Community Health Nursing Lecture 1 PDF

Community Health Nursing Community/ Public Health Nursing Community health nursing and public health nursing are often used interchangeably to indicate the specialty of nursing that has the community or population as the focus of practice. Incorporating knowledge from biostatistics, epide...

Community Health Nursing Community/ Public Health Nursing Community health nursing and public health nursing are often used interchangeably to indicate the specialty of nursing that has the community or population as the focus of practice. Incorporating knowledge from biostatistics, epidemiology sciences as well as nursing, community health nurses apply synthesis of knowledge and skills from these disciplines to maintain and improve health of communities. Community health practice focuses on communities or populations. Health promotion. Prevention of disease or injury. Comprehensive care for maintaining or improving a community’s health. Community/ Public Health Nursing  The major goal of community health nursing is to preserve the health of the community and surrounding populations by focusing on health promotion and health maintenance of individuals, families and groups within the community.  Community health nursing is associated with health and the identification of populations at risk.  Community health nursing focuses on the multiple determinants of health to improve population health outcomes.  Community/ Public Health Nursing Community- oriented nurses provide care to promote quality of life. “It is easier to promote health than to maintain people in sickness” (Florence Nightingale) Community health nurse typically deals with groups in the community. The challenge, in this specialty is to change the focus from individual/acute care to an emphasis on health promotion and community/population health concepts. A qualified C/PHN nurse must know the population being served and must have the skills to deliver comprehensive population‐focused care that improves the individuals’ experience of care.  Community Definition “a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging ”.(Allender and Spradley ,2005). “a group of people sharing common interests, needs, resources and environment “(Thomas , 2003). “a group of people who share some type of bond , who interact with each other , and who function collectively regarding common concerns” (Clark , 2003). Geopolitical communities. e.g. cities, neighborhoods, districts, and nations. Phenomenological communities. e.g. schools, universities, churches and mosques. Population and aggregate are related terms often used in public health: a group of people having common personal or environmental characteristics, all people in a defined community. Definition of Health “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” (WHO,1958) Social “of or relating to living together in organized groups or similar close aggregates”. Refers to units of people in communities who interact with each other. Social health, community vitality, a result of positive interaction among groups within the community with an emphasis on health promotion and illness prevention. The extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; on the other hand to change or cope with the environment. Health is seen, therefore as a resource for everyday life, not the objective of living, it is a positive concept emphasizing social and personal resources, and physical capacities (WHO,1986). Health is a resource to be used rather than a goal. Definition of Health Family, society and environment are interrelated and have an impact on health. Illness. Health and peak wellness are on a continuum; health is fluid and changing. Consequently, within a social environment. The state of health depends on the goals, potentials and performance of individuals, families, communities, and societies  The health-illness continuum The health illness continuum shows the relative nature of health and illness, at any given time a person can be placed at some point along the continuum Total disability or death Optimal health Increasing level increasing level of illness of wellness Determinants of Health and Illness  Health care access  Economic conditions,  Social and environmental issues, and  Cultural practices.  Interaction of the negative factors may lead to disease, death, and disability.  Individual biology and behaviors influence health through interaction with each other and with the individual’s social and physical environments. Determinants of Health and Illness Indicators of Health and Illness Useful for  Health providers  Policy makers  Community health nurses. Most common indicators:  Morbidity, mortality, & other health status data. Life expectancy, infant mortality, age-adjusted death rates, cancer incidence rates.  These data are useful in analyzing health patterns over time, comparing communities from different geographical regions or comparing different aggregates within community.  Changes in mortality reflect a number of social, economic, health service and related trends. Characteristics of Community Health 1. Status 2. Structure 3. Function, activity and process Status  It is the most common and acceptable way to understand the health of the community.  It involves different components, e.g., physical, emotional, and social aspects.  Physical components of community health include:: morbidity rates mortality rates birth rate life-expectancy indices, and risk-factor profiles.  Emotional components include: mental health indices suicidal rate of different groups of people.  Social components include: crime rates other rates that can reflect social health.  Most statistics can be obtained from the government reports, e.g., annual health report, census and from government department websites. Structure Community health, when examined from the structure perspective can be defined as “services and resources provided in the community”. Indicators to measure community health can be:  Service use patterns.  Treatment data from various health agencies. Include government and non-government organizations (NGO) Provider/client relations Take into consideration any under-reported situations Function, Activity and Process  It includes the process of effective community functioning or problem solving.  Indicators to measure community health can be:  Effective communication between groups Management of relationships within the society.  Commitment of the people to strike benefits for the community Why Health Promotion? The changing pattern of disease  More lifestyle related diseases, e.g., coronary heart disease  The changing concepts of health  Consideration of psychological and social health The changing role of health care professionals;  Nurses as health educators to promote health  Health promotion has gained increasing attention Helping People to Talk About Their Health Needs Neuman Systems Model  Within the model of Neuman systems, “client” or “client system” is composed of features embedded within a specific structure.  A person, a family, a community, or a social problem is considered to be “a client” or “a client system” composed of variables (physiological, psychological, sociocultural, developmental and spiritual).  composed of a [central] core or essential survival factor structure and surrounding concentric defensive rings. Neuman Systems Model  The client system develops a series of defenses that are used as protection to interact with the environment called "defense lines." The “normal line of defense” can be interpreted as the client's usual level of wellness.  Beyond this line of defense is the “flexible line of defense”, which prevents client system stressor invasions, keeps the system free from stressor reactions or symptoms. Neuman Systems Model  The lines of resistance are within the normal line of defense.  When an environmental stressor breaks through the normal protection line and causes an adverse reaction, the resistance lines are triggered to protect the basic structure that is at the center or core of the client system.  To penetrate the lines of resistance leaves the fundamental structure at risk and poses a potentially lethal threat to the client system.  The effect of the stressor can be affected by the number of stressors the client system faces at a particular time, the intensity of the stressors, and the stability or well-being state of the system. Neuman Systems Model  Neuman Systems Model  Neuman views nursing as a unique profession concerned with the variables that influence the response the patient might have to a stressor.  Nursing also addresses the whole person, giving the theory a holistic perspective.  The model defines nursing as “actions which assists individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient-client system, through nursing interventions to reduce stressors.”  Neuman also says the nurse’s perception must be assessed in addition to the patient’s, since the nurse’s perception will influence the care plan he or she sets up for the patient.  The Systems Model views the role of nursing in terms of the degree of reaction to stressors, as well as the use of primary, secondary, and tertiary interventions.