Nursing Care of the Community (Famorca et al., 2013) PDF

Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  CHAPTER 1: FUNDAMENTAL CONCEPTS OF COMMUNITY HEALTH NURSING ❖ COMMUNITY/PUBLIC HEALTH NURSING — The synthesis of nursing practice and public health practice. ❖ MAJOR GOAL OF CHN Preserve the hea...

Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  CHAPTER 1: FUNDAMENTAL CONCEPTS OF COMMUNITY HEALTH NURSING ❖ COMMUNITY/PUBLIC HEALTH NURSING — The synthesis of nursing practice and public health practice. ❖ MAJOR GOAL OF CHN Preserve the health of the community and surrounding population by focusing on health promotion and health maintenance of individual, family and group within community. Thus CHN/ PHN is associated with health and identification of population at risks rather than with an episodic response to patient demand. ❖ MISSION OF PUBLIC HEALTH Social justice that entitles all people to basic necessities, such as adequate income and health protection, and accepts collective burdens to make possible. ❖ DEFINITION OF HEALTH ACCORDING TO: WHO ▪ “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Murray ▪ “a state of well-being in which the person is able to use purposeful, adaptive responses and processes physically, mentally, emotionally, spiritually, and socially.” Pender ▪ “actualization of inherent and acquired human potential through goal- directed behavior, competent self-care, and satisfying relationship with others.” Orem ▪ “a state of person that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning.” ❖ SOCIAL “of or relating to living together in organized groups or similar close aggregates” ❖ SOCIAL HEALTH Connotes community vitality and is a result of positive interaction among groups within the community with an emphasis on health promotion and illness prevention. ❖ COMMUNITY Seen as a group or collection of locality-based individuals, interacting in social units, and sharing common interests, characteristics, values, and/ or goals. ❖ DEFINITION OF COMMUNITY ACCORDING TO: Allender ▪ “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.” Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Lundy and Janes ▪ “A group of people who share something in common and interact with one another, who may exhibit a commitment with one another and may share a geographic boundary.” Clark ▪ “A group of people who share common interests, who interact with each other, and who function collectively within a defined social structure to address common concerns.” Shuster and Goeppinger ▪ “A locality-based entity, composed of systems of formal organizations reflecting society’s institutions, informal groups, and aggregates.” ❖ TWO MAIN TYPES OF COMMUNITIES (Maurer & Smith, 2009) Geopolitical Communities AKA Territorial Communities ▪ Most traditionally recognized. ▪ Defined or formed by both natural and man-made boundaries and include barangays, municipalities, cities, provinces, regions, and nations. Phenomenological Communities AKA Functional Communities ▪ Refer to relational, interactive groups, in which the place or setting is more abstract, and people share a group perspective or identity based on culture, values, history, interest, and goals. ❖ POPULATION Typically used to denote a group of people having common personal or environmental characteristics. ❖ AGGREGATES Subgroups or subpopulations that have some common characteristics or concerns. ❖ DETERMINANTS OF HEALTH 1. Income and Social Status Higher-income and social status are linked to better health. The greater the gap between the richest and poor health, the greater differences in health. 2. Education Low education levels are linked with poor health, more stress and lower self- confidence. 3. Physical Environment Safe water and clean air, healthy workplaces, safe houses communities and roads all contribute to good health. 4. Employment and Working Conditions People in employment are healthier, particularly those who have control over their working conditions. 5. Social Support Networks Greater support from families, friends and communities is linked to better health. 6. Culture Customs and traditions, and the beliefs of the family and community all affect health. 7. Genetics Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Inheritance plays a part in determining lifespan, healthiness, and the likelihood of developing illnesses. 8. Personal Behavior and Coping Skills Balanced eating, keeping active, smoking, drinking and how we deal with life’s stresses and challenges all affect health. 9. Health Services Access and use of services that prevent and treat disease influences health. 10. Gender Men and women suffer from different types of diseases at different ages. ❖ INDICATORS OF HEALTH AND ILLNESS National Epidemiology Center of DOH, PSA, and Local Health Centers/Offices/ Departments ▪ Provide morbidity, mortality, and other health status related data. Local Health Centers/Offices/Departments ▪ responsible for collecting morbidity and mortality data and forwarding the information to the higher level of health, such as Provincial Health office. Nurses should participate in investigative efforts to determine what is precipitating the increased disease rate and work to remedy the identified threats or risks. ❖ DEFINITION AND FOCUS OF PUBLIC HEALTH AND COMMUNITY HEALTH DEFINITION OF PUBLIC HEALTH ACCORDING TO: ▪ C. E. WINSLOW “Public health is the science and art of: 1. preventing disease, 2. prolonging life, and 3. promoting health and efficiency through organized community effort for: i. sanitation of the environment, ii. control communicable infections, iii. education of the individual in personal hygiene, iv. organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and v. “development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.” (Hanlon) PUBLIC HEALTH ▪ Key Phrase Definition: “through organized community effort”. ▪ Connotes organized, legislated, and tax-supported efforts that serve all people through health departments or related governmental agencies. 9 ESSENTIAL PUBLIC HEALTH FUNCTIONS (ACCORDING TO WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC) 1. Health situation monitoring and analysis 2. Epidemiological surveillance/ disease prevention and control Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  3. Development of policies and planning in public health 4. Strategic management of health systems and services for population health gain 5. Regulation and enforcement to protect public health 6. Human resources development and planning in public health 7. Health promotion, social participation and empowerment 8. Ensuring the quality of personal and population-based health service 9. Research, development, and implementation of innovative public health solution COMMUNITY HEALTH o Extends the realm of public health to include organized health efforts at the community level through both government and private efforts HEALTH PROMOTION AND LEVELS OF PREVENTION o Health Promotion ▪ Activities enhance resources directed at improving well-being. o Disease Prevention ▪ Activities protect people from disease and effects of disease. LEAVELL AND CLARK’S THREE LEVELS OF PREVENTION 1. Primary Prevention - Relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. 2. Secondary Prevention - Early detection and prompt intervention during the period of early disease pathogenesis. - Implemented after a problem has begun but before signs and symptoms appear and targets populations who have risk factors (Keller). 