NRSG 527 Principle and Practice of Community Health Nursing III PDF

PRINCIPLE AND PRACTICE OF COMMUNITY HEALTH NURSING III NRSG 527 BY ABARIBE, C.E UNIT 1 Community/Community Health Structure  The structure/pattern of the family  Community structure, decision making structure of a community  Staffi...

PRINCIPLE AND PRACTICE OF COMMUNITY HEALTH NURSING III NRSG 527 BY ABARIBE, C.E UNIT 1 Community/Community Health Structure  The structure/pattern of the family  Community structure, decision making structure of a community  Staffing in primary health care system and their roles and functions  Working with groups in the community-cooperation, mobilization and in collaboration.  Population-focused practice LEARNIG OBJECTIVES By the end of this lecture the students would be able to; 1. Define a family from community health nursing perspective 2. Discuss why choosing a family perspective in community nursing care 3. List and explain different family views 4. Define a community 5. Define community structure, list and discuss elements/basics of community structure 6. Describe a healthy community and factors to consider for a healthy community 7. Define decision-making and highlight the decision-making process of a community 8. Explain reasons for community decision-making and strategies used by community leaders in participatory planning and decision making  THE STRUCTURE/PATTERN OF THE FAMILY  Individuals in a family can be thought of as a living system. Each person is one of the elements that are interrelated with one another.  A boundary or imaginary wall exists around the family, similar to the thin membrane of a cell wall. This boundary can vary; it can be rigid and impenetrable, or it can be a permeable membrane that allows exchange in and out of the system.  Each member, although only a part of the system, has the potential to change the patterns and organization of the entire system. Together, the individuals within the family make up something new that is different from and greater than the simple sum of its members.  Living systems have parts that undergo growth and change. At any given point in time, the individuals in the family will be undergoing change themselves. The members are growing, developing, learning, and changing, usually on trajectories or paths that are recognizable as part of the life cycle. Thus, the family as a living system is constantly changing.  The boundaries of the system permit some exchange of information between the inside and the outside.  Why Choose a Family Perspective? 1. Family thinking gives a broader picture. Viewing an individual in a smaller framework may narrow the information and the understanding of the problem. This view assumes that individuals act independently and in an isolated way when they are actually intimately connected with larger systems. When a family member is being assessed, that person may be completely understood only if he or she is viewed within the context of the gestalt—the whole situation. Assessment using an individual perspective may miss important interrelated aspects of the problem or resources that can be used to promote health and alleviate distress. Why Choose a Family Perspective cont’d? 2. The family is a unit of care. People often live in households as families. Families are organized in a structure with identified roles and leadership, and society expects families to assume some responsibility for each member. The family divides its economic resources. Family members also have emotional ties to each other. Even though society has assumed some of the family’s functions (i.e., education), the family remains a workable unit. 3. The family assumes a crucial role in maintaining health. Such a strong relationship exists between the family and health care that the role of the family becomes paramount in maintaining health. Health beliefs, values, and behaviors are learned and supported in the family. Health promotion activities are taught and implemented. The family is sometimes the primary care provider for its members who are ill and dependent. Changes in lifestyle are often required of the whole family if the level of wellness of one of the members is affected Why Choose a Family Perspective cont’d? 4. Dysfunction in one member may be related to disturbance in the whole family. Because a family operates as a system, a symptom in one member may be a signal that something is happening in the family as a whole. The family will sometimes work hard on one health problem, with some good results, only to have another health problem present in a second family member. 5. Dysfunction in one member may lead to added stress and depletion of resources for a family. Caring for a member who is ill or dependent can deplete financial resources, physical energy, and other sources of family support. The health of other members is sometimes disturbed. In many instances, the ability of the family to fulfill its maintenance functions for its members, such as giving time and attention to young children or sharing recreational activities, is affected by the illness of a member. Why Choose a Family Perspective cont’d? 6. Family and intimate relationships are important for tracking the occurrence and incidence of disease. To community/public health nurses who are attempting to prevent, track, and record disease processes, the relationships within families and with other intimate partners are clearly significant. Family information is used in assessing needs, determining health care priorities, finding cases, tracking and preventing the spread of communicable diseases, educating for preventive purposes, and organizing the delivery of care to special and large populations. The family is an essential piece of these epidemiological health care functions. 