Fundamental Concepts Of Community Health Nursing PDF

FUNDAMENTAL CONCEPTS OF COMMUNITY HEALTH NURSING  OBJECTIVES 1. Define health 2. Discuss the focus of public health 3. List the 3 levels of prevention and give one example each 4. Explain the differences among community health nursing, public health nursing and community based-nu...

FUNDAMENTAL CONCEPTS OF COMMUNITY HEALTH NURSING  OBJECTIVES 1. Define health 2. Discuss the focus of public health 3. List the 3 levels of prevention and give one example each 4. Explain the differences among community health nursing, public health nursing and community based-nursing. 5. Cite the distinguishing features of community health nursing 6. Discuss public health nursing practice in terms of public health”s core functions. 7. Compare the different field of community health nursing practice 8. Apply the competency standards of nursing practice in the Philippines in Community health nursing practice. 9. Discuss community health nursing interventions based on the intervention wheels 10. Outline the historical development of public health and public health nursing in the Philippines. DEFINITIONS OF HEALTH AND COMMUNITY Health A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (WHO,1958) A state of well being in which the person is able to use purposeful, adaptive responses and processes physically, mentally, emotionally, spiritually and socially. (Murray et al.,2009) Actualization of inherent and acquired human potential through goal-directed behavior, Actualization of inherent and acquired human potential through goal-directed behavior,competent self- care, and satisfying relationship with others”.(Pender et al.,2006) A state of a person that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning. (Orem,2001) Community A collection of people who interact with one another and whose common interests or characteristics form the basis for sense of unity or belonging. (Allender et al., 2009) A group of people who share something in common and interact with one another, who may exhibit a commitment with one another and may share a geographic boundary. (Lundy and Janes, 2009)  A locality –based entity, composed of systems of formal organizations reflecting society’s institutions, informal groups and aggregates. (Shuster and Goeppinger,2008) A group or collection of locality-based individuals interacting in social units and sharing common interests,characteristics,values, and/ or goals.( Maurer ans Smith, 2009) Four (4) Defining Attributes of Community 1. People 2. Place 3. Interaction 4. Common characteristics,interests or goals  Two Main Types of Communities 1. Geopolitical communities ▪ Most traditionally recognized or imagined. ▪ Defined or formed by both natural and manmade boundaries and include barangays, municipalities, cities, provinces, regions and nations. ▪ May also be called territorial communities 2. Phenomenological communities ▪ Refer to relational, interactive groups ▪ Place and setting is more abstract ▪ People share a group perspective or identity based on culture, values, history, interests and goals. ▪ Examples: schools,colleges, universities; churches and mosques; various groups or organizations. ▪ Described also as functional communities ▪ A community of solution ▪ A collection of people who form a group specifically to address need or concern. Ex. Gawad Kalinga Population ▪ A group of people having common personal or environmental characteristics ▪ All of the people in a defined community Aggregates ▪ Subgroups or subpopulation ▪ Have common characteristics or concerns (Clark,2008) ▪ Examples: Age groups or groups undergoing DETERMINANTS OF HEALTH AND DISEASE WHO Health Determinants 1. Social and Economic Environment 2. Physical Environment 3. Person’s individual characteristics and behaviors Determinants that are specifically mentioned 1. Income and social status 2. Education 3. Physical environment 4. Employment 5. Social support networks 6. Culture 7. Genetics 8. Personal behavior and coping skills 9. Health Services 10. Gender INDICATORS OF HEALTH AND ILLNESS Commonly reported indicators: 1. Life expectancy 2. Infant mortality 3. Maternal mortality 4. Age-adjusted death rates 5. Disease incidence rates DEFINITION AND FOCUS OF PUBLIC HEALTH AND COMMUNITY HEALTH Public Health ▪ The science and art of 1. Preventing disease 2. Prolonging life 3. Promoting health and efficiency Three primary functions of Public Health (Institute of Medicine of USA,1988) Core public health functions 1. Assessment Regular collection, analysis and information about health conditions, risks and resources in a community. 2. Policy development Use of information gathered during assessment to develop local and state health policies and to direct resources toward these policies. 3. Assurance Focuses on the availability of necessary health services throughout the community.  DIRECT SERVICES TO COMMUNITIES Two (2) Avenues 1. Environmental Health Services Protect the public from hazards e.g polluted water, tainted food 1. Personal Health Care Services Immunization,FP,well infant and maternal care,treatment prevalent health conditions, communicable and non communicable ESSENTIAL PUBLIC HEALTH FUNCTION 1. Health situation monitoring and analysis 2. Epidemiological surveillance/disease prevention and control 3. Development of policies and planning in public health 4. Strategic management of health systems and services for population health gain 5. Regulation and enforcement to protect public health 6. Human resources development and planning in public health 7. Health promotion, social participation and empowerment. 