3. Tertiary Prevention - Targets populations that have experienced disease or injury and focuses on limitations of disability and rehabilitation. - Aim: Reduce the effects of disease and injury and to restore individuals to their optimum level of functioning. DEFINITION OF COMMUNITY HEALTH NURSING ACCORDING TO: ▪ AMERICAN NURSES ASSOCIATION (1980) Global or umbrella term; broader and more general specialty area that encompasses subspecialties that include public health nursing, school nursing, occupational health nursing, and other developing fields of practice, such as home health, hospice care, and independent nurse practice “the synthesis of nursing practice and public health practice applied to promoting and preserving health of the populations.” (ANA, 1980) PUBLIC HEALTH NURSING o A component or subset of CHN o The synthesis of public health and nursing practice Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  PHN according to FREEMAN (1963): o Public Health Nursing may be defined as the field of professional practice in nursing and in public health in which technical nursing, interpersonal, analytical, and organizational skills are applied to problems of health as they affect the community. ▪ These skills are applied in concert with those of other persons engaged in health care, through comprehensive nursing care of families and other groups and through measures for evaluation or control of threats to health, for health education of the public and for the mobilization of the public for health action. PHN according to ANA (1996): o “The practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences” o “Population-focused, with the goals of the promoting health and preventing disease and disability for all people through the creation of conditions in which people can be healthy.” Community-Based Nursing o Application of the nursing process in caring for individuals, families and group where they live, work go to go school, or they move through the health care system o Setting-specific, and the emphasis is on acute and chronic care and includes practice areas such as home health nursing and nursing in outpatient or ambulatory setting. ❖ CHN VS. COMMUNITY-BASED NURSING CHN ▪ emphasizes preservation and protection of heath ▪ the primary client is the community Community-based Nursing ▪ Emphasizes on managing acute and chronic ▪ the primary clients are the individual and the family ❖ POPULATION-FOCUSED NURSING Concentrates on specific groups of people and focuses on health promotion and disease prevention, regardless of geographical location (Baldwin et al., 1998) Focused Practice: 1. Focuses on the entire population 2. Based on assessment of the populations’ health status 3. Considers the broad determinants of health 4. Emphasizes all levels of prevention 5. Intervenes with communities, systems, individuals and families Goal – promote healthy communities ❖ CHN PRACTICE REQUIRES THE FF. TYPES OF DATA FOR SCIENTIFIC APPROACH AND POPULATION: 1. The epidemiology or body of knowledge of a particular problem and its solution 2. Information about the community Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  TYPES OF INFORMATION SOURCES Demographic Vital Statistics; census Groups at High Risk Health statistics; disease statistics Services/Providers Available City directors, phone books, local/regional social workers, list of low income providers, CH nurse ❖ Family – Basic unit of care in CHN ❖ Individual – Focus in the clinic or health center ❖ THE INTERVENTION WHEEL Proposed in the late 1990s by nurses from the Minnesota Department of Health ▪ To describe the breadth and scope of public health nursing practice. ▪ Recognized as a framework for community and public health practice Consist of 17 health interventions are grouped into 5 wedges 3 Important Elements: ▪ It is population-based ▪ It contains 3 levels of practice (Community, Systems, and Individual/Family) ▪ It identifies and defines 12 public health interventions ▪ ❖ 17 PUBLIC HEALTH INTERVENTIONS AND DEFINITION (Keller et al., 2004) 1. Surveillance – Monitors health events 2. Disease and other Health Event Investigation – Systematically gathers and analyzes data regarding threats to the health of populations 3. Outreach – Locates populations of interests or populations at risk 4. Screening – Identifies individuals with unrecognized health risk factors 5. Case Finding – Identifies risk actors and connects them with resources 6. Referral and Follow-up – Assists individuals and families, families, groups, organizations ad communities to identify and access necessary resources 7. Case Management – Optimizes self-care capabilities of individuals and families Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  8. Delegated Functions – Direct care tasks that the nurse carries out 9. Health Teaching – Communicates facts, ideas and skills that change knowledge, attitudes values, behaviors, and practice 10. Counseling – Establishes an interpersonal relationship; with the intention of increasing or enhancing their capacity for self-care and coping 11. Consultation – Seeks information and generates optional solutions to perceived problems 12. Collaboration – Commits two or more persons or an organization 13. Coalition Building – Develops alliances among organizations 14. Community Organizing – Helps community groups to identify common problems or goals mobilizes resources and develop and implement strategies 15. Advocacy – Pleads someone’s cause or acts on someone’s behalf 16. Social Marketing – Utilizes commercial marketing principles for programs 17. Policy Development and Enforcement – Place issues on decision makers’ agendas, acquires plan of resolution ❖ EMERGING FIELDS OF CHN IN THE PHILIPPINES HOME HEALTH CARE o This practice involves providing nursing care nursing care to individuals and families in their own places of residence mainly to minimize the effects of illness and disability. HOSPICE HOME CARE o Homecare rendered to the terminally ill. Palliative care is particularly important ❖ ENTREPRENURSE o A project initiated by the Department of Labor and Employment (DOLE), in collaboration with the Board of Nursing of the Philippines, Department of Health, Philippines Nurses Association and other stakeholders to promote nurse entrepreneurship by introducing a home health care industry in the Philippines. o It aims to: 1. Reduce the cost of health care for the countries indigent population by bringing primary health care services to poor rural communities 2. Maximize employment opportunities for the countries unemployed nurses 3. Utilize the countries unemployed human resources for health for the delivery of public health services and the achievement of the country’s Millennium Development Goals (MDG) on maternal and child health, (DOLE, 2013) o Main Purpose of Entreprenurse – To deliver home health care services ❖ COMPETENCY STANDARDS IN CHN 1. Safe and Quality Nursing Care ▪ knowledge of health/illness status of the client, sound decision making; safety, comfort, privacy, administration of meds and health therapeutics and nursing process. 2. Management of Resources and Environment ▪ organization of workload; use of financial resurces for client care; mechanism to ensure proper functioning of equipment and maintenance of a safe environment Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  3. Health Education ▪ assessment of client’s learning needs; development of health education plan and learning materials and implementation and evaluation of health education plan 4. Legal Responsibility ▪ adherence to the nursing laws as well as to national, local and organizational policies including documentation of care given to clients. 5. Ethicomoral Responsibility ▪ respect for the rights of the client; responsibility and accountability for own decisions and actions; and adherence to the international and national codes of ethics for nurses 6. Personal and Professional Development ▪ identification of own learning needs, pursuit of continuing education; involvement in professional image; positive attitude towards change and criticism 7. Quality Improvement ▪ data gathering for quality improvement; participation in nursing rounds; identification and reporting of solutions to identifies problems related to client care. 8. Research ▪ research-based formulation of solutions to problems in client care and dissemination and application of research findings 9. Records Management ▪ accurate and updated documentation of client care while observing legal imperatives and record keeping 10. Communication ▪ uses therapeutic communication techniques, identifies verbal and nonverbal cues, responds to client needs, while using formal and informal channels of communication and appropriate information technology 11. Collaboration and Teamwork ▪ establishment of collaborative relationship with colleagues and other members of health team ❖ HISTORY OF PUBLIC HEALTH AND PUBLIC HEALTH NURSING IN THE PHILIPPINES 1577 o Franciscan FriarJuan Clemente opened medical dispensary in Intramuros for the indigent 1690 o Dominican Father Juan de Pergero worked toward installing a water system in San Juan del Monte and Manila 1805 o Smallpox vaccination was introduced by Francisco de Balmis , the personal physician of King Charles IV of Spain 1876 o First medicos titulares were appointed by the Spanish government Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  1888 o 2-year courses consisting of fundamental medical and dental subjects was first offered in the University of Santo Tomas. Graduated were known as “cirujanos ministrantes” and serve as male nurses and sanitation inspectors 1901 o United States Philippines Commission, through Act 157, created the Board of Health of the Philippine Islands with a Commissioner of the Public Health, as its chief executive officer (now the Department of Health Fajardo Act of 1912 o Created sanitary divisions made up of one to four municipalities. Each sanitary division had a president who had to be a physician 1915 o The Philippine General hospital