Community Health Nursing Concepts PDF

REVIEW OF COMMUNITY HEALTH NURSING CONCEPTS Module I Dr. Regie De Jesus College of Health Sciences COMMUNITY HEALTH NURSING II DEFINITION OF COMMUNITY HEALTH NURSING "The utilization of the nursing process in the different levels of clientele-individuals, families...

REVIEW OF COMMUNITY HEALTH NURSING CONCEPTS Module I Dr. Regie De Jesus College of Health Sciences COMMUNITY HEALTH NURSING II DEFINITION OF COMMUNITY HEALTH NURSING "The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation." (Maglaya, et al) Goal: "To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness" (Nisce, et al) DEFINITION OF COMMUNITY HEALTH NURSING A learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the client's optimum level of functioning (OLOF) thru' teaching and delivery of care (Jacobson) A service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools, workplace for the promotion of health, prevention of illness, care of the sick at home and rehabilitation (Dr. Ruth B. Freeman) PHILOSOPHY OF CHN “The philosophy of CHN is based on the worth and dignity of man.”(Dr. M. Shetland) MISSION OF PUBLIC HEALTH Health Promotion Health Protection Health Balance Disease prevention Social Justice BASIC PRINCIPLES OF CHN 1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems – e.g. children, elderly), and the community. 2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care BASIC PRINCIPLES OF CHN 3. CHN practice is affected by developments in health technology, in particular, changes in society, in general 4. The goal of CHN is achieved through multi-sectoral efforts 5. CHN is a part of health care system and the larger human services system. ROLES OF THE PUBLIC HEALTH NURSE Clinician, who is a health care provider, taking care of the sick people at home or in the RHU Health Educator, who aims towards health promotion and illness prevention through dissemination of correct information; educating people Facilitator, who establishes multi-sectoral linkages by referral system Supervisor, who monitors and supervises the performance of midwives ROLES OF THE PUBLIC HEALTH NURSE Health Advocator, who speaks on behalf of the client Advocator, who act on behalf of the client Collaborator, who working with other health team member Change Agent, who motivates changes in health behavior to promote and maintain health ROLES OF THE PUBLIC HEALTH NURSE Recorder/Reporter/Statistician Prepares and submits required reports and records Maintain adequate, accurate, and complete recording and reporting Reviews, validates, consolidates, analyzes, and interprets all records and reports Prepares statistical data/chart and other data presentation ROLES OF THE PUBLIC HEALTH NURSE Researcher Participates in the conduct of survey studies and researches on nursing and health-related subjects Coordinates with government and non- government organization in the implementation of studies/research  NOTE: In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions or is not available, the Public Health Nurse will take charge of the MHO’s responsibilities. THEORETICAL MODELS OR APPROACHES IN CHN a. Health Belief Model (HBM)- b. Milio’s Framework for Prevention c. Nola Pender’s Health Promotion Model d. Lawrence Green’s PRECEDE-PROCEED MODEL Health Belief Model (HBM) -1958 basis for much of the practice of health education and promotion today. This model found that information alone is rarely enough to motivate people to act for their health. Individuals must know what to do and how to do it before they can take action. Health Belief Model (HBM The model postulates that health-seeking behaviour is influenced by a person's perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat. HBM is a good model for addressing problem behaviors that evoke health concerns (e.g., high-risk sexual behavior and the possibility of contracting HIV)  Concept Definition Perceived One’s belief regarding the chance of getting susceptibility a given condition Perceived One’s belief in the seriousness of a given severity condition Perceived One’s belief in the ability of an advised action benefits to reduce the health risk or seriousness of a given condition Perceived One’s belief regarding the tangible and barriers psychological costs of an advised action Cues to an Strategies or conditions in one’s environment action that activate readiness to take action Self-efficacy One’s confidence in one’s ability to take action to reduce health risks HBM concepts all relate to the client’s perceptions Milio’s Framework for Prevention proposed that health deficits often result from an imbalance between a population’s health needs and its health sustaining resources. She challenged the common notion that a main determinant for unhealthful behavioural choice is lack of knowledge. Milio’s Framework for Prevention She proposed that most human beings make the easiest choices available to them most of the time. Health promoting choices must be more readily available and less costly than