Nursing Interventions for Community Health and Development PDF

**CHN-FINALS** **Nursing Interventions for Community Health and Development Introduction** - The World Health Organization\'s (1978) definition of health emphasizes not only the prevailing physical and mental conditions of the people and the community. It also considers the political,...

**CHN-FINALS** **Nursing Interventions for Community Health and Development Introduction** - The World Health Organization\'s (1978) definition of health emphasizes not only the prevailing physical and mental conditions of the people and the community. It also considers the political, economic, social and cultural dimensions that affect their living conditions and quality of life. - In this context, the interventions of the nurse cannot be limited to actions geared towards the reduction of mortality and morbidity. - Community health nursing interventions necessarily call for improvements in the standards of living and quality of life of the people and the community. The WHO definition of health, therefore, clearly makes a stand on the link between health and development, It implies that a healthy population is a moving force for economic growth of the community. Consequently, marked improvement in the economic conditions of the people will enable them to enjoy a sustained level of health and wellness. - In the health development process, the Alma Ata Declaration (1978) stress two important concerns in addressing health issues in the community. - The first concern is the need for an integrated approach in solving health problems. Community health needs and problems are not solved by simply inducing changes in personal and group attitudes and behavior. If one expects a lasting and sustainable solution, reforms have to be carried out within the health care delivery system and the larger socio-economic and political system. - The second important concern is the need for enhanced capability for greater participation and involvement of the people in health efforts including policy making and influencing decisions. Often, the people most affected by the problem by the problem feel helpless simply because they do not believe they have the power to change their situation. In other words, community health nursing interventions must focus on providing health. related interventions to improve the health status of the population and enhancing the capability of the community to manage its own health. In organizing the community, the nurse goes through the following phases (Andamo, 1986; Manaliti, 1985): A. **Preparatory Phase** - The activities in the preparatory phase include area selection, community profiling, entry in the community and integration with the people. 1. **Area selection** - To guide the nurse in choosing and prioritizing areas for community health development, the following questions must be answered: - Is the community in need of assistance? - Do the community members feel the need to work together to overcome a specific health problem? - Are there concerned groups and organizations that the nurse can possibly work with? - What will be the counterpart of the community in terms of community support, commitment and human resources? 2. **Community profiling** - Once the area has been selected, a community member who is known and accepted by the people will be chosen to act as the contact person. The contact person can identify other persons who can be depended upon to initiate activities in the community. - These people will compose the core group who will assist the nurse in doing a community profile. A community profile provides an overview of demographic characteristics, community and health-related services and facilities. - It will serve as an initial database of the community and provide the basis for planning and programming of organizing activities. It can also help determine the appropriate approach and method of organizing specific to the population group or sectors that will be organized. 3. **Entry in the community and integration with the people.** - Before actual entry into the community, basic information about the area in relation to the cultural practices and lifestyle of the people must be known. Establishing rapport and integrating with them will be much easier if one is able to understand, accept or imbibe their community life. - Living with the people, undergoing their hardships and problems and sharing their hopes and aspirations help build mutual trust and cooperation. B. **Organizational Phase** - The organizational phase consists of activities leading to the formation of a people\'s organization. 1. **Social preparation** - The integration work paves the way for the nurse to be introduced into the community and signals the beginning of the social preparation phase, while continuously learning more about the conditions of the community, the nurse deepens and strengthens her ties with the people. 