began to extend public health nursing services in the homes of patients by organizing a unit called Social and Home Care services Asociacion Feminista Filipina (1905) o Lagota de Leche was the first center dedicated to the service of the mothers and babies 1947 o The Department of Health was reorganized into bureaus: quarantine, hospitals that took charge of the municipal and charity clinics and health with the sanitary divisions under it. 1954 o Congress passed RA 1082 or the Rural Health Act that provided the creation of RHU in every municipality RA 1891 o Enacted in 1957 amended certain provisions in the Rural Health Act ▪ Created 8 categories of rural health units corresponding to the population size of the municipalities RA 7160 (Local Government Code) o Enacted in 1991, amended that devolution of basic health services including health services, to local government units and the establishment of a local health board in every province and city of municipality Millennium Development Goals o Adopted during the world summit in September 2000 FOURmula One (F1) for health, 2005 and Universal Health Care in 2010 agenda launched in 1999 Universal Health Care o Aims to achieve the health system goals of better health outcomes, sustained health financing, and responsive health system that will provide equitable access to health care Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  CHAPTER 2: THEORETICAL FOUNDATIONS OF COMMUNITY HEALTH NURSING PRACTICE ❖ HISTORICAL PERSPECTIVES ON NURSING THEORY Florence Nightingale − First nurse to formulate a conceptual foundation for nursing practice. − She believed that clean water, clean linen, access to adequate sanitation and a quiet environment would improve health outcomes. Other early nursing theories were extremely narrow and depicted health care situations that involved only one nurse and one patient. − Noticeably, the family and other health care professionals were absent from the context of the theories. From 1980 onwards, several nursing theorists including, Dorothy Johnson, Sister Callista Roy, Imogene King, Betty Neuman and Jean Watson have included community perspectives in their definition of health. ❖ HOW THEORY PROVIDES DIRECTION TO NURSING o Goal of Theory – To improve nursing practice by acting as a guide. ❖ GENERAL SYSTEMS THEORY General Systems Theory - the basis, in part, of several nursing theories. It is applicable to the different levels of the community health nurse’s clientele: ▪ Individuals ▪ Families ▪ Groups ▪ Aggregates and communities. Client ▪ considered as a set of interacting elements that exchange energy, matter or information with the external environment to exist (Katz and Kahn, 1966; von Bertalanffy, 1968) This theory is useful when: ▪ analyzing interrelationships of the elements within the client and the environment For example: the family has the basic structures that all open systems have. o It has boundaries that separate it from its environment. Culture and the Family Code dictate the boundaries of the Filipino Family. The Family Environment constitutes everything outside its boundaries that may affect it; the family home and the community and its institutions make up the immediate environment and should be considered in the assessment of family health status. The family gets inputs of matter (food, water), energy, and information from the environment Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  OUTPUTS are material products, energy and information that result from the family’s processing of inputs. Examples are health practices and the health status of the family members. FEEDBACK is the information from the environment directed back to the system, it allows the system to make the necessary adjustments for better functioning. o For example: a nurse’s feedback to a mother that her child is underweight makes the mother more aware of her child’s needs and allows her to take action. SUBSYSTEMS are the components of a system that interact to accomplish their own purpose. (Family members) SUPRASYSTEMS are a bigger system composed of families who interrelate with and affect one another. (Families) ❖ SOCIAL LEARNING THEORY It is based on the belief that learning takes place in a social context; people learn from one another and learning is promoted by modeling or observing other people. It assumes that all personas are thinking beings that are capable of making decisions and acting according to expected consequences of their behavior. The environment affects learning but learning outcomes depend on the learner’s individual characteristics. Application of the theory can be done by: − Catching the person’s attention with different strategies − Promoting retention of learning − Providing opportunities for reproduction or imitation of the procedures − Motivating the person by explaining the benefits possible by practicing the behavior ❖ THE HEALTH BELIEF MODEL Initially proposed in 1958 The model provides the basis for much of the practice of health education and promotion today. This model found that information alone is rarely enough to motivate people to act for their health. Individuals must know what to do and how to do it before they can act. Model’s concepts – all relate to the client’s perceptions For example: Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  − The cue to action in the prevention of dengue fever may be provided through an information campaign. → This makes the people in a barangay aware of the disease and that everyone is susceptible to the possibly fatal disease. → The HBM would be used by the nurse to help clients in making behavior modifications to avoid dengue. CONCEPT DEFINITION Perceived Susceptibility → One’s belief regarding the chance of getting a given condition Perceived Severity → One’s belief in the seriousness of a given condition Perceived Benefits → One’s belief in the ability of an advised action to reduce the health risk or seriousness of a given condition Perceived Barriers → One’s belief regarding the tangible and psychological costs of an advised action Cues to an Action → Strategies or conditions in one’s environment that activate readiness to take action Self-Efficacy → One’s confidence in one’s ability to take action to reduce health risks ❖ MILIO’S FRAMEWORK FOR PREVENTION Milio (1976) proposed that health deficits often result from an imbalance between a population’s health needs and its health sustaining resources. She stated that diseases associated with excess occurred in affluent societies (obesity) and diseases that result from inadequacies in food, shelter and water afflict the poor. Therefore, poor people in affluent societies experience the least desirable combination of factors. Personal and societal resources affect the range of health promoting or health damaging choices available to individuals. Personal resources include the individual’s awareness, knowledge, and health beliefs. Money and time are also personal resources. She proposed that most human beings make the easiest choices available to them most of the time. Health promoting choices must be more readily available and less costly than health damaging options for individuals to gain health. This theory is broader than the HBM, it includes economic, political and environmental health determinants rather than just the individual’s perceptions. This theory encourages the nurse to understand health behaviors in the context of their societal milieu. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ❖ PENDER’S HEALTH PROMOTION MODEL The model explores many biopsychosocial factors that influence individuals to pursue health promotion activities. The model depicts complex multidimensional factors which people interact with as they work to achieve optimum health. CONSTRUCTS/VARIABLES OF HPM Individual Characteristics Each person’s unique characteristics and and Experiences experiences affect his or her actions. Their effect depends on the behavior in question Prior Related Behavior Prior behaviors influence subsequent behavior through perceived self-efficacy, benefits, barriers and affects related to that activity. Habit is also a strong indicator of future behavior. Behavior Specific In the HPM, these variables are considered to be Cognitions an Affect very significant in behavior motivation. They are a “core” for intervention because they may be modified through nursing actions assessment of the effectiveness of interventions is accomplished by measuring the change in these variables. Perceived Benefits Of The perceived benefits of a behavior are strong Action motivators o that behavior. These motivate the behavior through intrinsic and extrinsic benefits. Intrinsic benefits include increased energy and decreased appetite. Extrinsic benefits include social