Module 1: Introduction to Community Health Nursing (Philippines)

Republic of the Philippines President Ramon Magsaysay State University (Formerly Ramon Magsaysay Technological University) Iba, Zambales, Philippines MODULE I INTRODUCTION TO COMMUNITY HEALTH NURSING RIZZA B. EGALLA, MAN, LPT, RN...

Republic of the Philippines President Ramon Magsaysay State University (Formerly Ramon Magsaysay Technological University) Iba, Zambales, Philippines MODULE I INTRODUCTION TO COMMUNITY HEALTH NURSING RIZZA B. EGALLA, MAN, LPT, RN FACULTY, PRMSU COLLEGE OF NURSING DEFINITION OF TERMS COMMUNITY Community is seen as a group of collection of locality-based individuals, interacting in social units and sharing common interests, characteristics, values, and/ or goals. DEFINITION OF TERMS  In recent nursing literature, community has been defined as “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” (Allender et al., 2009, p. 60).  “a group of people who share something in common and interact with one another, who may exhibit a commitment with one another and may a share a geographic boundary” (Lundy and Janes, 2009, p. 16); DEFINITION OF TERMS “a group of people who share common interests, who interaction with each other, and who function collectively within a defined social structure to address common concerns” (Clark, 2008, p. 27). “ a locality- based entity, composed of systems of formal organizations reflecting society’s institutions, informal groups and aggregates” (Shuster and Goeppinger). Two Main Types of Community (Maurer and Smith (2009) A. Geopolitical communities- also called as territorial communities. are most traditionally recognized. defined or formed by both natural and man- made boundaries and include barangays, municipalities, cities, provinces, regions and nations. Two Main Types of Community (Maurer and Smith (2009) b. Phenomenological communities- also called as 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. Definition of Health HEALTH WHO (1958, p.1) defined health as “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.”  Modern Concept of Health- refers to optimum level of functioning of individual, family, community optimum level of health is influenced by the Ecosystem. Ecosystem Factors  Socio-economic status  Hereditary factor  Health care delivery system  Activities and Behavior  Environmental Factors Determinants of Health 1.Income and social status 2.Education 3.Physical environment 4.Employment and working conditions 5.Social support networks 6.Culture 7.Genetics 8.Personal behavior and coping skills 9.Health services 10.Gender  INDICATORS OF HEALTH AND ILLNESS National Epidemiology Center of DOH, Philippine Statistics Authority (PSA) and local health centers/ offices/ departments- provide morbidity, mortality and other health status related data. Local health centers/ offices / departments Nurses should participate in investigative efforts to determine what is precipitating the increased disease rate and work to remedy the identified threat or risks. DEFINITION AND FOCUS OF PUBLIC HEALTH AND COMMUNITY HEALTH C. E Winslow is known for the following classic definition of public health: “Public health is the science and art of 3P’s: Preventing disease Prolonging life, and Promoting health and efficiency through organized community effort for: - sanitation of the environment; - control of communicable infections; - education of the individual in personal hygiene; - organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and DEFINITION AND FOCUS OF PUBLIC HEALTH AND COMMUNITY HEALTH Hanlon- “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”. Jacobson- achievement of OLOF (Optimum Level of Functioning) through health teaching.  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 (WHO) 1.Health situation monitoring and analysis. 2.Epidemiological surveillance/ disease prevention and control. 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. 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. WHAT IS NURSING? Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness. WHAT IS COMMUNITY HEALTH NURSING? “the synthesis of nursing practice and public health practice applied to promoting and preserving health of the populations (ANA, 1980). 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. Public Health Nursing (PHN)- the term used before for Community Health Nursing (broader and includes independent nursing practice).  Ultimate Goal of CHN “To raise the level of health of the citizenry” - To enhance the capacity of individuals, families and communities to cope with their health needs. MISSION OF PUBLIC HEALTH is a social justice that entitles all people to basic necessities, such as adequate income and health protection, and accepts collective burdens to make possible. PUBLIC HEALTH NURSING (Freeman) The field of professional practice 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. Community Health Nursing (Maglaya et al) The utilization of the nursing process in the different levels of clientele, individual, family, community ad population groups concerned with the Promotion of health Prevention of disease and Disability and Rehabilitation COMMUNITY-BASED NURSING application of the nursing process in caring for individuals, families