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C2: concepts ,definitions of community health nursing Objective: 1. Define community and distinguish it from public health 2. Describe the four stages of community health development. 3. Describe the eight characteristic of community health nursing. The concept of community: Community i...

C2: concepts ,definitions of community health nursing Objective: 1. Define community and distinguish it from public health 2. Describe the four stages of community health development. 3. Describe the eight characteristic of community health nursing. The concept of community: Community is collection of people who, live together in same geographical area, who share some important feature of their lives and share same interest, who interact with one another and whose common characteristic and holding the same right and privileges. Community and public health: Community health and public health share many features.both are organized community effort aimed at the promotion ,protection and preservation of the public’s health. Historically s a practice specialty public health has bee associated primarily with the effort of official or Govemental entities for example federal ,state, or local tax-supported health agencies that target a wide range health issues. In contrast ,private health effort or non- governmental organization such as those of society work toward solving selected health problems. Such as American lung cancer. Bothe terms are interchangeable. Currently community health practice encompasses both approach and works collaboratively with all health agencies and NGO which are concerns with public’s health. Community health practice refers to a focus on specific designed communities.It is a part of larger public health effort and recognized the fundamental concepts and principle of public heath as its birthright and foundation of practices. Public health is the science and arts of preventing disease ,prolonging the life and promoting healthy through organized community effort for the sanitation of the environment , the control of communicable infections ,hygiene ,the education of the population Community Health: Is the identification of needs along with the protection and improvement of collective health ,within a geographically defined area. Historical development of community health nursing: Before the nature of community health nursing can be fully grasped or it is necessary to understand its root and factors that shape its growth. Community practice has developed to accommodate the needs of a changing society. Yet it has always maintaining its initial goal of improving community health. Stages: 1- Early home-care nursing (before mid-1800s The origins of early nursing care: The early root of home care nursing began with religious and charitable group. The early nightingale years :Much of the foundation of modern community heath nursing practice was laid through Florence nightingale. She started to give care for the sick and injured people in the war (Grimean War). Thousand of injured people lay in street without bed, cleaned covering food. Florence organized competent nursing care and established kitchen for those people. Later she demonstrated that nursing intervention could prevent illness and improve the health of population. Mrs. nightingale concern for population at risk also she give care for people in their home. In addition she helped in establishment first nonreligious school for nurses 1860 at St. Thomas Hospital in London. She promoted a stander for proper education and supervision of nurses in practice known as nightingale model. 2- District Nursing (Mid 1800s-1900) Nightingale’s continued influence : the next stage is the establishment of formal organization of visiting nursing or district nursing. in 1859 ,William Rathbone an England philanthropist became convinced of the value of home nursing as result of private care given to his wife. He employed Mary Robinson the nurse who give care to his wife to visit poor people and teach them the proper hygiene and sanitation. In 1861 with Florence Nightingale’s help and advise Rathbone opened a training school for nurses connected with Royal Liverpool infirmary. Also a nurse training Institute of district nursing established in Manchester in 1864, nurse were train to dispensed food and medicine. Home Visiting Takes Root: Home visit takes root ( in District Nursing): in the united states the first community health nurse, France Root ,hired by the Women’s Brach of New York Mission in 1877,pioneered home visit to the poor in New York City.District nursing association were founded in Buffalo in 1885 and in Boston. These district association served only sick and poor people because rich people have their won private home nurse. The work of district nurse is focus on mostly on the care of individual. They check temperature, pulse rate and give simple treatment as directed by physician. 3- Public health nursing (1900 to 1970) Nurses making a difference: by the beginning of 20the century ,district nursing had broadened its focus to include the health and welfare of the general public not just for poor In this stage a specialized program such as infant welfare, tuberculosis clinics and venereal disease were developed.. The role of district nurses has expand in this stage, while caring for sick people ,health teaching ,disease prevention and health promotion has pioneered 4- Community health nursing (1970 to present) The emergence of the term community health nursing foreshowed a new era. By late 1920 and early 1970 while public health nurses continued their work ,many other nurses who were not practicing public health were based in community. Their practice setting include community clinic, doctor offices, schools, primary health care This term was not university accepted and many people had difficulty distinguishing community health form public health. Confusion also arose regarding the question of whether community health nursing was generalized or specialized. Confusion also arose regarding the role and functions of community health nurses. Eight characteristics of community health nursing: 1. Population focused: Means it is concerned for the health status of population group and their living environment. A population may consist of the elderly living through community. Or it may be scattered group with common characteristics such as people at high risk of developing heart diseases. Population could be children or pregnant women at risk of health problem...ect. 2. The greatest good for the greatest number of-2 people A population –oriented focus involves a new outlook and set of attitudes individualized care is important but prevention of aggregate problem in community health reflect more accurately its philosophy and benefits more people. furthermore because community health nurses are concerned about several aggregate at the same time ,service will of necessity be provided to multiple an overlapping group. 3. Client as equal partners The goal of public health is to increase quality and years of life and eliminate health disparities “ this goal requires a partnership effort.just as learning cannot take place in the school without students participation ,the goal of the public cannot take without consumers participation. Client health status and health behavior cannot be change unless people accept and apply the proposal presented by the community health nurse. Public health nurse can encourage individuals’ participation by promoting their autonomy rather than permitting dependency. The quality of care is affected when the consumer dose not understand and cannot participate in the health care process. Health literacy or the ability to obtain process and understanding basic health information services need to make appropriate health decision. Self care. The process of taking responsibility for developing one’s own health potential. Self Care deficit: when people’s ability to continue self-care activities drops below their needs. 4. Prioritizing primary prevention In community health nursing the promotion of health and prevention of illness are a first order priority.less emphasis is place on curative care. Another distinguishing characteristic of community health is its emphasis on positive health and wellness.community health nurses concentrate on the wellness end of the health continuum in a variety of ways. They teach proper nutrition ,promote immunization among school preschool children ,encourage regular exercise. 5. Selecting strategies that create health condition in which population may thrive: With our population focus , it prudent for community health nurses to design intervention for the whole community ,not limiting it “ to those seek service or otherwise vulnerable “ but directed toward the entire population within a community and the system that may affect the health of those individual ,families and population. We do this by having “social and health care trend ,changing concerns and policy and legislation activities” 6. Actively reaching out We know that some client are more prone to develop disability (poor, no access to heath care services ,homeless) outreach efforts are needed to promote the health for theses clients and prevent disease. 7. Optimal use of available resource It is our duty to wisely use the resources we are given. For most public health agencies ,budgets are critically stressed.tertiary health are sues up the greatest percentage of our health care dollar ,leaving. 8. Interprofessional collaboration Community health nurses must work in cooperation with other team members ,coordination services and addressing the needs of population group.other health care works and organization and client is essential for establishing effective services and program.  CS 3: Population And Community Health Objectives: 1. Describe Community Meaning And Dimensions Of Community As Client. 2. Apply Nursing Process In The Community As A Framework In The Community. 3. Describe Community Based Initiative (CBI) In Oman. 4. Identify The Objectives And Responsibilities Of CBI Department In Oman. Community As A Client: Community As A Client Refers To A Group Or Population Of People As The Focus Of Nursing Services. It Is Population Focuses- Practice That Distinguished Community Health Nursing From Other Nursing Specialty. Dimension Of The Community As Client: Community Having Three Dimension. 1- People/Status: The Most Common Measure Of The Health Of The Community. It Typically Comprises Morbidity And Mortality Data Identifying The Physical ,Emotional ,Social Determination Of The Heath. Physical And Social Indices Include Vital Statistics ,Leading Causes Of Death ,Illness, Suicide Rate And Rate Of Drug And Alcohol Addition. Social Determination Can Be Identify By Crime Rate, Functional Ability Level Or By High School Dropout. Other Demographic Characteristics Such As Single Female Headed Household Can Help Status Measures. 2- Structure : Its Refers To Services And Resources. Community Association Group And Organization Provide A Means For Accessing Needed Services. Adequacy And Appropriateness Of Health Services Can Be Determined By Examine The Pattern Of The Use ,Number And Types Of Health And Social Services And Quality Measures. Demographical Data Such As Socioeconomic And Racial Distribution ,Age , Gender And Education Level Are Also Important Indicators Of Community Structure. 3- Process: Reflect The Community Ability To Function Effectively. It Include Process Within The Community (Collaboration Between Subsystems Of Education And Health.For Instance Between Community And State Of National Level. In A Classic Work, Cottrell (1976) Describe Community Competency As A Key Component Of Process Dimension. A Competent Community Can : Collaborate Effectively In Identifying Community Needs, achieve working according to a set goals, agree on ways and means implement the set goals and Collaborate Effectively To Take Required Action. Features Of The Community Community Having Three Features: 1- Location Includes: Community Boundaries: Location Of Health Services Geographic Feature Climate Flora And Fauna Human Made Environment. Refer to page 464. 