rewards such as compliments and monetary rewards. Perceived Barriers to Barriers are perceived unavailability, Action inconvenience, expense, difficulty or time regarding health behaviors Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Perceived Self-Efficacy Self-efficacy is one’s belief that he or she is capable of carrying out a health behavior. If one has high self-efficacy regarding a behavior, one I more likely to engage in that behavior than if one has low self-efficacy. Activity Related Affect The feelings associated with a behavior will likely affect whether an individual will repeat or maintain the behavior Interpersonal Influences I the HPM, these are feelings or thoughts regarding the beliefs or attitudes of others. Primary influences are family, peers, and health care providers. Situational Influences These are perceived options available, demand characteristics, and aesthetic features of the environment where the behavior will take place. For example, a lovely day will increase the probability of one taking a walk; the fire code will prevent one from smoking indoors. Commitment to a Plan of Pender states that “commitment to a plan of Action action initiates a behavioral event”. This commitment will compel one into the behavior until completed, unless a competing demand or preference intervenes. Immediate Competing These are alternative behaviors that one Demands and considers as possible optional behaviors Preferences immediately prior to engaging in the intended, planned behavior. One has little control over competing demands, but one has great control over competing preferences Health Promoting This is the goal or outcome of the HPM. The aim Behavior of health promoting behavior is the attainment of positive health outcomes ❖ THE TRANSTHEORETICAL MODEL Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  This model combines several theories of intervention. It is based on the assumption that behavior change takes place over time, and progresses through stages Each stage is stable and is open to change; Meaning one may stop in one stage, progress to the next stage or return to a previous stage. Change is difficult. People may resist change for many reasons. Change may be unpleasant, require giving up pleasure, be painful, stressful, etc. CORE CONSTRUCTS OF THE TTM STAGES OF CHANGE DESCRIPTION Precontemplation Individual has no intention to take action toward behavior change in the next 6 months. May be in this phase due to a lack of information about the consequences of the behavior or due to failure on previous attempts at change. Contemplation The individual has some intention to take action toward behavior change in the next 6 months. Weighing pros and cons to change. Preparation The individual intends to take action within the next month and has taken steps toward behavior change. Has a plan of action. Action The individual has changed overt behavior for less than 6 months. Has changed behavior sufficiently to reduce risk of disease Maintenance The individual has changed overt behavior for more than 6 months. Strives to prevent relapse. The phases may last months to years. Decisional balance Pros The benefits of behavior change Cons The costs of behavior change ❖ PRECEDE-PROCEED MODEL Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  It provides a model for community assessment, health education planning, and evaluation. PRECEDE, which stands for predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation is used for community diagnosis. PROCEED, stands for policy, regulatory, and organizational constructs in education and environmental development, is a model for implementing and evaluating health programs based on PRECEDE. Predisposing factors: people’s characteristics that motivate them toward health- related behavior. Enabling factors: conditions in people and the environment that facilitate or impede health related behavior. Reinforcing factors: feedback given by support persons or groups resulting from the performance of health-related behavior CHAPTER 3: PRIMARY HEALTH CARE ❖ SEPTEMBER 6-12, 1978 o First International Conference for PHC at Alma Ata, USSR, Russia ❖ Letter of Instruction (LOI) 949 o legal basis for PHC in the Philippines o signed by Pres. Ferdinand Marcos o THEME: Health in the Hands of the People by 2020 ❖ Primary Health Care (Definition) o the essential care made universally accessible to individuals and families in the community through their full preparation. ❖ Universal Goal o Health For All by the Year 2000 - this is achieved through community and individual self-reliance ❖ 5 KEY ELEMENTS 1. Reducing exclusion and social disparities in health (universal coverage). 2. Organizing health services around people’s needs and expectations (health service reforms). 3. Integrating health into all sectors (public policy reforms). 4. Pursuing collaborative models of policy dialogue (leadership reforms). 5. Increasing stakeholder participation. ❖ 8 Essential Health Services → E - Education for health → L - Locally endemic disease control → E - Expanded program for immunization → M - Maternal and child health including responsible parenthood → E - Essential drugs → N - Nutrition → T - Treatment of communicable and noncommunicable diseases → S - Safe water and sanitation ❖ KEY PRINCIPLES 1. 4 A’s ▪ Accessibility o distance/travel time required to get to a health care facility/service. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  o the home must be w/in 30 min. from the Brgy. health stations ▪ Affordability o Consideration of the individual, family, community, and government can afford the services o The out-of-pocket expense determines the affordability of health care. o In the Philippines, government insurance is covered through philhealth ▪ Acceptability o Health care services are compatible with the culture and traditions of the population. ▪ Availability o A question whether the health service is offered in health care facilities or is provided on a regular and organized manner.  Examples: o Botika ng Bayan ▪ Ensures the availability and accessibility of affordable essential drugs. ▪ It sells low-priced generic home remedies, OTC and common antibiotics. o Ligtas sa Tigdas ang Pinas ▪ Mass door-to-door measles immunization campaign. ▪ Target age: 9 months-below 8 years old 2. SUPPORT MECHANISM ▪ There are 3 major resources: i. People ii. Government iii. Private Sectors (e.g. NGO, church…) 3. MULTISECTORAL APPROACH ▪ Intrasectoral linkages (Two-way referral system) o communication, cooperation, and collaboration within the health sectors. ▪ Intersectoral Linkages o between the health sector and other sectors like education, agriculture, and local government. officials. 4. COMMUNITY PARTICIPATION ▪ A process in which people identify the problems and needs and assumes responsibilities themselves to plan, manage, and control. 5. EQUITABLEDISTRIBUTION OF HEALTH RESOURCES ▪ 2 DOH programs to ensure equitable distribution: i. Doctor to the Barrio (DTTB) Program - the deployment of doctors to municipalities that are w/o doctors. - deployed to unserved, economically depressed 5th or 6th class municipalities for 2 years. ii. Registered Nurses Health Enhancement and Local Service (RN HEALS) - training and program for unemployed nurse - deployed to unserved, economically depressed municipalities for 1 year. 6. APPROPRIATE TECHNOLOGY ▪ Health Technology includes: - tools Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  - drugs - methods - procedures and technique - people’s technology - indigenous technology ▪ Criteria for Appropriate health technology Safety Effectiveness Affordability Simplicity Acceptability Feasibility and Reliability Ecological effects Potential to contribute to individual and community development ❖ R.A. 8423 - Traditional and Alternative Medicine Act of 1997 (Juan Flavier) MEDICINAL USE/INDICATION PREPARATION PLANTS 1. Lagundi → Asthma, cough and colds, fever, → Decoction dysentry, pain → Wash affected site → Skin disease (scabies, ulcer, with decoction eczema), wounds 2. Yerba Buena → Headache, stomachache → Decoction → Cough and colds → Infusion → Rheumatism, Asthritis → Massage sap 3. Sambong → Antiedema/antiurolithiasis → Decoction 4. Tsaang Gubat → Diarrhea → Decoction → Stomachache 5. Niyog- → Antielminthic → Seeds are used niyogan 6. Bayabas → Washing wounds → Decoction → Diarrhea, gargle, toothache 7. Akapulko → Antifugal → Poultrice 8. Ulasimang → Lowers blood uric acid → Decoction Bato/ Pansit- (rheumatism and gout) → Eaten raw pansitan 9. Bawang → Hypertension, lowers blood → Eaten raw/fried cholesterol → Apply on part → Toothache Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  10. Ampalaya → Diabetes mellitus (mild non- → Decoction insulin-dependent) → Steamed ❖ MEDICINAL PLANT PREPARATION 1. DECOCTION - boiling the plant material in water for 20 min. 2. INFUSION - plant material is soaked in hot water for 10 - 15 minutes. 