2. **Spotting and developing potential leaders** - As a result of living and being with the people, the nurse comes to know who among them have deep concern and understanding of the conditions of the community. - However, it is necessary that they should also be able to gain the trust and respect of the community members. Providing opportunities that will demonstrate their potential as leaders can test their commitment to the community\'s well-being. The nurse must consciously provide learning experiences that will prepare them as future leaders of the community. **Characteristics** 1. trust and respect 2. Committed/ commitment 3. Understand and articulate 4. Willingness- best quality 3. **Core group formation (democratic process)** - The core group consists of the identified potential leaders who will be tasked with laying down the foundation of a strong people\'s organization. Ideally, the core group represents the different sectors of the community - women, youth, farmers or workers - depending on the type of the community. - The nurse assists the sectoral representatives in forming core groups in their respective sectors. She also facilitates in skills development of core group members related to the tasks they will assume in the organization. The core group serves as training ground for developing the potential leaders in: - Democratic and collective leadership - Planning and assuming tasks for the formation of a community-wide organization - Handling and resolving group conflicts - Critical thinking and decision-making process 4. **Setting up the community organization** - This organization will facilitate wider participation and collective action on community problems. The organizational structure must be simple to facilitate consultation and decision-making among its members. Part of the organizational structure will be working committees specifically created to look into the different concerns of the organization and community. One such committee is the health committee. The nurse assists in laying out plans of the health committee that initially includes identification of prospective community health workers (CHWs). The committee may decide to involve them in the next phase. C. **Education and Training Phase** - The purpose of the education and training phase is to strengthen the organization and develop its capability to attend to the community\'s basic health-care needs. - This can be achieved by conducting the community diagnosis, training of community health workers, undertaking health services and mobilization and leadership skills training. 1. **Conducting community diagnosis** - The community diagnosis is done to come up with a profile of local health situation that will serve as basis of health programs and services to be delivered to the community. - The nurse assists the people in developing a plan and in the actual conduct of community diagnosis. She also helps the community to identify, analyze and understand the implications of the data that they have collected. 2. **Training of community health workers** - After the results of the community diagnosis has been presented, the community decides on the roles the community health workers are expected to perform and the competencies and personal qualities they should possess. Based on an agreed upon criteria, the people will decide who will be trained as community health workers based on the expected roles of the CHWs. - After the community health workers have been named, the nurse facilitates the conduct of a training needs assessment (TNA) to determine the level of health skills and knowledge the trainees possess. The results of this assessment will serve as the basis for the health skills training curriculum which will focus on the required competencies. 3. **Health services and mobilization** - The organization takes the lead in undertaking activities that will solve the problems the community is confronted with. Engaging them in collective work gives the people opportunities to test and strengthen collective spirit and at the same time, build and enhance their confidence. Oftentimes, people are very eager to act without consideration to resources needed to carry out the action. 4. **leadership-formation activities** - The process of developing community leaders is a continuous and sustained process. Leaders learn a lot by engaging in actual organizational activities such as conduct of meetings, assessment, planning, implementation, monitoring and evaluation of activities. They can utilize these opportunities in mastering organizing skills, human relations development or supervisory skills. D. **Intersectoral Collaboration Phase** - As the organization grows, its needs will also grow. The need for resources-material, human, financial- will have to be sourced externally. Assistance and support in any form can be funneled into the organization through collaboration with other organizations and communities. - The nurse is in the best position to facilitate and coordinate with institutions, agencies and other key people to articulate the community\'s need for support and assistance. E. **Phase-Out** - As the organization and the community assume greater responsibility in managing their health-care needs, the nurse gradually prepares for turn-over of work and develops a plan for monitoring and subsequent follow-up of the organization\'s activities until the community is ready for full disengagement and phase-out. - 5 years phase out **THEORIES** - The Health Belief Model - Milio's Framework for Prevention - Nola's Health Promotion Model - Lawrence's Precede Proceed Model **THE HEALTH BELIEF MODEL** - The Founders of HBM HBM was developed in the 1950s and proposed by social psychologists namely: 1. Irwin Rosenstock 2. Godfrey Hochbaum 3. Stephen Kegeles 4. Howard Leventhal - It was developed in the U.S. Public Health Service to better understand the widespread failure of screening programs for tuberculosis. - The Health Belief Model predicts that a specific health behavior is more or less likely based on an individual\'s perceptions of disease severity and personal susceptibility to the disease combined with perceived benefits and barriers to that behavior. **Concept of Health Belief Model** - The health belief model is a psychological model that attempts to explain and predict health behaviors by focusing on the attitudes and beliefs of individuals. The key variables of the health belief model are as follows: 1. **Perceived threat to sickness or disease (perceived susceptibility)** - Refers to an individual's belief about how likely they are to contract a particular illness or health condition. The higher the perceived risk, the more motivated the person may be to take preventive action. 