Overview of CHN (handouts) PDF

Community health nursing overview CHN “The utilization of the nursing process in the different levels of clientele – individuals, families, population groups and communities, prevention of disease and disability and rehabilitation” – Maglaya - A science of Public Health combined...

Community health nursing overview CHN “The utilization of the nursing process in the different levels of clientele – individuals, families, population groups and communities, prevention of disease and disability and rehabilitation” – Maglaya - A science of Public Health combined with Public Health Nursing Skills and Social Assistance with the goal of raising the level of health of the citizenry, to raise optimum level of functioning of the citizenry. -WHO- Public Health According to C.E. Winslow § 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 Principles of CHN ✘ The family is the unit of care. ✘ The community is the patient in CHN. ✘ The goal of improving community health is realized through multi-disciplinary effort. ✘ There are 4 levels of clientele in CHN practice. ✘ The practice of CHN is affected by the changes in society in general and the developments of the fields in particular. ✘ CHN is part of the community health system, which in turn is part of the larger human services system. Basic Concepts of CHN q Primary focus is health promotion and disease prevention. q Practice extends from individual to family, population group and community. q CHNurses are generalists. q Contact with client continues through time and all types of health care. q Nature of practice require application of concepts of various sciences. q Implicit in CHN is the nursing process.  Overview of Public Health Nursing in the Philippines q Public /Community Health Nursing is the synthesis of nursing practice and public health practice. q Major goal of CHN: q preserve the health of the community and surrounding population by focusing on health promotion and health maintenance of individual, family and group within the community. q PHN is associated with health and identification of population at risk rather than episodic response to patient demand. q Mission of Public Health: ü is SOCIAL JUSTICE that entitles all people to basic necessities, such as adequate income and health protection and accepts burdens to make it possible. ü PHN is associated with health and identification of population at risk rather than episodic response to patient demand. Salient Features of CHN ✘ Theoretical basis for practice: Knowledge and skills from the sciences of public health and nursing. ✘ Setting/place of practice and activities: health centers, clinics, homes, schools and places of work. ✘ Objectives: § promote and maintain health § restoration of the sick to health and rehabilitation § to enhance the capabilities of individuals, families, population groups and the community § to take care of their own health and cope with health problems. ✘ Patients and levels of clientele: individual, families, population group at risk, community. ✘ Perspective and orientation when establishing priorities for care: § health of the total population or community as a whole. § the greatest good for the greatest number rather than solely the needs of an individual patient or family. ✘ Range of service provided: health promotion, disease prevention, curative and rehabilitation nursing service.  ✘ Emphasis of care: health promotion and maintenance and disease prevention. ✘ Types of clients: well and the sick CLIENTS OF CHN q INDIVIDUAL § people who consult at the health center and receive health services. § seen during home visits, school health consultation, workplace visit-conference & other community-based activities. § “entry point” in working with the whole family. q FAMILY § number of person joined together by bonds of marriage, blood or adoption. § ”basic unit of care” in CHN § locus of decision making on health matters. § 6 health tasks: 1. recognizing interruptions of health and development 2. seeking health care 3. managing health and non-health crises 4. providing nursing care to the sick, disabled and dependent member 5. maintaining a home environment conducive to good health personal development 6. maintaining a reciprocal relationship with the community & health institutions. q POPULATION GROUP “AGGREGATE” § Group of people who share common characteristics, development stage or common exposure to particular environment factors, & consequently common health problems. § ex. Group: children, elderly, community = Children 10 leading ailments/defects among school children 1. dental caries; 2. intestinal helminthiasis; 3. colds; 4. pediculosis; 5. upper respiratory tract infection; 6. enlarged glands; 7. tinea flava 8. protein – energy malnutrition; 9. error of refraction; 10. otitis media = Elderly Leading causes of morbidity among older person: 1. Influenza; 2. Respiratory problems (TB, Bronchitis, Pneumonia); 3. Cardiovascular problem (hypertension & disease of the heart); 4. Malignant neoplasms 5. Accidents = Community - is a group of people sharing common geographic boundaries and/or common values and interests. - functions within a particular sociocultural context. THEORETICAL MODELS IN CHN Definition of Health ✘ 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. Models of Health ✘ MEDICAL MODEL (M.B. BELLOC AND