3. POULTRICE - directly apply plant material on the affected part, usually in bruises, wounds, and rashes. 4. TINCTURE - mix the plant material in alcohol. ❖ ALTERNATIVE HEALTH CARE MODALITIES TERM DEFINITION 1. Acupressure - Application of pressure on acupuncture pts. W/o puncturing the skin 2. Acupuncture - Uses special needles to puncture and stimulate specific part of the body 3. Aromatherapy - Combines essential aromatic oils to then applied to the body 4. Nutritional - “Nutritional healing”, this improves health by enhancing Therapy the nutritional value to reduce the risk of the disease 5. Pranic Healing - Follows the principle of balancing energy 6. Reflexology - Application of pressure on the body’s reflex joints to enhance body’s natural healing. ❖ PRIMARY CARE o Includes health promotion, disease prevention, health maintenance, counseling, patient education and diagnosis and treatment of acute and chronic illness in different health settings (American Association of Family Medicine) o Refers to the first contact of a person with a professional o A model of nursing care that emphasizes continuity of care o Nursing care is directed towards meeting all the patient’s need. PRIMARY HEALTH CARE PRIMARY CARE Focus of client Family and community Individual Focus of care Promotive and preventive Curative Decision-making Community-centered Health worker driven process Outcome Self-reliance Reliance on health workers Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Rural-based satellite Mostly urban places; hospital, Setting for services clinics; community health clinics centers Development and Goal Absence of disease preventive care CHAPTER 4: COMMUNITY ORGANIZING: ENSURING HEALTH IN THE HANDS OF THE PEOPLE ❖ DEFINITION OF COMMUNITY ORGANIZING o Community Organizing as a Process ▪ It consists of steps or activities that instill and reinforce the people’s self- confidence on their own collective strengths and capabilities (Manalili, 1990). ▪ It is the development of the community’s collective capacities - to solve its own problems and aspire for development through its own efforts. ▪ It is a continuous process of educating the community - to develop its capacity to assess and analyze the situation (which usually involves the process of consciousness raising), plan and implement interventions (mobilization), and evaluate them. ▪ It is a process of educating and mobilizing members of the community - to enable them to resolve community problems. It is a means to build the community’s capacity to work for the common good in general and health goals. o Community Organizing and Community Health Nursing Practice Have Common Goals: ▪ People empowerment, development of self-reliant community, and improved quality of life. - As a result, they become the health care professionals’ partners in health care delivery and overall community development. Community development means improvement access to resource (including health resources) that will enable the people to improve their standards of living and overall quality life. The emphases of community organizing in primary health care are the following: 1. People from the community working together to solve their own problems. 2. Internal organizational consolidation as a prerequisite to external expansion 3. Social movement first before technical change 4. Health reforms occurring within the context of broader social transformation. Community development is the end goal of community organizing and all efforts towards uplifting the status of the poor and marginalized. COMMUNITY DEVELOPMENT – entails a process of assessment of the current situation, the identification of needs, deciding on appropriate courses of actions or response, mobilization of resources to address these needs, and monitoring and evaluation by the people. COMMUNITY ORGANIZING is a value-based process, tracing its roots to three basic values: (LOCOA, 2005). o Human Rights Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ Based on the worth and dignity inherent to all human beings: the right to life, the right to development as persons and as a community, and the freedom to make decisions for oneself. o Social Justice ▪ Entails fairness in the distribution of resources to satisfy basic needs and to maintain dignity as human beings. o Social Responsibility ▪ An offshoot of the ethical principle of solidarity, which points to people being part of one community and is reflected in concern for one another. ❖ CORE PRINCIPLES AND GROUNDS FOR THE PRACTICE OF COMMUNITY ORGANIZING: o Anchored on the basic values of: ▪ human rights ▪ social justice ▪ social responsibility ❖ COMMUNITY ORGANIZING IS PEOPLE-CENTERED: o The basic premise of any community organizing endeavor ▪ the people are the means and ends of development, and community empowerment is the process and the outcome (Felix, 1998). ▪ It is people-centered (Brown, 1985) in the sense that the process of critical inquiry is informed by and responds to experiences and needs of the marginalized sectors/people. o Community organizing is not meant for person-to-person interaction, with only a few who will benefits from any undertakings and activities. o Community organizing is a people-centered strategy, with emphasis on the development of human resources necessitating education. The educational processes are interactive, empowering both the learners (the members of the community) and the teacher (the nurse), leading to decision making that plays a part in human development (Brown, 1985). ❖ COMMUNITY ORGANIZING IS PARTICIPATIVE: o The participation of the community in the entire process-assessment, planning, implementation, and evaluation-should be ensured. The community is considered as the prime mover and determinant, rather than beneficiaries and recipients, of development efforts, including health care. o For people empowerment, community participation is a critical condition for success (Reid, 2000). In community participation decision making and responsibility are in the hands of ordinary people, not just the elite. Distinction is not made among different groups and different personalities (Reid, 2000). ❖ COMMUNITY ORGANIZING IS DEMOCRATIC: o Community organizing should empower the disadvantage population. It is a process that allows the majority of people to recognize and critically analyze their difficulties and articulate their aspiration. Hence, their decision must reflect the will of the whole, more so the will of the common people, than that of the leaders and the elite. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  o Conflicts are inevitable in group dynamics. They are to be expected in organizing work. Thus, the organizer and community leaders require skills to effectively process and manage these conflicts. o Effort must be exerted to achieve a consensus. This requires a participative and consultative approach. ❖ COMMUNITY ORGANIZING IS DEVELOPMENTAL: o Community organizing should be directed towards changing current undesirable conditions. The organizer desires changes for the betterment of the community and believes that the community shares these aspirations and that these changes can be achieved. o Beyond health or economic improvement, community organizing seeks authentic human development. ❖ COMMUNITY ORGANIZING IS PROCESS-ORIENTED: o The community organizing goals of empowerment and development are achieved through a process of change. o Community organizing is dynamic. With the evolving community situation, monitoring and periodic review of plans are necessary. Through efforts of community members to identify and deal with other problems leads to sustenance of the community organizing efforts. ❖ PHASES OF COMMUNITY ORGANIZING:  PRE-ENTRY ▪ Pre-entry involves preparation one the part of the organizer and choosing a community for partnership. Preparation includes knowing the goals of the community organizing activity or experience. It also necessary to delineate criteria or guidelines for site selection. Making a list of sources of information and possible facility resources, both government and private, is recommended. For the novice organizers, preparation includes a study or review of the basic concepts of community organizing. Proper selection of possible barriers, threats, strengths, and opportunities at this stage is an important determinant of the overall outcome of community organizing. ▪ Communities may be identified through different means: ✓ Initial data gathered through an ocular survey ✓ Review of records of a health facility ✓ Review of the barangay/municipality profile ✓ Referrals from other communities