health damaging options for individuals to gain health. This theory is broader than the HBM, it includes economic, political and environmental health determinants rather than just the individual’s perceptions. This theory encourages the nurse to understand health behaviors in the context of their societal milieu. Milio’s Propositions 1. Population health results from deprivation and/excess of critical health resources. Example: Individuals / families living in poverty have poorer health status compared with middle & upper class Milio’s Propositions 2. Behaviors of populations result from selection from limited choices Example: Positive and negative lifestyle choices ( e.g., smoking, alcohol use, safe sex practices, regular exercise, diet/nutrition, seatbelt use) are strongly dependent on culture, socioeconomic status, and educational level Milio’s Propositions 3. Organizational decisions & policies (GO & NGO) dictate many of the options available to individuals/populations & influence choices Example: Health insurance coverage and availability are largely determined and financed by private companies (e.g. Medicare and Medicaid) and employers (e.g. private insurance); the source and funding of insurance very strongly influence health provider choices and services. Milio’s Propositions 4. Individual choice related to health- promoting or health-damaging behaviors is influenced by efforts to maximize valued resources Example: Choices and behaviors of individuals are strongly influenced by desires, values and beliefs. For example, the use of barrier protection during sex by adolescents is often dependent on peer pressure and the need for acceptance, love and belonging. Milio’s Propositions 5. Alteration in patterns of behavior resulting from decision making of significant number of people in a population can result in social change. Example: Some behaviors such as tobacco use have become difficult to maintain in many settings or situations in response to organizational and public policy mandates. Milio’s Propositions 6. Without concurrent availability of alternative health-promoting options for investment of personal resources, health education will be largely ineffective in changing behavior patterns. Example: Addressing persistent health problems (e.g. overweight/obesity) is hindered because most people are very aware of what causes the problem, but are reluctant to make reluctant lifestyle changes to prevent or reverse the condition. Often "new" information (e.g., a new diet) or resources (e.g., a new medication) can assist in attracting attention and directing positive behavior changes. Nola Pender’s Health Promotion Model The model explores many biopsychosocial factors that influence individuals to pursue health promotion activities. The model depicts complex multidimensional factors which people interact with as they work to achieve optimum health. Individual Each person’s unique characteristics and characteristics experiences affect his or her actions. Their and experiences effect depends on the behavior in question Prior related Prior behaviors influence subsequent behavior behavior through perceived self-efficacy, benefits, barriers and affects related to that activity. Habit is also a strong indicator of future behavior. Behavior specific In the HPM, these variables are considered to cognitions an be very significant in behavior motivation. They affect are a “core” for intervention because they may be modified through nursing actions assessment of the effectiveness of interventions is accomplished by measuring the change in these variables. Perceived benefits The perceived benefits of a behavior are strong of action motivators o that behavior. These motivate the behavior through intrinsic and extrinsic benefits. Intrinsic benefits include increased energy and decreased appetite. Extrinsic benefits include social rewards such as compliments and monetary rewards. Perceived barriers Barriers are perceived unavailability, to action inconvenience, expense, difficulty or time regarding health behaviors Perceived self- Self-efficacy is one’s belief that he or she is efficacy capable of carrying out a health behavior. If one has high self-efficacy regarding a behavior, one I more likely to engage in that behavior than if one has low self-efficacy. Activity related The feelings associated with a behavior will affect likely affect whether an individual will repeat or maintain the behavior Interpersonal I the HPM, these are feelings or thoughts influences regarding the beliefs or attitudes of others. Primary influences are family, peers, and health care providers. Situational These are perceived options available, demand influences characteristics, and aesthetic features of the environment where the behavior will take place. For example, a lovely day will increase the probability of one taking a walk; the fire code will prevent one from smoking indoors. Commitment to a Pender states that “commitment to a plan of plan of action action initiates a