L. BRESLOW) ”Health is the state of being free of signs or symptoms of disease.” = This means that if MAN’s systems, organs are functioning and does not manifest any abnormality as it responds to the demand of the environment (Internal or External) then he is considered healthy. ✘ HEALTH – ILLNESS CONTINUUM (Mc Cann/Flynn and Heffon) ”Health is a constantly changing state.” = because of the various factors present in the environment and as MAN interacts with it, his health status changes and it will not remain the same. ✘ ROLE PERFORMANCE MODEL (Parson) ”Health is the ability to perform all those roles from which one has been socialized.” = a person is therefore considered healthy if he performs all the expectations imposed on him especially on health activities. ✘ HIGH LEVEL WELLNESS (Dunn) ”Functioning to ones maximum potential while maintaining balance and purposeful direction in the environment” = MAN to be considered healthy has to maintain a continuous balance within the environment he is functioning. ✘ WORLD HEALTH ORGANIZATION (WHO) ”Health is the state of complete physical, mental, social well being and not merely the absence of disease” = MAN to be considered healthy has to posses a functional body system, can think rationally, and should interact with society effectively and it is not just the absence of any abnormality in this body system.  ✘ NEEDS – FULFILLMENT MODEL ”Health is a state in which needs are being sufficiently met that allow an individual to function successfully in life with the ability to achieve the highest potential ” = MAN to be considered healthy has to satisfy his needs not just being happy of what is happening around him. Factors Affecting Health ✘ INTERNAL FACTORS = Heredity or Genetics – transmission of traits from parents to offspring. = Coping Mechanism – determines how individual handle activities related to maintenance and promotion of good health. ✘ EXTERNAL FACTORS = Political (leadership) – how he/she manages and involves other people in decision making. = Culture (values, beliefs, attitudes & customs) – understand that there are practices which would be normal in a particular society and viewed negative by others, and so we have to define what is acceptable and not acceptable in a particular society. = Socio Economic – refers to the production activities, distribution and consumption of goods of an individual. THEORETICAL MODELS IN HEALTH PRECEDE-PROCEED MODEL PRECEDE which stands for predisposing, reinforcing, enabling constructs in educational diagnosis and evaluation is used for community diagnosis. PROCEED stands for policy, regulatory, and organizational constructs in education & environmental development, is a model for implementing and evaluating programs based on PRECEDE. Health Promotion Model It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client’s level of well-being. Core Concepts: 1. Individual Characteristics and Experiences: Prior Related Behavior: Past behaviors influence current health choices. If someone has a history of regular exercise, they're more likely to continue this behavior. Personal Factors: These include biological (age, gender), psychological (self-esteem, motivation), and socio-cultural (ethnic background, education level) factors. 2. Behavior-Specific Cognitions and Affect: Perceived Benefits of Action: Beliefs about the positive outcomes of a behavior can motivate people to engage in healthy behaviors. Perceived Barriers to Action : These are the obstacles that hinder individuals from engaging in a behavior. Perceived Self Efficacy : Confidence in one’s ability to take action and persist in that action. 3. Behavioral Outcomes: Commitment to a Plan of Action : planning and strategizing how to achieve the desired health behavior. Health Promoting Behavior: This is the goal or outcome of HPM. The aim of health promoting behavior is the attainment of positive health outcomes. 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. The theory highlights four main processes: 1. Attention: Observing and focusing on the behavior being modeled. 2. Retention: Remembering the behavior observed. 3. Reproduction: Ability to replicate the behavior. 4. Motivation: Having a good reason to imitate the behavior. MILIO’S FRAMEWORK FOR PREVENTION Focuses on the role of community and environmental factors in health and disease prevention. The framework highlights how policy and environmental changes can lead to healthier behaviors. It emphasizes the need for structural changes in society to promote health and prevent disease. KEY CONCEPTS Health Policy: Policies can create environments that either support or hinder healthy lifestyles. Effective health policies can provide the necessary resources and opportunities for people to make healthy choices. Environmental Influences: The environment plays a significant role in shaping health behaviors. Changes in the environment, such as improved access to healthy foods or safer neighborhoods, can lead to better health outcomes. The Philippine Health Care Delivery System q is an organized plan of services. q rendering health care services to the people. q totality of all policies, infrastructure, facilities, equipment, products, human resources and services that address the health needs problems and concerns for all people. Significant Milestone ü The DOH remains to be the national government’s biggest health care provider. ü The DOH exercises regulatory powers over health facilities and products. ü The DOH takes the lead in formulation of policies and standards related to health facilities, health products and health human resources. ü It provides the LGU the necessary support in managing their local health system. DOH VISSION: “The DOH is the champion for health for all in the Philippines” DOH MISSION: “Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health” DOH CORE VALUES: The DOH adheres to the highest values of work as it pursues its vision for the organization. 