Community Health Nursing PDF

COMMUNITY outdoor environment which might cause illness, According to World health Organization (1974) disability or discomfort through interaction with ​ It is a social group determined by geographical...

COMMUNITY outdoor environment which might cause illness, According to World health Organization (1974) disability or discomfort through interaction with ​ It is a social group determined by geographical the human system (US- DHHS, 1988 in Clemen boundaries and/or common values and interest et.al, 1995) ​ community members know and interact with one another ​ Nurses must act as an advocate for clients on ​ creates norms, values and social institution. issues relevant to environmental concerns. This role includes informing clients about these Josten (1989) and Hunts (2001) hazards and urging self-responsibility in ​ refers to a community as “people, location, and maintaining a healthy community. social system.” THE COMMUNITY HEALTH CARE PROCESS People: Families, Culture and Community 1.​ Establishing a working relationship with the - The variety of individuals, families and cultural groups community comprising a community contributes to the overall Community assessment or diagnosis complexion of that community. 2.​ Planning for community health 3.​ Nursing interventions, monitoring and - A focus on the family is vital in promoting the health supervision of individuals as well as the health of the community. 4.​ Evaluating community health interventions 5.​ FAMILY COMMUNITY DIAGNOSIS ​ is the first social institution established by man. ​ useful framework in formulating a community health nursing diagnosis and facilitating a higher CULTURE level of wellness for the identified client ​ is the sum total of man’s experiences as he community interacts with his environment and fellowmen. ​ others call it community assessment or ​ It contributes to the over all character of a situational analysis. community and health needs. ​ It is learned, shared and transmitted to Initial perception of the client community is done through succeeding generations OCULAR SURVEY or WINDSHIELD SURVEY. ​ ​ Walking around the area allows time to be seen Location: Community Boundaries and to see, to absorb the atmosphere of the -Community boundaries neighborhood. ​ are important because they often determine what services are available to families living Establishing a Working Relationship with the Community within a particular ​ geographic area. Vital to the success on the use of the health care process is establishing rapport with the client community Social System before hoping to gain their cooperation to help ​ It is the relationship that community members themselves. The working relationship is made formal form with each other. ​ through contract setting where an agreement is made on ​ By interacting in groups, it provides the: socialization, role ​ fulfillment, goal ​ Goals and objectives of working with them achievement, and member support. ​ Duration and frequency of nurse-client community contact ​--Expectations A HEALTHY COMMUNITY ​ Also, a CHN nurse should explore: - Attitude of the community of interest A healthy community is considered a caring community. - The need to identify rules or protocols that It is one which: need to be followed ❖​ Prompts its members to have a high degree of awareness that “WE ARE ​ Community Assessment/Diagnosis COMMUNITY” ​ helps the nurse/midwife gain an ❖​ Uses its natural resources and conserves it for understanding of community dynamics future generations because health action occurs in the community ❖​ Recognizes and involves the existence of sub- groups Interdependent Conditions in Conducting Community ❖​ Is prepared to meet problems Is a Diagnosis problem-solving community ❖​ Has open channels of communication 1. Health status of the community ❖​ Makes each of its systems resources available Involves people in the environment considering ❖​ Has legitimate and effective ways to settle two interrelated ​ factors: disputes ​ People factors ❖​ Encourages maximum citizen participation in ​ Environmental factors decision-making 2. Health capability of the community ❖​ Promotes high level of wellness among its The community’s ability to deal with its identified members problems represented by the degree to which it is able to cope with its problems and needs ENVIRONMENTAL SENSITIVITY IN COMMUNITY to what extent its economic, institutional and human HEALTH NURSING resources are able to do the things required to assure - Historically, environmental health has been community’s stability one of the earliest public health concerns 3. Health action potential involves an estimate of the basic values and beliefs that Environmental health provide stimulus for action, the institutional system that ​ is the “systematic development, promotion and supports the action, and the habits the community has conduct of measures that modify or otherwise developed for dealing with common problems control those external factors in the indoor and  Sample Survey ​ “Instead of a census, demographic information can still be collected from a sample of a given Elements of a Comprehensive Community Diagnosis population. - Demographic Values - Total population and geographical distribution Population Size - Topography - knowing the population size of a place allows the nurse - Climate to make comparisons about population changes overtime. - Demographic characteristics - Increase in the population due to excess of births - Health statistics compared to ​ deaths - Trends - Population density Natural increase – the difference between the number of births and ​ deaths occurring in a specified period Health Resources of time. - Manpower resources Rate of Natural increase - the difference between the - Material resources Crude Birth Rate ​ and the Crude Death Rate occurring - Political/Leadership Patterns in a population in a specified ​ period of time. The initial tasks done by a nurse/midwife prior to Natural increase = No. of births – No. of deaths (specified community diagnosis includes year) ​ Prepare materials and tools needed for Rate of Natural Increase interview = Crude Birth Rate – Crude Death Rate ( specified year) ​ Organize the community diagnosis team​ ​ Inform the community Population Composition is described in terms of its age and sex. ​ Sex composition – compares the number of Socio-Economic-Cultural Values males to the number of females in the - Social indicators population. - Economic indicators ​ Age composition - Median age divides the - Cultural indicators population into two equal parts - Environmental Variables ​ - Health Statistics Variables Dependency ratio- compares the number of economically ​ dependent with the economically Steps in Conducting Community Diagnosis productive group in the ​ population. ​ Determine the Objectives Age and sex composition – can be illustrated through a ​ Defining the sturdy population population pyramid. ​ Determine data to be collected ​ Collecting the Data Sex composition - windshield survey - Sex Ratio = Number of males x 100 - informative interview Number of females - participant observations - examination of secondary data Population Distribution – described in terms of: ​ Developing the Instruments - Urban-Rural Distribution ​ Actual data gathering ​ Data collection - Population density – determines how congested a ​ Data presentation place is and has ​ implication in terms of the adequacy ​ Data analysis of basic health services ​ present in the community. ​ Identifying the community health problems - Crowding Index – the ease by which communicable ​ Priority setting diseases can be ​ transmitted from one hose to another - nature of the problem susceptible host. - magnitude of the problem - modifiability of the problem Vital statistics – is an essential tool in forecasting, - preventive potential implementing, monitoring, and evaluating health program. - social concerns Planning Application of Public Health Tools in Community ​ process whereby information about a Health Nursing/Midwifery community is systematically collected ​ used to structure a usable community health Demography – is the science that deals with the study of plan that empowers communities to choose human population size, composition and distribution in strategies for health. space. ​ Population size- refers to the number of Concepts of Planning people in a given place or area at a given time. ​ Concerned with the future ​ A systematic process Sources of Demographic Data ​ A continuous and dynamic process Census ​ Flexible ​ is the official and periodic enumeration of ​ Change-oriented population, - De jure method is done when people are assigned The Planning Process to the place they usually live in regardless of where they Situational Analysis ( Where are we now?) are at the time of the census. - gather health data - De facto method is done when people are assigned - tabulate, analyze and interpret data to the place where they are physically present at the time -Identify health problem of the census regardless of their usual place of residence. - Prioritizing Problems – to set targets and allocate resources for each problem  - The integration work provides the opportunity for the Establishing Goals and Objectives (Where do we want nurse to ​ continue and learn more about the community to go?) and deepen/strengthen his ties with the identified potential - Goal is a general statement of intent or purpose leaders ​ and the rest of the people. - Objectives are the precise statements of the desired outcome ​ (SMART) To ensure sustained participation, the following are to - Operational Target identifies how an objective could be considered be achieved, it should indicate: - Orienting community leaders - Specific measures for the desired change to take - Formation of core group effect - Information dissemination through conduct of - Priority population group purok assembly ​ and meeting - Target dates - Clustering of the barangay - Selection and training of BHW Identifying Intervention Activities (How do we get - Household listing there?) - Spot Mapping Strategies should be defined Strategies To ensure the support and participation of the community - approaches or techniques to facilitate accomplishment of leaders, proper orientation briefing should be done. set objectives and targets. It should take advantage of the strengths ​ and offset the weaknesses The following preparation includes: of the program. - What to prepare: 1. Communications or letters signed by the city/municipal Activities should be defined health officer Activities 2. Agenda -are specific and concrete steps and actions to accomplish 3. Visual for orientation the ​ set objectives and operational targets 4. Document proceedings of the meeting 5. Plan for the conduct of community orientation Developing workplans 6. Tips in conducting a meeting -Worplans are essential for effective and efficient 7. Dress simply program ​ implementation 8. Be courteous 9. Start the meeting formally Evaluation of plan (How do we know we are there?) 10. Define purpose/objective and expected outputs of the Evaluation meeting - is the final step of the planning exercise where plan 11. Discuss the agenda one at a time implementation/execution is controlled and 12. Elicit opinions and suggestions from the audience achievement is ​ measured, in order to determine 13. Record decisions/comments and suggestions progress and as a basis for ​ introducing necessary 14. Before ending the meeting, recap all decisions corrections/revisions. 