Week 2.2 Overview of Public Health Nursing PDF

OVERVIEW OF PUBLIC HEALTH NURSING Definition of Terms ◦ Community ◦ ⎯ Are social structures that exhibits and create norms and values that establish social institution (WHO) ◦ Health ◦ ⎯ A state of complete physical, mental and social being and not merely the absence of disease or infirmity (...

OVERVIEW OF PUBLIC HEALTH NURSING Definition of Terms ◦ Community ◦ ⎯ Are social structures that exhibits and create norms and values that establish social institution (WHO) ◦ Health ◦ ⎯ A state of complete physical, mental and social being and not merely the absence of disease or infirmity (WHO) ◦ Community Health ◦ ⎯ Extends the realm of public health to include organized health efforts at the community level through both government ◦ and private sectors Community Health Nursing ⎯ “The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation. ” (Maglaya, et al) ⎯ Goal: “To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness” (Nisce, et al) ⎯ Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability (WHO Expert Committee of Nursing) ⎯ A learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the client’s optimum level of functioning thru’ teaching and delivery of care (Jacobson) ⎯ A service rendered by a professional nurse to IFCs, population groups in health centers, clinics, school’s workplace for the promotion of health, prevention of illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman) 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.  Basic Principles of CHN ◦ In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care ◦ 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 ◦ CHN is a part of health care system and the larger human services system Evolution of CHN Brief History of PHN/CHN: ◦ August 1, 1922 - was first introduced in the course nursing the Phili of nursing the Philippines. ◦ Philippine Health Services - established the course together with UP, PGH, Public Welfare Commission, Phil. Chapter of American Red Cross and other charitable and organizations in manila. ◦ Made in due to increasing demand for public health services needs in the city and rural districts Rural Health Units ◦ established by the Government to meet the demands of the public for their health services needs ◦ Amended by RA. No. 1891 (June 22, 1957) - creation of rural health units of eight different categories corresponding to eight population group of communities to be served.  Sanitation of environment Control of communicable infections Education of the individual in personal hygiene According to C.E.Winslow, which of the following is the goal of Public Health? ◦ “All public health efforts are for people to realize their birthrights of health and longevity.” ◦ “For people to attain their birthrights of health and longevity” According to DR. Margaret Shetland, the philosophy of Public health nursing/CHN ◦“The worth and dignity of man“ ◦This is a direct quote from Dr. Margaret Shetland’s statements on Public Health Nursing. Role and Responsibilities of Community Health Nurse “The main focus of community health nurse is health promotion.” 1. Programmer/Planner ⎯ Identifies the needs and concerns of individuals, groups, families, and the community ⎯ Formulates health plans, especially in the absence of a community physician ⎯ Interprets and implements nursing plans and programs ⎯ Assists other health team members in implementing health programs in the setting 2. Health Educator/Trainer/ Counsellor ⎯ Acts as resource speaker on health and health-related services ⎯ Advocate health programs in the community through dissemination of IEC or Information Education and Communication materials ⎯ Conducts advocacy educations concerning premarital, breastfeeding, and immunization counselling ⎯ Organizes orientation/ training of concerned groups like pregnant mothers ⎯ Identifies and interprets training needs of health team members and formulate appropriate training program for them ⎯ Conducts and facilitates necessary training or educational orientation to other health team members in the community ◦ “The recipient of care of community public health nursing practice is extended not only to the individual but also to benefit the whole family and community.” 3. Community Organizer ⎯ Promotes self- reliance of community and emphasizes their involvement and participation in planning, organizing, implementing and evaluating of health services ⎯ Initiates and implements community development activities 4. Coordinator of services ⎯ Coordinate’s health services with concerned individuals and families through the community health team members, government organizations and non- government organizations ⎯ Coordinate’s nursing plans and programs with other health programs  “Community health nurses are generalists in terms of their practice through life’s continuum.” 