2- Population: Size Density Composition /Demographic Rate Of Growth Or Decline- Mortality Cultural Characteristic.Education Level 3- Social System: The Concepts Of A Social System (People Who Made Up The Community Such As Parent, Spouse ,Employee, Citizen The Health Care Delivery System As Part Of The Social System. E.G What Is The Level Of Health Promotion Is Carried Out By The Health System. Apply Nursing Process To The Community: The nursing process provides a framework or structure on which community health nursing action are based. Application of the process varies with each situation but the nature of process remain the same. Certain characteristic of that process are important for community health nurse to emphasis in their practice. Characteristics Of Community Process Deliberative: The Nursing Process Like The Research Process In EBP. IT Is Deliberative- Purposefully Rationally And Carefully Thought out. It Requires The Use Of Sound Judgement That Is Based On Adequate Information. Further More For Deliberative Problem Solving Is Necessary Skills For Working With Community Health Team To Address The Need And Health Problem Of The Community. Adaptable: The Nursing Process Is Adaptable. Its Dynamic Nature Enable The Community Health Nurse To Adjust Appropriately To Each Situation And To Be Flexible In Applying The Process To Aggregate Health Needs. Furthermore Its Flexibility Is A Reminder To The Nurses That Each Community Situation Is Unique.  Cyclical: The Nursing Process Is Cyclical And In Constant Progression. Steps Are Repeated Over And Over In The Nurse Aggregate Client Relationships. The Nurse Engage In Continual Interaction ,Data Collection Analysis ,Intervention And Evaluation. Client Focused: The Nursing Process Is Client Focused. It Is Used For And With Client. Community Health Nurse Use The Nursing Process For The Express Purpose Of Addressing The Health Of Population. They Are Helping Client Directly Or Indirectly. Interactive: In That Nurse And Client Are Engage In A Process Of Ongoing Interpersonal Communicated. Giving And Receiving Accurate Information Is Necessary To Promote Understanding Between Nurse And Client And Foster Effective Use Of The Nursing Process. Need Oriented: Community Nurse Used Nursing Process To Anticipate The Need Of The Of Population And Anticipate Strategy On How To Prevent Health Problem. The Nurse Should Think Of Nursing Diagnosis As Ranging From Health Problem ,Identification Of The Needs To Primary Prevention And Health Promotion. Interaction With Community: All Steps Of Nursing Process Depend On Interaction. Reciprocal Exchange And Influence Among People. For Example Listening To A Group Of Elderly People ,Reaching A Class Of Expectant Mother ,Working With The Parents To Set Up A Dental Screening, All These Involve Communication, Relationship And Interaction. Types Of Community Needs Assessment: After Considering The Importance Of Community Partnerships And Coalitions, The Community Nurse Is Ready To Determine The Community’s Needs. Assessmet Is The Key Initial Steps Of The Nursing Process. Community Needs Assessment Is The Process Of Determining The Real Or Perceived Needs Of A Defined Community. Types Of Community Needs Assessment: 1. Familiarizing Or Windshield Survey 2. Problem-Oriented Assessment 3. Community Subsystem Assessment. 4. Comprehensive Assessment 5. Community Assets Assessment Community Assessment Methods: Survey Descriptive Epidemiology Studies Geographic Information Systems Community Forums Or Town Hall Meeting Focus Group Survey: A Surveys Is An Assessment Method In Which A Series Of Questions Is Used To Collect Data For Analysis For Specific Group Of People. Descriptive Epidemiologic Studies: Which Examines The Amount And Distribution Of A Certain Disease Or Health Condition In A Population By Person (Who Is Affected ) Time (When Dose The Cases Occur) And Place Where Does The Condition Occur).Descriptive Epidemiology Studies Are Useful To Determine Individual At Risk ,Where And When Might Occur. Geographic Information System Analysis: GIS Was Introduced As A Health Information Technology. It Mapping And Visualization Of The Health Disparities And Their Relationship To The Geographical Location Of The Health Services. Which Allow For Better Resources Allocation To Disparate And Underserved Population. Community Forum Or Town Hall Meeting: The Method Is Designed To Obtain Community Opinion. This Method Is Use To Elicit Public Opinion On Varity Of Issues Such As Health Care Concern, Feeling About Issues In The Community Such As Gangs. Focus Group: This Is Similar To Community Forum It Designed To Obtain Opinion Of Community.However Only A Small Group Of Participant. Sources Of Community Data: Primary And Secondary (Formal And Informal Leaders ,Community Members Because The Data Are Obtain Directly Form The Community. International Sources (Data Collected By Several Agencies Such As Who, Health Organization ,American Health Organization) National Sources. State And Local Sources.(The Most Significant State Source Of Assessment Data Comes From The State Health Department For Collecting Vital Statistics And Morbidity Rate. Data Analysis And Diagnosis: Data Analysis Process. First The Data Must Be Validated.Are They Accurate ,Complete And Representative Of The Community.Several Validation Process May Use. Date Can Be Rechecked By Other. Subjective And Objective Data Should Be Compared. Then Data Should Be Separated Into Categories As Physical , Social And Environment. Some Computer Program Cab Be Used To Analysis Assessment Data ( SPSS) Community Diagnosis Formation Please Refer To Chn Course Syllabus Practicum Pp.42-45 Community Base Initiative In Oman Community Health Nursing: The Ministry Of Health ,Oman Has Realized The Important Of The Holistic Approach In Addressing The Determination Of Health Through The Community Based Initiatives(CBI),such As The Healthy Cities, Health Villages And Neighborhoods, Health Lifestyle Program And Community Support Group.Therefore In August 2006 A Fully –Fledged Department Was Established In MOH/DGHA To Provide Technical Support ,Management And Leadership To Regions/Sites Implementing Various CBI Program Objectives And Responsibility Of Cbi Department In Oman: Achieve Health Promotion Through CBI Project In Healthy Lifestyle And Environment. Promote Inter-sector Collaboration And Make People Partners I Development. Provide Support To Achieve Self-reliance To Improve The Socio-economic And Health Status Of Some Societies. Responsibility Of The Department Establishing Policies Related To The Program Of Community Based Initiative For Health Support By Liaising With The Parties Related To The Health Sector. Monitor The Implementation Of The Yearly Plan For Programs Of Community Based Initiative And Related Activities. Training Qualifying National Teams In Health Community Management Preparing Revising And Developing Work And Measurement Guideline For The Implementation Of Cbi. Provide Technical Support To Areas Implementing Community Based Initiative Seeking Funds For Implementation Of Projects.  CS 4: Definitions, Principles & Activities Of Primary Health Care Objective: 1. Define the term Primary Health Care 2. Discuss the various elements constituting Primary Health Care. 3. Identify the objectives of Primary Health Care 4. Describe the principles of Primary Health Care 5. Discuss the vision of Quality Assurance Improvement and Patient Safety program in PHC. Primary Health Care- Definition: “ PHC is an essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation at a cost that community and country can afford to maintain at every stage of their development in the spirit of Self-Reliance and Self- Determination” - It forms an integral part of: - the country's health system - the overall social and economic development of the community. - It is the first level of contact of individuals and the family with the national health system - Brings health care as close as possible to where people live and work. Elements OF primary health care: 1. Education concerning prevailing health problems and preventive and control methods. 2. Promotion of food supply and proper nutrition 3. Adequate supply of safe water and basic sanitation 4. Maternal and child health care including family planning 5. Immunization against the major infectious diseases 6. Prevention and control of locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8. Provision of essential drugs 1-Education and information concerning prevailing health problems and methods of preventing and controlling them -Education to make the individual able to think and decide about his health, accept health measures, having healthy environment. -Education based on socio-economic conditions, politics, culture and religion. 2- Promotion of food supply and proper nutrition Focus is on: -Under nutrition. -Child and maternal malnutrition. -Promotion of better nutrition. -Correction of faulty feeding practices -Prevention of infectious diseases which are nutrition-related eg: Diarrhea. 3- Adequate supply of safe water and basic sanitation - Safe, adequate and accessible supplies of water. - Proper sanitation. The main objectives of this PHC elements are: - To prevent disease - Improve the quality of life and well being by:  Promoting personal and community hygiene,  Ensuring the availability of safe water supply and sanitation facilities  Associating water supply and sanitation with other health and/or development programs. 4- Maternal and child health including family planning -Aims at promoting and protecting the health of children and women of childbearing age, so that -All children have the possibility for healthy growth and development and -Reproductive life of women is compatible with a state of health and well being. MCH/FP care includes at least five main functions: a. Antenatal care b. Delivery care c. Post natal care d. Child care e. Family planning care 5- Immunization against the major infectious diseases - To reduce morbidity and mortality against the major killers of children. - Priority is given to the following diseases:. 1. Diphtheria, 2. Whooping cough, 3. Tetanus, 4. Measles& Rubella, 5. Polio myelitis, 6. Tuberculosis, 7. Hepatitis B, 8. Mumps and 9. Pneumococcal infections -The goal: to provide immunization for all children of the world with special priority given to those in developing countries. - In addition, children are protected in the first year of life. -Tetanus immunization for pregnant mothers. 6- Prevention and control of locally endemic diseases MALARIA - NMEP(National Malaria Eradication Programme) - Launched in Al Sharquiya governorates in 1990 with main objectives of stopping local transmission and eliminate the reservoir of infected cases. - Strategies applied were: - vector control(larviciding) - early case detection - prompt radical treatment. 7- Treatment of common diseases and injuries A. Diarrheal Diseases: Prevention of diarrheal morbidity and mortality is a vital part of national strategies of PHC. Diarrheal disease control includes at least three main functions namely; a. Diagnosis of diarrheal disease b. Provision of appropriate treatment c. Management of outbreaks of diarrheal diseases and its prevention To achieve these appropriate information, appropriate technologies, equipments and supplies, improved communication, supervision and technical support is required. B. Common Accidents in the home - Accidents are among the highest causes of death in most countries. -The aim: -To provide first aid on the spot -To provide adequate treatment at the appropriate level of care -To prevent the occurrence of similar accidents in the future -To provide programs for active rehabilitation of disabled persons, children as well as adults. Three types of home accidents have been chosen : -a. Cuts -b. Burns& scalds -c. Poisoning 8- Provision of essential drugs Aim: - Making drugs available to users of the health systems at all levels of PHC, all over the country, at all times by -Instituting an efficient system of drug acquisition, storage, distribution and utilization. - Drug management in primary health care is an integral part of the overall drug management plan for a country wide health system. 