1. Integrity 2. Excellence 3. Compassion and respect for human dignity 4. Commitment 5. Professionalism 6. Stewardship of the environment Devolution of health services One of the most significant laws that radically changed the landscape of the health care delivery in the country is RA 7160 or more commonly known as the Local Government Code. The code AIMS to: Transform local government units into self – reliant communities and active partners in the attainment of national goals through a more responsive and accountable local government structure instituted through a system of decentralization. Types of Health Care Personnel Primary – is the first point of contact for patients and provides care to minor and simple cases. o Midwife o CHW o BNS Secondary – care provided by specialists and includes more specialized medical services. o PHN o MHO Tertiary – care involved highly specialized care. o Subspecialist MD o Advanced Practice Registered Nurses (APRN) The direction being pursued by the DOH is guided by the: Ø Millennium Development Goals Ø Medium – Term Philippines Ø Development Plan Ø Health Sector Reform Agenda Ø FOURmula One Ø National Objectives for Health Millennium development goals (mdg) ✘ On September 6 to 8, 2000, world leaders on the UN General Assembly participate in Millennium Summit. The result of the summit was a resolution entitled United Nations Millennium Declaration. ✘ In this declaration, the world leaders recognized their collective responsibility to uphold the principles of human dignity, equality and equity at the global level The declaration expressed the commitment of the 191 member states, including the Philippines, to reduce extreme poverty and achieve seven other targets- now called the Millennium Development Goals (MDGs) by the year 2015. Medium – term Philippine development plan ✘ MTPDP 2004 – 2010 spells out the priority strategies to meet the basic needs of the poor. The following health priorities were identified: a.) reduction of the cost of medicines; b.) expansion of health insurance particularly for indigents through premium subsidy; c.)strengthening national and local health systems through the implementation of the Health Sector Reform Agenda; 4.) improvement of health care management systems; 5.) improvement of health and productivity; 6.) establishment of drug treatment and rehabilitation centers and the expansion of existing ones. Health sector reform agenda (hsra) ✘ The DOH come up with the HSRA 1999-2004 that included the following reforms: ○ provide fiscal autonomy to government hospitals; ○ secure funding for priority public health programs; ○ promote development of local health systems and ensure its effective performance; ○ strengthen the capacities of health regulatory agencies; ○ expand the coverage of the National Health Insurance Program. FOURmula one for health (f1) ✘ 3 goals: ○ better health outcomes; ○ more responsive health systems; ○ equitable health care financing; ✘ Elements of the strategy: ○ health financing; ○ health regulation; ○ health service delivery; ○ good governance National objectives for health (noh) ✘ VISION: “Health For All Filipinos” ✘ MISSION: “Ensure Accessibility & Quality of Health Care to Improve the Quality of Life of All Filipinos, Especially the Poor” ✘ GOALS: (1). Better health Outcomes; (2). More responsive health system; (3). More equitable health care financing National objectives for health (noh) ✘ OBJECTIVES: (1). Secure increased , better and sustained investment in health; (2.). Assure the quality and affordability of health goods and services; (3). Improve the accessibility and availability of basic and essential health care for all; (4). Improve health systems performance at the national and local levels. ✘ PRINCIPLES: (1). Fostering a strong and healthy nation; (2.). Enhancing the performance of the health sector; (3). Ensuring universal access to quality health care; (4). Improving macro-economic and social conditions for better health gains. Referral system Intersectoral Linkages: o Primary Health Care forms an integral part of the health system and over-all social and economic development of the community o Necessary to unify health efforts within the health organization itself o Implies integration of health plans with the plan for the total community development o Sector most closely related to health: o Agriculture o Education o Public works o Local government o Social welfare o Population control o Private sector Intrasectoral Linkages o Within health sector – acceptance of primary health care necessitates the restructuring of the health system to broaden health coverage and make health service available to all o Primary health care is the hub of the health system Role and Functions of a PHN Health Service