Introduction to Community and Public Health Nursing PDF

Introduction to Community and Public Health Nursing Lea Andreau S. Liwagon, MSN, RN Clinical Instructor Health an Evolving Concept, The Goal of Nursing in the Community Chapter 1 Community A group or collection of people who has common interests, goals, and/or characteristi...

Introduction to Community and Public Health Nursing Lea Andreau S. Liwagon, MSN, RN Clinical Instructor Health an Evolving Concept, The Goal of Nursing in the Community Chapter 1 Community A group or collection of people who has common interests, goals, and/or characteristics as well as share geographic area and interact with each others. (Nies & McEwen, 2011) Two types: 1. Geopolitical communities - defined or formed by both natural and manmade boundaries and include cities, counties, states, and nations (e.g. barangay, city or municipality) 2. Phenomenological communities/ functional communities - refer to relational, interactive groups based on culture, values, history, interests, and goals. (e.g. religion, LGBTQ+ community, nursing community) Key Term: Community Vitality - The ability of a community to sustain itself into the future as well as provide opportunities for its residents to pursue their own life goals and the ability of residents to experience positive life outcomes. Health "A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" (WHO, 1958). Social means “of or relating to living together in organized groups or similar close aggregates” (American Heritage College Dictionary, 1997) refers to units of people in communities who interact with each other. “Social health” connotes community vitality and is a result of positive interaction among groups within the community with an emphasis on health promotion and illness prevention. Health In the mid-1980s, the WHO expanded the definition of health to include the following socialized conceptualization of health: The extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, and physical capacities. (WHO, 1986, p. 73) Key Terms: Health Situations – the state of being bodily and mentally vigorous and free from disease National Health Situation – the condition of any unit, society, etc., The economic health of the nation Global Health – is the health of populations in the global context; it has been defined as the area of study , research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Health as Human Right Health as a human right is grounded in the Universal Declaration of Human Rights (UDHR) UDHR Article 25.1 declares “ Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social service. ( UDHR, 1948). Health as Human Right Core Components of the Right to Health Availability - the need for a sufficient quantity of functioning health facilities, goods and services for all. Accessibility – entails that health facilities, services and goods must be made possible and obtainable to everyone. Acceptability- corresponds to respect for the medical ethics, being culturally appropriate and gender sensitive. This clearly define the need for health care centers, products services and programs to be people centered, able to accommodate the specific needs of diverse population groups and adheres to the international standards of medical ethics for informed consent and confidentiality. Quality – health facilities, commodities and services must be in accordance with scientific and medical standards. Quality health service need to be safe, effective, people-centered, timely, equitable, integrated and efficient. Health as Human Right by DOH Article II Section 11 and 15 of the 1987 Philippine Constitution, affirms health as a fundamental human right and recognizes the obligation of the state to protect and promote the right to health of all Filipinos. ( Republic of the Philippines’ official Gazette, 1987) With this, The DOH was established to lead the health sector towards assuring quality health care in promoting and protecting the health of all Filipinos. MODELS OF HEALTH - These models provide different perspectives and frameworks for understanding health and well-being. Clinical Model – Health is the absence of signs and symptoms of disease and illness refers to its presence. Role Performance Model – The individual’s ability to perform societal roles defines what health is in this model. Adaptive Model – Health is a dynamic state. An individual is considered to be healthy if he/she was able to adjust positively to social, mental, and physiological changes. Eudaimonistic Model – An elevated level of wellness suggests optimal health and illness is reflected by a lack of vitality. Illness is indicated by a denervation or languishing, a wasting away, or lack of involvement with life. Determinants of Health and Disease Biology – an individuals genetic make up, family history and any physical and mental health problems developed in the course of life. Behaviors – the individual’s responses to internal stimuli and external conditions. Social environmental – includes interactions and relationships with family, friends, co-workers, and others in the community like social institutions. Physical environment – is what is experienced by the senses – what is smelled, touched, heard, and tasted. Policies and interventions – have a profound effect on the health of individuals Social Determinants Health Are conditions in which people are born, grow, live, work and age; might also be circumstantial elements as such housing, work conditions and access to recreational activities; circumstances that influence how an individual will develop sickness, what risk factors they are exposed to, how they access services; and how they utilized the appropriate services; and is shaped by the distribution of money, power and resources at global, national and local levels (CSDH,2008) May also include occupation, circumstances affecting the way in which people work, income culture, religion, education, racial and gender