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Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  CHAPTER 1: FUNDAMENTAL CONCEPTS OF COMMUNITY HEALTH NURSING ❖ COMMUNITY/PUBLIC HEALTH NURSING — The synthesis of nursing practice and public health practice. ❖ MAJOR GOAL OF CHN Preserve the hea...

Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  CHAPTER 1: FUNDAMENTAL CONCEPTS OF COMMUNITY HEALTH NURSING ❖ COMMUNITY/PUBLIC HEALTH NURSING — The synthesis of nursing practice and public health practice. ❖ MAJOR GOAL OF CHN Preserve the health of the community and surrounding population by focusing on health promotion and health maintenance of individual, family and group within community. Thus CHN/ PHN is associated with health and identification of population at risks rather than with an episodic response to patient demand. ❖ MISSION OF PUBLIC HEALTH Social justice that entitles all people to basic necessities, such as adequate income and health protection, and accepts collective burdens to make possible. ❖ DEFINITION OF HEALTH ACCORDING TO: WHO ▪ “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Murray ▪ “a state of well-being in which the person is able to use purposeful, adaptive responses and processes physically, mentally, emotionally, spiritually, and socially.” Pender ▪ “actualization of inherent and acquired human potential through goal- directed behavior, competent self-care, and satisfying relationship with others.” Orem ▪ “a state of person that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning.” ❖ SOCIAL “of or relating to living together in organized groups or similar close aggregates” ❖ SOCIAL HEALTH Connotes community vitality and is a result of positive interaction among groups within the community with an emphasis on health promotion and illness prevention. ❖ COMMUNITY Seen as a group or collection of locality-based individuals, interacting in social units, and sharing common interests, characteristics, values, and/ or goals. ❖ DEFINITION OF COMMUNITY ACCORDING TO: Allender ▪ “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.” Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Lundy and Janes ▪ “A group of people who share something in common and interact with one another, who may exhibit a commitment with one another and may share a geographic boundary.” Clark ▪ “A group of people who share common interests, who interact with each other, and who function collectively within a defined social structure to address common concerns.” Shuster and Goeppinger ▪ “A locality-based entity, composed of systems of formal organizations reflecting society’s institutions, informal groups, and aggregates.” ❖ TWO MAIN TYPES OF COMMUNITIES (Maurer & Smith, 2009) Geopolitical Communities AKA Territorial Communities ▪ Most traditionally recognized. ▪ Defined or formed by both natural and man-made boundaries and include barangays, municipalities, cities, provinces, regions, and nations. Phenomenological Communities AKA Functional Communities ▪ Refer to relational, interactive groups, in which the place or setting is more abstract, and people share a group perspective or identity based on culture, values, history, interest, and goals. ❖ POPULATION Typically used to denote a group of people having common personal or environmental characteristics. ❖ AGGREGATES Subgroups or subpopulations that have some common characteristics or concerns. ❖ DETERMINANTS OF HEALTH 1. Income and Social Status Higher-income and social status are linked to better health. The greater the gap between the richest and poor health, the greater differences in health. 2. Education Low education levels are linked with poor health, more stress and lower self- confidence. 3. Physical Environment Safe water and clean air, healthy workplaces, safe houses communities and roads all contribute to good health. 4. Employment and Working Conditions People in employment are healthier, particularly those who have control over their working conditions. 5. Social Support Networks Greater support from families, friends and communities is linked to better health. 6. Culture Customs and traditions, and the beliefs of the family and community all affect health. 7. Genetics Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  Inheritance plays a part in determining lifespan, healthiness, and the likelihood of developing illnesses. 8. Personal Behavior and Coping Skills Balanced eating, keeping active, smoking, drinking and how we deal with life’s stresses and challenges all affect health. 9. Health Services Access and use of services that prevent and treat disease influences health. 10. Gender Men and women suffer from different types of diseases at different ages. ❖ INDICATORS OF HEALTH AND ILLNESS National Epidemiology Center of DOH, PSA, and Local Health Centers/Offices/ Departments ▪ Provide morbidity, mortality, and other health status related data. Local Health Centers/Offices/Departments ▪ responsible for collecting morbidity and mortality data and forwarding the information to the higher level of health, such as Provincial Health office. Nurses should participate in investigative efforts to determine what is precipitating the increased disease rate and work to remedy the identified threats or risks. ❖ DEFINITION AND FOCUS OF PUBLIC HEALTH AND COMMUNITY HEALTH DEFINITION OF PUBLIC HEALTH ACCORDING TO: ▪ C. E. WINSLOW “Public health is the science and art of: 1. preventing disease, 2. prolonging life, and 3. promoting health and efficiency through organized community effort for: i. sanitation of the environment, ii. control communicable infections, iii. education of the individual in personal hygiene, iv. organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and v. “development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.” (Hanlon) PUBLIC HEALTH ▪ Key Phrase Definition: “through organized community effort”. ▪ Connotes organized, legislated, and tax-supported efforts that serve all people through health departments or related governmental agencies. 