5. Provider of Nursing Care ⎯ Renders direct care to various clients with different needs, may it be at home, in school, clinics or work settings ⎯ Involves the family in the care of the sick or dependent individual, i.e., sick child “Continuity of care with the client, family or and the community extends for a longer time involving individuals of all ages and health needs” 6. Health Monitor ⎯ Monitors and detects the presence of health concerns in the community through contacts or home visits. ⎯ Utilizes various effective data gathering techniques in keeping an eye on the health status of all recipients of care. ⎯⎯ Records and reports health status and presence of health problems in the community “The nature of nursing practice in the community needs the knowledge of biological and social sciences, ecology, clinical nursing, and community organizing, for it to be effective.” 7. Researcher ⎯ Follows a systematic process of monitoring the health status of the community through the conduct of surveys and home visits ⎯ Conducts researches concerning the health of the community ⎯ Coordinates with government and non- government organizations in the conduct and implementation of studies 8. Statistician ⎯ Records data systematically and ensures its validity through accurate and complete data gathering ⎯ Reports prepared reports to concerned organizations i.e. government organization for immediate necessary plans or programs ⎯ Consolidates and reviews reports efficiently. ⎯ Analyzes and interprets consolidated data for monitoring the development in the health matters of the whole community “This field of nursing practice utilizes a dynamic process (assessment, planning, implementation, and evaluation) in the provision of continuous care until termination is implicit.” 9. Change Agent ⎯ Promotes and motivates change in the community in their health practices and lifestyle behaviors for them to promote and maintain good health, be knowledgeable and has the initiative in accessing health services ⎯ Inculcates self- reliance to brought about development and improvement in the community Core Values of a Community Health Nurse 1. Integrity Skills attribute to integrity ⎯ Care Comes First – Communication is key. Listen to others, and provide information and advice clearly so every patient can understand. Make well-informed decisions that are best for the patient. Do not accept gifts for preferential treatment. ⎯ Confidentiality- states that anything said to nurses and other health-care providers by their patients must be held in the strictest confidence. ⎯ Veracity- requires nurses to be truthful. Truth is fundamental to building a trusting relationship. ⎯ Accountability- linked to fidelity and means accepting responsibility for one’s actions. Nurses are accountable to their patients and to their colleagues. ⎯ Respect Dignity – Protect patient privacy. Never give client information to an unauthorized person, and preserve anonymity when citing patient cases in coursework, research, or other public documents. ⎯ Honesty and Integrity – Do not plagiarize coursework or professional assessments. Compile an accurate CV to reflect your education and work experience. Always aspire to the highest levels of personal and professional conduct. ⎯ Uphold reputation – be aware that all actions—even outside of work—may have consequences. Core Values of a Community Health Nurse 2. Professionalism Skills attribute to professionalism ⎯ High Standards of Care – Be punctual. Acknowledge when a situation is beyond your professional scope. Don’t be afraid to ask for help. ⎯ Leadership – A sought-after attribute, leadership is founded on excellent communication skills, attention to detail, respect, and resourcefulness. Professionals commonly build leadership skills as they move on to more senior roles in which they can guide others to provide higher levels of care. 3. Competence ⎯Conflict resolution – This involves a professional’s ability to de-escalate a problem. It requires the nurse to consider the needs of everyone involved in the conflict, while communicating possible solutions with respect. ⎯ Ethical thinking – This skill enables nurses to make value-based judgments that align with professional standards and moral codes, prioritizing the needs of patients and colleagues ahead of their own. ⎯ Adaptability – This demonstrates the capacity to combine new information with education, experience, and professional guidelines to re-evaluate a situation and make changes that lead to more effective solutions. Core Values of a Community Health Nurse 4. Commitment ⎯ Fidelity- a promise that the individual will fulfill all commitments made to himself or herself and to others. ⎯ Accountability- linked to fidelity and means accepting responsibility for one’s actions. Nurses are accountable to their patients and to their colleagues. 