Provider: ✘ Carries out health services contributing the prevention of illness, early treatment of illness and rehabilitation, implementation of guidelines related to health as well as following policies on health for health promotion. Facilitator: ✘ Helps plan a comprehensive health program with the people. assists people to establish and find means of achieving their own goals. Health Counselor: ✘ Serves as a catalyst of change encourage verbalization of problems. Help people look at themselves see the nature of their discontent and barriers to their problems and provide health counseling including emotional support to individuals, family, population group and community. Co Researcher: ✘ Provides the community with stimulation necessary for a wider or more complex study problems. Enforce community to do prompt and intelligent reporting of epidemiological investigation of diseases. Suggest areas for research. Provide them with technical assistance in the conduct of research thru capability training. Participates in the planning for the study and formulating procedures. Assists in the collection of data. Help interpret findings collectively. Health Educator: ✘ Facilitates in the improvement of the health of the people by employing various methods or acceptable, appropriate procedures to stimulate, arouse and guide people to voluntarily adopt healthful ways of living. Taking into consideration the following aspects of health education: ○ Information – provision of knowledge ○ Education – change in knowledge, attitude and skills ○ Communication – exchange of information Emerging Field of CHN in the Philippines Home health care: ✘ this practice involves providing nursing care to individuals and families in their own places of residence mainly to minimize the effects of illness and disability Hospice home care: ✘ homecare rendered to the terminally ill; palliative care is particularly important. EntrepreNurse: ✘ A project initiated by the DOLE in collaboration with the BON in the Phil. , DOH, PNA, and other stakeholders to promote nurse entrepreneurship by introducing home health care industry in the Phil. Faith Community Nursing or Parish Nursing: ✘ art and science of nursing combined with spiritual care; provision of holistic care to members of the faith community. SCHOOL HEALTH NURSING R.A. 124 in 1947 An act to provide for medical inspection of children enrolled in private schools, colleges and universities The practice of school nursing includes the policies and standards of the DepEd and the standards of the nursing profession. School Nursing aims to promote the health of school children and preventing health problems that would hinder their learning and performance of their developmental tasks. SCHOOL HEALTH PROGRAM ✘ Health promotion for school personnel. ✘ School – community projects and outreach ✘ Nutrition and food safety ✘ Physical education and recreation ✘ mental health, counselling & social supports COMPONENTS OF SCHOOL HEALTH PROGRAM ✘ Health education activities are based on the identified educ. Needs of the target population. ✘ Physical education should focus on activities that children can continue into their adult years, such as walking, swimming, biking and jogging. ✘ Health services focus on preventive services (health screening), including health screening for completeness of immunization. emergency care management of acute & chronic health conditions ✘ Health screening appropriate referrals regular deworming ✘ Nutrition eating disorders obesity nutritional education programs ✘ Counseling, psychological and social services Promotion of Mental health & reduction of threats to mental health are important to children and adolescents.  ✘ Healthy school environment School nurses and other school personnel should be aware of risk factors and signs that could indicate a tendency towards violence. Healthy school environment DepEd Order No. 40, s. 2012 CHILD PROTECTION POLICY ✘ Health promotion for school staff Giving of workshops on exercise and nutrition. Screening for increased BP Establish weight management programs OCCUPATIONAL HEALTH NURSING ✘ Identify: Health Hazards – are the elements in the work environment that can cause work-related diseases to the worker. Safety Hazards – are the unsafe conditions or unsafe acts that significantly increase the risk of a worker to be injured. ✘ is aimed at assessing workers in all occupations to cope with actual and potential stresses in relation to their work and work environment. It is geared at helping workers attain and maintain optimum level of physical and psychological functioning. ✘ Determinants Occupational nursing practice are government policies and standards (e.g. Dept. of Labor and Employment, DOH, SSS, PhilHealth & Employees Compensation Commission) ✘ Professional standards such as those recommended by the (OHNAP) & (PNA) R.A. 1054 Occupational Health Act. an occupational nurse must be employed when there are 30 to 100 employees and the workplace is more than 1 km. away from the nearest health center. ✘ Working conditions and rest periods normal hours of work of any employee shall not exceed 8 hours a day. health personnel: 100 bed capacity (hospital) 1,000, 000 pop. (city/municipality) = 8hrs/day, for 5 days a week. = 6 days or 48 hrs. (inc. demand) 30% additional compensation of their regular wage for work on 6th. day