1. Provision of an accessible, comprehensive as well as specialized PHC service to the community. 2. Advanced capacity building to the health professionals in leadership, management and clinical skills. 3. Implementing PHC policies. 4. To strengthen the screening in Primary Health Care through defaulter tracing and early detection of diseases and its management among above 40 years. 5. Implementing effective and accredited CPD training Program for PHC workers. Principles of PHC (Course Book): A. Universal coverage of the population with care provided according to need. B. Services should be promotive, preventive, curative and rehabilitative. C. Services should be effective, culturally acceptable, affordable and manageable. D. Community should be involved to promote self-reliance. E. Approaches to health should be related to other sectors of development. Quality Assurance / improvement and patient safety program: - VISION: The vision of Quality Assurance /improvement is to provide a health service that is accessible, acceptable, efficient, effective and safe that is continuously evaluated and improved. - It is worth mentioning that the absence of quality systems in health care organizations lead to increase and irrationalized expenses of health services, users dissatisfaction as well as high rates of medication and medical errors. - In its endeavor to improve the quality of health services, The MOH has adopted a Total Quality strategy to establish and maintain quality management systems in Health care institutions. -The effective implementation of quality systems requires joint work between all health care workers in one side and different community sectors on the other.  CS5: Primary Health Care Services In Oman Objectives: 1. Identify the main primary health care services that are implemented in Oman. 2. List the objectives of each primary health care services. 3. Describe the various activities that are provided by each service. 4. Specify the roles of community health nurse in providing primary health care service. 5. Differentiate between the various types of referral system in Oman. 6. Discuss the roles & responsibilities of health team members during the process of referral. Services of PHC: 1. Health Education 2. Promotion of Proper Nutrition 3. Environment Health 4. Maternal Health 5. Child Health 6. School Health 7. Immunization Against Childhood Diseases 8. Control Of Diseases 9. Mental Health 10. Eye Health 11. Oral Health 12. Community Participation 13. Adequate Supply And Rational Uses of Essential Drugs 14. Inter-sectoral Cooperation 15. Treatment of Common Diseases And Injuries 1. Health education: - It is a process by which people learn and as a result of their learning, they can change their attitude toward health. - It motivates and help people to adopt and maintain healthy practices and lifestyles Who are the health educators? - Each individual of a health team is responsible about health education. - Clear plan - It should be given in every hospital, health center, school, home. - Using different methods 2. Promotion of proper nutrition Nutrition plays important role on quality of life. - Maternal malnutrition cause of poor health of women and their infants. - Malnutrition in adults can reduces their work capacity, therefore interferes with their personal and professional development. Promotion of proper nutrition According to WHO (2020): – 47 million children < 5 years of age are wasted (weight-for-height z score < −2 SD), 14.3 million are severely wasted and 144 million are stunted (low height-for-age), while 38.3 million are overweight or obese. – Around 45% of deaths among children < 5 years of age are linked to undernutrition. Promotion of proper nutrition Diarrhea and Malnutrition: - Frequent diarrhea leads to malnutrition - Children with diarrhea must continue to be fed properly PHC Objectives Regarding Nutrition: – Promotion of activities that can improve food supply at the family level – Correction of faulty feeding habits – Treatment and prevention of anemia, vitamin A deficiency – Prevention and early management of diarrhea and acute respiratory infections Role of PHC team: 1. Assessing and defining the problem by survey, making a plan of work, this should include:  Availability of nutritious food materials.  Customs and traditions with food handling, storage practices.  Environmental and personal hygiene.  Voluntary organizations that can support promotion of nutritional status in the community.  Socio-economic situation of different families. 2. Determining nutritional status of children by growth monitoring. 3. Knowing and minimizing the risk factors which may lead to malnutrition. 4. Detecting early signs of malnutrition and taking appropriate actions (anemia, Kwashiorkor, marasmus). At family level, family should be educated on: ❖ Selection of right kind of local food ❖ Planning of a nutritionally adequate diet according to the family budget ❖ Correction of wrong dietary practices ❖ Breast feeding for infants and correct feeding practices ❖ Nutritional needs of pregnant and lactating women ❖ Encourage food production by the family (kitchen garden, poultry and cattle). At individual level: ❖ Organize health clinics related to motherhood (ANC/PNC) ❖ Organize well baby clinics (Immunization, growth monitoring) ❖ Organize health education activities related to nutrition  3. Environmental health: The main aims in PHC are: - To prevent diseases related to unsafe drinking water, lack of sanitation and poor hygiene - To improve quality of life and health of the population by promoting personal and community hygiene Activities related to environmental health: – Promotion of personal and community hygiene – Provision of safe drinking water – Proper system of excreta disposal – Food quality control – Control of vectors, flies, mosquitoes and cockroaches – Training of local workers and health volunteers – Participation in arranging village cleaning campaigns – Inter-sectoral coordination Community education relate to environment: – Assess their environmental health needs – Identify resources to meet those needs – Implement plan – Continue and monitor the newly initiated activities – Periodically evaluate environmental health activities 4. Maternal health Objectives: ❖ To promote health of the mother by maintaining the healthy growth of the fetus and the mother. ❖ To reduce maternal mortality and morbidity The main activities – Antenatal care – Intranatal care – Post natal care Antenatal care activities: – Identify pregnant women in community – Follow the pregnancy – Identify risk factors in mother and fetus – Educate them – Administer tetanus toxoid – Decide about the place of delivery Aim of Intra Partum Care: - To conduct the delivery under aseptic technique - Minimum injury for both - Efficient dealing with complications and timely referral - Baby should be given to the mother immediately after birth Postnatal Care Objectives: – To prevent complications of post partum period – To restore and maintain the health of the mother and new born – To provide health education to the mother and family with stress on breast feeding, personal hygiene and family planning Postnatal Care Activities: – Physical examination, at PNC 2 weeks and 6 weeks. – Health education on diet, exercise, baby care, importance of BF – Anemia should be treated – Focus on immunization (inj. TT) 5. Child Health: Objectives: – To protect and promote the health of children by meeting special biological and psychological needs during the rapid process of human growth and development. – To reduce the infant and child morbidity and mortality. Common problem in new born: – Low birth weight. – Difficulty in breathing. – Neonatal tetanus. – Infection of any injury. – Head or brain injury. – Conjunctivitis. Common problem in Infant and children: – Malnutrition – Diarrhea – Respiratory infection – Infectious diseases (Mumps, Whooping cough, Chicken pox,,ect) Main activities of child health care: – Promote breast feeding – Growth monitoring – Immunization against childhood diseases – Weaning – HE – Nutritional surveillance and prevention of malnutrition 6. School health program: Objectives: – To meet comprehensively the physical and social health needs and problems of school age children. – Safe guarding the health of should children is extremely important so that they grow educated ,physically and mentally health adult. – Conversant with principle of health protection and promotion and thus ultimately provide healthy environment to their own families. Activities in school health: – Screening of school children to detect any diseases or abnormality. – Health education to school children on personal hygiene, diseases prevention and health promotion. – Immunization against childhood disease. 7. Immunization against childhood disease. Objectives: – To sustain and consolidate high immunization coverage of children under one year of age against the ten preventable childhood disease (diphtheria, pertussis, tetanus, poliomyelitis , tuberculosis, measles and viral ,hepatitis B and HIB). – To eradicate poliomyelitis – To immunize all pregnant women with two doses of tetanus toxoid in order to eradicate neonate tetanus. Objectives of vaccination: – To minimize the morbidity and mortality due the preventable disease among children. – To promote the growth and development of new generation of children that comprise the future of the nation. – To ensure that all children 0-10 year of age are protected against childhood disease by completing the vaccination in time. – To continue the protection against children disease by giving booster doses at the right time to children who are vaccinated. – To vaccinate all pregnant women at the child bearing age with tetanus toxoid. PHC workers MUST be knowledgeable and skilled about: – The vaccine for target diseases – The correct technique of giving vaccine – Prepare and conduct immunization sessions. PHC must ensure:  Availability of vaccine  Availability of equipment  Vaccines are kept in proper condition and maintain cold chain till vaccines are used. – Cold Chain is the system which ensures that vaccines remain potent from the moment of manufacture to the time of immunization. – A vaccine is potent if it is in good condition. Heat ,sunlight and freezing can destroy the vaccines. Heat and sunlight damage live vaccine. Freezing damage killed vaccine and toxoids. – VACCINES TEMPERATURE BETWEEN +2 TO +8 C AT ALL TIME. 8. Control of diseases – Objectives: – To maintain epidemiological surveillance of health problems, communicable and non-communicable diseases in the country. Communicable diseases: Control Communicable diseases by: ❖ Providing information about diseases ❖ Advising people to adopt personal hygiene habit ❖ Promote immunization ❖ Follow up treatment Non-Communicable diseases Objectives 1. Cardiovascular diseases -To prevent and reduce the prevalence and incidence of cardiovascular diseases through: – Primary prevention of coronary heart diseases by control preventable risk factors. – Early detection and control of hypertension – Follow up: maintenance therapy can be continued at health center 2. Management and control of diabetes – To prevent, control and implement comprehensive management program of diabetes and its complication. – Diagnosis and treatment at PHC. – Heath education on controlling diabetes. 