5. Openness ⎯ We want our community to have confidence in their local health services. ⎯ We foster greater confidence and cooperation through open communication. ⎯ Our performance is open to public scrutiny through patient and employee surveys. ⎯ We welcome and use feedback as a tool to do better. ⎯ We encourage those around us to speak up and voice their ideas as well as their concerns by making it clear that speaking up is worthwhile and valued. ⎯ We communicate clearly and with integrity. Core Values of a Community Health Nurse 6. Teamwork ⎯ Collaboration -working with others and being able to communicate and cooperate is crucial to developing an efficient work environment that places patient needs at the forefront ⎯ Cooperate with team members and respect their contributions. Always treat everyone with respect. ⎯ Team Leader – excellent communication skills leadership skills as they move on to more senior roles in which they can guide others to provide higher levels of care. 7. Patriotism ⎯ National pride is the feeling of love, devotion and sense of attachment to a homeland and alliance with other citizens who share the same sentiment. Filipino Culture, Values and Practices in relation to Health Care of Individual and Family. ◦ Culture is socially transmitted behavior, patterns, rules of conduct, arts, values, beliefs, custom, rituals, lifeways, and products of existence that guide the worldwide and decision making. ◦ Madeleine Leininger recognized the need to focus on culture in nursing as she predicted that nursing and health care would become global. The major concepts of Leininger’s Theory is cultural diversity and goal of nursing is to provide patient with culturally specific nursing care. ◦ Key component of the nursing assessment process in order to plan in a manner that is sensitive and respectful of the individual needs of the client /significant others Cultural considerations ⎯ An individual may not necessary identify strongly with the specific group just because he/she was born into it. ⎯ An individual may identify with more than one group. ⎯ Client may choose to practice selected custom of a group while not honoring others. ⎯ How a client identifies with a culture, ethnic group, or religion may affect his/her health practices and care up to the end of life. ⎯ Rituals tend to become most important to individuals at times of significant life transitions ⎯ When ethical dilemmas arise, the leader of the spiritual or cultural group might be consulted. Assessment ⎯ Does the client identify strongly with a specific group or groups? ⎯ What are the beliefs, customs, practices and rules that are most important to the client? ⎯ How can the health care team support the client and plan of care that will address these needs? Are there special wishes/needs? ⎯ Is the client part of a community, congregation, or extended family structure? Does this play an important part in his/her life? ⎯ How do the identified culture(s) influence feelings about health and care? It is important to assess areas related to the situation (e.g., for a client newly diagnosed with AIDS? What gives the client’s life meaning? What does pain mean to this client? Selected examples of diverse cultures that might influence health care practices 1. Jehovah’s Witness ⎯ Urge members to refuse blood transfusion 2. Seventh-day Adventist ⎯ Prohibit consumption of pork, shellfish, alcohol, coffee and tea. 3. Hindus ⎯ Prohibit consumption of beef (all meat and alcohol are avoided by the most devout). ⎯ Food is eaten with right hand (regarded as clean) Selected examples of diverse cultures that might influence health care practices 4. Muslims ⎯ Prohibit consumption of pork and pork products and alcohol. Consumption of blood is forbidden; therefore, all meat and poultry ate cooked to well done. ⎯ Bread is required with each meal (a gift from God) ⎯ Food is eaten with the right hand (regarded as clean) ⎯ Beverages are not consumed until after the meal (some believe it unhealthy to eat and drink at the same time). Some Muslims d o not mix hot and cold foods at the same time. ⎯ Fasting as the start of a remedy: prophet Mohammad said” stomach is the house of every disease” ⎯ High concern for ingredients in mouthwash, non-home- prepared food, medication (gelatin capsule derived from pig, insulin, etc.) ⎯ Special daily prayer times ✓ Need basin of water to wash before praying ✓ Bed or chair facing Mecca ✓ Read or listen to the Qur’an ⎯ Death is God’s will and foreordained. The worldly life is preparation for eternal life. ⎯ Death rituals ✓ Body washed three times by Muslim of the same gender and wrapped in white ✓ Buried as soon as possible in brick-or