CHN 113 A&B - Community Health Nursing 2 PDF

CHN 113 A&B COMMUNITY HEALTH NURSING 2 COMMUNITY  A group of people with common characteristics or interest living together within a territory or geographical boundary.  CLASSIFICATIONS OF COMMUNITIES: 1. URBAN-increased in population, industrial type of work 2. RURAL- decreased...

CHN 113 A&B COMMUNITY HEALTH NURSING 2 COMMUNITY  A group of people with common characteristics or interest living together within a territory or geographical boundary.  CLASSIFICATIONS OF COMMUNITIES: 1. URBAN-increased in population, industrial type of work 2. RURAL- decreased in population, agricultural type of work 3. RURBAN- combination of rural and urban 4. SUBURBAN- periphery around the urban areas 5. METROPOLITAN- expanding urban areas 4 ASPECTS OF COMMUNITY 1. SOCIAL – communication and interaction of the people 2. CULTURAL – norms, values and beliefs of the people 3. POLITICAL – governance and leadership of the people 4. GEOGRAPHICAL – boundaries of the community COMPONENTS OF A COMMUNITY: A. PEOPLE B. 8 SUBSYSTEMS: 1. Housing 2. Education 3. Fire and Safety 4. Politics and Environment 5. Health 6. Communication 7. Economics 8. Recreation HEALTH:  Is the state of complete physical, mental and social well being and not merely the absence of disease of infirmity  DETERMINANTS OF HEALTH: 1. Income and social status 2. Education 3. Physical environment 4. Employment and working conditions 5. Social support network 6. Culture 7. Genetics 8. Personal behavior and coping skills 9. Health Services 10. Gender THEORETICAL MODELS/APPROACHES:  Theories and Models for community health nursing  Nightingale's theory of environment  Orem's Self care model  Neuman's health care system model  Roger's model of the science and unitary man  Pender's health promotion model  Roy's adaptation model  Milio's Framework of prevention  Salmon White's Construct for Public health nursing  Block and Josten's Ethical Theory of population focused nursing Theory of Florence Nightingale  Born - 12 May 1820  Founder of mordern nursing.  The first nursing theorist.  Also known as "The Lady with the Lamp"  She explained her environmental theory in her famous book Notes on Nursing: What it is, What it is not.  She was the first to propose nursing required specific education and training.  Her contribution during Crimean war is well-known.  She was a statistician, using bar and pie charts, highlighting key points.  International Nurses Day, May 12 is observed in respect to her contribution to Nursing.  Died - 13 August 1910 Assumptions of Nightingale's Theory  Natural laws  Mankind can achieve perfection  Nursing is a calling  Nursing is an art and a science  Nursing is achieved through environmental alteration  Nursing requires a specific educational base  Nursing is distinct and separate from medicine Nightingale's Canons: Major Concepts  Ventilation and warming  Light, Noise  Cleanliness of rooms/walls  Health of houses  Bed and bedding  Personal cleanliness  Variety  Chattering hopes and advices  Taking food. What food?  Petty management/observation Theory of Florence Nightingale Nursing Paradigms  Nursing Nursing is different from medicine and the goal of nursing is to place the patient in the best possible condition for nature to act. Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving situation. They can be done by anyone."  Person People are multidimensional, composed of biological, psychological, social and spiritual components.  Health Health is "not only to be well, but to be able to use well every power we have" Disease is considered as dys-ease or the absence of comfort.  Environment "Poor or difficult environments led to poor health and disease". "Environment could be altered to improve conditions so that the natural laws would allow healing to occur." FOR MIDTERM OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES  The Department of Health and the Public Health System have evolved into what is now in response to the challenges of the times, so has Public Health Nursing practice been influenced by the changing global and local health trends. These global and country health imperatives brought Public Health Nursing into new frontiers and have positioned nurses to emerge as leaders in health promotion and advocacy.  This perception has been validated by a World Health Organization (WHO) report, acknowledging the significant contribution of the nursing workforce to the achievement of health outcomes, particularly that of the Millennium Development Goals (MDG) Changes in the Public Health System:  Shifts the demographic and epidemiological trends in diseases, including the emergence and re-emergence of new diseases and the prevalence of risk and protective factors.  