or institutions or through a series of meetings ✓ Consultation from the local government units (LGUs) or private institutions. ✓ An ocular survey done at this stage. ✓ Courtesy call to the Mayor Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020   ENTRY INTO THE COMMUNITY ▪ Entry into the community formalizes the start of the organizing process. This is the stage where the organizer gets to know the community and the community likewise gets to know the organizer. An important point to remember this phase is to make courtesy call to local formal leaders (barangay chairperson, council members) Equally crucial but often overlooked is a visit to informal leaders recognized in the community, like elders, local health workers, traditional healers, church leaders, and local neighborhood association leaders. ▪ Considerations in the Entry Phase: The community organizer’s responsibility to clearly introduce themselves and their institution to the community. A clear explanation of the vision and mission, goals, programs, and activities must be given in all initial meetings and contacts with the community. Preparation for the initial visit includes gathering basic information on socioeconomic conditions, traditions including religious practices, overall physical environment, general health resources. the community organizer must keep in mind that the goal of the process is to build up the confidence and capacities of people. Manalili describe two strategies for gaining entry into a community: 1. Padrino – a patron, usually barangay or some other local government official. The padrino, in an effort to boost the organizer’s image, tends to preset the intended project output, thereby creating false hopes. 2. Bongga – as the easiest way to catch the attention and gain the “approval” of the community. This strategy exploits the people’s weaknesses and usually involves doles-out, such free medicines. CHAPTER 5: HEALTH PROMOTION AND CAPACITY BUILDING STRATEGIES ❖ HEALTH PROMOTION Green and Kreuter (1991) ▪ Any combination of health education and related organizational, economic, and environmental supports for behavior of individual, groups or communities conducive to health Parse (1990) ▪ Behavior that is motivated by the desire to increase wellbeing and to reach the best possible health potential ❖ HEALTH PROTECTION Parse (1990) ▪ Behaviors in which one engages with the specific intent to prevent disease, detect disease in the early stages or to maximize health within constraints of disease ▪ = ❖ HEALTH RISK – The probability that a specific event will occur in a given time frame Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Risk Assessment ▪ Conducted to determine health risks to individuals, groups and populations. A systematic way of distinguishing the risks posed by potentially harmful exposures STEPS OF RISK ASSESSMENT o Hazard Identification o Risk Description o Exposure Assessment o Risk Estimation Risk Factor – an exposure that is associated with a disease o 3 Criteria for Establishing a Risk Factor 1. The frequency of the disease varies by category or amount of factor. 2. The risk factor must precede the onset of the disease. 3. The association of concern must not be due to any source of error. o Two Types of Risks Factors Modifiable Risk Factors – individual has some control Non- Modifiable Risk Factors – little or no control. ▪ (Ex. genetic makeup, gender, age) Risk Reduction – a proactive process in which individuals participate in behaviors that enable them to react to actual or potential threats to their health Risk Communication – process through which public receives information regarding possible threats to health  To improve the nutritional status of the population, nutrition and education is essential. The 10 NUTRITIONAL GUIDELINES FOR FILIPINOS were developed to facilitate dissemination simple and practical messages to encourage healthy diet and lifestyle. 1. Eat variety of foods everyday 2. Breast feed infants exclusively from birth to 4-6 months and give appropriate foods while continuing breastfeeding 3. Maintain children’s normal growth through proper diet and monitor their growth regularly 4. Consume fish, lean meat, poultry or dried beans 5. Eat more vegetables, fruits and root crops 6. Eat foods cooked in edible/cooking oil daily 7. Consume milk and milk products and other calcium rich foods such as small fish and dark leafy vegetables everyday 8. Use iodized salt but avoid intake of excessive intake of salty foods 9. Eat clean and safe food 10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid drinking alcoholic beverages Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Sleep is essential component of chronic disease prevention and health promotion. HOW MUCH SLEEP DO YOU REALLY NEED? AGE SLEEP NEEDS Newborn (1-2 months) ✓ 10.5-18 hours ✓ 9-12 hours during night Infants (3-11 months) ✓ 30-minute to 2 our naps 1-4 times a day Toddlers (1-3 years) ✓ 12-14 hours Preschoolers (3-5 years) ✓ 11-13 hours School-aged children (5-12 years) ✓ 10-11 hours Teens (11-17 years) ✓ 8.5-9.25 hours Adults ✓ 9 hours Older Adults ✓ 9 hours  Sleep Hygiene (National Sleep Foundation 2010) 1. Avoid caffeine and nicotine close to bedtime 2. Avoid alcohol as it can cause sleep disruptions 3. Retire and get up at the same time everyday 4. Exercise regularly but finish all exercise and vigorous activity at least 3 hours before bedtime 5. Establish a regular relaxing bedtime routine (a warm bath, reading a book) 6. Create a dark, quiet, cool sleep environment 7. As much as circumstances allow, have comfortable beddings 8. Use the bed for sleep only. Do not read, listen to music or watch TV in bed 9. Avoid large meals before bedtime  Smoking Cessation is an important step in achieving optimum health. The American Cancer society recommends the following Steps to Quit Smoking: 1. Make decision to quit. 2. Set a date to quit and choose a plan 3. Deal with withdrawal through. Avoid temptation 4. Staying off tobacco is a lifelong process. Remind yourself of the reasons why you quit  Alcohol Consumption Health authorities have defined moderation as: o Not more than 2 drinks a day for the average sized man o Not more than 1 drink a day for the average size woman Heavy Drinking o consuming more than 2 drinks/day on average for men and more than 1 drink per day for women Binge drinking o drinking 5 or more drinks on a single occasion for men / 4 or more drinks on a single occasion for women Excessive Drinking o can take the form of heavy drinking/ binge drinking/ both. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ❖ Organized by the WHO, the 1st International Conference on Health Promotion was held at Ottawa, Canada on November 17-21, 1986. o It calls for a commitment to health promotion to achieve the goal of Health for All by the year 2000 and beyond. ▪ The charter defines HEALTH PROMOTION as: the process of enabling people to increase control over and improve their health. It is not just the responsibility of the health sector but goes beyond healthy lifestyles to well-being. ❖ 3 BASIC STRATEGIES FOR HEALTH PROMOTION 1. Advocacy for health to provide for the conditions and resources essential for health 2. Enabling all people to attain their full health potential 3. Mediating among the different sectors of society to achieve health ❖ 5 PRIORITY ACTION AREAS PROVIDES SUPPORT FOR THESE 3 STRATEGIES: 1. Build Healthy Public Policy 2. Create Supportive Environments 3. Develop Personal Skills 4. Reorient Health Services 5. Moving into the Future ❖ HEALTH EDUCATION o a process of changing people’s knowledge, skills and attitudes for health promotion and risk reduction. o The nurse participates in health education by empowering people so that they are able to achieve optimum health and prevent disease by bringing out lifestyle changes and reducing exposure to health risk in the environment ❖ BASIC PRINCIPLES THAT GUIDE THE EFFECTIVE NURSE EDUCATOR (based onKnowles Theory on adult learning) 1. Message send a clear/understandable message to the learner. Consider factors that may affect learner’s ability to receive and retain info. 2. Format strategy must match the objectives 3. Environment conducive environment for learning, therapeutic and supportive relationship with the learner 4. Experience organize positive and meaningful learning experience 5. Participation engage learner in participatory learning by involving then in the discussion, solicit feedback 6. Evaluation use tools such as quizzes, individual conferences and return demonstration Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  CHAPTER 6: FAMILY HEALTH NURSING ❖ FAMILY DATA ANALYSIS Data analysis is done by comparing findings with accepted standards for individual family members and for the family