Introduction To Community Health Nursing PDF

COMMUNITY HEALTH NURSING II: (POPULATION GROUPS & COMMUNITY AS CLIENTS) – LECTURE NRCM0113 INTRODUCTION TO COMMUNITY HEALTH NURSING INTRODUCTION AIMS OF COMMU...

COMMUNITY HEALTH NURSING II: (POPULATION GROUPS & COMMUNITY AS CLIENTS) – LECTURE NRCM0113 INTRODUCTION TO COMMUNITY HEALTH NURSING INTRODUCTION AIMS OF COMMUNITYHEALTH NURSING Community health implies in integration of To improve quality of life Preventive, Promotive and Curative aspects of health To reduce risk factors services. The nurse most directly concerned with To improve standard of living giving health education and care to individuals and To strengthen self-care activities of individuals families in the community OBJECTIVES DEFINITION To prevent, promote, maintain and restore the COMMUNITY: It is a social group determined with community health geographical boundaries, common values and To reduce morbidity and mortality rate among interests. Its members know and interact with each community other. It functions within a particular structure and To increase the life span for individuals exhibits and creates norms, values and social institutions Health is a state of complete physical, mental, social, spiritual wellbeing, and not merely an absence of disease or infirmity. Nursing is a service which includes care to the sick, care of the whole patient, the care of patient’s environment, health education and health services to the individual family and society for the prevention of disease and promotion of health. COMMUNITY HEALTH NURSING: It is defined as nursing services organized by a community or agency PRINCIPLES OF COMMUNITY HEALTH NURSING to carry out nursing aspects of community health Nursing services should be planned according to the programme in homes, schools, industries or in the need of the community health centers Community nurses should function in collaboration and coordination with other personnel to achieve DEFINITION OF COMMUNITY HEALTH NURSING optimum community health. Community health nursing is a synthesis of nursing Community health nurse should be qualified and are and public health practice applied of promoting and accountable, responsible and authorized health preserving the health of people. The practice is authority for her services general and comprehensive. It is not limited to a Job condition should be conductive for optimum particular age group or diagnosis, and continuing, not satisfaction episodic. Health services should be based on the felt needs ACCORDING TO JACOBSON: All CHNs and supervisors should function as a team “IT IS A LEARNED PRACTICE DISCIPLINE WITH THE Professional relationship and etiquette are essential in ULTIMATE GOAL OF CONTRIBUTING TO THE community health services PROMOTION OF THE CLIENT’S OLOF (OPTIMUM Health services should be available to all people LEVEL OF FUNCTIONING) THROUGH TEACHINGAND irrespective of their age, sex and status DELIVERY OF CARE.” The CHN should never accept money or gifts COMMUNITY HEALTH NURSING IDENTIFIES THE Health service should be realistic in terms of available NEEDS OF HOLISTIC CARE APPROACH. personnel & facilities PHILOSOPHY OF COMMUNITY HEALTH NURSING Follow up services Individuals right Evaluation of services of being healthy Facilities for further training & continuing education Working together towards Influential people should help in carrying out the common goal health activities Social systems 1  CONCEPT OF COMMUNITY HEALTH NURSING THEORETICAL MODELS /APPROACHES OF CHN HEALTH BELIEF MODEL The Health Belief Model states that people's beliefs influence their health-related actions or behaviors. Individuals will likely take action when experiencing a personal threat or risk, but only if the benefits of taking action outweigh the barriers, whether real or perceived. The Health Belief Model is a theoretical model that can be used to guide health promotion and disease SCOPE OF COMMUNITY HEALTH NURSING prevention programs. It is used to explain and predict Home care individual changes in health behaviors. It is one of the Nursing homes most widely used models for understanding health MCH and family planning behaviors. School health nursing Key elements of the Health Belief Model focus on Health care services individual beliefs about health conditions, which Industrial nursing services predict individual health-related behaviors. Domiciliary nursing service Geriatric nursing service Mental health nursing service Rehabilitation centers FEATURES OF COMMUNITY HEALTH NURSING 1. PEOPLE - most important feature (age, size, race, population, health belief, principles, level of education) 2. LOCATION 3. SYSTEM FUNCTIONS OF CHN MILIO’S FRAMEWORK FOR PREVENTION Comprehensive health care to individuals, families Nancy Milio a nurse and leader in public