3. Prevention and control of cancer – To prevent and reduce the incidence of cancer. – Refer the suspected cases to the regional hospital – Educate people on prevention of certain types of risk factors. 9. Mental health Objectives: – To promote mental health, prevent mental illness, provide treatment to mentally ill person and rehabilitate them as necessary. – To promote mental health awareness in community. Function of health workers at PHC level: – Detection of mentally ill person in community – Assessing ten mental health condition – Give proper treatment or refer to hospital Mental health education: 1. Mental diseases are preventable and treatable 2. After successful treatment a person can live a normal life 3. Mental illness are not infectious 4. Magic and supernatural power has nothing to do with mental illness. 5. Treatment in hospital 6. Treat than married 7. Alcohol use can lead to mental problem. 10. Eye health care Objectives: – To prevent and control avoidable blindness – To reduce blindness due to Cataract, Glaucoma, ect These can be achieved by: – Conducting health education activities. – Proper assessment of eye problem, treatment of minor eye problems and referral of serious problems to specialists. Eye diseases that are seen in PHC can be classified as: 1. Eye diseases which can be treated by trained PHC workers, such as Conjunctivitis, Trachoma, Subconjunctival Hemorrhages. 2. Eye diseases in which treatment initiated and referred to specialist for further treatment, such as corneal ulcers, laceration to eyeball, burns. 3. Eye problems which need immediately referred to ophthalmologist, such as acute attack of glaucoma, cataract, retinal detachment 11. Oral health Objectives: – To reduce the oral health problems (dental caries and periodontal disease) through balanced and integrated curative and preventive dental health program. Role of health workers in promotion of oral health: – Oral health education (parents and children) – Holding toothbrush drills for school children – Screening: 6-7 years old children annually, pre-school children and mothers as part of MCH program. – Referral and follow up 12. Community participation Objectives: – Involvement of community in process of self-care, health promotion and disease prevention. - Effective PHC implementation can not be achieved without community involvement. How to stimulate community involvement? (education, communication, religious leaders, influential person) 13. Inter-sectoral cooperation Objectives: – To involve other sectors like education, social welfare, ect and addressing themselves to uplift the quality of human life. Wilayat health committee is established to perform: – Suggest future expansion of health service. – Plan and implement inter-sectoral activities such as environmental health. – Community involvement in health promotion. 14. Treatment of common diseases and injuries Objective: – Proper management of common diseases and injuries. Aim: – Immediate diagnosis and treatment of common diseases and injuries. – Refer patient to hospital if diagnostic facilities are not available in health center. – Follow up maintenance therapy 15. Adequate supply and rational use of essential drugs Objectives: – To ensure the regular supply to all people of safe and effective drugs of acceptable quality with adequate control. – Essential drugs are those drugs that achieve the widest possible coverage of population with proven efficacy and safety. Criteria of Essential drugs: – Less toxic – Cost of combination product is less than the sum of individual product. – Has greater therapeutic effect – Compliance is improved. Role of PHC team: – Educate community about drug misuse. – Keep dangerous drugs in separate cabinet with separate register. – Management of drugs – Keep a small stock of life saving drugs in separate and easy reach place. – In charge should make sure that vaccines are kept under right storing condition and right temperature. Study page 66 Roles of nurses in providing PHC service (SLA) - Assessing health status of individual, families, community - Providing integrated health care (emergency treatment) - Training and supervising health workers. - Monitoring record reports of vital statistics Current practice of CHN in Oman: (SLA) – Patient who found to have complications and don’t meet criteria for admission, are referred back to the physician for further investigations. – Patients who found to meet admission criteria, are admitted into service and individualized patient and family centered care delivered to him/her in their home. – Three more healthcare programs were integrated into community health service in Oman ( elderly care program, palliative care (prevention and relief of suffering), heart failure service) Referral: With increasing specialization, the referral hospitals would function well only with organized referral system, thus avoiding direct access. Referral: Process in which the treating physician at lower level of health service, who has inadequate skills or lesser facilities at his level to manage a clinical condition, seeks the assistance of better equipped and specially trained person with better resources. Types of referral : 1. Routine referral: Facilities could be availed by PHC institution for laboratory, radiological 2. Emergency referral: made in emergency cases which can not be totally managed at primary health institution. Reasons for referral: – Expect opinion – Admission and management of patient – For investigation Health Care Team: Role & Interrelationship Main characteristics of team: - Have common goals and objectives - Cooperation between members - Have a leader - Follow set of rules and norms Health personnel in health team in PHC: - Medical officer -Administrative officer -Health assistant - Nursing staff - Sanitary inspector - Sanitary assistant - Midwife - Assistant pharmacists - Laboratory technician / X ray technician - Spray man, drivers Role & Interrelationship: The level of manpower and skills should match the tasks to be carried out and the staff is adequately distributed throughout the wilayat health centers. Role of medical officer: – Responsible for functioning of health center and overall supervision of PHC team. – Ensure implementation of national policies and strategies of health services delivery. – Assign work among the staff members according to the work needs. – Arrange for training and retraining of members of PHC team. Role of administrator: – Ensure proper maintenance of building, furniture and equipment and arrange replacement when needed. – Supervise all members in PHC team attendance in time and absence. – Participate in promoting community involvement. – Supervise cleanliness of health center. Role of senior staff nurse: – Perform nursing duties in health center according to standard. – Prepare well balanced duty schedule ensuring utilization of nursing skills 24 hours/ day based on patient needs, staff capabilities and recourses availably. – Administer medications, treatment and patient care according to policy. – Participate in outreach program. Role of staff nurse: – Perform nursing duties in health center according to standard. – Assume in charge duties as directed by superiors. – Administer medications, treatment and patient care according to policy. – Participate in patient education.  CS6: NATIONAL CONTROL PROGRAM (NCP) Objectives: 1. Identify the main issues that necessitate the emergence of communicable disease control program 2. Identify the evolution history of communicable disease control. 3. Describe the CHN’s role in the process of investigating reportable 4. Explain the strategies used for the three levels of prevention in communicable disease control. 5. Discuss the issues and challenges of the national control programs as practiced in MoH (Refer course syllabus pg17 ) 6. Discuss the role of CHN during the nursing process for the communicable disease control. Issues Related To Emergence Of CD: - Numerous changes in issues related to public health nationally and globally since last century. - Achievement in health, safety, longevity and disease control improved lives of many population. - Ongoing work of the public health nurse in advocating for the communities through disease prevention and health promotion. Ongoing Issues: - Higher morbidity of various age group related to communicable diseases rather than death. - Continuing disproportionate morbidity and mortality among lower socioeconomic populations. - Emergent, newly identified resurging diseases related to changing environments, global mobility and need for space.(eg: H1N1) - Development of antibiotics resistant strains of bacteria leads to occupational health challenges.eg: MDRTB - Potential terrorists attacks utilizing biological agents. - Ongoing public empowerment through education regarding healthy life practices, and current health research about disease, cancer prevention through diet and immunization and the environment. Evolution Of Communicable Disease Control: communicable disease those of epidemic and pandemic disease such as TB, influenza, or AIDS. the first documented global threat from communicable disease began in the 13th century. it was responsible for killing 25% of population in European countries. not until 1700 and 1800 were the causative organisms for various infectious disease recognized through the assistance of increasingly sophisticated microscopy. with these discoveries came early attempts to create ways to prevent the spread of such organisms. WHO came into existence as the arm of united nations in 1948. it was established to tackle world health issues. it has evolved into multifaceted agency provide services ongoing health /illness research, education, medical responds and disease control one disease , smallpox is an example of communicable disease control success story smallpox first responded to a crude vaccine was that developed in 18th century. the vaccine was studied perfected and used globally for decades. Community Health Nurse’s Role: Process Of Investigating Reportable Communicable Diseases Process of investigating reportable communicable diseases: Each state has a state health department, but not all states have local level sites like a county health department. Some of the state or local health department utilize a combination of nurses, epidemiologists, and communicable disease investigators. The CDC and WHO provide guidance documents that assist state public health agencies develop investigation policy and procedures for local level investigator to use. State health departments commonly specify two other circumstances that must be reported: 1- any outbreak or unusually high incidence of any disease. 2- any occurrence of an unusual disease of public health importance. The local health department/agency is the initial point of notification of communicable disease investigation. In most states, reporting known or suspected cases of a reportable disease is generally considered to be an obligation of: Physicians, dentists, nurses, and other health professionals. Medical examiners Administrators of hospitals, clinics, nursing homes, schools, and nurseries. -Some states also request reporting from Laboratory directors. any individual who knows of or suspects the existence of a reportable disease. These steps include interviewing individuals, contact and additional case finding, analyzing information gathered from surveillance, intervening to control the disease, and elimination or eradication. Interview: Prior to contacting an individual for an interview: - review the information received from mandated reporters for completeness. - clarify that the disease is suspect or lab confirmed. - review the case definition. A case is the individual who ether has a laboratory confirmed reportable disease or meets the clinical definition in an investigation. - many disease has specific questionnaires that are useful when interviewing the client. The interview: Maintaining a neutral and nonjudgmental attitude during the interview process will elicit information more readily, especially when discussing an STD.  