CHN-REVIEWER-NI-VALMONTE.pdf

CHN LECTURE REVIEWER Dr. Ruth B. Freeman -CHN -Rendered by a professional nurse to IFCs -Population groups in: -Health centers -Clinic Schools -Workplace for the promotion of health -Prevention of illness -Care of the sick at home and rehabilitation - A learned practic...

CHN LECTURE REVIEWER Dr. Ruth B. Freeman -CHN -Rendered by a professional nurse to IFCs -Population groups in: -Health centers -Clinic Schools -Workplace for the promotion of health -Prevention of illness -Care of the sick at home and rehabilitation - A learned practice discipline with the ultimate goal of contributing individuals and collaboration with other to promotion of the clients optimum level of Functioning thru teaching and delivery of case. - Is a population focused community oriented approach aimed at health , promotion of an entive population and prevention of disease, disability and premature death in population. - Unique to community health nursing is the opportunity for nurses to learn and develop partnerhip skills with all stakeholders and key actions in their communities - Relies heavily on the systematic process of designing and delivering , health services and nursing care to improve the health of the entire community, community health nursing is a specialty in nursing.  PRINCIPLES AND PHILOSOPHY OF CHN 1. The recognized need of individuals, families and communities, provides the basis For CHN practice. - Purpose is to further apply public health measure within the framework of total chn effort 2.Knowledge and understanding of the objectives and policies of the agency facilities goal achievement. - the mission statement commits community Health Nurses to positively actualize their service to this end 3.CHN considers the family as the unit service - It is level of functioning is influenced by the degree to which it can deal with its own problems, therefore the family is an effective and available chanel the most of the CHN efforts. 4.Respect for the values customs and beliefs of the client and contribute to the effectiveness of care of the client - CHN services must be available sustainable and affordable to all regardless of race creed, color and socioeconomic status. 5.CHN integrated health education and counselling as vital parts of function - These encourage and support community efforts in the discussion of issues to improve the peoples health. 6.Collaborative work relationehips with co-workers and members of the health team facilities accomplishment of goal - Each member is helped to see how his/her work benefit the whole enterprise. 7.Periodic and continuing evaluation provides the mears for assessing I the degree to which CHN goals and objectives are being attained - clients are involved in the appraisal oftheir health program through consultations, observations, and accurate recording 8. Continuing staff education program quality service to client and one essential to upgrade and maintain sound nursing practice in their setting of Professional interest and needs of community health nurses are considered in planning staff development programs of the agency 9.Utilization of the indigenous and existing community resources maximizing the success of the effort of the community health nurses: - The use of local available ailment, linkages with existing community resources both public and private increase the awareness of what care they need and what are entitled 10.Active participation of the individual family and community in planning and making decisions for their health care needs, determine to large extent of the success of CHN program - Organized community groups are encouraged to participate in the activities that will meet community needs and interest. 11.Supervision of nursing services by qualified CHN personnel, provides guidance and direction for the work to be done. - Potential employees for effective and efficient work are developed 12.Accurate recording and reporting serve as basis for evaluation of the progress of planned programs and activities and as a guide for the future actions. - Maintenance of accurate records is a vital responsibility of community health nurses as these are utilized in studies and resembles as a legal documents  Features of Community Health Nursing 1. Clinicians on Direct care providers - the nurse ensures health care services not just to individuals and families but also groups and population of the community - For community health nurses, the olinicians role involves certain emphasis, different from basic nursing ie: Holism, health promotion and skill expansion 2.Educator - It is widely recognize that health teaching is a part of good nursing practice and one of the major Functions of a community health nurses. - Assess the Knowledge, attitudes, values, beliefs, behaviors, practices, stages of changes and skill of the community people and provides health education according to their knowledge level. 