health policy and groups and public health education developed a framework Develops goals to meet needs- action program, for prevention that includes concepts of community- evaluating progress oriented, population focused care. (1976,1981). Assistance to family in improving environmental The basic treatise is that behavioral patterns of conditions populations and individuals who make up populations Providing safe environment in home, school and are a result of habitual selection from limited choices. industry She challenged the common notion that a main Providing supportive services to doctor such as early determinant for unhealthful behavioral choice is lack symptom detection of knowledge. Demonstration and teaching of skilled nursing care of Governmental and institutional policies, she said set the sick in home the range of options for personal choice making. Supervising the work of midwives It neglected the role of community health nursing, Helping in the adjustment of social and emotional examining the determinants of community health and conditions that affect health attempting to influence those determinants through Coordination of work with health care professionals public policy. Revising and revitalizing plan and programs For these 3 general categories of nursing intervention Epidemiologic investigations in field of communicable have also been put forward, they are diseases 1. Education directed toward voluntary change in Organizing planned group classes in health the attitude and behavior of the subjects Development and utilization of facilities 2. Engineering directed at managing risk-related Responsible for planning, implementation & variables evaluation of a practical plan of nursing 3. Enforcement directed at mandatory regulation to administration achieve better health Involving in research and collection of vital statistics 2  NOLA PENDERS HEALTH PROMOTION DIFFERENT FIELDS OF COMMUNITY HEALTH The Health Promotion Model (HPM) Focuses on NURSING helping people achieve a higher level of well-being 1. SCHOOL HEALTH NURSING and providing health professionals with positive The school nurse provides care for injuries and acute resources to help patients achieve behavior-specific illness for all students and long-term management of changes. students with special health care needs. The goal of the HPM is not just about helping patients Responsibilities include assessment and treatment prevent illness through their beliefs and attitudes, but within the scope of professional nursing practice, also seeking the means by which a person can pursue communication with parents, Referral to physicians, better health or ideals four assumptions: and provision or supervision of prescribed nursing 1. Individuals strive to control their own behavior. care. The school nurse promotes a healthy school 2. Individuals work to improve themselves and their environment The school nurse provides health environment. education by providing health information to 3. Health professionals comprise the interpersonal individual students and groups of students through environment, which influences individual health education, science, and other classes. behaviors. Conducting screenings and writing referrals for health 4. Self-initiated change of individual and services. environmental characteristics is essential to 2. COMMUNITY HEALTH NURSING changing behavior. Provide patient care in clinical and nonclinical These assumptions can help clients prioritize other settings, from hospitals and clinics to schools and needs, especially health concerns. churches. LAWRENCE GREENS’ PRECEDE MODEL Educating communities about nutrition, hygiene and (Predisposing, reinforcing, enabling, constructs in disease prevention. Providing care for groups and educational, and environmental development) individuals in remote locations The PRECEDE-PROCEED model is a comprehensive Assessing the needs of the community. structure for assessing health needs for designing, 3. COMMUNITY MENTAL HEALTH NURSING implementing, and evaluating health promotion and Provide education regarding mental illness, physical other public health programs to meet those needs. health concerns, chronic disease management, PRECEDE provides the structure for planning a wellness, relapse prevention and medications to targeted and focused public health program. patients, families, care givers and team members The application of the PRECEDE-PROCEED model was QUALITIES OF CHN divided into three categories: Educational qualification 1) planning, including the program design; Interest 2) implementation; and Understanding in people’s behavior 3) evaluation Sincerity It involves the identification of desired outcomes and Empathy program implementation: Implementation: Design Friendly intervention, assess availability of