7. The unique goals of family nursing Individual health, supportive interpersonal relationships, and an effective family unit can be achieved only by using a family perspective. Family is the umbrella under which all other nursing should be practiced. Therefore, a family is an open and developing system of interacting personalities with a structure and process enacted in relationships among the individual members, regulated by resources and stressors, and existing within the larger community. DIFFERENT FAMILY VIEWS Family can be viewed as; 1. Structure 2. Process 3. Function 1. Structure  Structure refers to the elements of the family and the organization of these elements within the family. Over the life of a family, structure does not remain exactly the same, but a certain continuity of structure is maintained.  Anthropologically, family structure has been defined using family types in terms of lineage and power. For example, families may be matriarchal or patriarchal.  Other people look at the arrangement of members within the system in terms of subsystems, coalitions, and other structures that have hierarchies and boundaries.  Father as head of the family…………. Family Forms  Some type of family exists in all societies, although there is a wide diversity of forms. Variations may even exist among classes within the same society  Let’s mention some forms of family we have 2.Process A process is a phenomenon that occurs over time.  Families, individuals, and society go through processes of growth, development, and change.  The term implies change, but within every change, some pattern and connectedness with previous and future patterns is often found.  Family process can be defined as predictable and repetitive interaction patterns within families. For example, mom always watches Johnnie’s behavior very closely. Johnnie gets upset by this and complains to dad. Dad goes to mom and complains that she is too harsh with Johnnie. Mom backs off for a while but soon resumes her attention.  These interaction(s) can be observed in dyads (two-person groups), or in interconnecting triangles (three-person groups) within the family.  Families also seem to have a characteristic way of interacting as a unit in relation to the outside world. This process can be open or closed, separate or connected.  Families may allow information from the environment to help them solve a problem or close themselves off from outside influence. Families may act together in a cohesive manner, withdraw from each other, or even split apart.  The behavior of the family may be random and chaotic or rigid and predictable.  Family strengths Ability to provide for physical needs Ability to provide for emotional needs Ability to provide for spiritual needs Respect for parental views and decisions on child rearing Responsible community relationships Ability to communicate openly and in depth Ability to grow with and through children Ability to help itself and accept help when needed Consensual decision making Flexibility of family functions and roles Provision of security, support, and Mutual respect for individuality encouragement Ability to see crisis as a means of growth Family unity and loyalty and intra-family cooperation Ability to relate to each other and to foster growth-producing relationships 3.Function  Family function is used to describe results or the effectiveness of families.  Does the family operate in a way that successfully provides for the needs of its members?  Successful functioning is a measure of normality or health.  Examining how well individual family members care for self and others is a way of assessing that family’s level of health.  Unhealthy families are called dysfunctional.  Family functioning is best viewed as a continuum.  When the words functional and dysfunctional are used, family functioning can be considered good or bad. There is no such thing as a good family or a bad family.  All families fall somewhere along a continuum from minimal functioning to optimal functioning in which all members benefit  For optimal family functioning, the structure and process must combine in a way that allows the family to be effective.  Understanding the particular stresses and history that have shaped a specific family’s current way of operating helps the nurse understand that family.  Conversely, the typical level of functioning of a family may determine its developing processes and structure (e.g., divorce, single parenthood, the arrangement of subsystems). Structure, process, and function are interrelated, and all of these aspects must be considered when assessing a family. FAMILY STYLE AREAS OF NEED FOR THE FAMILY PRINCIPLES OF FAMILY CARE PLANNING COMMUNITY STRUCTURE, DECISION MAKING STRUCTURE OF A COMMUNITY TERMS  Community  Community structure  Decision making  COMMUNITY  Community is an English word derived from the French word “"Communauté", which comes from the Latin word “communitas” meaning "public spirit".  