3.Advocate -the issue of client rights is important health care today. Every patient or client has the right to advocate of patients right about their care 4. Managerial - The nurse exercises administrative direction toward the accomplishment of specified goals by assessing client needs planning and organizing - to meet those needs directing and controlling and evaluating the progress to assure that the goals are met. 5.Collaborator Role - community Health nurses seldom practice in isolation, they must work with many people including clients with other nurses, physicians, social workers, and community leaders, therapist, nutritionists, occupational therapists psychologists, epidemiologist, biostatistician, legistator etc as a member of the health team 6.Leader Role - community health nurses are becoming increasingly active * in the leader role. - As a leader nurse instructs, influences or persuades to effect change that, will positively affect peoples health - The leadership role primary functions is to use a change of health policy based on community peoples health thus, the community health nurse becomes an agent of change 7.Research Role - In the research role, community health nurse engage in systematic in investigation collection and analysis of data and to solve problems and enhance community health nursing practice.  Public Health Nursing as a Population based practice Public Health Nursing - Practice of promoting and protecting health of the population using Knowledge from nursing social and public health sciences (APHA, Public Health Nursing Section 1996) - Population Focused community oriented nursing practice - Goal is prevention of disability for old people through the creation of conditions in which people can be healthy Community Health Nursing - synthesis of nursing practice and public health practice applied to providing and preserving health population Community - People in place with potential interaction that leads to shared values, norms and culture - A group of people with diverse characteristics who are linked by social ties, share common perspective and engaging in joint action in geographic location or settings - Asocial group of any size whose members reside in a spectio locality, government and often have a common cultural and historical heritage. - A group of people who occupies a common contigous territory that is possesed by a common set of traditions associated with their living together in that territory and served by a set of local institutions in which the people are concious with their own interests Types of community: Formal Community - Engage in joint activities and discussion that help each other and share information with each other, they are about their standing in each other Example of formal community: - Eco villages - Co housing and communities - Religious communities Informal Community -Set of a personal relationship, social networks and common interest and emotional sources of motivations Example of informal community: -Academic Community -Recreational Community -Retirement Community Urban Community -Large in terms of land area and population. Advance in science and technology with favorable physical environment and diverse cultural and the people are engaged in various occupations Types: -Condominium -Social space community -Physical or Virtual Space -Physical social center gathering space Healthy Community - Not only upon the genetics of the residents but also upon the environment within which those individuals live - Creates and improves the environment and expands resources HEALTH ENVIRONMENT HEALTHY COMMUNITY HEALTH CARE ACCESS -Health Education - Job training -Safe environment -Public transpo -Employment -Safe housing -Quality Education -Recreation COMPONENTS OF A HEALTHY COMMUNITY - clean, safe and quality environment (Including housing) - Ecosystem that is stable now and sustainable in the long term. - A strong mutually supportive and non-exploitative community - High degree of public participation and control over decisions directing life, health and wellbeing. - Meeting of the basic needs (foods, water, shelter, income, safety wark For all people - Access to wide variety of experiences and sources with the possibility of multiple contact interactions and communication. - A diverse vital and innovative economy - Encouragement of connections with the past with the varied cultural and biological heritage and with Other groups and individuals. - A city for (design) that is compatible with and enhances the preceeding parameters and form of behaviors. - An optimum level of public health and sick care service that is accessible to all high health status (both high positive health status and low disease status) CHN THEORETICAL MODELS AND ITS PROCESSES - A theory that is built upon a set of identified constructs - Construct is a representation of a concept within a theoretical framework. It is considered as the base of theory - A model exist to supply structure and support the development of a health promotion intervention Health Belief Model - First developed in 1950s by psychologist Hochbaum Rosenstock and kegels -Focus on attitude and belief of a person Perceived susceptibility - The chance he/she will contact the healthcare provider Perceived serenity -How serious a condition might be including the medical , clinical or social consequence Perceived Benefits -Effectiveness of the behaviors to reduce the threat of the health condition Perceived Barriers -Negative consequences for taking the action (social, financial, emotional and physical) Cues to action -Motivate or rewind to take action Self efficacy -Ability to take action and the perception to success Transtheoretical Model: -Developed by psychologist James Prochaska and carlo diclemente (1984) -Observation that go through similar sequential Pre contemplation -No intention to change within next months Action -Implementation of strategies Maintenance -Prevent relapse and is more confident of the behavior change within the next 6 months Community Health Assessment and Group Evaluation (CHANGE) - Data collection and planning resource for community member - Developed through a collaboration of the health communities programs and within the division of adult and community health - Common purpose and to began in fall 2007 and first literation prioritize needs was piloted - Purpose is to gather and organized data on community assets for improvement - Improves community health by providing feedback on actions that should be developed and implemented to transform communities into those that supports healthy living  CHANGE TOOL C - ommitment A - ssessment P - lanning I - mplementation E - valuation Commitment -Address issues and establish partnerships with other agencies - Give participants ownership of the process of the process and a ready pool of fiscal and human resources to support policy. Assessment - Gathering of data and input on what community needs - Provides way for the community’s voice to be heard - Community Organizining Needs Planning - Natural progression from assessing a community needs - Team that takes action to develop the community action plan for the change Implementation - Executing the plan you have developed - Collaboration with community team stakeholders and partners  Social Cognitive Theory By: Alfred Bandura Assumptions of Social-Cognitive Theory: 1.People learn by observing others. 2. Leaning is an internal process that may or may not lead to a behavior. 3. Goal-directed behavior 4. Behavior eventually becomes self-regulated 5. Reinforcement and punishment have indirect effects on learning Components of SCT: Reciprocal Determinism - > This refers to the dynamic behavior and reciprocal interaction of person, environment (social context) and behavior (responses to stimuli to achieve goals) Behavioral Capability > Refers to a person's actual ability to perform a behavior through essential knowledge and skills. in order to successfully perform a behavior, a person must know what to do and how to do it. People learn from the consequences of their behavior, which also affects the environment in which they live. Observational Learning > This asserts that people can witness and observe a behavior conducted by others, and then reproduce those actions Reinforcements - This refers to the intemal or extemal responses to a person's behavior that affect the likelihood of continuing or discontinuing the behavior. Expectations - This refers to the anticipated consequences of a person's behavior. Outcome expectations can be health-relaled or not health-related. People anticipate the consequences of their actions before engaging in the behavior, and these anticipated consequences can influence successful completion of the behavior. Self-efficacy - This refers to the level of a person's confidence in his or her ability to successfully perfom a behavior.  People learn by observing others. - People will typically try to imitate behavior of models who do something well, not poorly. - A model must have prestige and power. - Models are more effective if they are engaging in gender appropriate behaviors. - The behaviors being modeled should be relevant to the learner's situation. Demographic Data - Demographic Data refers to data that is statistically socio-economic in nature such as population, race, income, education and employment, which represent specific geographic locations and are often associated with time. Two types of Sources of Data Primary Data - collected by yourself (Subjective or Objective) - Self Assessment (HRAs) - Written Questionnaires - Telephone interviews - Face-to-face interviews - Electronic interview - Group interview - Maybe gathered from opinion leaders, key informants, community forum, focus group - Direct or indirect observation (walk-through) Secondary Data - "no contact data;" collected by someone else. - Data from the government agencies, non government agencies, existing records, literature searches Population Population size structure refers to the density of individuals within different size classes of a population. For the purpose of estimating production, breaking down a population into size classes is essential for applying methods used in estimating growth and the loss of individuals over time due to mortality, as well as providing a convenient way for estimating biomass. Population distribution -means the pattern of where people live. (Exp. Age Distribution and sex distribution) Two types of Population Actual Population - Refers to all persons who, on the census date, were in the reference territory, whether they resided in the same municipality in which they were counted (present