The interview may be by telephone or in person. Introduction of self and purpose of the confidential nature of the interview is essential. Eliciting what the individual knows about the disease may give the nurse an idea of the individual’s knowledge base. Gathering the information by using a disease-specific questionnaire may lead to a possible source of the disease, or to additional infected contacts. The nurse will contact individuals identified as possibly infected by the identified case. Surveillance of reportable disease is the next step. Effective surveillance and control can lead to elimination and eradication of disease in many cases. Elimination is stopping of a disease in a defined geographical region (An example; No natural cases of measles in US), whereas eradication is the extinction of naturally occurring disease. By maintaining high levels of immunization, only imported cases of measles have occurred for years. An example of eradication of disease is smallpox. Primary Prevention: In the context of communicable disease control, two approaches are useful in achieving primary prevention : Education using mass media with targeting health massages to aggregates Immunization Education: Health education in primary prevention is directed both at helping individuals understand their risk and promoting healthy behaviors. Targeting meaningful health message to aggregates: To deliver effective health promotion and disease prevention message, the message must reach the target group (at risk) population. This requires correct identification of characteristics of the target audience in terms of educational level, salience of the issue, involvement of the target audience with the issue, and their access to the media channel used. Cultural issues affect people’s interpretation of messages. 4 Principles for adapting health messages to specific population subgroups: 1. Develop educational materials from the community perspective, reflecting respect for the community values and traditions, relevance to community needs and interests, and participation to of the community in the preparation and use of the materials. 2. Materials must be related to the delivery of the health services that are available, accessible, and acceptable to the target population. 3. All materials must be pretested and have demonstrated attractiveness, comprehension, acceptability, ownership, and persuasiveness. 4. Materials must have a readability level for the intended audience. Ways to communicate: The use of traditional and new communication technologies can serve the global population. Radios, television, in person interaction, and print/ signage have been used for years to promote health messages. Internet has been used for some time now as a repository of information. The use of cell phones, Internet, texting, tweeting, and the use of social networking like Facebook are examples of new ways to send messages to communicate to and with people. Immunization: It is process to stimulate the individual’s immune system to create antibodies the particular infectious disease. Vaccine-Preventable Diseases: Hepatitis A and B, H. influenza type b, measles, polio, diptheria, pertussis, influenza, and chickenpox are examples of diseases that can be prevented through immunization. Immunity may be either passive or active. Passive immunity is short-term resistance to specific disease-causing organism, it may be acquired naturally like the newborns or artificially through inoculation with pooled human antibody that gives temporary protection. Active immunity is long term resistance to a specific disease causing organism, it also can naturally or artificially acquired. A vaccine is a preparation made from a live organism or an inactivated form of the organism. Schedule of recommended immunization: A schedule for the administration of childhood vaccination, based on recommendations by the ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the CDC. (Table 8-4) The CDC also provides “catch up” schedules for children not receiving their first immunization at birth according to the standard schedule. Factors influencing the recommended age at which vaccines are administered include the age specific risks of the disease, the age specific risks of complications, the ability of persons of a given age to produce an adequate and lasting immune response, and the potential for interference with the immune response acquired from passively transferred maternal antibodies. In general, vaccines are recommended to the youngest age group at risk whose members are known to develop an acceptable antibody response to vaccination. Recommendations for vaccine administration may revised in light of specific circumstances, ex, it is now recommended that infants receive HBV at birth, whether the mothers have positive or negative response to HB surface antigen. Herd Immunity: It is the immunity level present in a particular population of people. In case of few immune individuals exist within a community, herd immunity is low, and the spread of disease is more likely. Whereas immunization of more individuals in the community contributes to high proportion with acquired resistance to the infectious agent, playing a role in higher herd immunity. Assessing immunization status of the community: Determining the immunization status of children in a community can be a time-consuming but worthwhile task. Public health nurses can access the children and school entry immunization data through their state’s immunization agency as well as state immunization registries. Other community sitting in which the public health nurse identify under immunization children include homeless shelter and other public service setting. Barriers to immunization coverage: Improving immunization coverage requires examination of the reasons why children are not immunized. There are many barriers consider as challenges the community health nurse may have to deal with when working with the community and trying to effect adequate immunization coverage for the general public and protection from VPDs (Vaccine- Preventable Diseases) There are five barriers: 1. Religious Barriers 2. Financial Barriers 3. Social and Cultural barriers 4. Philosophical Objections 5. Provider Limitations Religious Barriers: - The right to religious freedom gives individuals the constitutional right to exemption from immunization if they object to vaccination on religious ground. - Problems arise when members of exempted groups are found together in community settings, raising the risk of disease spread because of a lower herd immunity. Financial barriers: Access to affordable immunization programs may be a significant factor for immunization delays in families with limited incomes. Such families may have had more priorities than vaccinations for otherwise well child. Social and Cultural Barriers: Education levels, transportation problems, as well as access to the health facilities can pose essential barriers to immunization coverage for children and all family members. The paperwork involved in obtaining the informed consent of parents may be intellectually intimidating for some parents. Working parents may find it difficult, if not impossible to reach an immunization clinic with child during working hours. Meeting immunization needs for minority groups involves understanding cultural concepts related to health care and preventive measures. Language barriers may lead parents to feel confused, overwhelmed, and unable to access the services. Philosophical Objections - Many caring parents have philosophical objections to immunization because they fear harming their children. - This puts the child “behind” on immunizations, according to the AAP schedule. - Community/public health nurses should be aware that caring parents are talking about these issues, reading about them, and trying to make informed decisions. - It may be helpful to offer information or websites that address many myths surrounding childhood immunization. Provider Limitations - Health care providers may contact with an eligible child, yet fail to offer vaccination. - There are some limitations for the provider to be aware of, example: 1. Reviewing child’s immunization record. 2. Maintaining safety and efficacy of administering multiple vaccines on the same occasion. 3. Deferring administration of vaccine based on condition. 4. Recalling and notifying parents for the next immunization. Planning and implementing an immunization campaign: Immunization campaigns targeting specific subgroups can be effective if they include the following: a. Community assessment for the target groups b. Assessment of and planning for the needs of the target groups, such as transportation, need for language interpreters, provision of child care, or dealing with high illiteracy rates. Adult Immunization: Adults are at as great a risk for a VPD as is a child if they are unimmunized. Some of the immunizations given for adults are tetanus, pertussis, influenza, and pneumococcal. Adults may require immunizations to prevent occupational exposure to blood, blood products, or other potentially contaminated body fluids. History of high-risk conditions promote adult vaccination. Factors that may contribute to low vaccination levels among adults: 1. Limited comprehensive vaccine delivery system. 2. No such requirements exist for all adults. 3. Health care providers may not be current with the adult-recommended immunizations. 4. Comprehensive vaccination programs have not been established in siting where healthy adults congregate. 5. Clients and providers may fear adverse effects after vaccination. International travelers, Immigrants, refugees: As Americans interact more with their neighbors in other parts of the world, the incidence of Americans with tropical or imported diseases rises. An average flight can be equal to incubation period infectious diseases, ad microbial agents could be spread to the globe. At a minimum, all the international travelers should take steps to be adequately immunized as required by international health practice. These steps include being immunized with recommended vaccines for the particular area of the world, being knowledgeable about food and water precautions as well as the basic first aid for the care of simple injuries. The travelers who neglect to take the recommended travel vaccines end up with generally preventable illnesses, which can cost them time, money, and their health. Secondary prevention: Two approaches of communicable diseases: 1. Screening 2. Disease case and contact investigation 1.Screening: Is used in community health and disease prevention to describe programs that provide disease testing opportunities to detect diseases in group of asymptomatic apparently healthy individuals. Common screening measures can include: 1.Prenatal hepatitis B 2.Urine chlamydia and gonorrhea 3.Monteux tuberculin skin test There are several screening tests available for HIV : Oral fluids testing Rapid finger stick Enzyme immunoassay (more sensitive screening) The HIV screening test confirmed by supplemental test such as : A. Western blot B. Immunofluorescence assay Criteria for screening tests: Validity and Reliability Predictive value and yield 1. Validity and Reliability : Validity : refers to test’s ability to accurately identify those with the disease. Reliability: refers to test’s ability to give consistent results when administered on different occasions by different technicians. 2. Predictive value and yield Predictive value of screening test: is important for determining whether screening intervention is justified. Yield : refers to number of positive results found per number tested. *Epidemiologic criteria for screening intervention for detection of health problems (p.277) The ethics represented by these statement include : Clear and unwavering respect for dignity and worth of individuals across racial. Gender. Religious. Sexual. Tribal. Ethnic. 