Community is a group of people living in the same place or having a particular characteristic in common (healthy community) OR  A community is a social group whose members have something in common, such as a shared government, geographic location, culture, or heritage. Community can also refer to the physical location where such a group live and work. OR  A community is a social unit (a group of living things) with commonality such as norms, religion, values, customs, or identity. Communities may share a sense of place situated in a given geographical area (e.g. a country, village, town, or neighbourhood) or in virtual space through communication platforms.  COMMUNITY STRUCTURE  Community structure is defined as the internal structure of an employment area, town, city, neighbourhood or another urban area.  It includes the population and housing, jobs and production, service and leisure time areas, along with transport routes and technical networks, their location and relationships.  Elements of Community structure The structure of a community is vital to its successes and failures. Having a good structure will support the Community occupants - to live, build, be and play as a cohesive network. There are 4 main elements to the Community structure. These are the; 1. Participants - the life force of the community; the strength of the community lies in the relationships and interactions of the people living in it. 2. Organizational Elements - legalities, activities, communal processes; Organizational elements pertain to the way we interact with each other and the land, the wider community, other intentional communities and the world at large. A natural and peaceful flow within the community manifests when such organizational elements work well together creating invisible 'ties that bind', contributing to building healthy relationships. Organizational elements can be twisted over time through our collective decision making process to best suit our collective needs. Elements of Community structure cont’d 3. Physical Elements - space uses of land, village and farm  Physical elements are the elements which are bound to the earth (the use of land).  The land is usually divided with a balance between agroforestry, agricultural, naturally reserved areas and the village land which will further be divided between private homes and communal/collective spaces.  The land will provide food security in every possible niche. The designation of lands are broken down into the following 4 zones;  Village Zones: The design and layout of a village greatly on the efficiency of a community, on the psyche and health of its members and on the interactions and relationships that people have to each other and the environment  Farm Zones  Agroforestry Zones  Protected Preserve Zones Elements of Community structure cont’d 4. Production Elements- work, products and services.  The primary purpose of Production Elements is to sustain the diverse needs of the community members, and  the secondary purpose is to produce certain goods or services that the community can exchange with other communities or for sale to the world at large.  Each Production Element can be set up in the form of a Project, Business or Cooperative, then the income generated can be shared among community members or used for a community project. CATEGORIES OF A COMMUNITY A number of ways to categorize types of community have been proposed. One such breakdown is as follows: 1. Location-based communities: ranges from the local neighbourhood, village, town or city, region, nation. These are also called communities of place 2. Identity-based Communities: range from the local clique, sub- culture, ethnic group, religious, multicultural or pluralistic civilization, or the global community cultures of today. They may be included as communities of need or identity, such as disabled persons, or frail aged people. 3. Organizationally-based Communities: range from communities organized informally around family or network-based guilds and associations to more formal incorporated associations, political decision- making structures, economic enterprises, or professional associations at a small, national or international scale. COMMUNITY BUILDING Community building is a conscious process and a deliberate effort to design a community based on the knowledge and application of certain rules. There are four stages of community building. 1. Pseudo-community: When people first come together, they try to be "nice" and present what they feel are their most personable and friendly characteristics. 2. Chaos: People move beyond the inauthenticity of pseudo-community and feel safe enough to present their "shadow" selves. 3. Emptiness: Moves beyond the attempts to fix, heal and convert of the chaos stage, when all people become capable of acknowledging their own weakness and brokenness, common to human beings. 4. True community: Deep respect and true listening for the needs of the other people in the community. HEALTHY COMMUNITY A healthy community is a community that showcases a balanced economic, social, human and environmental factors to promote the physical, mental and social well-being of people who live and work in the community.  