resources, and Charitable implement program. Resourceful Cooperative responsible Initiative Skillful in o Observation o Communication o Interviewing o Technical skills Ability to o Interpret o Judge o Take decisions 3  CONCEPTS OF HEALTH DIMENSIONS OF HEALTH BIOMEDICAL CONCEPT Health is multidimensional. Traditionally health has been viewed as an absence of disease, and if one was free from disease, then the person was considered healthy. This concept known as biomedical concept. It has the basis in the germ theory of disease. The medical profession viewed the human body as a machine, disease as a consequence of the breakdown of the machine and one of the doctors’ tasks as repair of the machine. ECOLOGICAL CONCEPT Deficiencies in the biomedical concept gave rise to other concepts. PHYSICAL DIMENSION Health as a dynamic equilibrium between man and The stage of physical health implies the notion of his environment and disease a maladjustment of “perfect functioning” of the body. human organism to environment. It conceptualizes health biologically as a state in Dubos defined "health implies the relative absence of which every cell and every organ is functioning at pain and discomfort and a continuous adaptation and optimum capacity and in perfect harmony with the adjustment to the environment to ensure optimal rest of the body. function". The signs of physical health in an individual are: The ecological concept raises two issues- imperfect o A good complexion, man and imperfect environment. o A clean skin, o Bright eyes, PSYCHOLOGICAL CONCEPTS o Lustrous hair with a body well clothed with firm flesh, Contemporary developments in social science not too fat, revealed that health is not only a biomedical o A sweet breath, phenomenon, but one which is influenced by social, o A good appetite, psychological, cultural, economic and political factors o Sound sleep, of the people concerned. o Regular activity of bowels and bladder and smooth, These factors must be taken in to consideration in easy, defining and measuring health. o Coordinated bodily movements. Thus, health is both a biological & social phenomenon. EVALUATION OF PHYSICAL HEALTH Self-assessment of overall health HOLISTIC CONCEPT Inquiry in to symptoms of ill-health and risk factors The holistic model is a synthesis of all the above Inquiry in to medication concepts. Inquiry in to levels of activity It recognizes the strength of social, economic, political Inquiry in to use of medical services and environmental influences on health. Standardized questionnaires for cardiovascular It has been variously described as a unified or diseases, respiratory diseases. multidimensional process involving the well-being of Clinical examination the whole person in the context of his environment. Nutrition and dietary assessment This approach implies that all sectors of society have Biochemical and laboratory investigations. effect on health. Agriculture, Animal Husbandry, Food, Industry, MENTAL DIMENSION Education, Housing, Public Works, Communications Mental health is not mere absence of mental illness. and Other Sectors. Good mental health is the ability to respond to many The emphasis is on the promotion and protection of varied experiences of life with flexibility and a sense health. of purpose. Mental health has been defined as a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a coexistence between the realities of self and that of other people and that of the environment. 4  The characteristics of a mentally healthy person are OTHERS o A mentally healthy person is free from internal Philosophical dimension conflicts: he is not at war with himself. Cultural dimension o He is well-adjusted, i.e., he is able to get along well Socio-economic dimension with others. Environmental dimension o He searches for identity. Educational dimension o He has a strong sense of self-esteem. Nutritional dimension o He has good self-control balances Curative dimension o He faces problems and tries to solve them Preventive dimension intelligently. VITAL STATISTICS SOCIAL DIMENSION INTRODUCTION Social well-being implies harmony and integration Vital statistics constitute an essential tool in within the individual, between each individual and demography like statistical study of population and the world in which they live. public health. They provide answer to various health It has been defined as the quantity and quality of an related questions individual’s interpersonal ties and the extent of ORIGIN OF VITAL STATISTICS involvement with the community. The social dimension of health includes the level of JOHN GRAUNT (1620-1674) Who studied the weekly bills of mortality and social skills one possesses, social functioning and the ability to see oneself as a member of a large society. discovered Urban death and Rural