2. **Belief of consequence (perceived severity)** - This is the individual's belief about the seriousness of the condition and its potential consequences, such as physical, emotional, or social harm. If a person believes an illness could severely impact their life, they are more likely to engage in health-protective behaviors. 3. **Potential positive benefits of action (perceived benefits)** - Refers to the belief that taking a specific health-related action will reduce the risk or impact of a disease. Individuals weigh how effective they think the action will be in improving their health. 4. **Perceived barriers to action** - These are the perceived obstacles or challenges that might prevent an individual from engaging in a recommended health behavior, such as financial costs, fear, inconvenience, or side effects. 5. **Exposure to factors that prompt action (cues to action)** - These are external or internal factors that prompt individuals to take action, such as a reminder from a healthcare provider, media campaigns, or experiencing symptoms. 6. **Confidence in ability to succeed (self-efficacy).** - Refers to the individual's confidence in their ability to perform the desired health behavior successfully. Higher self-efficacy increases the likelihood of taking and sustaining action. **MILIO'S FRAMEWORK FOR PREVENTION** - Emphasizes how societal structures influence health choices and outcomes - Health Policy and Public Health Work: Known for work in health policy, community health, and public health education - Pioneered the Concept of Health Lifestyles - Highlighted the role of socioenvironmental factors in promoting or inhibiting healthy behavior - A framework for prevention that includes concepts of community-oriented, population-focused care. It described sometimes neglected role of community health nursing to examine the determinants of a community \' s health and attempt to influence those determinants through public policy. - Milio stated that behavioral patterns of the populations- and individuals who make up populationare a result of habitual selection from limoted choices. She challenged the common notion that a main determinant for unhealthnful behavioral choice is lack of knowledge. **NOLA PENDER'S HEALTH PROMOTION MODEL** - Health promotion is a comprehensive concept that encompasses the process of enabling individuals and communities to improve their health and enhance their wellbeing. - It involves a range of strategies aimed at increasing awareness, providing education, and fostering environments that support healthier choices. - Health promotion transcends traditional healthcare boundaries, focusing on preventive measures and empowering individuals to take control of their health through informed decision-making. **Importance of the Model in Nursing and Health Education** - The significance of the Health Promotion Model in nursing and health education cannot be overstated. It provides a structured approach for nurses and educators to design interventions that address immediate health issues while promoting long-term wellness. By applying the principles of the HPM, healthcare professionals can better assess the unique needs of individuals and communities, tailoring their strategies to foster positive health behaviors and outcomes. **KEY COMPONENTS** 1. Individual Characteristics and Experiences 2. Behavior-Specific Cognitions and Affect 3. Behavioral Outcome **LAWRENCE GREEN PRECEDE & PROCEED MODEL** - The "Precede-Proceed Model" is a widely used framework for designing and evaluating health promotion and disease prevention programs. - It was developed by Lawrence Green and Marshall Kreuter, and its purpose is to guide public health professionals, researcher, and planners in systematically planning health intervention, implementing them, and evaluating their outcomes. - Precede and Proceed are the components **PRECEDE (Prodisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation)** - This part of the model focuses on the diagnostic stages that help identily the key factors influencing health behaviors and outcomes. **PROCEED (Policy. Regulatory, and Organizational Constructs in Educational and Environmental Development)** - This part of the model focuses on the implementation and evaluation of the intervention programs, taking into account the environmental and policy factors that impact health outcomes **UNIVERSAL HEALTH CARE** **1. What is the Universal Health Care in the Philippines?** - Through the implementation of Universal Health Care, it is ensured that all Filipinos will have fair and equal access to health care products and services that are of high quality while remaining within their financial means. - By age 21 mandatory required philhealth   - 4ps automatic nag babayad ng philhealth **What is Republic Act No. 11223?