and group where they live, work, go to school, or they move through the health care system. setting-specific such as home health nursing. COMMUNITY HEALTH NURSING vs COMMUNITY BASED NURSING Community Health Nursing - Emphasizes preservation and protection of health. - The primary client is the community. Community-based Nursing - Emphasizes on managing acute and chronic - The primary clients are 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. Focused practice: 1.Focuses on the entire population 2.Is 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 TYPES OF DATA IN CHN The epidemiology or body of knowledge of a particular problem and its solution Information about the community  TYPES OF SOURCES INFORMATION Demographic Vital Statistics; census Groups at high risk Health Statistics; disease statistics Services/ providers City directors, phone available books, local/ regional social workers, list of low income providers, CH nurse 3 IMPORTANT ELEMENTS OF CHN 1.It is population-based/ focused - Population- focused nursing care means providing care based on the greater need of the majority of the population. 2. It contains 3 levels of clientele (IFC) - Individual - Family (basic unit of care) - Community (patient) 3 IMPORTANT ELEMENTS OF CHN 3. It identifies and defines 12 Public Health Intervention Surveillance- monitors health events Disease and other health investigation Outreach- locates populations of interests or populations at risk Screening- identifies individuals with unrecognized health risk factors Case finding- identifies risk factors and connects them with resources 3 IMPORTANT ELEMENTS OF CHN Referral and follow-up- assist to identify and access necessary resources Case management- optimizes self-care capabilities of individuals and families Delegated functions- direct care tasks that the nurse carries out Health teaching- communicates facts, ideas and skills that change knowledge, attitudes, values, behaviors and practice. 3 IMPORTANT ELEMENTS OF CHN Counseling- establishes an interpersonal relationship with the intention of increasing and enhancing their capacity for self-care and coping. Consultation- seeks information and generates optional solutions to perceived problems. Collaboration- commits two or more persons or an organization Coalition building– develops alliances among organizations. TYPES OF FAMILY IN THE COMMUNITY a. Nuclear Family- consists of father, mother, and children (either adopted or biological). b. Extended- consists of father, mother, and children with other relatives. c. Single- Parent- single with children d. Binuclear/ Reconstituted- extended family consisting of 2 or more separate household from separated or divorced parents with children. TYPES OF FAMILY IN THE COMMUNITY e. Step Family- remarriage of a widowed person with children. f. Compound Family- one man/ woman with several spouses g. Cohabiting Family- lived-in unmarried couple h. Dyad- husband and wife without children i. Homosexual family- female-female or male- male, gay or lesbian with or without children j. Communal Family- e.g. bahay-ampunan, home for the aged, kumbento k. No-Kin- have no legal or blood tie to each other TYPES OF FAMILY IN THE COMMUNITY Compound Family where a man has more than one spouse; approved by Philippine authorities only among Muslims by virtue of Presidential Decree No. 1083, or also known as the Code of Muslim Personal Laws of the Philippines (Office of the President, 1977). BASIC PRINCIPLES OF CHN The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems- e.g. children, elderly), and the community. The client is considered as an ACTIVE partner NOT PASSIVE recipient of care. BASIC PRINCIPLES OF CHN CHN practice is affected by developments in health technology, in particular, changes in society, in general. The goal of CHN is achieved through multi- sectoral efforts. ROLES OF THE PUBLIC HEALTH NURSE REMEMBER: Generalist never Specialist Clinician, who is a health care provider, taking care of the sick people at home in the RHU. Health Educator, who aims towards health promotion and illness prevention through dissemination of correct information; educating people (knowledge, skills, attitude- KSA). Facilitator, who establishes multi-sectoral linkages by referral system. Supervisor, who monitors and supervises the performance of midwives. Leader, Role Model, and Change Agent Researcher OBJECTIVES OF PUBLIC HEALTH CODES C- ontrol of Communicable Diseases O- rganization of Medical and Nursing Services D- evelopment of Social Machineries E- ducation of IFC on personal hygiene - Health Education is the essential task of every health worker S- anitation of the environment PUBLIC HEALTH WORKERS (PHW) Medical Officer (MO)- Physician Public Health Nurse (PHN) – Registered Nurse Rural Health Midwife (RHM)- Registered Midwife Dentist Nutritionist Medical Technologist Pharmacist Rural Sanitary Inspector (RSI) – must be a sanitary engineer COMPETENCY STANDARDS IN COMMUNITY HEALTH NURSING Safe and quality nursing care Management of resources and environment Health education Legal responsibility Ethico-moral responsibility Personal and professional development Quality improvement Research Records management Communication Collaboration and teamwork