death. He is called Social health is rooted in positive material father of vital statistics management and positive human environment which WILLIAM FARR (1807 – 1883) is concerned with the social network of the individual. Who analyzed the vital events, which serve as Yard SPIRITUAL DIMENSION stick for measuring the health status of the population. Spiritual health refers to part of the individual which He is called Father of Medical Statistics reaches out and strives for meaning and purpose of life. DEFINITION It is the intangible something that transcends Vital statistics may be defined as the systematic physiology and psychology. collection and compilation and presentation, analysis It includes integrity, principles and ethics, the purpose and distribution of statistics pertaining to vital events in life, commitment to some higher being and belief are recorded. E.g., live birth, deaths, marriages etc. and belief in concepts that are not subject to state-of- that occur in the community. the-art explanation. CLASSIFICATION OF VITAL STATISTICS EMOTIONAL DIMENSION Mortality Statistic Historically the mental and emotional dimensions Morbidity Statistics have been seen as one element or as two closely Fertility Statistics related elements. Population Statistics Mental health can be seen as knowing or cognition METHODS OF COLLECTING VITAL STATISTICS while emotional health refers to feeling. Population Census Method The mental and emotional aspects of humanness may Civil Registration Method have to viewed as two separate dimensions of human Sample Registration System health. Model Registration System / Rural survey of causes of VOCATIONAL DIMENSION Death The vocational aspect of life is a new dimension Medical certification of causes of death It is a part of human existence National Sample survey When work is fully adapted to human goals, Institutional Records / Hospital Records capacities and limitations, work often plays a role in METHODS OF COLLECTING VITAL STATISTICS promoting both physical and mental health. Community survey Reports Physical work is usually associated with an Notification Disease Register improvement in physical capacity, while goal Epidemiological surveillance Report achievement and self-realization in work are a source Environmental health Records of satisfaction and enhanced self-esteem. Other Health Manpower Statistics Vocational dimension may be a source of income Population Surveys Miscellaneous Sources 5  USES OF VITAL STATISTICS ASFR (AGE SPECIFIC FERTILITY RATE) To find out what are the leading causes of morbidity No. of birth in specific age of women ASFR = × 1000 and mortality. No. of women in sp. Age with mid year population To know what is the age, sex, class and area wise Calculate the following distribution of various health related variables TFR (TOTAL FERTILITY RATE) Sum of all specific fertility rate × width of each age group To find out what is the composition of the population TFR = 1000 and what are the future trends GFR (GROSS FERTILITY RATE) To know what health program should be given priority No. of live birth To compare the present health statistics with past GFR = × 1000 No. of women between the age Grp of 15 − 49 statistics MAINTENANCE OFHEALTH For planning and administration of health services To determine the priority of health problems HEALTHY LIFESTYLES To discover the solution for any health problem Wellness is determined partly by lifestyle choices. To estimate future needs and demand Studies by the National Institute of Aging show that: To promote health legislation o Healthy eating – Moderate alcohol use For the evaluation of the health program success or o Physical activity – Safe environments failure o Mental stimulation – Social supports For the prediction of health trends. o Not smoking – Regular health care o Active social engagement METHOD OF CALCULATING MID YEAR POPULATION are important in maintaining health and independence. Natural Increase Method Arithmetic Progression Method OTHER FACTORS RELATED TO WELLNESS Geometric Progression Method Fitness: can prevent heart disease, hypertension, and lower back pain. ARITHMETIC PROGRESSION METHOD Preventive care: including immunizations and health Eg: The population of Avadi in 2009-5,10,000 and in the care screening tests. year 2018 - 6, 20000. Calculate the midyear population in Spiritual health 2007. Safety: prevention of injuries and accidents, Population in 2018 = 6, 20000 emergency preparedness, CPR. Population in 2009 = 5, 10000 Nutrition: prevent diseases like osteoporosis and So, the difference = 1,10,000 is for 10 years cancer, proper nutrients. So, per year is 1, 10000/10 = 11000 Tobacco Addiction Midyear population always should be calculated from Stress Management end February to 1st of July (so that is 6 year and 4 months) HEALTH