** - In this section, \"Republic Act No. 11223,\" often known as the Universal Health Care Act, is referred to as the Act. The state\'s policy is to preserve and promote the right to health of all Filipinos as well as instill health consciousness in them. The following are the principles: - an integrated and comprehensive approach to ensuring that all Filipinos are health literate, have healthy living conditions, and are protected from hazards and risks that could affect their health - a health care model that provides all Filipinos with access to a comprehensive set of quality and cost-effective promotive, preventive, curative, rehabilitative, and palliative health services without causing financial hardship - a health care model that prioritizes the needs of the population who are most vulnerable. **Universal Health Care is important** - The idea behind universal health care is to make sure that everyone has access to services that will keep them healthy and happy in affordable way. - The current government is committed to reducing these inequities through the **"Kalusugan Pangkalahatan"** universal healthcare scheme, which involves addressing problems in the \"six building blocks\" of UHC:   - information systems - regulation - service delivery - human resources - financing, - governance - The Universal Health Coverage are governed by 3 pillars - service delivery - health financing   - governance. **Why Universal Health Care is important?** - It encompasses the entire range of vital health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. **MCN** - **Started 28 days normal**: Typically, a menstrual cycle is around 28 days. This cycle prepares the female body for pregnancy. - **Zygote development**: After fertilization, the zygote (fertilized egg) begins to divide and develop, eventually implanting itself in the uterine lining. - **5 million sperm cells. 1-2 alive**: Out of millions of sperm cells, only a few typically survive the journey through the female reproductive system to reach and fertilize the egg. Challenges - Travel   - Acidity   - Cloudy in mucus **Leopold\'s Maneuver** - A series of techniques used by healthcare providers to determine the position of the fetus inside the uterus. **Second Trimester** - **Fundic height**: Measurement from the pubic bone to the top of the uterus (fundus) to monitor fetal growth. - **FHT**: Fetal Heart Tones, typically measured using a Doppler device, with 120 beats per minute being within the normal range. - **Eclampsia**: A severe complication of pregnancy characterized by high blood pressure and signs of damage to another organ system. - **Stress**: Emotional and physical stress can affect pregnancy, potentially leading to complications. - **Chronic disease of the mother**: Pre-existing conditions like heart disease or diabetes can complicate pregnancy and require careful management. - **Present status: heart disease, diabetic**: Indicates the current health status of the mother, which includes heart disease and diabetes, both of which need special attention during pregnancy. - **Previous weight to present weight**: Monitoring weight gain is crucial for ensuring the health of both mother and baby. - **Tetanus toxoid**: Tetanus vaccination can be given at any time during pregnancy to protect both mother and baby. - TT1, 2, 3, 4, 5 Protection sa baby at nanay - Complete tetanus vaccination provides protection for up to 10 years. - **Penta vaccine**: is given three times to a one-month-old baby, protecting against five serious diseases. - **Postpartum visits:** occur three times within the first 28 days after birth to monitor the mother\'s recovery and the baby\'s health. - **Vitamin A:** is given to mothers after delivery to boost their immune system. - **Pag may sakit** - binibigay ngaun bukas at after 6 months - **Normal** - ngayon at after 6 months   **Trimester Supplements** - **1^st^ trimester** - folic acid   - **2^nd^** **trimester -** folic acid plus (may Ferrous sulfate) cbc   - **3^rd^ trimester** - fundic height, fetal head, Leopold maneuver perform no. 4 **TUBERCULOSIS (TB)** - **Tuberculosis (TB)**: An infectious disease caused by the bacteria *Mycobacterium tuberculosis*, primarily affecting the lungs but can also impact other parts of the body. - **BCG**: Bacillus Calmette--Guérin, a vaccine primarily used against tuberculosis. - **Sputum examination**: A test to detect the presence of TB bacteria in the mucus that is coughed up from the lungs. - **Airborne droplets**: TB is spread through tiny droplets released into the air when a person with active TB disease coughs, sneezes, or speaks. - **2 months medication**: After two months of medication, a person with TB is usually no longer contagious. **TB Treatment** - **6 months**: Standard TB treatment duration is usually 6 months. - First-line anti-TB drugs 1. **Sensitive pyrazinamide** 2. **Rifampicin** 3. **Isoniazid** - pyrazinamide is often part of the initial treatment. - **MDR (Multi-Drug Resistance)**: Refers to TB strains resistant to at least isoniazid and rifampicin, the two most powerful TB drugs. - **Streptomycin**: An antibiotic used to treat TB, particularly drug-resistant strains. - **6 months become 9 months pag matigas ulo dadagdag 4 months**: Treatment duration can be extended to 9 months or more if the patient is non-compliant or if the disease is more severe. - **Hemoptysis (coughing of blood)**: A symptom of advanced TB where the person coughs up blood. **DENGUE** - **Anomalies aegypti and Anomalies albopictus mosquitoes**: These are the primary vectors for transmitting the dengue virus. Aedes aegypti thrives in urban areas, while Aedes albopictus is found in more rural settings. - **Day-bite mosquito**: Both Aedes species primarily bite during the day. - **Prone Baby:** Children up to 11 years old are particularly vulnerable to dengue. - **High fever for 3 days**: One of the initial symptoms of dengue. - **Bone, abdominal problems**: Dengue can cause severe muscle and joint pain, sometimes referred to as \"breakbone fever.