cement grave with the body facing Mecca (no cremation and typically no autopsy) Selected examples of diverse cultures that might influence health care practices 5. Roman Catholic ⎯ Anointing of the sick (last rites) for the seriously Ill. This sacrament of healing discusses God’s grace and brings physical and spiritual strength ⎯ attending mass ⎯ praying the rosary and novena ⎯ expressing devotion to saints and the Virgin Mother ⎯ receiving the sacraments and holy communion ⎯ reconciliation ⎯ anointing the sick ⎯ observing religious holidays and rituals ⎯ going on pilgrimages Health Beliefs and Behaviors: Health Behaviors ⎯ Filipino older adults tend to cope with illness with the help of family and friends, and by faith in God. ⎯ Complete cure or even the slightest improvement in a malady or illness is viewed as a miracle. ⎯ Filipino families greatly influence patients’ decisions about health care. ⎯ Patients subjugate personal needs and tend to go along with the demands of a more authoritative family figure in order to maintain group harmony. ⎯ They may even resort to utilizing traditional home remedies such as alternative or complimentary means of treatment. ⎯ They may discuss their concern with a trusted family member, friend, spiritual counselor or healer (Yeo, 1998). ⎯ Seek medical advice from family members or friends who are health professionals is also a common practice among Filipino older adults and their family members, especially if severe somatic symptoms arise (Anderson, 1983). Responses to Mental Illness Indigenous traits common among elderly Filipino Americans when faced with illness related to mental conditions: ⎯ Devastating shame (Hiya) ⎯ Sensitivity to criticism (Amor Propio) Coping Styles ◦ Coping styles common among elderly Filipino Americans in times of illness or crisis include: ◦ ⎯ Patience and Endurance (Tiyaga): the ability to tolerate uncertain situations ◦ ⎯ Flexibility (Lakas ng Loob): being respectful and honest with oneself ◦ ⎯ Humor (Tatawanan ang p\Problema): the capacity to laugh at oneself in times of adversity ◦ ⎯ Fatalistic Resignation (Bahala Na): the view that illness and suffering are the unavoidable and predestined will of God, in which the patient, family members and even the physician should not interfere ◦ ⎯ Conceding to the wishes of the collective (Pakikisama) to maintain group harmony Cultural Values ⎯ Smooth Interpersonal Relationships are a core value for every Filipino community ⎯ They involve a shared identity, engagement on an equal basis with others ⎯ Give importance to the individual versus agencies or institutions. This cultural characteristic is also known as “Personalism.” ⎯ The high value placed on sensitivity and regard for others, respect and concern, understanding, helping out, and consideration for others’ limitations, often creates discord with American tendencies toward openness and frankness (Agoncillo & Guerrero, 1987; Enriquez, 1994). ⎯ Perceptions regarding physician preferences dictate who will provide care and how much trust is given. Two main concepts determine the interaction between a Filipino and a health care provider: 1. “One of Us” (Hindi ibang Tao) versus 2. “Not one of Us” (Ibang Tao) Health providers who are respectful, amenable and willing to accommodate the patient’s needs are considered to be Hindi ibang Tao. ◦ If the provider is considered Ibang Tao, Filipino Americans will be reluctant to express their feelings and emotions. They will designate a family member to mediate or advocate on their behalf while responding politely to the provider at a formal and superficial level. The concept “Not one of Us” The concept “One of Us” includes: involves civility (Pakikitungo) mutual trust/rapport (Pakikipagpalagayan mixing (Pakikisalamuha) ng loob) joining/participating (Pakikilahok) getting involved (Pakikisangkot) adjusting (Pakikisama) oneness/full trust (Pakiisa) (Pasco, 2004; Enriquez, 1994; Pe Pua, 1990). Family and Filial Responsibility ⎯ Children are taught to show affection for older family members and respect for older adults and authority. ⎯ Seek the advice of and accept the decisions of their older adults. ⎯ They are obligated to care for older adults and aging parents, and maintain group harmony, loyalty, and emotional ties with parents and other family members across the life span (Chao & Tseng, 2002; Mc Bride, 2006; Miranda, Mc Bride & Anderson, 2000; Superio, 1993). Spiritual Life and Religiosity ⎯ Religion is deeply embedded in and intertwined with Filipino culture. It is central to people’s lives and enables them to face life’s challenges and adversities with strength and optimism (Tompar-Tiu & Sustento- Seneriches, 1995). ⎯ Filipino use spirituality and religion as part of their coping practice, especially when dealing with illness.