2. Disease case and contact investigation: Are fundamental public health strategies for controlling and preventing the spread of infectious diseases. (MPH and Michael, 2021) Tertiary Prevention: 1. Care and treatment 2. Isolation and quarantine 2 methods for keeping infected person and noninfected persons apart to prevent the spread od a disease 1. isolation 2. quarantine - Isolation- separation of the infected persons (or animals) from others for the period of communicability to limit the transmission of the infectious agent to susceptible persons. - Quarantine- restrictions placed on healthy contacts of an infectious case for the duration of the incubation period to prevent disease transmission if infection should develop What is the different between the two methods? Safe handling and control of infectious : Control of infectious in community health also relies upon the proper disposal of contaminated wastes. The CDC supports and encourages universal precautions universal precautions includes the following:  Hand washing  Bagging and discarding articles contaminated with infectious material  Use of proper personal protective equipment  Waste capable of producing an infectious diseases requirements for medical waste disposal are for waste to be segregated into categories of: 1. Used and unused sharp 2. Cultures and stocks of infectious agents 3. Human blood and blood product 4. Human pathologic, isolation, and animal waste. 4 key elements of an infectious waste management program are applicable to community practice: 1. Health professionals must be able to correctly distinguish waste that poses a significant infections hazard from other biomedical waste that poses no greater risk than general municipal waste and such infectious waste must be clearly defined. 2. the waste management program must have administrative support and authority to institute practice guidelines and provide the containers and other resources needed for safe disposal of infectious wastes. 3.Handling of the infectious wastes must be minimized. 4.An enforcement or evaluation mechanism must be in place to insure that the goal or reducing the potential for exposure to infectious waste in the community is met. A. Control of Communicable Disease 1. Vector borne diseases Issues & challenges: - The vector-borne disease included in the list of priority disease in Oman are: 1-leishmaniosis 2- Malaria 3- Acute-hemorrhagic fevers including ( CCHF, WNV,RVF,DF & 171-1F), -According to Annual Health Report 2020 of Oman, 310 acute Hemorrhagic Fever cases were reported in 2020. also, the cases were increased in these recent years.) In 2008 consultancy visit from WHO was conducted to review the leishmaniosis situation -An independent vertical program for Malaria eradication exists Within the Ministry of Health which has a vector control section. -The bionomics of vectors other than malaria is currently under study that includes: 1- identification of the species 2- seasonal 3- spatial distribution(density mapping) 4- efficiency for transmission. Viral Hemorrhagic Fevers: - No human cases due to West Nile Virus fever (WNV) were reported in Oman.( - Similarly Rift Valley fever (RVF) was also not reported in humans or animals. - One indigenous case of Dengue was reported in 2000. -According to Annual Health Report 2020 of oman,300 cases of Dengue were reported in 2020. - Travel associated dengue cases continue to be diagnosed among the expatriate population in Oman. Schistosomiasis Control in Dhofar: -Science 1979, Dhofar governorate was a low transmission area for intestinal Schistosomiasis. -Beginning of elimination process of Schistosomiasis in (2003) with objective to strengthen and sustain control of indigenous transmission of S.mansoni. -Two outbreaks of Schistosomiasis infection occurred in 1982 and 1999. - Following the recent outbreak in 1999, the annual surveillance of the Schistosomiasis among school children showed increasing of stool positive cases in 2000 to 2003 and then dramatically decrease in 2004. - from 2017-2020, zero cases of Schistosomiasis were reported as annual health report 2020 said. Brucellosis Control In Dhofar: -Brucellosis is one of the major zoonotic infectious diseases in the Governorate of Dhofar. -316 cases were reported in 2000 as against 94 cases in 2008. - -From 2003 animal population is being immunized by Ministry of Agriculture against brucellosis that might have also contributed to the reduction of the number of cases. - as annual health report 2020; the cases were declined in the last five years, 130 cases of Brucellosis were reported in 2020. What are the reasons of the decline: - Laboratory diagnostic techniques. - Expansion of laboratory diagnostic facilities. -Improved awareness of community against high risk behavior. What are the Challenges and constraints facing human Brucellosis control: 1- long term commitment(12 years) by the Ministry of Agriculture for animal vaccination program. 2- Maintain high immunization coverage and cold chain. 3- Non-availability of brucellosis program manager. 2. Infection Control Program: - Standard precautions; encompass all the basic principles of infection control that are mandatory in all health care facilities. Their application extends to every hospitalized patient, regardless of their diagnosis, risk factors and presumed infectious status, to reduce the risk to patient and staff of acquiring an infection. - Hand hygiene is very much at the core of standard precautions and is the most effective infection control measure. -These precautions essentially to provide a clean environment and promote patient safety at a very basic level. -Transmission-based Precautions; (airborne, droplet and contact precautions). -prevention of site-specific or device-related infections, in particular urinary tract infections, surgical site infections, pneumonia and bloodstream infections Organizational Structure: Infection control section..........by the epidemiologist. -A restructuring proposal.......to improve line of authority and communication between infection control team, committee and other bodies within regional and referral hospitals. - Policies and guidelines: The gulf cooperation council (GCC) Infection Control Manual (‫ المجلس‬approved by the GCC Health Ministers is under print by the Executive Board.of the Health Ministers Council of the GCC‫)التنفيذي‬ - Availability and specifications of medical supplies: Adequate specifications of critical supplies related to infection control is to be developed in with input from clinicians, infection control experts and department of specification and supplies in the medical store. - Occupational safety of Health care workers: -to protect health care workers by HBV and influenza vaccine. - A standardized blood and body fluid exposure reporting system has been proposed to capture the root causes of needle stick injures and other forms of exposures. -Ongoing education is to be conducted to the health care workers about standard precautions to prevent occupational hazards. - Supervision and monitoring system: a preliminary auditing check lists were developed, and regular visits were made to health care facilities. - Networking: -Information is exchanged with GCC countries through the GCC IC (gulf cooperation council Investigating Committee) committee. -Links are established with the regional and international organizations working in infection control. -More efforts and resources needed to be channeled to facilitate infection control professionals attend local, regional and international meetings/ conferences. 3.STI control Program background: -STI is not considered to be a significant problem in Oman. STI published in 1996. Issues: -Burden of STI diseases -Surveillance in STI needs to strengthen -Guidelines -Training Challenges: *Private sector involvement *Burden of disease in expatriates  Seven acute encephalitis syndrome cases were recorded according to annual health report 2020. 4. HIV control program -In 1984 first HIV case was reported from Oman. -Major mode of transmission is heterosexual contact. Males are predominantly affected and 15-49 age group patients make +12 major part of the total HIV cases. - Universal screening for antenatal mothers was started in 2009 -Surveillance -Mother to child transmission -Treatment monitoring -Creation of system of treatment monitoring so as program can monitor this aspect and amend strategies for better management and control of the HIV. -HIV counselors' needs to be trained or retrained for all aspects related to program. -147 Omani cases of positive HIV in 2020, as annual health report 2020. -The cascade of HIV care in Oman, 2015-2018: A population-based study from the Middle East. -All cases of Omani people living with HIV (>12 years old) who were reported to the NAP from 1984 through December 2018 were included. -To evaluate the programmatic success in Oman and improvement in care, retention in care, ART coverage and viral suppression was observed among people living with HIV in 2015-2018. - Population-based data on all diagnosed people living with HIV reported to the National AIDS.Programmed in 1984–2018 were used -Study showed the cascade of HIV care to evaluate the programmatic success in Oman that a significant improvement in linkage to care and HIV viral suppression among people living with HIV in Oman in 2015-2018. (Elgalib,2020) B. Control of chronic non-communicable diseases 1. National Cancer Control Program 2. National Tobacco Control Program 3. Mental health & Drug ControlProgram 4. National non- communicable Screening Program 1. National Cancer Control Program - Introduction: - Every year, more than a thousand cancer cases are diagnosed in the Sultanate of Oman, which poses a major challenge to the health and patient care sector. - According to Al-Bahrani et al., (2019) Cancer may be a critical open wellbeing issue in all nations. The worldwide burden of cancer is assessed in 2018 to be 18.1 million unused cancer cases. It is fourth cause of patient mortality in Oman. Notably, there was an increment of 10.2% in the whole frequency cases in 2016 (n=1780) compared to 2015 (n=1,615). The strategic areas of work of the national control program are: 1-Data collection, analysis and reporting ( Oman National Cancer Registry ). 2-Comprehensive management of cancer cases in the National Oncology center with chemotherapy being made available in regional oncology satellite unite. 3-The MOH is the central focal point for dissemination of information on cancer, liaising with other institution (MOH and other) dealing with cancer. 1985-----Establishing the Omani national cancer registry. 1996----- Establishing the department for monitoring and control of non-communicable disease of the general directorate of health affairs. 2001----- compulsory reporting of the first by decree issued the minister of health. non-communicable disease(cancer) Issues and challenges: The annual reports of ONCR : - shows that incidence of cancer remains more or less the same over the past ten years. - The challenge every year is to collect the data from all sources. - Very often physicians do not complete the notification forms. - Active reporting the major method of data collection. - Collecting information from all the Ministry of Health hospitals. - In 2006 we have liaised the major private hospitals in Muscat to collect cancer data. - Data on mortality is necessary for a cancer registry for which a vital registration system would be very useful. - Mortality statistics are an indicator of the duration of survival of pts and the cause of death and will enable the cancer registry to take part in some international research studies. - Availability of mortality data will make Omani's data more comprehensive and easily accepted in publication of the International Agency for Research on Cancer. - All modalities of treatment for cancer are available in Oman an important component in the care for patient pain and palliative care. 2.The National Tobacco Control Program Introduction  The WHO’s Tobacco Free Initiative (TFI) is conducted from headquarters in Geneva and regional and national offices around the world.  