discrimination. One Health Concept: A framework for community and Public Health Nursing Recognizing the connection between human, animal and environmental health Calls for a consolidated interaction between human health, veterinary medicine, and public and environmental health professionals, clinicians, researchers, and agencies functioning hand in hand for a worthwhile and sustainable health interventions in addressing worldwide and environmental health challenges. The reciprocal actions may occur at several levels which is from management of zoonotic infectious disease outbreaks to consolidated policy-making and funding resolutions. Ex. National rabies prevention and control program, Avian Influenza Protection Program, Philippines Inter-agency Committee on Zoonoses. One Health Approach Foundations of Community and Public Health Nursing Practice Chapter 2 Hierarchy of Nursing Science Community / Public Health Nursing is placed in the apex of the hierarchy of nursing field because of its impact Community & Public Health to the population. Nursing Mental Health & Psychiatric Nursing Mother & Child Health Nursing Adult Health Nursing Key Concepts of Community and Public Health Nursing 3 Basic Concepts: 1. The community as a client 2. Health as a goal 3. Nursing as the vehicle or means to achieve its aims. Definition of Community Health Nursing Community Health Nursing – specialized field of Occupational Faith nursing practice that renders care to individuals, Health Nursing Community families, and communities; focusing on health Nursing promotion and disease prevention through people empowerment. Community Health Nursing Health promotion and disease prevention are the core 0r Public Health of community health nursing practice. Nursing Nurse help people gain independence in health Correctional School Health Nursing Nursing  Janet Heinrich and Ruth Freeman (1981) “Community Health Nursing is an area of human services directed toward developing and enhancing the health capabilities of people – either singly, as individuals, or collectively, as groups and communities.” American Nurses Association “The synthesis of nursing practice and public health practice applied by promoting and preserving the health of populations.”  Maglaya “The utilization of the nsg. process in the diff levels of clientele- individual, families, population, groups, and community concerned with: a. promotion of health b. prevention of diseases c. disability & rehab Jacobson “CHN is learned practice discipline with the ultimate goal of contributing, as individual & in collaboration with others, to the promotion of the client’s optimum level of functioning through teaching & delivery of care.” Nursing Function: a. Independent b. Collaborative or Interdisciplinary---Health Team Approach  Freeman “Unique blend of nursing & public health practice aimed at developing & enhancing health capabilities of the people, service rendered by a professional nurse with the comm., groups, families, and individual at home, in H centers, in clinics, in school, in places of work for the ff:” 1. Promotion of health 2. Prevention of illness 3. Care of the sick at home and rehab 4. Self-reliance Roles of Community Health Nurse 3 roles of professional Nurse (according to The Philippines Professional Regulatory Board of Nursing) a. Health care provider b. Manager-leader c. Researcher Public Health Definition Charles Edward Winslow “Public Health is the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health; organizing these benefits in such fashion as to enable every citizen to realize his birthright of health and longevity.”  The term Public Health connotes – organized, legislated and tax-supported efforts that serve all people through health departments or related governmental agencies. Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world. Public Health Intervention Model The intervention Wheel contains 3 important elements: a. It is population based b. It contains three levels of practice ( community/ population, systems, and individual/family) c. It identifies and defines 17 public health interventions Public Health Interventions: 1. Surveillance 2. Disease & other health - describes & monitors health event investigation events & systematic - systematically gathers & collection, analyzes analysis & interpretation of data regarding threats of populations, ascertains the health data for planning, source of threats, identifies implementing, & evaluating cases & other risk & public health interventions. determine control measures. Public Health Interventions: 3. Outreach 4. Screening - Locates population of - identifies individual with interest/ population at risk unrecognized health risk & provides information factors or asymptomatic about the nature of the disease condition. concern, what can be done about it, and how services can be obtained. Public Health Interventions: 5. Case finding 6. Referral & follow-up - Locates individuals & - Assist individuals, families, families with groups, organizations, & identified risk factors & communities to identify & connect them with the access necessary resources. resources to prevent or resolve problems/ concerns. Public Health Interventions: 7. Case management - Optimizes self care capabilities of individuals & families & the capacity of systems & communities to coordinate & provide services. Public Health Interventions: 8. Delegated Functions – carries 9. Health Teaching-Communicates out direct care task under the facts, ideas, and skills that change authority of a health care knowledge, attitudes, values, practitioner as allowed by law. beliefs, behaviors, and practices of individuals, families, systems, and/or communities. Public Health Interventions: 10. Counselling – Establishes an 11. Consultation - seeks interpersonal relationship with a information and generates community, a system, and a family optional solutions to perceived or individual, with the intention