unit. The nurse correlates findings in the different data categories and checks for significant gaps in information or the need for more details related to a finding. ❖ SYSTEM OF ORGANIZING FAMILY Data (adapted from Nies and McEwen, 2011) Family Structure and characteristics are reflected in: ✓ Data on household membership ✓ Demographic characteristics ✓ Family members living outside the household ✓ Family mobility ✓ Family dynamics (emotional bonding, authority and power structure, autonomy of members, division of labor, and patterns of communication, decision making, and problem and conflict resolution). ✓ Data on family structure can be visualized clearly through graphic tools such as genogram ecomap and family tree. Socioeconomic characteristics include: ✓ Data on social integration (ethnic origin, languages and dialects spoken, and social networks) ✓ Educational experiences and literacy ✓ Work history ✓ Financial resources Leisure time interests ✓ Cultural influences ✓ Spirituality or religious affiliation Family Environment ✓ Refers to the physical environment inside the family’s home/residence and its neighborhood. Family Health and Health Behavior include: ✓ Family’s activities of daily living ✓ Self-care ✓ Risk behaviors ✓ Health history ✓ Current health status ✓ Health care resources (home remedies and health services) ❖ FAMILY NURSING DIAGNOSIS Nursing diagnoses may be formulated at several levels: ✓ As an Individual family member ✓ As a family unit ✓ As the family in relation to its environment/community. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  International (NANDA-I, 2011) ✓ Serve as a common framework of expressing human responses to actual and potential health problems. Family Coping Index ✓ This tool is based on premise that nursing action may help a family in providing for a health need or resolving a health problem by promoting the family’s coping capacity. ❖ NINE AREAS OF ASSESSMENT OF THE FAMILY COPING INDEX (Freeman and Heinrich, 1981): i. Physical Independence → Family members’ mobility and ability to perform activities of daily living (personal hygiene) ii. Therapeutic Competence → Ability to comply with prescribed or recommended procedures and treatments to be done at home. iii. Knowledge of Health Condition → Understanding of the health condition or essentials of care according to the developmental stages of family members. iv. Application of Principles of Personal and General Hygiene → practice of general health promotion and recommended preventive measures. v. Health Care Attitudes → family’s perception of health care in general. vi. Emotional Competence → Degree of emotional maturity of family members according to their developmental stage. vii. Family Living Patterns → Interpersonal relationships among family members, management of family finances, and the type of discipline in the home. viii. Physical Environment → includes home, school, work, and community environment that influence the health of family members. ix. Use of Community Facilities → ability of the family to seek and utilize, as needed, both environment-run and private health. ❖ FORMULATING THE PLAN OF CARE Planning involves: o priority setting o establishing goals and objectives o determining appropriate interventions to achieve goals and objectives. Stancope and Lancaster (2010) ▪ The nurse’s role at this stage consists of offering guidance, providing information, and assisting the family in the planning process. Priority Setting – determining the sequence in dealing with identified family needs and problems. 1. Family safety: A life threatening situation is given top priority. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  2. Family perception: Priority is given to the need that the family recognizes as urgent or important. 3. Practicality: Together with the family the nurse looks into existing resources and constraints. 4. Projected effects: The immediate resolution of a family concern gives the family a sense of accomplishment and confidence in themselves and the nurse. ❖ ESTABLISHING GOALS AND OBJECTIVES Goal ▪ Desired observable family response to planned interventions in response to a mutually identified family need. Objectives ▪ the desired step by step family responses as they work toward a goal. ▪ Workable, well stated objectives should be SMART: ✓ S: Specific ✓ M: Measurable ✓ A: Attainable ✓ R: Relevant ✓ T: Time bound ❖ DETERMINING APPROPRIATE INTERVENTIONS o Freeman and Heinrich categorize nursing interventions into three types: ▪ 3 Types of Nursing Interventions: 1. Supplemental Interventions – actions that nurse performs on behalf of the family when it is unable to do things for itself. 2. Facilitative Interventions – actions that remove barriers to appropriate health action such as assisting the family to avail of maternal and early childcare services. 3. Developmental Interventions – aim to improve the capacity of the family to provide for its own health needs such as guiding the family to make responsible health decisions. o Implementing the Plan of Care I. Implementation is the step when the family or the nurse execute the plan of action. ❖ EVALUATION – To evaluate is to determine or fix the value. Formative Evaluation – judgment made about effectiveness of nursing interventions as they are implemented. Summative Evaluation – determining the end results of family nursing care and usually involves measuring outcomes or the degree to which goals have been achieved. ASPECTS OF EVALUATION: ✓ Effectiveness – determination of whether goals and objectives were attained. ✓ Appropriateness – suitability of the goals/objectives and interventions ✓ Adequacy – degree of sufficiency of goals/objectives and interventions ✓ Efficiency – relationship of resources used to attain the desired outcomes Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ❖ FAMILY-NURSE CONTACTS The family-nurse relationship is developed through family-nurse contacts, which may take the form of a: ▪ Clinic Visit ▪ Group Conference ▪ Telephone Contact ▪ Written Communication ▪ Home Visit CLINIC VISIT o takes place in a private clinic health center, barangay health station. o Major advantage: ▪ A family member takes the initiative of visiting the professional health worker, usually indicating the family readiness to participate in the health care process. ▪ Because the nurse has greater control over the environment, distractions are lessened, and the family may feel less confident to discuss family health concerns. GROUP CONFERENCE o Appropriate for developing cooperation, leadership, self-reliance and or community awareness among group members. o The opportunity to share experiences and practical solutions to common health concerns is a strength of this type of family-nurse contact. WRITTEN COMMUNICATION o used to give specific information to families, such as instructions given to parents through school children. HOME VISIT o Home visit is a professional, purposeful interaction that takes place in the family’s residence aimed at promoting, maintaining, and restoring the health of the family or its members. o Advantages: 1. It allows first-hand assessment of the home situation. 2. The nurse can seek out previously unidentified needs. 3. It gives the nurse an opportunity to adapt interventions according to family resources. 4. It promotes family participation and focuses on the family as a unit. 5. Teaching family members in the home is made easier by the familiar environment and the recognition of the need to learn as they are faced by the actual home situation. 6. The personalized nature of home visit gives family a sense of confidence in themselves and in the agency. o Disadvantages: 1. The cost in terms of time and effort. 2. There are more distractions because the nurse is unable to control the environment. 3. Nurse’s safety. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  o Phases of Home Visit I. PREVISIT PHASE Nurse contacts the family, determines the willingness for a home visit, and sets an appointment with them. A plan for the home visit is formulated during this phase. The ff. are specific principles in planning for a home visit: Being a professional contact with the family, the home visit should have a purpose. Purposes: o To have a more accurate assessment o To educate the family about measures of health promotion, disease prevention and control of health problems. o To provide supplemental interventions for the sick, disabled or dependent family member. o To provide family with greater access to health resources in the community. Use information about the family collected from all possible sources such as records, other personnel or agency, or previous contacts with the family. The home visit plan focuses on identified family needs, particularly needs organized by the family as requiring urgent attention. The client and the family should actively participate in planning for continuing care. The plan should be practical and adaptable. II. IN-HOME PHASE This phase begins as the nurse seeks permission to enter and lasts until he or she leaves the family’s home. It consists of initiation, implementation, and termination. o Initiation ▪ It is customary to knock or ring the doorbell and at the same time, in a reasonably loud but nonthreatening voice say, “Tao po. Si Jenny po to, nurse sa health center?” ▪ On entering the home, the nurse acknowledges the family members with a greeting and introduces himself and the agency he represents. ▪ Observes environment for his own safety and sits as the family directs him to sit. ▪ Establish rapport by initiating a short conversation. ▪ States the purpose of the visit the source of information. o Implementation ▪ Involves the application of the nursing process, assessment, provision of direct nursing care as needed, and evaluation. o Termination ▪ Consists of summarizing with the family the events during the home visit and setting a subsequent home visit or another form of family-nurse contact. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ Use this time to record findings, such as vital signs of family members and body weight. III. POSTVISIT PHASE Takes place when the nurse has returned to the health facility. Involves documentation of the visit. ❖ THE NURSING BAG Frequently called the PHN bag is a tool used by the nurse during home or community visits to be able to provide care safely and efficiently. Serves as a reminder of the need for hand hygiene and other measures to prevent the spread of infection. Nursing bag usually has the ff. contents: - Articles for infection control - Articles for assessment of family members - Note that the stethoscope and sphygmomanometer are carried separately. - Articles for nursing care - Sterile items - Clean articles - Pieces of paper Use of the Nursing Bag o Bag technique helps the nurse in infection control. o Bag technique allows the nurse to give care efficiently. o It saves time and effort by ensuring that the articles needed for nursing care are available. o Bag technique should not take away the nurse’s focus on the patient and the family. o Bag technique may be performed in different ways, principles of asepsis are of the essence and should always be practiced. ❖ For infection control the ff. activities should be practiced during home visits: 1. Remember to proceed from “clean” to “contaminated”. 2. The bag and its contents should be well protected from contact with any article in the patient’s home. 3. Line the table/flat surface with paper/washable protector on which the bag and all of the articles to be used are placed. 4. Wash your hands before and after physical assessment and physical care of each family member. 5. Bring out only the articles needed. 6. Do not put any of the family’s articles on your paper lining/washable protector. 7. Wash your articles before putting them back into you bag. 8. Confine the contaminated surface by folding the contaminated side inward. 9. Wash the inner cloth lining of the bag, as necessary. Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  CHAPTER 7: THE NURSING PROCESS IN THE CARE OF THE COMMUNITY ❖ THE NURSING PROCESS IN THE CARE OF THE COMMUNITY A community is a group of people who: Have a common interest or characteristics Interact with one another Have sense of unity or belonging Function collectively within a defined social structure to address common concerns A community may be phenomenological (functional) or geopolitical (territorial) ❖ PRINCIPALS OF COMMUNITY HEALTH NURSING 1. Community is the focus of care; nurse responsibility is to the community as a whole 2. Give priority to community needs 3. Work with the community as an equal partner of the health team 4. Focus on primary prevention for appropriate activities 5. Promote a healthful physical and psychosocial environment 6. Reach out to all who may benefit from a specific service 7. Promote optimum use of resources 8. Collaborate with others working in the community health ❖ Conditions in the community affecting health People Location Social system ❖ Characteristics of a healthy community A shared sense of being a community based on history and values A general feeling of empowerment Existing structures that allow subgroups within the community to participate in decision making The ability to cope with change, solve problems, and manage conflicts within the community through acceptable means Open channels of communication Equitable and efficient use of community resources ❖ Aims 1. Achieve a good quality life 2. Create a health supportive environment 3. Provide basic sanitation 4. Supply access to health care ❖ COMMUNITY ASSESSMENT o the data needed to be collected depend on the objectives of community assessment. o In general, the nurse needs to collect data on the three categories of community health determinants: people, place, and social system. ❖ DATA COLLECTED FOR THE HEALTH P.A.T.C.H: (Planed Approach To Community Health) PROCESS FOR HEALTH PLANING Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  1. Community Profile - Demographic educational and economic data 2. Morbidity and Mortality Data - Including unique health events (e.g., completion of barangay health station, a typhoon that caused flooding of residential areas) 3. Behavioral Data - Focusing on behavioral risk factors, such as smoking, drinking, and leading a sedentary lifestyle, and prevailing good health practices in the community, such as breast feeding and getting regular exercise 4. Opinion Data - from community leaders, such as what they think about the main health problems of the community their causes, measures that may alleviate or correct them Problem-oriented assessment is focused on an aspect of health: focusing on what’s problem the community have in mind ❖ TOOLS IN COMMUNITY ASSESSMENT Collecting Primary Data ▪ Observation Ocular survey/ windshield survey ▪ Survey ▪ Informant interview Talks to the community people Key informants: consist of formal and informal community leaders or persons of position and influence ▪ Community forum Pulong–pulong sa barangay Focus group o Secondary Data Source ▪ Health records and reports ▪ Field Health Service Information (FHSIS) recording and reporting tools ▪ FHSIS is as basis for: i. Priority setting by local governments ii. Planning and decision making at different levels (barangay, municipality, district, provincial, and national) iii. Monitoring and evaluating health program implementation  The FHSIS Manual of Operations i. Individual Treatment Record (ITR) – Building block of FHSIS ▪ Health workers are advised not to rely on client-maintained ii. Target Client List ▪ Target Client List for prenatal care ▪ Target Client List for postpartum care ▪ Target Client List of under 1-year-old children ▪ Target Client List for family planning ▪ Target Client List for sick children Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  ▪ National Tuberculosis Program Register ▪ National Leprosy Control Program Central Registration Form iii. Summary Table (Accomplished by Midwife) iv. Monthly Consolidation Table (MTC)  The Reporting Forms (as Enumerated in The FHSIS Manual of Operations) i. Monthly Forms (Regularly prepared by the midwife and summited to the nurse) a. Program Report (M1) ▪ Contains indicators categorized as maternal care, childcare, and family planning b. Morbidity Report (M2) ▪ contains list of all cases of disease by age and sex. ii. Quarterly Forms (Prepared by the nurse) a. Program Report (Q1) ▪ 3-month total indicators categorized as maternal care, family planning, childcare, dental health, and disease control b. Morbidity iii. Annual Forms a. A-BHS - Demographic, environmental, and natality data b. Annual Form 1 (A-1) - Prepared by the nurse and is the report of the RHU or health center. - It contains demographic and environmental data and data on natality and mortality for the entire year. c. Annual Form 2 (A-2) - prepared by the nurse, is the yearly morbidity report by age and sex d. Annual For 3 (A-3) - prepared by the nurse, yearly report of all mortality by age and sex disease registry census data ❖ COMMUNITY DIAGNOSIS Community diagnosis is the process of determining the health status of the community and the factors responsible for it. In this phase, the health workers make a judgement about the community’s health status, resources and health action potential or likely hood that the community will act to meet health needs to resolve health problems. This consist of: ▪ The health risk or specific problem to which the community is exposed. ▪ The specific a