residents) or were passing through (transient). Projection Population -Population forecasts or Projection Population are used to summarize existing knowledge of population change to help decision makers. A population projection gives a picture of what the future size and structure of the population by sex and age might look like. It is based on knowledge of the past trends, and, for the future, on assumptions made for three components: fertility, mortality and migration. HEALTH INDICATORS Crude Birth Rate (CBR) - Is a measure of one characteristic of the natural growth or increase of a population Crude Death Rate (CDR) - Is a measure of one mortality from all causes which may result in a decrease of population Infant mortality/Death Rate - Is the death of an infant under one year of age Neonatal Mortality Rate - is the death among live births during the first 28 completed days of life Maternal Mortality Rate MATERNAL MORTALITY/DEATH - is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. MATERNAL MORTALITY RATE (MMR) - It measures the risk of dying from causes related to pregnancy, childbirth and puerperium. It is an index of the obstetrical care needed and received by the women in a community TOTAL NUMBER OF DEATHS FROM MATERNAL CAUSES REGISTERED FOR A GIVEN YEAR ---------------------------------------------------------------------------------------------- = Total number of live births registered of same year Multiply to 1000 Mortality/Death Rate A mortality rate is a measure of the frequency of occurrence of death in a defined population during a specified interval. Morbidity and mortality measures are often the same mathematically; it's just a matter of what you choose to measure, illness or death. The top three causes of death in the country in 2020 were ischaemic heart diseases, neoplasms, and cardiovascular diseases. Morbidity Rate Morbidity Rate refers to the rate at which a disease occurs in a population. These illnesses can range from acute to chronic, long-lasting conditions. The rate of morbidity can be used to determine the health of a population and its health care needs. PHILIPPINE DEMOGRAPHIC PROFILE The Philippine Statistics Authority (PSA) announced today that based on the 2020 Census of Population and Housing (2020 CPH), the total population of the Philippines as of May 01, 2020 is at 109,035,343. Epidemiology -Epidemiology" is derived from Greek word: - "Epi"- on or upon -Demos" - people -Logos" - the study Hence, epidemiology is the study on the people or population Epidemiology Definition The study of the distribution and determinants of health-related events in a specified population, and the application of (of the study) in order to control health problems (Porta, 2008) "Epidemiology is the study of distribution of diseases or a physiological condition in human population and of the factors that influence this distribution" -(Lilienteld, 1980) Epidemiological approach Believes that the frequency of a disease in a population is governed by the interaction of a large number of different factors or determinants. Believes that by studying these interactions it may become possible to manipulate some of the determinants involved, and so reduce the frequency with which the disease in question occurs. Three Objectives of Epidemiology: 1. Measure health 2.Identify the causes of ill-health 3. Intervene in order to improve health Purposes Of Epidemiology 1.Identify causes and risk factors for disease. 2.. Determine the extent of disease in the community. 3.Study natural history and prognosis of disease. 4. Evaluate preventive and therapeutic measures 5. Provide foundation for public policy -Epidemiologists are required to have some knowledge of the disciplines of public health, clinical medicine, pathophysiology, statistics, and the social sciences. public health - because of the emphasis on disease prevention. clinical medicine - because of the emphasis on disease classification and diagnosis. pathophysiology - because of the need to understand basic biological mechanisms in disease. statistics - because of the need to quantify disease frequency and its relationships to antecedents. social sciences - because of the need to understand the social context in which disease occurs and presents.  Epidemic- refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area Endemic- the amount of a particular disease that 'is usually present in a community Pandemic- refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people. Outbreak- carries the same definition of epidemic, but is often used for a more limited geographic are The Agent - the "What" originally referred to an infectious microorganism or pathogen: a virus, bacterium, parasite, or other microbe. Generally, the agent must be present for disease to occur; however, presence of that agent alone is not always sufficient to cause disease. A variety of factors influence whether exposure to an organism will result in disease (i.e. pathogenicity and dose) The Host- the "Who" refers to the human who can get the disease. A variety of factors intrinsic to the host, sometimes: called risk factors, can influence an individual's exposure, susceptibility, or response to a causative