A human component gives us the "meaning in our lives."  A strong economic base provides opportunities to earn a fair living.  A social base provides essential services and opportunities to grow and interact.  The health and welfare of our community is delicately balanced on a sustainable and clean environment Factors to consider for a health community The following factors are necessary to achieve and sustain healthy communities;  Community spirit  A community vision to guide development.  Willingness to invest in the community. Leaders with the capacity to seek  Understanding the community's information and make decisions. economic system in light of the Commitment to long term planning and changing world economy. action.  Leaders who can build Strong communication networks. partnerships. Finding what is unique to a community Being willing to be innovative. An active core of community workers. Organizing and maximizing human and financial resources. Elements of “sense of community”  Membership: feeling of belonging or of sharing a sense of personal relatedness  Influence: mattering, making a difference to a group and of the group mattering to its members  Reinforcement: integration and fulfillment of needs,  Shared emotional connection DECISION MAKING STRUCTURE OF A COMMUNITY  Decision-making is the process of making choices by identifying a decision, gathering information, and assessing alternative resolutions Effective Decision Making The community decision making process involves the following;  Examining the situation.  Arriving at goals.  Identifying key problems.  Determining priorities.  Identifying and analyzing alternative solutions.  Selecting a course of action.  Developing an action plan.  Implementing the plan.  Evaluating the outcome  Key questions to ask during decision making process are:  Is everyone involved who needs to be?  Did everyone agree on the definition of the situation?  Was everyone clear on how the decision was made?  Were personal or value conflicts resolved to everyone's satisfaction?  Was the chosen solution realistic and reachable?  Community Involvement People have the right to participate in decisions which have an effect on their well-being. It will be to their benefit to exercise that right - to collaborate in setting goals, in organizing themselves and mobilizing the resources to achieve these goals Community decision making has some basic beliefs and values:  Every community has strengths, every community has problems and concerns  The people within each community have the ability to solve their own problems and achieve their own goals  Nothing happens in a vacuum - decision making must suit the area where the challenge exists  The community must involve and have participation by all those affected at each stage of the process  Communities need to identify their own needs, set priorities, plan for the future and take responsibility for their own future. "Progress is impossible without change and those who cannot change their minds cannot change anything." - George Bernard Shaw Community Needs Once the decision has been made, you are ready for the next step - identifying needs. This can be done through a "community needs assessment." It is a way of finding out:  What is needed?  How many have the need?  Who are they?  How important is it that this decision/need be filled?  What is already being done?  What else - additional ideas, changes can be done?  Who else is interested in doing something about this decision? The information you collect can be of two types, "quantitative or hard data" (facts, figures and numbers) and "qualitative or soft data" (peoples' opinions and statements). Both types of information can help you take action. Methods of Initiating Action Several methods can be used to gather information to carry on with good decision making, they include;  a review of population statistics  a review of the community resources and services  a survey of community leaders  focus groups  public meetings  brainstorming  nominal groups 1. Statistics A wide range of statistical data concerning the demography and economy of the community can be gotten through the local, state, zonal or federal governments, as well as many agencies and institutions in the community. Information can be pulled from these resources. Remember: numbers are interesting, but they are just part of the community picture and are not always the best indicator of the decision to take. 2. Community Survey A community survey is usually a standard questionnaire that is widely distributed throughout the community. It can be handled through the mail, by phone, or in face-to-face interviews. While doing this, keep in mind your potential target groups - the people you especially want to reach. It is almost impossible to make a community decision that will meet the needs of everyone. You will want to collect your information noting differences across age groups and sex (i.e., seniors, young mothers, preschoolers, school age children, teenagers, young men, etc.).  3. Community Leader Interviews Key informants are the people in the community who are seen as leaders - people with a better than average understanding of issues or community dynamics. All people should be asked the same set of questions.. 