9 ESSENTIAL PUBLIC HEALTH FUNCTIONS (ACCORDING TO WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC) 1. Health situation monitoring and analysis 2. Epidemiological surveillance/ disease prevention and control Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  3. Development of policies and planning in public health 4. Strategic management of health systems and services for population health gain 5. Regulation and enforcement to protect public health 6. Human resources development and planning in public health 7. Health promotion, social participation and empowerment 8. Ensuring the quality of personal and population-based health service 9. Research, development, and implementation of innovative public health solution COMMUNITY HEALTH o Extends the realm of public health to include organized health efforts at the community level through both government and private efforts HEALTH PROMOTION AND LEVELS OF PREVENTION o Health Promotion ▪ Activities enhance resources directed at improving well-being. o Disease Prevention ▪ Activities protect people from disease and effects of disease. LEAVELL AND CLARK’S THREE LEVELS OF PREVENTION 1. Primary Prevention - Relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. 2. Secondary Prevention - Early detection and prompt intervention during the period of early disease pathogenesis. - Implemented after a problem has begun but before signs and symptoms appear and targets populations who have risk factors (Keller). 3. Tertiary Prevention - Targets populations that have experienced disease or injury and focuses on limitations of disability and rehabilitation. - Aim: Reduce the effects of disease and injury and to restore individuals to their optimum level of functioning. DEFINITION OF COMMUNITY HEALTH NURSING ACCORDING TO: ▪ AMERICAN NURSES ASSOCIATION (1980) Global or umbrella term; broader and more general specialty area that encompasses subspecialties that include public health nursing, school nursing, occupational health nursing, and other developing fields of practice, such as home health, hospice care, and independent nurse practice “the synthesis of nursing practice and public health practice applied to promoting and preserving health of the populations.” (ANA, 1980) PUBLIC HEALTH NURSING o A component or subset of CHN o The synthesis of public health and nursing practice Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  PHN according to FREEMAN (1963): o Public Health Nursing may be defined as the field of professional practice in nursing and in public health in which technical nursing, interpersonal, analytical, and organizational skills are applied to problems of health as they affect the community. ▪ These skills are applied in concert with those of other persons engaged in health care, through comprehensive nursing care of families and other groups and through measures for evaluation or control of threats to health, for health education of the public and for the mobilization of the public for health action. PHN according to ANA (1996): o “The practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences” o “Population-focused, with the goals of the promoting health and preventing disease and disability for all people through the creation of conditions in which people can be healthy.” Community-Based Nursing o Application of the nursing process in caring for individuals, families and group where they live, work go to go school, or they move through the health care system o Setting-specific, and the emphasis is on acute and chronic care and includes practice areas such as home health nursing and nursing in outpatient or ambulatory setting. ❖ CHN VS. COMMUNITY-BASED NURSING CHN ▪ emphasizes preservation and protection of heath ▪ the primary client is the community Community-based Nursing ▪ Emphasizes on managing acute and chronic ▪ the primary clients are the individual and the family ❖ POPULATION-FOCUSED NURSING Concentrates on specific groups of people and focuses on health promotion and disease prevention, regardless of geographical location (Baldwin et al., 1998) Focused Practice: 1. Focuses on the entire population 2. Based on assessment of the populations’ health status 3. Considers the broad determinants of health 4. Emphasizes all levels of prevention 5. Intervenes with communities, systems, individuals and families Goal – promote healthy communities ❖ CHN PRACTICE REQUIRES THE FF. TYPES OF DATA FOR SCIENTIFIC APPROACH AND POPULATION: 1. The epidemiology or body of knowledge of a particular problem and its solution 2. Information about the community Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  TYPES OF INFORMATION SOURCES Demographic Vital Statistics; census Groups at High Risk Health statistics; disease statistics Services/Providers Available City directors, phone books, local/regional social workers, list of low income providers, CH nurse ❖ Family – Basic unit of care in CHN ❖ Individual – Focus in the clinic or health center ❖ THE INTERVENTION WHEEL Proposed in the late 1990s by nurses from the Minnesota Department of Health ▪ To describe the breadth and scope of public health nursing practice. ▪ Recognized as a framework for community and public health practice Consist of 17 health interventions are grouped into 5 wedges 3 Important Elements: ▪ It is population-based ▪ It contains 3 levels of practice (Community, Systems, and Individual/Family) ▪ It identifies and defines 12 public health interventions ▪ ❖ 17 PUBLIC HEALTH INTERVENTIONS AND DEFINITION (Keller et al., 2004) 1. Surveillance – Monitors health events 2. Disease and other Health Event Investigation – Systematically gathers and analyzes data regarding threats to the health of populations 3. Outreach – Locates populations of interests or populations at risk 4. Screening – Identifies individuals with unrecognized health risk factors 5. Case Finding – Identifies risk actors and connects them with resources 6. Referral and Follow-up – Assists individuals and families, families, groups, organizations ad communities to identify and access necessary resources 7. Case Management – Optimizes self-care capabilities of individuals and families Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  8. Delegated Functions – Direct care tasks that the nurse carries out 9. Health Teaching – Communicates facts, ideas and skills that change