agent. - social determinants - genetic composition, - nutritional and immunologic status, - presence of co-morbid disease or medications, - psychological makeup The Environment - the "Where" -The environment is the favorable surroundings and conditions external to the host that cause or allow the disease to be transmitted. - Also refers to extrinsic factors that affect the agent and the opportunity for exposure. - physical factors such as geology and climate, - biologic factors such as insects that transmit the agent, - socioeconomic factors such as crowding, sanitation, and the availability of health services. - Determinants of health Factors in Disease Transmission An agent is necessary to cause a disease in a susceptible host Infectivity - is a measure of the ability of a disease agent to establish itself in the host Pathogenicity - is an epidemiological term used to describe the ability of a particular disease agent of known virulence to produce disease in a range of hosts under a range of environmental conditions. Virulence - a measure of the severity of a disease caused by a specified agent. The Chain of infection The transmission of infection depends on six elements which link together like a chain. If any link is broken then the chain is broken and infection cannot be transmitted. Therefore, to prevent germs from infecting more people, we must break the chain of infection!  A major goal of epidemiology is to assist in the prevention and control of disease and in the promotion of health by discovering the causes of disease and the ways they can be modified. Community Health Nurse (CHN) working as the member of health care team in various health agencies are to participate in epidemiological studies done in their community. They need to participate actively, meaningfully and intelligently throughout the process. Identification of problem In the community setting at various levels confront many health- threatening situations and health deficits in people which affect their health and wellbeing, example:- repeated spells of diarrhea among children, noncompliance with immunization schedule by children, antenatal checkup, increase in the conduct of home delivery by indigenous birth attendants, noncompliance of eligible couple. These problems has to identify by the health wakes through the survey, field work, asking question, observation etc. This is the beginning of the problem identification. after that one liter to state the problem precisely, set the objectives to study, define the concepts, operation able in the study and tries to identify the hunch/hypothesis to be tested Identification of population. Epidemiology study involves investigation about population. information of population bare and its charaderistics are required for computing rates and ration and for doing comparisons it is very important to identify the whole population the target population if it is any selected group by age, ser, occupation, physiological states etc Review of literature. Through this the epidemiologist get the idea regarding what has already been done in the regarding what has already been done in the problem area understudy and how health problem have been prevented and treated. It helps us understand the problem area, suggest hypothesis, strengthen the hypothesis already; formulate and suggest effective line of action and study design. Review of literature also helps to justify or avoid duplication Designing of study: The designing of study is selected to achieve the objectives of the study. The other faculty which are considered for selection of study design are the urgency of achieving of objectives, the need for accuracy and reliability, the ability, of the investigate and economic capacity cross sectional or prevalence study design is used objectives is to make community assessment. The study designing will determine whether the data are going to be conducted retrospectively from existing records or new data will be generated and collected by asking question by making observation and examination or by all methods. Collection of data. Question can be asked through the interview or by written responds, observation is another method for collection of data. And also laboratory investigation, examination and measurement may be required to collecting the data. Thus Varity of instrument may require for data collection. Some of there may be standardized and available and can be used. Some of there may have to be developed like questionnaire, interview schedule, observation check list. After the instrument ready collecting the data through the pilot study to check the reliability. Finally the data is collected. Analysis and Interpretation of the data and its finding. Once the data is collected it is compiled that is it is summed up, computed into rate and ratio, presented in tables, graph and charts tested statistically. This done according to the objectives and hypothesis of the study. Conclusion and Implication One the basis of finding conclusion is draw and stated. The is discussed results are and Implication in terms of possible application is discussed. REVIEWER BY: John Isaac Valmonte. SN. CREDITS TO: Sir Jello Robil. RN, MPH, USRN