New technologies for health care, communication and information  Existing and emerging environmental hazards, some associated with globalization  Health reforms GLOBAL AND NATIONAL HEALTH SITUATIONS 6 PROMINENT GLOBAL HEALTH ISSUES TO BE AWARE OF:  PANDEMIC  ENVIRONMENTAL FACTORS  ECONOMIC DISPARITIES AND ACCESS TO HEALTH CARE  POLITICAL FACTORS  NONCOMMUNICABLE DISEASES  ANIMAL HEALTH, FOOD SOURCING, AND SUPPLY  1. PANDEMICS  According to an article published in the Bulletin of the World Health Organization, pandemics are defined as global disease outbreaks.  Examples of pandemics include certain influenza outbreaks, COVID-19, and other viral threats that reflect our vulnerability to widespread diseases—many of which originate in animals.  2. ENVIRONMENTAL FACTORS  Storms, flooding, droughts, and air pollution make it easier for diseases to spread across large groups of people. The immediate solution is to provide resources like bottled water and sanitation technology, but global health must also focus on the prevention of environmental challenges in the first place.  “Climate change is thought by many global health experts to be the greatest threat to human health,” Dr. Macpherson says. “Global policies to mitigate mankind’s contribution to climate change are gaining traction.”  3. ECONOMIC DISPARITIES AND ACCESS TO HEALTH CARE  communities across the world still lack access to basic health education and health care  results in health disparities, such as high infant mortality rates, which are often related to geography  Other disparities are the result of income inequality, with individuals and families simply unable to afford health care that is otherwise unavailable.  4. POLITICAL FACTORS  Inadequate access to health care is exacerbated when international politics enter the mix. As conflicts within or between nations destroy critical infrastructure, average citizens become more vulnerable to diseases. This leads them to seek opportunities to flee the dangerous situations that threaten their well-beings.  5. NONCOMMUNICABLE DISEASES  Heart disease, stroke, cancer, diabetes, and other noncommunicable diseases (NCDs) account for 70 percent of all deaths worldwide, according to the WHO.  The WHO notes that 85 percent of premature NCD-related deaths occur in low- and middle-income countries. Reducing the number of NCDs globally means reducing the factors that disproportionately arise in lower-income communities. 6. ANIMAL HEALTH, FOOD SOURCING, AND SUPPLY  Agricultural practices, including irrigation, pesticide use, and waste management, can influence animal health, making disease transmission a concern at every stage of the food supply chain. With pathogens originating from animals or animal products playing such a significant role in disease transmission, veterinary medicine must be included in any effort to improve global health.  EPIDEMIOLOGY  Is the study of occurences and distribution of diseases as well as the distribution and determinants of health states or events in the specified population and the application of this study to the control of health problems.  Epidemiologists are concerned not only with deaths, illness and disability, but also with more positive states and with the means to improve health  The backbone in the prevention of disease 2 main areas of investigation  The first area (describes the distribution of health status in terms of): age, gender, race, geography, time  The second area (involves explanation of the patterns of disease distribution in terms of causal factors)  USES OF EPIDEMIOLOGY ACCORDING TO MORRIS, Epidemiology is used to:  Study of the history of the health population and the rise and fall of diseases and changes in their character  Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence, prevalence, disability and mortality, to set health problems in perspective and to define their relative importance and to identify groups needing special attention  Study the of health services with a view of improving them  Estimate the risk of disease, accident, defects and the chances of avoiding them  Identify syndromes by describing the distribution and association of clinical phenomena in the population  Complete the clinical picture of chronic disease and describe their natural history  Search for causes of health and disease by comparing the experience of groups that are clearly defined by their composition, inheritance, experience, behavior and environments. THE EPIDEMIOLOGIC TRIANGLE  AGENT  Is the intrinsic property of microorganisms to survive and multiply in the environment to produce disease  ENVIRONMENT  The sum total of all external condition and influences that affects the development of an organisms which can be biological, social and physical  It affects both agent and host  HOST  The state of the host at any given time is a result of the interaction of genetic endowment with environment over the entire lifespan  COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH - A social development approach that aims to TRANSFORM the APATHETIC, INDIVIDUALISTIC, and VOICELESS POOR into DYNAMIC, PARTICIPATORY and POLITICALLY responsive community. - A process, by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitude and practices in the community IMPORTANCE OF COPAR  COPAR is an important tool for community development and people empowerment as this:   helps the community workers generate community participation in development activities.   