knowledge, attitudes values, behaviors, and practice 10. Counseling – Establishes an interpersonal relationship; with the intention of increasing or enhancing their capacity for self-care and coping 11. Consultation – Seeks information and generates optional solutions to perceived problems 12. Collaboration – Commits two or more persons or an organization 13. Coalition Building – Develops alliances among organizations 14. Community Organizing – Helps community groups to identify common problems or goals mobilizes resources and develop and implement strategies 15. Advocacy – Pleads someone’s cause or acts on someone’s behalf 16. Social Marketing – Utilizes commercial marketing principles for programs 17. Policy Development and Enforcement – Place issues on decision makers’ agendas, acquires plan of resolution ❖ EMERGING FIELDS OF CHN IN THE PHILIPPINES HOME HEALTH CARE o 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 o Homecare rendered to the terminally ill. Palliative care is particularly important ❖ ENTREPRENURSE o 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. o It aims to: 1. Reduce the cost of health care for the countries indigent population by bringing primary health care services to poor rural communities 2. Maximize employment opportunities for the countries unemployed nurses 3. Utilize the countries unemployed human resources for health for the delivery of public health services and the achievement of the country’s Millennium Development Goals (MDG) on maternal and child health, (DOLE, 2013) o Main Purpose of Entreprenurse – To deliver home health care services ❖ COMPETENCY STANDARDS IN CHN 1. Safe and Quality Nursing Care ▪ knowledge of health/illness status of the client, sound decision making; safety, comfort, privacy, administration of meds and health therapeutics and nursing process. 2. Management of Resources and Environment ▪ organization of workload; use of financial resurces for client care; mechanism to ensure proper functioning of equipment and maintenance of a safe environment Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  3. Health Education ▪ assessment of client’s learning needs; development of health education plan and learning materials and implementation and evaluation of health education plan 4. Legal Responsibility ▪ adherence to the nursing laws as well as to national, local and organizational policies including documentation of care given to clients. 5. Ethicomoral Responsibility ▪ respect for the rights of the client; responsibility and accountability for own decisions and actions; and adherence to the international and national codes of ethics for nurses 6. Personal and Professional Development ▪ identification of own learning needs, pursuit of continuing education; involvement in professional image; positive attitude towards change and criticism 7. Quality Improvement ▪ data gathering for quality improvement; participation in nursing rounds; identification and reporting of solutions to identifies problems related to client care. 8. Research ▪ research-based formulation of solutions to problems in client care and dissemination and application of research findings 9. Records Management ▪ accurate and updated documentation of client care while observing legal imperatives and record keeping 10. Communication ▪ uses therapeutic communication techniques, identifies verbal and nonverbal cues, responds to client needs, while using formal and informal channels of communication and appropriate information technology 11. Collaboration and Teamwork ▪ establishment of collaborative relationship with colleagues and other members of health team ❖ HISTORY OF PUBLIC HEALTH AND PUBLIC HEALTH NURSING IN THE PHILIPPINES 1577 o Franciscan FriarJuan Clemente opened medical dispensary in Intramuros for the indigent 1690 o Dominican Father Juan de Pergero worked toward installing a water system in San Juan del Monte and Manila 1805 o Smallpox vaccination was introduced by Francisco de Balmis , the personal physician of King Charles IV of Spain 1876 o First medicos titulares were appointed by the Spanish government Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020  1888 o 2-year courses consisting of fundamental medical and dental subjects was first offered in the University of Santo Tomas. Graduated were known as “cirujanos ministrantes” and serve as male nurses and sanitation inspectors 1901 o United States Philippines Commission, through Act 157, created the Board of Health of the Philippine Islands with a Commissioner of the Public Health, as its chief executive officer (now the Department of Health Fajardo Act of 1912 o Created sanitary divisions made up of one to four municipalities. Each sanitary division had a president who had to be a physician 1915 o The Philippine General hospital began to extend public health nursing services in the homes of patients by organizing a unit called Social and Home Care services Asociacion Feminista Filipina (1905) o Lagota de Leche was the first center dedicated to the service of the mothers and babies 1947 o The Department of Health was reorganized into bureaus: quarantine, hospitals that took charge of the municipal and charity clinics and health with the sanitary divisions under it. 1954 o Congress passed RA 1082 or the Rural Health Act that provided the creation of RHU in every municipality RA 1891 o Enacted in 1957 amended certain provisions in the Rural Health Act ▪ Created 8 categories of rural health units corresponding to the population size of the municipalities RA 7160 (Local Government Code) o Enacted in 1991, amended that devolution of basic health services including health services, to local government units and the establishment of a local health board in every province and city of municipality Millennium Development Goals o Adopted during the world summit in September 2000 FOURmula One (F1) for health, 2005 and Universal Health Care in 2010 agenda launched in 1999 Universal Health Care o Aims to achieve the health system goals of better health outcomes, sustained health financing, and responsive health system that will provide equitable access to health care Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020