4 Focus Groups This is simply a group interview. An experienced discussion leader meets with 6 to 12 people whose experience relates directly to the decision. Questions are raised and participants are given a chance to present and discuss their opinions. Their reactions are then analyzed. 5. Public Meetings This is a discussion with many people. Public meetings or forums allow two-way communication between the group interested in this decision and other community members. This is an excellent way to reach a very large portion of your community.  6. Brainstorming Here, creative thinking takes precedence over practicality. The concept is to review all possible ideas, regardless of how impractical they may seem. This gets many new and novel ideas before a group for discussion. It moves people to think beyond normal day to day and conventional techniques that have failed to come up with a solution. 7. Nominal Groups  The Nominal group is a formal meeting of individual members that proceeds as follows:  Each member silently expresses his or her ideas about the problem and alternative solutions in writing without any consultation with other members.  At the end of the time period (about 10 to 15 minutes), each member shares his or her views with the other members in a highly structured round-robin fashion. When a member's turn comes up he or she may share only one idea per round.  As each member expresses an idea, a recorder writes down the idea on a flip chart or board. The process continues until all ideas are listed, with no reference to whom the ideas belong.  All ideas on the board are then discussed with respect to their merits, feasibility and all other qualities.  The group then votes silently on the ideas (usually ranking the ideas in order of preference). The pooled outcome of the individual ranking or rating determines the group's choice.  Participatory decision-making (PDM)  PDM is the strategic use of community engagement to inform and legitimize the decision-making process.  PDM ensures community involvement its process thus building trust and confidence in both the decision-makers and the decision process.  PDM is geared towards recognizing mutual goals and perspectives, uncovering values, sharing problem identification, co-creating knowledge, understanding interdependencies, complexities and trust.  PDM accomplishes several collaborative leadership goals.  It increases community capacity and builds social capital, while complying with legislation that requires the public be informed on issues and decisions that affect them.  PDM increases the legitimacy of a decision, thus increasing support for the decision.  Finally, community inclusive processes like PDM cultivate a broad range of perspectives which results in better decisions Reasons for Community Decision-Making 1. Build Community Capacity; involving those affected by a given problem increases their collective ability to find solutions. People learn through experience. Providing opportunities to influence decisions facilitates community members’ ability to make better decisions. 2. Create Social Capital – PDM creates social capital: trust and confidence develop when leaders and constituents work together to pursue the common good. As communities become more diverse the need for social capital and participatory, collaborative decision-making increases. 3. Ensure Compliance – In many instances there is a requirement to at least inform, if not include, the public in decision-making. For example, school boards are tasked with building public goodwill and seeking diverse perspectives. The ethics of public school governance require striving for broad representation of community members, parents, staff and students. Reasons for Community DM Cont’d 4. Improve Legitimacy, Transparency and Inclusion – PDM fosters the perceived legitimacy of decisions. In a pluralistic society where consensus is difficult, the legitimacy and acceptance of decisions is dependent on the decision-making process itself. 5. Make Better Decisions – Under certain conditions, large groups of ordinary people are better at problem solving and making decisions than small groups of experts. The conditions include problem type, group size and structure, and the settings under which they make the decision.  Strategies used by community leaders in participatory planning and decision making Collaborative leaders understand that leading from behind is not giving up control, the use the following strategies; i. Invitation: community leaders invite community members especially focal persons and stakeholders to meetings ii. Information: community leaders inform the community about any identified issue and plans you have laid down, do not have any hidden agenda iii. Inclusion/Involvement: community leaders involve the community members in decision making to ensure diverse views are well represented. Do not take decisions in isolation. iv. Inspiration: community leaders inspire and motivate the community members.  Community leaders must recognize the importance of involving the community in both defining problems and searching for solutions.  