of problems or issues through increasing or enhancing their interactive problem solving with a capacity for self-care and coping. community system and family or individual. Public Health Interventions: 12. Collaboration – Commits two 13. Coalition Building – promotes or more persons or organizations and develops alliances among to achieve a common goal be organizations or constituents for a enhancing the capacity of one or common purpose more of the members to promote and protect health Public Health Interventions: 14. Community Organizing – 15. Advocacy – Pleads someone’s Helps community groups to cause or acts on someone’s identify common problems or behalf, with a focus on developing goals, mobilize resources, and the community, system, and develop and implement strategies individual or family’s capacity to for realizing the goals they plead their own cause or act on collectively have set their own behalf Public Health Interventions: 16. Social marketing – Utilizes 17. Policy Development & commercial marketing principles enforcement – Places health and technologies for programs issues on decision makers’ designed to influence the agendas, acquires a plan of knowledge, attitudes, values, resolution, and determines beliefs, behaviors, and practices of needed resources, resulting in the population of interest laws, rules, regulations, ordinances, and policies. Policy enforcement compels others to comply with laws, rules, regulations, ordinances, and policies. Public Health 3 primary functions by National Academy of Medicine 1. Assessment - the regular collection, analysis information sharing about health conditions risk & resources in a community 2. Assurance - Focuses on the availability of necessary health services through-out the community. Includes maintaining the ability of both public agencies & private providers to manage day-to- day operations & having the capacity to respond to critical situations and emergencies. 3. Policy development - Use of information gathered during assessment to develop local & state health policies & to direct toward those policies. Definition of Public Health Nursing A field of professional practice in nursing and in public health in which technical nursing, interpersonal, analytical, and organizational skills are applied to problems of health as they affect the community. Public Health Nursing was seen as a subspecialty nursing practice generally delivered within official or governmental agencies. Public Health Nursing is defined as the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. (American Public Health Association, 1996,p.5) Roles of Public Health Nurse a. Healthcare provider b. Health Educator c. Program Implementer d. Community Organizer e. Manager/Leader f. Researcher/Epidemiologist g. Client Advocate See page 19 for details Philosophical and Ethical Underpinnings Public Health Nursing is anchored on the primacy of worth and dignity of man. UNESCO declaration (2005) – human dignity, human rights, and fundamental freedoms are to be fully respected and that the interest and welfare of the individual should have priority over the sole interest of science and society. Watson (2009) – caring is the moral ideal of nursing whereby the end is protection, enhancement and preservation of human dignity. Characteristics and features of Community and Public Health Nursing CPHN is development CPHN is multidisciplinary CPHN is ecology oriented CPHN promotes social justice CPHN values consumer involvement CPHN uses prepayment mechanism CPHN focuses on preventive service CPHN offers comprehensive care Community and Public Health Nursing Competencies Analytic assessment Skills Policy Development/program Planning Skills Communication Skills Cultural Competency skills Community Dimensions of practice skills Public Health Sciences Skills Financial Planning and Management Skills Leadership and Systems thinking skills Levels of Clientele in Community and Public Health Nursing 4 Levels of Clientele a. Individuals b. Families c. Groups d. Communities RA 9173 The Philippine Nursing Law 2002 – a person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood and old age. Nurses are responsible to the promotion of health and prevention of illnesses. Essential Public Health Functions 1. Health situation monitoring & analysis. 2. Epidemiological surveillance/ disease prevention & control. 3. Development of policies & planning in public health. 4. Strategic management of health systems & services for population health gain. 5. Regulation & enforcement to protect public health. 6. Human resources & planning in public health. 7. Health promotion, social participation, & empowerment. 8. Ensuring the quality of personal & population- based health service. 9. Research, development, & implementation of innovative public health solutions. Comparison and Contrast: Community Health Nursing and Public Health Nursing Similarities Both aim to improve the health of populations and focus on health promotion and disease prevention. Utilize nursing knowledge and skills to assess health needs and implement interventions. Work collaboratively with other healthcare professionals and community organizations. Comparison and Contrast: Community Health Nursing and Public Health Nursing Differences Scope: Community health nursing focuses on individual and family care within communities, while public health nursing has a broader scope, targeting entire populations. Approach: Community health nursing is more direct and personal, providing hands-on care and health education. Public health nursing is more strategic, involving policy-making, program development, and community-wide health initiatives. Settings: Community health nursing operates in localized settings like homes, schools, and community centers. Public health nursing is more likely to be found in public health departments, government agencies, and organizations focusing on public health research and policy.