behavioral event”. This commitment will compel one into the behavior until completed, unless a competing demand or preference intervenes. Immediate These are alternative behaviors that one competing considers as possible optional behaviors demands and immediately prior to engaging in the intended, preferences planned behavior. One has little control over competing demands, but one has great control over competing preferences Health promoting This is the goal or outcome of the HPM. The behavior aim of health promoting behavior is the attainment of positive health outcomes Lawrence Green’s PRECEDE- PROCEED MODEL It is a comprehensive structure for assessing health needs for designing, implementing, and evaluating health promotion and other public health programs to meet those needs It provides a model for community assessment, health education planning, and evaluation. PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation. PRECEDE Social assessment: Determine the social problems and needs of a given population and identify desired results. Epidemiological assessment: Identify the health determinants of the identified problems and set priorities and goals. Ecological assessment: Analyze behavioral and environmental determinants that predispose, reinforce, and enable the behaviors and lifestyles are identified. Identify administrative and policy factors that influence implementation and match appropriate interventions that encourage desired and expected changes. Implementation of interventions. PROCEED stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development. I PROCEDE Implementation: Design intervention, assess availability of resources, and implement program. Process Evaluation: Determine if program is reaching the targeted population and achieving desired goals. Impact Evaluation: Evaluate the change in behavior. Outcome Evaluation: Identify if there is a decrease in the incidence or prevalence of the identified negative behavior or an increase in identified positive behavior.  Predisposing factors: people’s characteristics that motivate them toward health-related behavior. Enabling factors: conditions in people and the environment that facilitate or impede health related behavior. Reinforcing factors: feedback given by support persons or groups resulting from the performance of health-related behavior PRECEDE-PROCEED invites participation from community members, and has the potential to increase community ownership of the program EMERGING FIELDS OF CHN IN THE PHILIPPINES SCHOOL HEALTH NURSING - the application of nursing theories and principles in the care of the school population Focus: Promotion of health and wellness of students and teachers Primary Role of CHN: to ensures that educational potential is not hampered by unmet health needs Functions of the School Nurse: 1. School Health and Nutrition survey 2. Putting up a functional school clinic 3. Health assessment 4. Standard vision testing 5. Ear examination 6. Height and weight measurement and nutritional status determination 7. Medical referrals 8. Attendance to emergency cases 9. Student health counselling Functions of the School Nurse: 10.Health and nutrition education activities 11.Organization of school-community health and nutrition councils 12.Communicable disease control 13.Establishment of data bank on school health and nutrition activities EMERGING FIELDS OF CHN IN THE PHILIPPINES OCCUPATIONAL HEALTH NURSING the application of nursing principles and procedures in conserving the health workers in all occupations Mission: To assure that every man and woman in the country is safe and in healthful working conditions R.A. 1054 is also known as the Occupational Health Act  Based on R.A. 1054, an occupational nurse must be employed when there are 30 to 100 employees and the workplace is more than 1 km. away from the nearest health center Occupational hazards: Physical, , chemical, biological, mechanical, psychosocial EMERGING FIELDS OF CHN IN THE PHILIPPINES HOME HEALTH CARE – this practice involves providing nursing care nursing care to individuals and families in their own places of residence mainly to minimize the effects of illness and disability. HOSPICE HOME CARE – homecare rendered to the terminally ill. Palliative care is particularly important ENTREPRENURSE A project initiated by the Department of Labor and Employment (DOLE), in collaboration with the Board of Nursing of the Philippines, Department of Health, Philippines Nurses Association and other stakeholders to promote nurse entrepreneurship by introducing a home health care industry in the Philippines. AIMS OF ENTREPRENURSE 1. Reduce the cost of health care for the country’s indigent population by bringing primary health care services to poor rural communities 2. Maximize employment opportunities for the country’s unemployed nurses 3. Utilize the countries unemployed human resources for health for the delivery of public health services MODULE REQUIREMENTS Answer the activity in Module I in page 11 and 12.