Leaders who are willing to reach out to their community or their stakeholders, ask the hard questions and work collaboratively and cooperatively to co-discover community informed solutions. WORKING WITH GROUPS IN THE COMMUNITY: COOPERATION, MOBILIZATION AND IN COLLABORATION. POPULATION-FOCUSED PRACTICE COMMUNITY COOPERATION/ORGANIZATION  Community cooperation and organization is essential in promoting collective action for the people’s healthy living, as such the community has to be organized in a manner that will promote development.  Effective community organization is necessary to ensure the judicious use of resources and self-reliance.  Community organization refers to the planned design of the structure of the community showing the relationship between the various groups and individuals and the roles each is expected to play to meet set objectives.  A good organization ensures that a given task is accomplished in good time, at reduced cost and minimal disruption in the ordinary life of the people.  COMMUNITY MOBILIZATION  Community mobilization involves arousing the interest of the people and encouraging them to participate actively in solving their problems.  Community mobilization and eventual participation requires time, patience and understanding on the part of the health workers in order to achieve success.  This is not a one-time activity, but rather, a continuous exercise, which should constitute an integral aspect of efforts, aimed at initiating health actions by the people themselves  Community mobilization is essential because; 1. it is necessary for the sustainability of community programmes. 2. Even when the community have the resources for reasonable development, they must be convinced of what is being demanded of them to enable them continue to give the necessary support even when the assisting agencies have gone. 3. It will help the community to look inwards and devisee a means of helping themselves. **The aim of mobilization is to enable members of the community identify with and participate in activities affecting their own lives Steps to be taken in mobilization activities 1. Know the community: the community here could mean a village, a ward or the whole of a local government.  It is important that you will study the community and have a good geographical knowledge of it which include; knowing where the population centers are, having a rough idea of how many settlements are there, the average size of each settlement, the distance between them, and the natural impediments to communication e.g. mountains, rivers, swamps, etc.  Geographical knowledge of the area should of a community should include knowing and identifying the community leadership structure covering both formal (political and traditional) and informal (opinion leaders).  Clubs, associations, age grades, religious organizations and other groups working in the community should also be taken special note of since they influence the behaviour of the people 2. Plan for mobilization activities: once the geographical extent of the target community is known, the next step is to use the information gotten to draw up a mobilization plan. 3. Identify community entry points during the first visit: the entry points will vary from level to level.  At the local government level, the entry point will be the LGA Chairman  For health facilities, the supervisor or the PHC Coordinator  For the village, the traditional ruler  At ward/community level, the ward/community head  Village level, the traditional authority During the first contact, time should be taken to explain in some details;  What the PHC programme is all about;  What the government is doing in this regard;  What the community contribution could be; and  How the community participation would make a difference to the programme A more general meeting of the elders and/or influential people should be requested for at a later date. Ensure that date, time, and venue are fixed for the second round of meetings at the convenience of all those invited to participate  4. Attend the second meeting Adopt a participatory approach  At this second meeting, take your time to explain what the programme is all about, what the government is doing in this regard, what the community contributions should be i.e. the need to set up a Community Development Committee (CDC), how important these contributions are for the programme to succeed.  Care should be taken to answer all questions, however avoid promises to the community that would be impossible for the government, you, or the community to fulfil. 5. Attend subsequent (follow-up) meetings  Meet the different wards or village heads  Obtain a formal reaction from the community  Explain points that were unclear to the community at previous meetings; and  Clarify all questions Constraints to community mobilization 1. Quick-fix it packages 2. Local politics 3. Bitter experiences: past experiences of abandoned projects 4. Ill-equipped facilitators; equipped with knowledge and skill 5. Selfishness; recognition-seeking individuals may sabotage projects COMMUNITY COLLABORATION Find out agents that collaborate with the health workers or the community in order to have a successful programme or community outreach  THANK YOU FOR LISTENING QUESTIONS AND CONTRIBUTION?????? THANK YOU FOR PAYING ATTENTION IN CLASS QUESTIONS???????