maximizes community participation and involvement.   prepares people/clients to eventually take over the management of development programs in the future PRINCIPLES OF COPAR: 1. People, especially he most OPPRESSED, EXPLOITED, AND DEPRIVED ( women sectors, children, handicapped, elderly, youth ) open to change, have the capacity to change, and are able to bring about change. 2. COPAR should be based on the interest of the POOREST SECTORS of society. 3. COPAR should LEAD TO SELF-RELIANT COMMUNITY AND SOCIETY.  PROCESS USED:  A PROGRESSIVE CYCLE OF ACTION- REFLECTION-ACTION which begins with small, local and concrete issues identified by the people and the evaluation and reflection of and on the action taken by them.  CONSCIOUSNESS-RAISING through experiential learning is central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action.  COPAR is PARTICIPATORY AND MASS-BASED because it is primarily directed towards and biased in favour of the poor, the powerless and the oppressed.  COPAR is GROUP-CENTERED AND NOT LEADER ORIENTED. Leaders are identified, emerged and tested through action rather than appointed or selected by some external force or entity.  COMMUNITY ORGANIZING - the process whereby the community members develop the capability to assess their health needs and problems, plan and implement actions to solve these problems. - carried out by the nurse with the goal of motivating, enhancing and seeking wider community participation in decision-making in activities that have the potential to impact positively on community health.  STAGES Stage 1. Community Analysis - the process of assessing and defining needs, opportunities and resources involved in initiating community health action program. 5 Components : 1. demographic, social and economic profile 2. health risk profile 3. health/wellness outcome profile 4. survey of current health promotion programs 5. studies conducted in certain target groups Steps: 1. Define the community. 2. Collect data. 3. Assess community capacity. 4. Assess community barriers. 5. Assess readiness for change. 6. Synthesis data and set priorities Stage 2. Design and Initiation 1. Establish a core planning group and select a local organizer. 2. Choose an organizational structure. a. Leadership board or council – existing local leaders working for a common cause b. Coalition – linking organization and groups to work on community issues c. Lead or official agency – a single agency takes the primary responsibility of a liaison for health promotion activities in the community. d. Grass-roots – informal structure in the community like the neighborhood residents e. Citizen panels – a group of citizens (5-10) emerge to form a partnership with a government agency. f. Networks and consortia – network develop because of certain concerns. 3. Identify, select and recruit organizational members. 4. Define the organization mission and goals. 5. Clarify roles and responsibilities of people involved in the organization. 6. Provide training and recognition. Stage 3. Implementation – put design into action. 1. Generate broad citizen participation. 2. Develop a sequential work plan. 3. Use comprehensive, integrated strategies. 4. Integrate community values into the programs, materials and Stage 4. Program Maintenance – at this point the program has experienced some degree of success and has weathered through implementation programs. To maintain and consolidate gains of the program, the following are essential: 1.Integrate intervention activities into community networks. 2.Establish a positive organizational culture. 3.Establish an ongoing recruitment plan. 4.Disseminate results. Stage 5. Dissemination - Reassessment * continuous assessment is a part of the monitoring aspect in the management of the program. Formative evaluation is done to provide timely modification of strategies and activities. 1. Update the community analysis. Is there a change in leadership, resources and participation? 2. Assess effectiveness of interventions/programs.  