The Framework Convention on Tobacco Control (FCTC) was developed after prolonged deliberation by member countries of WHO, in response to the global tobacco epidemic.  In March 2005, 59 countries have ratified the FCTC. The Sultanate of Oman has also ratified the FCTC on 9 March 2005.  The success of the FCTC as a tool for public health will depend on the energy, and poetical commitment that we devote to implementing it, in countries in the coming year. Issues and challenges: - There is an increasing lobbying for the banning of smoking in enclosed public places and various steps have been taken towards this goal. - Meetings with key policy makers are being conducted with the aim of drafting a national law for the control of tobacco use in accordance with the FCTC. -Theprocessofprintinghealthwarningsintheformofpictureswhichshould occupy at least 50% of the space on the cover of any cigarette packet is ongoing. - communicated with the Canadian authorities since they have Tread -y made this practice mandatory. also received 10 pictures from WHO. 3.Mental health & Drug Control Program Introduction: -The Sultanate of Oman has a keen interest in the reflected by the Ministry of Health, using the development of health care, which is five-year development plans in the development of health services Mental health hospitals:  Al-Rahma hospital in 1975 is The first mental health unit.  IbnSina hospital in 1983; it was the only hospital Specializing in the treatment of psychological diseases.  Al-Masra hospital was launched in Muscat Governance to cater the needs and services of mental health in Oman.( lunched in 1/1/2013). There are 15 psychiatric OPD distributed in different regions & covered the mental health & drug abuse issues. Issues; challenges: A-Mental Health: 1-The national mental health policy was formulated in 1992 and it has not been updated. 2-No national mental health law to protect human rights of the patients. B-Drug abuse: 1- very limited services. 2-Severe shortage of expertise on this field at all levels. 3- lack of integration with AIDS program. 4- lack of integration with primary health services 4.National non-communicable Screening Program. Introduction: The national screening program for non communicable is a pioneer project Is intended to provide a screening service for all Omanis aged 40 years and above who have never been previously diagnosed with diabetes, hypertension or chronic kidney disease The program targets five common conditions(DM, HTN, chronic renal impairment, obesity, & hypercholesterolemia) This program has ben given a high priority by top-level policy markers at the ministry following an evaluation of the results of the pilot project that took place between July and December 2006. The 3 main objective of this program: 1- Early detection of the disease cases & subsequent early intervention aiming at reduction 2- Enhancing community awareness about current health challenge. 3- Promoting and helping people attain health through health education that forms a part of the program. Issues & challenges: -Improving the client active participation rates, screening setting (Drugs/ Lab facilities), and health professional adoption & acceptance. -Capacity building of the well –being team with regard to risk, pre-disease & chronic disease management. -There is a shortage of manpower especially nutritionists and qualified health educators. -Extending the availability of the electronic screening module to all health centers and improving the reporting system. -Ensuring good compliance from pts with risk factors & pre-disease. -Equity in the service availability and care delivered to the clients. C. Malaria Eradication Program Introduction: Malaria was one of the major public health problems in Oman. In seventies; The endemicity(‫( توطن‬of the disease reached its peak, when about 300,000 clinical cases were recorded annually. To reduce the incidence of malaria cases (to a level of not a public health problem)..... the government was compelled(forced) to introduce a malaria control program. This graphs shows the Number of imported malaria cases in GCC countries. The graphs were made using data adopted from WHO, World Malaria Reports, 2019 and 2020 and the Malaria Atlas Project 2019 According to annual health report 2020: There is 79% decrease in the number of malaria cases reported in 2020 when compared to 2019. just 276 confirmed cases of malaria were recorded in 2020 in oman. Due to the emergence of resistance of falciparum malaria....to chloroquine and the Anophline mosquitoes to insecticide plus other technical factors. the control program did not achieve the goal of stopping malaria from being a public health problem. Ministry of Health decided to move from control to eradication. the National Malaria Eradication program (NM EP) was launched in Al- Sharquiya (North and South) Governorate ,,,,,,as a pilot project(experimental project) in 1991,,,,,,,, to: 1.stop local transmission 2.eliminate the reservoir of infection.  After the successful achievements of the pilot project in reducing the number of malaria cases, it was extended to the other Governorate in phases, with the following objectives: 1. To interrupt malaria transmission and deplete(minimize) the reservoir of infection to reach to an Annual Parasite Incidence (API) of 0.1/1000 population by the year 2000. 2. To eliminate residual infections and prevent re-establishment of transmission by the year 2005. 3. Maintenance of the incidence indigenous malaria cases at zero level by the year 2010. The strategies applied to achieve the objectives of the NMEP were: Integrated vector control (chemical larviciding and biological control in addition to imagociding through indoor residual spraying (IRS). and space spraying,). Early case detection and prompt radical treatment of cases (through Surveillance, Active and Passive Case Detection (ACD & PCD) involving both public and private health sectors and distribution of chemoprophylaxis for travelers to endemic countries). The interruption of malaria transmission was achieved in 2004 and maintained till September 2007 when a focus of local transmission was detected in Dakhiliya Governance (MOH 2013). In 2008, another outbreak of local transmission was reported in north Batinah Governance which was due to the increase in the number of imported cases. In 2013 a total of 1451 malaria cases were recorded, most of these cases were imported except 11 were locally transmitted which were secondary to an imported case. The majority (94.1%) of the diagnosed cases in 2013 were Plasmodium vivax and 5.9% of the cases were Plasmodium falciparum. Issues and challenges: 1. The increase in the development projects lead to the increase in the influx of imported malaria cases through the labor force from the malaria endemic countries. 2. Illegal migration from some of the source countries. 3. The climate change in the favor of vector breeding and survival. The role of community health nurse in using the nursing process for communicable disease control -Assessment is the first step in nursing process. -Community health nurse must use all assessment skills and tools available during contact with client , so as not to overlook the possibility of a communicable disease. -Assessment must be comprehensive , producing physical, social , and environmental data -The planning step in the nursing process involves different activities , depending on whether the intervention is for an individual, family, group , or entire community. -The nurse may assist a client or family to obtain an immunization or definitive treatment. - The nurse may assist the client through education about self-care related to disease symptoms that provide relief and in reducing the chance of transmission the disease to other in the family or community. -The implementation step, the nurse actually takes the action that was identified as necessary during assessment and planning. -In implementation step, the nurse may actually deliver the service or may supervise other staff or volunteers , as with a large immunization event. -Evaluation is an essential step in the nursing process. -It is the most important to determine whether actions have achieved the established goal. -EX. Have the outcomes been accomplished?  CS7: health education in the community Objectives: Define the term health education Define the various learning domains Explain the community health nurse’s role in teaching at three level. Review the back group history of HE department in Oman. Explain the responsibility of the HE information department in Oman Highlights the main activities achieve by health education department since its establishment. The HE Defined: The education process is a systematic ,sequential ,logical ,scientifically based ,planned course of action consist of two major interdependent operation :teaching and learning.this process form a continues cycle that also involves two interdependent players :teacher and the learner.Together ,they jointly perform teaching and learning activities , the outcome of which lead to mutually desired behavior change. Domains of learning: Cognitive Affective Psychomotor. Cognitive domain: Cognitive domain of learning involve the mid and thinking process. When the meaning an relationship of series facts. Cognitive domain deals with knowledge recalling and recognition ,development of intellectual abilities and skills. There are six major level in cognitive domain (knowledge ,comprehension ,application ,analysis ,synthesis and evaluation. Knowledge: Knowledge is the lowest level of learning according to Blooms’s taxonomy. Involve recall. If students remember material previously learned they have acquired knowledge.This level can be use with client who unable to understand underlying reason or rationales such as children or people who have strokes.for example stroke patient need to remember to take medication daily that regular exercise restores function. Although they may be not grasp the reason behind these measures. Comprehension: The second level of cognitive learning comprehension combine remembering with understanding and example of comprehension ‘female leady will describe a well-balance diet” Application: In this level the learning should not only describe the and understand material but also be able to apply it to new situation. For example diabetic client write down glucometer reading and to show the nurse at the next day. A school nurse could aske adolescent in a weight –loos group t keep a diet record for a week and share it with the group. Construction worker who understand the hazard has to transfer knowledge and comprehension into practice. Analysis: At this level the learner breakdown the learning material into parts distinguishing between elements and understand the relationship between elements.This level become preliminary in the solving problem. For example the mother analyze when she seeks to determine the cause of infant crying.after viewing the total situation she break it down into variables such hunger , pain she examine these parts and drown conclusion. Synthesis: Synthesis is the combination of all other previous mention level. The learner who achieve the learning not only analyze their problem but also able to production plan of situation and implement it. For example a young couple who want to toilet training their 2 year child may learning physical and psychological dimensions of toilet training analyze their situation and then develop plan for training the child. Evaluation: The high-test level of learning is evaluation.the learning can judges and evaluate the usefulness of masteries learned. With state purpose of learning ,learning able to judge their won health behavior by comparing with standers such as maintain of normal weight. Another example client at nutrition class will be able to measure the cholesterol content in one portion of the now –cholesterol dish. How to measure cognitive learning: Cognitive learning can be measure in term of client behavior. For instance that client have achieve teaching objective for the application of knowledge if their behavior demonstrate actual use of information taught. Affective domain: Affective domain in which learning occurs involves emotion feeling, behavior or affect. For example nurse want client to develop ability to accepts ideas that promote health even if those ideas conflict with the client own values. Attitude and value are learned.They develop gradually as the way an individual feels and respond is molded by family ,peers ,experience and culture.  