8. Ensuring the quality of personal and population-based health service 9. Research, development and implementation of innovative public health solutions PREVENTIVE APPROACH TO HEALTH Health promotion and levels of prevention Health promotion- activities enhance resources directed at improving well –being Disease prevention- Activities protect people from disease and the effects of disease Three (3) Levels of Prevention 1. Primary prevention Relates to activities directed at preventing a problem before it occurs Two elements: a. General health promotion b. Specific protection Examples of Primary Prevention a. Promotion of good nutrition b. Provision of adequate shelter c. Encouraging regular exercise  2. Secondary prevention Refers to early detection and prompt intervention during the period of early disease pathogenesis Implemented after a problem has begun;before signs and symptoms appear Examples: a. Mammography b. Blood pressure screening c. Newborn screening d. Mass sputum examination (PTb)  Tertiary prevention- Correction and prevention of deterioration of a disease state Aims a. Reduce the effects of disease and injury b. Restore individuals to their optimal level of functioning Examples: a. Teaching how to perform insulin injection techniques and disease mgt to a patient with Diabetes b. Referring a patient with spinal cord injury for occupational and physical therapy DEFINITION AND FOCUS OF CHN,PHN AND COMMUNITY –BASED NURSING Definition Community Health Nursing (CHN) The synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations (ANA,1980)Public Health Nursing (PHN) A field of professional practice in nursing and in public health in which technical nursing, interpersonal and analytical and organizational skills are applied to problems of health as they affect the A subspecialty nursing practice generally delivered within “official” or governmental agencies. The practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences (ANA;American Public Health Association,1996) Community- based Nursing Refers to “application of the nursing process in caring for individuals, families and groups where they live, work or go school or as they move through the health care system (McEwen and Pullis,2008) Comparison of CHN and Community –base Nursing in terms of: Goal: CHN emphasizes preservation and protection of Client In CHN the primary client is the community; in community-based nsg are the individual and the family Services In Community based nsg, largely direct, whereas in CHN servicers are both direct and indirect. DISTINGUISHING FEATURES OF COMMUNITY HEALTH NURSING PRACTICE 1. Population-focused approach and community health nursing interventions Population- focused practice (Minnesota DOH, 2003) Focuses on the entire population Is based on assessment of the populations’ health status Considers the broad determinants of health Emphasizes all levels of prevention LEVELS OF CLIENTELE OF THE COMMUNITY HEALTH NURSE Levels of clientele 1. Individual 2. Family 3. Group/aggregate 4. Community Family- basic unit of care  Intervention Wheel Framework for community and public health nursing practice 3 elements 1. It is population –based 2. Contains 3 levels of practice a. Community b. Systems c. Individual/family 3. Identifies and defines 17 public health interventions EMERGING FIELDS OF COMMUNITY HEALTH NURSING IN THE PHILIPPINES Established and recognized fields of practice of CHN 1. Public Health 2. Occupational Health 3. School Health HOME HEALTH CARE Providing nursing care to individuals and families in their own places of residence mainly to minimize the effects of illness and disability. HOSPICE HOME CARE A home care specifically rendered to a terminally ill to provide comfort.  EntrepreNurse A project initiated by the Department of labor and Employment (DOLE) Aims: 1. Reduce the cost of health care for the indigent population 2. Maximize employment opportunities for unemployed nurses 3. Utilized the country’s unemployed human FAITH COMMUNITY NURSING OR PARISH NURSING The practice of the art and science of nursing combined with spiritual care. COMPETENCY STANDARDS IN COMMUNITY HEALTH NURSING 11 Key areas of responsibility 1. Safe and quality nursing care ▪ Knowledge of health/illness status of the client ▪ Sound decision making ▪ Comfort and privacy of the client ▪ Priority setting based on client’s need ▪ Administration of medications and health therapeutics ▪ Use of the nursing process 2. Management of resources and environment ▪ Organization of workload ▪ Use of financial resources for client care ▪ Mechanism to ensure proper functioning of equipment ▪ Maintenance of a safe environment 3. Health Education ▪ Assessment of client’s learning needs ▪ Development of a health education plan and learning materials ▪ Implementation and evaluation of the health education plan 4. Legal responsibility ▪ Adherence to the nursing law and other relevant laws 5. Ethicomoral responsibility ▪ Respect for the rights of the client ▪ Responsibility and accountability fopr own decisions and actions ▪ Adherence to the international and national codes of ethics for nurses 6. Personal and professional development ▪ Identification of own learning needs ▪ Pursuit of continuing education ▪ Involvement in professional and civic activities ▪ Projection of a professional image ▪ Positive attitude toward change and criticism ▪ Adherence to professional standard 7. Quality improvement ▪ Data gathering for quality improvement ▪ Participation in nursing audits and rounds ▪ Identification and reporting of variances in client care ▪ Recommendation of solutions to identified problems r/t client care 8. Research ▪ Research based formulation of solutions to problems in client care ▪ Dissemination and application of research findings 9. Record Management ▪ Accurate and updated documentation of client care while observing legal imperatives in record keeping ▪ Identifies verbal and nonverbal cues ▪ Responds to client’s needs while using formal and informal channels of communication and appropriate technology 11. Collaboration and teamwork ▪ Establishment of collaborative relationship with colleahgues and other members of the health team HISTORY OF PUBLIC HEALTH AND PUBLIC HEALTH NURSING IN THE PHILIPPINES 1577- Franciscan Friar Juan Clemente opened a medical dispensary in Intramuros for the indigent. 1690-Dominican Father Juan de Pergero worked toward installing a water system in an Juan del Monte and Manila 1805-Smallpox vaccination was introduced by Dr. Francisco de Balmis 1876-First medicos titulares were appointed by the Spanish Government 1888- a 2 year course consisting of fundamental 1901-Created the Board of Health of the Philippine Islands (Act 157) Fajardo Act of 1912 -created sanitary divisions 1915-Philippine General Hospital began 1947- DOH was reorganized into bureaus 1954- congress pass RA 1082 or the Rural Health Act 1970- Philippine health care delivery system was restructured. Health care system are classified into primary, secondary and tertiary 1991-RA 7160 or the Local Government Code was enacted 1999-Health sector Reform agenda launched 2010- Universal Health Care