MAINTENANCE PRACTICES = 6 1/3= 19/3 Become aware of the obvious and not-as- 11,000 x 19/3 = 69,667 immediately obvious situations that trigger stress. Now the calculation is Pt = Po + rt o Minimize or avoid exposure to those situations. t = period in year after the last census. Establish good dietary habits. r = Annual increase rate o Eat well balanced, nutritious meals. Pt = population at the required time o Moderate intake of salts, fats, white sugar, Po = population at the last census caffeine, and alcohol. Establish a pattern of regular cardiovascular exercise. CALCULATION OF INCIDENCE AND PREVALENCE o Contributes to a positive mental attitude. RATE Avoid smoking. No. of new cases Incident Rate = × 1000 o Smokers are at a much greater risk of dying from Total population heart disease, respiratory disease, and cancer. New cases + Existing cases Prevalent Rate = o There are no “safe cigarettes”. Total population o Chewing tobacco and snuff should also be MORTALITY RATES avoided. Total no. of death Crude Death Rate = × 1000 Learn how to relax. Mid year population o Relaxation brings to the body enormous Still birth + Death under 1 week Perinatal Mortality Rate = × 1000 restorative energy. Total live birth + Still birth o Getting enough sleep is also important. 6  Develop and maintain social supports. HIGH RISK BEHAVIORS o Feeling connected to family, friends, classmates, Appropriate safety practices are essential. work colleagues, and/or to community, social, Sexual behaviors: abstinence, monogamy, seeking political, or religious organizations plays a vital health care for signs of sexually transmitted role in the maintenance of one’s mental well- infections. being. Obtain appropriate health screenings. Conflicts. Don't use tobacco or illegal drugs. o Expect conflicts to occur, but learn to deal with Don't drink and drive. them in a head-on manner. Use seat belts and other safety equipment. o An unnecessary burden is created when conflicts Take gun safety classes. are allowed to go unaddressed for too long. ALTERNATIVE HEALTH PRACTICES See your doctor regularly for preventive care. Health or medical practices are called “alternative” if Preventive services the following: they are based on untested, untraditional, or o Tests/screenings unscientific principles, methods, treatments, or o Measurements knowledge. o Advice about diet, exercise, tobacco, alcohol and If the “alternative” health practice is offered along drug use, stress, and accident prevention. with conventional medicine, it is referred to as o Immunizations. “complementary” medicine. o Special tests at certain times in your life. HOLISTIC HEALTH CARE To take care of your health, you need to feel Care that promotes physical, emotional, social, comfortable talking with your doctors and nurses. intellectual, and spiritual well-being by treating the Ask questions: if you don’t understand what they are whole body, mind, and spirit. saying, ask them to explain. Each person is recognized as a unique person with Tell providers your health history as well as your different needs. health now: mention family history of diseases and Uses many methods of diagnosis and treatment in conditions; provide a complete list of medications you addition to traditional Western medical practice. are taking, etc. BE A ROLE MODEL Follow up: Call the provider if you have questions or To be a good health care employee, you must need more information after you leave. consider your own health and be a role model for Every day you have a chance to make good choices your patients. about your health. Getting lots of sleep, maintaining good nutrition, and Set small goals instead of large ones that you won’t exercising daily are examples of healthy behaviors. be able to meet. Take care of your own health so that you can be Reduce your risk for heart disease. productive and have a positive impact on your Watch your weight. patients. Eat right. CONCLUSION Stay active. Health is not simply the absence of disease. Prevent skin cancer. It is the state of optimal physical and mental Prevent injuries. wellbeing. Take medicines correctly. Taking personal responsibility for your health care by Make smart choices about sexual and reproductive developing positive health behaviors is the most cost- health. effective way to ensure a longer, healthier, perhaps Overcome depression. more fun, and ultimately more productive life. Warning signs: Feel sad, hopeless, or guilty most of the time. Feel tired or lack energy. Thoughts of suicide or death. Sleep either too much or too little. Change in appetite – lost or gained weight. Lost interest and pleasure in daily activities. Problems making decisions or thinking clearly. Depression treated with counseling, medicine, or both. Treatment works gradually over several weeks. 7