Affective learning occurs in several level. At first level the individual are simply receptive learns ,just listen ,show awareness and attentive. At the second level learner become active particularly by respond to information in some ways for example willing to read education material and to participate in discussion. At the third level attach value to information.for example a nurse taught members of therapy group several principle to improve certain skills, members showed acceptance when they acknowledge important of these ideas.They shows appreciation to ideas by starting to practice them. Psychomotor domain: Psychomotor domain include visible demonstrable performance skills that require some kind of neuromuscular coordination.for example client in the community need to learning baby bathing. For psychomotor learning to take place some condition must be met: Learner must be capable of the skills. Learner must be has a sensory image of how to perform skills Learner must be practice the skill. The nurse must be certain that the learner is physically ,intellectually and emotionally capable of performing the skills Community health nurse roles at three level of prevention: Teaching at three level of prevention. Please read page 371 at your required text Health education in community (Oman) The department of health education and information was stablished primarily 1975 with only 7 staff , the number of health educators has now reached to 156 who are distributed in health care facilities in different governances.. The department works in collaboration with various heath department ,movement and private sectors in order to deliver health education service to the public. Organization structure of department Page 84 C/S The objective of the department: Raise public awareness in coordination with different health department and sectors Plan preventive measures and strategies in order to fight different health problem. Educated and encourage individual and communities about taking are of their health Eliminate possible health risk to foster positive practice. The department consists mainly of two sections: Programs Section and Legends Section. The program Section is specialized in the following: 1. Planning, following up and evaluating health education activities in the Ministry of Health to follow the health education activates in all governorates that include (programs, campaigns, exhibitions, during national and international occasions). 2. Develop the skills of the workers in the field of health education 3. Cooperate with different governmental and private sectors in order to set health plans and projects. 4. Follow the progress of the health indicators of the strategic plan. The Legends Section is specialized in the production of health education materials through coordination with different health sectors in the Sultanate and liaises with different media resources available aiming to increase the health awareness among public. The responsibilities of Health Education Department 1. Produce of IEC (Information, Education, Communication) materials. 2. Follow up and evaluate health education activities in all the regions in the Sultanate. 3. Broadcast health education programs in mass media. Train health educators. 4.Activate world, international, regional, and national days and occasions related to health issues by implementing different activities and campaigns. 5. Organize different health exhibitions. Highlights of the department activities in 2012: In 2012 many activities were achieved by different sections. The department organized and participated in five exhibitions for different purpose including the department's participation in the "Board of Health Ministers of the Gulf Cooperation Council conference" in its thirty seven session and the participation in the future vision conference for the health system 2050 "Elegant Care and Sustainable Health". In addition, 21 Health Education materials were produced in different health topics, and different health subjects and messages were broadcast in different TV and video. The department also, has achieved some of the objective indicators of the 8thFive Year Health plan such as, production of educational materials in the fields of chronic kidney disease and health life style and has developed a training program for health educators. In addition, the department organized two workshops during 2012, to enrich the health workers in the field of health education, and three staff from Health Education department participated in different meetings, conferences and workshops locally and internationally.  CS8: FAMILY HEALTH Objectives: 1. Define the term family and family health nursing. 2. Explain important family characteristics to be recognized by community health nurses. 3. Analyze the role of the community health nurse in caring and promoting the health of the family. Definition of family: Family as a basic unit of society (united nation) Views family as“ a householder and one or more other person living in the same household who are related to the household by birth , marriage , or adoption” (U.S.CensusBureau,2011) Define family as “tow or more individuals who depend on one another for emotional , physical, and economical support” (Kaakinen, 2010) Definition of family health: Define family health as a “dynamic changing relative state of wellbeing which include the biological, psychological, spiritual, sociological and culture factors of the family system ( Kaakinen, 2010) Family health concerned with how well the family function together as a unit. Family health nursing: Nurses can provide care to the individuals within the family or to the family as the client or to the family as a system. Some nurses view family nursing as part of other specialties such as community health nursing , maternal child nursing or mental health nursing. Nurses work with individuals within families every day. Most often, the individual is the recipient of care. While assessing the needs of the individual, the nurse needs to include the family in the assessment, as the family is the pivotal provider of care. Universal characteristics of families: Five of the most important family characteristics for community health nurses to recognize are as follows: 1-Every family is a small social system. 2- Every family moves through stages in its life cycle. 3-Every family has its own culture values and rules. 4- Every family has structure. 5-Every family has certain basic functions. 1.Families as social system: Interdependence among members Family Boundaries Energy Exchange Adaptive Behavior Goal-Oriented Behavior a. Interdependence among members: All the members of a family are interdependent; each member’s actions affect the other members, and what affects the family system affects each family member. Example: A father might consider some changes to reduce his risk of coronary heart disease. -If he cuts back over time the family income will reduce. -If he begins to eat different foods, food preparation and patterns of eating will change b. Family Boundaries: -Families as systems set and maintain boundaries: (ego-boundaries, generation boundaries, and familycommunity boundaries) that can include outside influences (permeable) or not (limiting). -These boundaries, which result from shared experiences and expectations. -Also, a greater concentration of energy exists within the family than between the family and its external environment, thereby creating a family system boundary c. Energy Exchange: As open systems, in order to function adequately, families exchange materials or information with their environment. This process is called energy exchange. d. Adaptive Behavior: Families are adaptive, equilibrium-seeking systems. In accordance with their nature, families never stay the same. They shift and change in response to internal and external forces. e. Goal-Oriented Behavior Families as social system are goal directed. Families exist for a purpose to establish and maintain a milieu that promotes the development of their members. To fulfill this purpose, a family must perform basic functions, such as providing love, security, identity, a sense of belonging. 2.Family life cycle: Family growth and develop continuously and adaptive to change(developmental stages). a. Stages of the family life cycle: There are two broad stages in the family cycles: 1. Expansion: as new members are added ,roles and relationships increase. 2. Contraction: as family members leave to start lives of their own, age, or die. - There are phases that are more specific in framework of the expanding-contracting family, such as launching of children and retirement of parents. b. Family developmental tasks: -All families, for instance, must provide for the physical needs of their members at every stage. -Physical maintenance for example parent’s ability to accept responsibility and procure necessary resources to provide food, clothing, and shelter. -Some function requires greater emphasis at certain stages, socialization for example consume much a family time during the early stages of child Development. See table 18.1 page 573 3. Family culture -Family culture is acquired knowledge that family members use to interpret their experiences and generate their behaviors that in turn influence their actions. -Three aspects of family culture deserve special consideration: 1. Shared values and their effect on behavior 2. Roles 3. Distribution and use of power a. Shared values and their effect on behavior: -Although families share many broad cultural values drawn from the larger society in which they live ,they also develop unique characteristic. Every family has its own set of values and rules for operation that can be considered as family culture. These values, often not verbalized, become powerful, determinants of what the family believes, feels, thinks, and does. -According to Sandip S Jogdand and JD Naik study which is (Study of family factors in association with behavior problems amongst children of 6-18 years age group) shows that The behavior problems have good prognosis if they are recognized earlier. Family has great role in prevention of behavior problems in children, so parental counseling may be helpful.(Sandip S Jogdand and JD Naik,2014) b. roles: -Roles the assigned or assumed parts that members play during day-to-day family living.for instance, the father role may be assigned as an authoritative one that includes establishing rules, judging behavior, and administering punishment for violation of rules. In another family, the father role maybe defined primarily as that of a breadwinner and supporting the mother’s decisions in day-to-day childrearing. If there is an absence of a male parent, a grandfather, uncle, friend, or even the mother may take over the father role. -Families distribute among their members all the responsibilities and tasks necessary to conduct family living. C. Distribution and use of power: Power is the poss