15. Plan for the next activities 16. Express gratitude for their presence NURSING INTERVENTIONS, MONITORING/SUPERVISION FOR COMMUNITY Phase 3 – Conduct a Study of the Community HEALTH AND DEVELOPMENT Phase 4 – Hold the Consultative Discussions with Community Leaders Community Organizations ​ During this phase, it is important to get the -It is stimulated by involvement of the community in policy consensus or negotiate agreement of the decisions that address the social, environmental and proposed directions and what specific actions to behavioral variables that make an impact on their health. be done for each problem and needs Phase 5 – Formation of Core Group Community Participation ​ The core group will be tasked with laying down - It is a process where the community organizes the foundation of a strong people’s organization itself to identify and analyze its own specific problem, plan and will serve as a training ground for a and implement appropriate actions to solve and address democratic and collective leadership. the health and health-related problems. - The qualities of a good barangay health -Creating awareness and interest worker: - Organizing the community 1. Credible in the community - The nurse/midwife creates opportunities for community 2. Understands the cultural setting of the community and participation respect it - The nurse provides direction on the type of activities to 3. Approachable be done 4. Leads by doing 5. Firm in decision-making 6. Open to criticisms PHASES IN COMMUNITY ORGANIZATION Phase 1 – Entry/Integration Phase 6 – Educate/Train/Communicate -Entry of the nurse/midwife to the community ​ Determination of training needs is the first step - Establish rapport (courtesy call) – a prerequisite to entry in the training process with least resistance ​ Training provides a motivational climate that - Paying courtesy to the people (house visit) brings about the optimum performance of the - Adapting a lifestyle in keeping with that of the residents core group to achieve the goals of the program - Be clear with your objectives and limitations Phase 7 – Mobilizing/Organizing Mobilization Phase 2 – Spotting and Developing Potential Leaders ​ involves the actual organization of the people, - Leaders are those who can extend to other people identification and setting-up of a system for - They should show leadership potential and be committed doing the assigned tasks, resource allocation to ​ the objectives, have integrity and are willing to including budgeting, target setting, indicators work for the desired change  and timetables for monitoring/supervision and d. If there is an improvement in the quality of evaluation purposes service Phase 8 – Monitoring/Supervision and Evaluation Conducting a Supervisory Visit ​ Evaluation of the progress/performance of the Supervisory visits must be planned program based ​ from the expectations set at the start of the plan The actual visit is composed of three parts: ​ Can be done through regular meetings with: ​ Opening brainstorming, field ​ Body observations,counseling/consultations, ​ Objectives, strategies, work plans, monitoring information dissemination and circulation of and evaluation updates for comments, and performance ​ Recommendations appraisals. ​ New area of concern of the health worker ​ Possible problems ​ Analyze objectives and extent to which they are Phase 9 – Building-up/Termination attained Closure The end goal of the community development effort is to build the capability of the people to identify their needs and problems and work together to solve these In making a report (closure), it should contain: needs/problems. ​ The contact worker/persons - In termination, the nurse/midwife should: ​ The purpose of the visit 1. Inform people concerned about the pending ​ Findings and observations disengagement ​ ​ Actions done 2. Prepare final reports with recommendations to officials ​ Unresolved problems requiring higher level concerned interventions Recommendations 3. Submit proposal for impact evaluation later to ​ Date of next visit determine changes/contributions of the program to the community. A supervisor must consider the following pointers: ​ Ensure that resources needed to accomplish How to Monitor? work are available ​ Conduct of field visit in order to see whether the ​ Provide a comfortable workplace activities which were planned are done ​ Ensure a reasonable workload ​ Interview target beneficiaries to see if they are ​ Regular supervisory visits and meetings should really receiving the service as recorded be organized and set ​ Review/Check records ​ Supervisory guidelines and protocols should be ​ Individual/Group conferences and meetings set and observed Monitoring methods Supervisory encounters should NOT be done in a hurry ​ Conduct of field visit If there are problems, workers should be helped to find ​ Review/check records and reports ways to resolve them ​ Check-lists Program objectives, strategies, operational targets, work ​ Interview target beneficiaries plans, monitoring and evaluation reports should be ​ Individual/group conferences and meetings regularly reviewed and correlated with supervisions Queries and problems that were not addressed during a Supervising previous visit should be addressed during the next visit Health workers need guidance and support to enable them to overcome problems and constraints, and to utilize and EVALUATING COMMUNITY HEALTH INTERVENTIONS maximize opportunities that they encounter in the program ​ EVALUATION is an essential component of implementation planning and should be built in as the plan of service is constructed Supervision is needed to be able to: Tools for evaluation ​ Facilitate program implementation 1. Use of indicators ​ Observe/improve work performance 2. Physical measurements used in measuring effects on ​ Make physical review of records to identify people deficiencies or non compliance 3. Surveys and field research ​ To motivate 4. Analysis of existing information Preparing a Supervisory Plan Steps in Evaluation ​ Identify areas/activities where supervision is ​ Deciding what to evaluate needed ​ Identify appropriate indicators -parameters that ​ Supervisory needs/problems may be prioritized measures changes directly or indirectly based on the following standards: ​ Indicator of Progress -Urgency of the need/problem ​ Indicator of Impact -Activities/strategies/available resources needed to meet ​ Indicator of Effectiveness the needs/problems ​ Indicator of Efficiency -Magnitude and extent of the need ​ Indicator of Appropriateness or Relevance -Time frame to carry out actions Gather and analyze data Develop objectives ​ Quantitative data Prepare activities, strategies and resources needed to ​ Qualitative data meet identified objectives ​ Making decisions Determine indicators for evaluation – use a checklist on: ​ Reporting and giving feedbacks a. Whether needs were met b. Degree of motivation c. If performance is improved/increased