\" - **Intestinal bleeding, nosebleed**: Signs of severe dengue, where there is a risk of bleeding due to low platelet counts. - **Low platelet count**: Low platelet count increases the risk of bleeding; skin rashes or eruptions are common in dengue. - **Treatment**: includes IV fluid therapy; patients are often advised to avoid colored foods to prevent confusion with symptoms like internal bleeding. **Vitamin A, C , zinc** **Vitamin A** - Severe pneumonia- Today, tomorrow after 6 months   - Normal- today and after 6 months - For Marasmus, protein deficiency **RABIES PROGRAM** - **Anti-rabies act of 2007**: Philippine law mandating rabies prevention and control measures. - **Republic Act 10631**: Promotes animal welfare, including protecting animals from cruelty. - **Pet ownership responsibilities**: Pet owners must vaccinate their pets and prevent them from causing harm. - **Different vaccines**: Various rabies vaccines for humans and animals. 1. **Active and passive vaccines**: Active vaccines stimulate the immune system; passive vaccines provide immediate antibodies. 2. **Human cell culture vaccines (Imovax, HDCV)**: Modern rabies vaccines that are safer and more effective. 3. **Animal cell culture vaccines (RabAvert)**: Another type of rabies vaccine requiring skin testing for allergies. - **Rabies transmission**: Rabies can be transmitted through bites from infected animals like dogs, cats, bats, and monkeys. **Categories of dog bites**: - Category 1: Superficial exposure (kissing, licking). - Category 2: Minor scratches or licking of open wounds. - Category 3: Severe bites. **Mode of injection 5 doses** - **Intradermal 1mL**: The rabies vaccine is administered intradermally (under the skin) at this stage. - **0 (Day 0)**: Initial vaccination to boost the immune system. - **Day 3**: Second dose of the vaccine. - **Day 7**: Third dose of the vaccine. - **Day 14**: Fourth dose of the vaccine. - **Last dose (Post-exposure, if the animal dies)**: An additional dose if the animal that bit the person dies. **Types of Rabies Vaccines** - **HDCV (Human Diploid Cell Vaccine)**: A modern rabies vaccine derived from human cell culture, highly effective and commonly used. - **PCECV (Purified Chick Embryo Cell Vaccine)**: Another type of rabies vaccine produced using chick embryo cells, also effective and widely used. **Trivia** - **Rabies dies in high temperatures**: The rabies virus is killed by high temperatures, such as those used in cooking. **Special Considerations** - **Pregnancy**: If a pregnant woman is bitten by a potentially rabid animal during the 1st or 2nd trimester, she can be vaccinated safely. **NEWBORN SCREENING** **Specimen Collection** 1. **Form first**: Always fill out the necessary forms before collecting any specimen. This ensures proper documentation and tracking. 2. **Ballpen color**: Use black or blue ink. Avoid red pens as red ink can be confused with blood. 3. **Massage the baby\'s foot**: Massage the baby\'s foot to stimulate blood flow before pricking for a blood sample. 4. **Pricking**: If there is not enough blood, you can prick the same site again. **Test Results** - **1 week result**: Results from the specimen collection typically take one week. **Conditions** 1. **Autism**: This particular specimen collection or tests mentioned do not trace or diagnose autism. 2. **Congenital Hypothyroidism**: A condition where the thyroid hormone is deficient, leading to problems with brain growth and potential intellectual disability. 3. **Congenital Adrenal Hyperplasia**: A genetic condition where the adrenal glands produce excessive androgens, affecting both males and females. 4. **Galactosemia**: A disorder affecting the liver\'s ability to process galactose, a sugar in milk. 5. **Phenylketonuria (PKU)**: A metabolic disorder that results in the buildup of phenylalanine, an amino acid, leading to brain development issues. 6. **G6PD Deficiency**: A condition that affects red blood cells, leading to anemia. **Emergency Cases and Pregnancy Complications** 1. **Antepartum hemorrhage**: Severe bleeding before childbirth. 12 hours repair to avoid death from hemorrhage   2. **Postpartum hemorrhage**: Excessive bleeding after childbirth. 2 hours depending on the passage of the blood: heavy, very light   3. **Ruptured uterus**: Requires immediate surgical repair, typically within 1 day, to prevent severe complications or death. 4. **Eclampsia**: Needs prompt treatment within 2 days to manage seizures and related complications. 5. **Obstructed labor**: Requires intervention within 3 days, often involving a C-section to deliver the baby safely. 6. **Puerperal sepsis**: Should be treated within 6 days with antibiotics and other supportive care to prevent it from becoming life-threatening.