the identified negative behavior or an increase in identified positive behavior. DIFFERENT FIELDS Different fields of NURSING  Community Based Nursing is the application of the nursing process in caring for individuals, families and groups where they live, work or go to school as they move through the health care system.  School Health Nursing School aims to promote the health of school personnel and students that could hinder learning or performance. According to World Health Organization (WHO, 1997), “to learn effectively, children need good health.” School Health Services:  Comprehensive School Health Education (Grades K-12)  Pysical Education and Activity  Nutrition Services  School Health Services  School Counseling, Psychological and Social Services  Health and Safe School Environment  Student, Family and Community Involvement in Schools  Health Promotion for School Staff  Occupational Health Nursing aimed at assisting workers in all occupations to cope with actual and potential stresses to their work and work environment.  Community Mental Health Nurses are specialized nurses who provide wholistic nursing services for people with mental health issues, in a community setting such as caring and confidential supports for the clients, using the recovery model for care. The services may include: 1. Treatment Planning 2. Medication Management 3. Assessment 4. Counseling 5. Family Support 6. Education 7. Group Support 8. Home Health Care 9. Hospice Home Care II. CONCEPT OF THE COMMUNITY A. TYPES OF COMMUNITIES B. CHARACTERISTICS OF A HEALTHY COMMUNITY C. COMPONENTS OF A COMMUNITY D. FACTORS AFFECTING HEALTH OF THE COMMUNITY 1.CHARACTERISTICS OF THE POPULATIONS 2. LOCATION OF THE COMMUNITY 3. SOCIAL SYSTEM WITHIN THE COMMUNITY E. ROLES AND ACTIVITIES OF COMMUNITY HEALTH NURSE TYPES OF COMMUNITIES 1. Geopolitical communities ❑ refers to a community defined by geographic and political boundaries, often influenced by governance, jurisdiction, and shared infrastructure. These communities are shaped by their location and the systems of authority that manage their affairs, such as local, regional, or national governments. ❑ defined or formed by both natural and man-made boundaries and include barangays, municipalities, cities, provinces, regions, and nations. Characteristics of Geopolitical Communities 1. Defined Boundaries: These communities have clear geographic or political borders, such as cities, towns, provinces, or nations. 2. Governance and Authority: Managed by a governing body like a local government, state, or national administration. 3. Shared Resources: Members often share resources like public utilities, healthcare, education, and law enforcement services. 4. Cultural and Economic Diversity: Can encompass diverse populations with varying cultural, economic, and social dynamics. 5. Community Identity: Residents often identify themselves as members of the geopolitical community based on their location. 2. Phenomenological Communities  are groups of individuals who share a common experience, perception, or understanding that shapes their sense of identity and belonging.  These communities are defined by subjective or personal experiences rather than by geographical or political boundaries. Characteristics of Phenomenological Communities 1. Shared Lived Experiences: 1. The community is formed based on common experiences or perceptions rather than physical proximity or formal membership. 2. Examples: People who have undergone the same life event (e.g., cancer survivors, people who have experienced grief, or those who share a cultural or historical event). 2. Subjective Connection: 1. Members of a phenomenological community feel connected due to their shared understanding or emotional connection to the experience. 2. This bond is less about formal interactions and more about a shared worldview or understanding. 1. Emotional or Psychological Bond: 1. The connection is often deep and personal, driven by empathy, solidarity, and mutual understanding. 2. Example: Support groups for individuals with addiction, where members bond over shared struggles and recovery journeys. 2. Formation Around Meaning or Purpose: 1. These communities often arise around a shared sense of purpose, belief, or goal. 2. Example: A spiritual community that shares the same religious practices, values, and worldview.  EXAMPLES OF PHENOMENOLOGICAL COMMUNITIES 1. Support group People who share common challenges or conditions come together to provide mutual support and understanding. 2. Cultural or Religious Communities: People who share the same cultural or religious practices form communities where they can relate to each other's experiences and beliefs. 3. Online Communities: Virtual communities formed around shared interests, experiences, or issues, where members communicate and share information based on common understanding. 4. Advocacy and Social Justice Groups Communities formed around collective action for social change, such as those fighting for human rights, environmental issues, or political causes. 5. Artistic and Creative Communities: People who share a creative or artistic vision come together to express their shared experiences or goals. Components of a Community A community can be described as a complex whole resulting from the combination of the environment, people health, quality of life, and economics. KEY: 1. People- fundamental component of community 2. Place - refers to the physical or geographical area in which the community exists. 3. Shared Interests or Goals- united by common interests or goals that provide a sense of purpose. Common interests bind individuals together and help foster collaboration. 4. Social Interaction Communities thrive on interaction between members, whether face-to-face or through virtual means. Social bonds are built through communication, shared experiences, and collaboration. 5. Social Structure Community has an underlying social structure that governs how members interact. It include leadership roles, organizations, formal or informal groups, and institutions. 6. Culture Culture refers to the shared values, beliefs, customs, traditions, and practices that characterize a community. 7. Institutions and Organizations It provides services, support systems, and resources that help the community function. 8. Resources and Infrastructure Resources refer to the materials, services, and opportunities available to the community. This includes physical infrastructure like roads, utilities, and public transportation, as well as human resources such as education, healthcare, and employment. 9. Leadership Effective leadership is crucial for guiding the community, making decisions, and ensuring that the needs of the members are met. Leadership can be formal (e.g., elected officials) or informal (e.g., community activists or elders). 10. Networks and Connections The connections between individuals, groups, and organizations within and outside the community. Strong networks enable communities to respond to challenges and seize opportunities more effectively. 11. Values and Norms Communities are guided by shared values and norms that define acceptable behavior and set expectations for how members should interact. These can include respect for diversity, cooperation, and collective responsibility. The values and norms shape how individuals behave and how resources are allocated within the community.