PHASES OF COPAR A. Pre-Entry Phase Community consultation/dialogues Setting of issues/considerations related to site location Development of criteria for site selection 1. high percentage of the family income is below the national poverty threshold 2. high malnutrition rate 3. lack of primary or secondary hospital within a 30minute ride from the area 4. area must not have relative peace and order problem 5. acceptance of the community > Site selection Preliminary social investigation  B.Entry Phase Integration with the community  Sensitization of the community; information campaign  Continuing/Deepening social investigation  Core group formation 1. belongs to the poor sector of the society 2. responsible and committed 3. able to communicate  Coordination with other community organization  Self-Awareness and Leadership Training (SALT)/ Action Planning Best technique to identify potential leaders: - observe people who are active in small mobilization activities that motivate residents to start working. C. Community Study/Diagnosis Phase  Selection of the research team  Training on data collection methods and techniques  Planning for the actual gathering of data  Data gathering  Training on data validation  Community validation  Presentation of the community study/ diagnosis and recommendations.  Prioritization of community needs/problems for action  TYPES OF COMMUNITY DIAGNOSIS 1. Comprehensive Community Diagnosis  Aims to obtain a general information about the community. Elements: A. Demographic variables B. Socio-economic and cultural variables C. Health and illness patterns D. Health resourcesPolitical/Leadership patterns 2. Problem-Oriented Community Diagnosis  type of assessment that responds to a particular need  D. Community Organization and Capability Building  Phase Community meetings to draw up guidelines for the organization  Election of officers  Delineation of the roles, functions and task of officers and members  Action-Reflection-Action session tool used to develop team-building and to promote an avenue to verbalize feelings, opinions and suggestions and enable them to participate in decision- making  Team building exercises  Working out legal requirements for the establishment of the CHO  Training of the CHO officers/ community leaders  E. Community Action Phase  Organization and training of CHW’s  Setting-up of linkages/network referral system  Project Implementation Monitoring Evaluation ( PIME ) of health services  Initialidentification and implementation of resource mobilization schemes F. Sustenance and Strengthening Phase - begins when the community organization has already established community members who are actively participating in community wide undertakings activities. > Formulation and ratification of constitution and by- laws  Identification and development of “Secondary” leaders  Setting up and institutionalization of a financing scheme for the community health activities  Formalizing and institutionalization of linkages, networks and referral systems  Continuing education and upgrading of community leaders, CHW’s and CHO members  Development of medium/ long term community health and development plans  CRITICAL STEPS (ACTIVITIES) IN BUILDING PEOPLE AND ORGANIZATION 1. INTEGRATION ***A community becoming one with the people in order to: A. Immerse himself in the poor community B. Understand deeply the culture, economy leaders, history rhythms and life style in the community. 2. SOCIAL INVESTIGATION - a systematic process of collecting and analyzing data to draw a clear picture of the community. - a process of systematically learning and analyzing the various structures and forces in the community > Also known as the “Community Study” 3. TENTATIVE PROGRAM PLANNING - CO to choose one issue to work on in order to begin organizing the people. 4. GROUNDWORK - going around and motivating the person on a one on one basis to do something on the issue that has been chosen. 5. THE MEETING - people collectively ratifying what have already decided individually. The meeting gives the people the collective power and confidence.Problems and issues are discussed. 6. ROLE PLAYING - means to act out meeting that will take place between the leaders of the people and the government representative’s.It is the way of training the people to anticipate what will happen and prepare themselves for such eventually. 7. MOBILIZATION OF ACTION - actual experience of the people in confronting the powerful and the actual exercise of the people power. 7. EVALUATION - the people reviewing the steps 1-6 so as to determine whether they were successfully or not on their objectives. 8. REFLECTION - dealing with deeper, on going concerns to look at the positive values CO is trying to build in the organization. It gives as the people time to reflect on the starch reality of the life compared in the ideal. 9. ORGANIZATION - the people organization is the result of many successive and similar actions of the people.A final organizational structure is set up with elected officers and supporting members.