Unit-1 PDF

Title of the Lesson: Definition of Terms (Lesson 1) For public health nurses to have a better understanding of how public health nursing came about in the Philippines, there are certain concepts and terms that must be understood and should serve as a point of reference in the foregoing...

Title of the Lesson: Definition of Terms (Lesson 1) For public health nurses to have a better understanding of how public health nursing came about in the Philippines, there are certain concepts and terms that must be understood and should serve as a point of reference in the foregoing terms to be discussed. Key concepts are: PUBLIC HEALTH- is a directed approach towards assisting every citizen to realize his birth rights and longevity. It is the science and art of preventing disease, prolonging life and efficiency through organized community effort for: The sanitation of the environment The control of communicable infections The education of the individual in personal hygiene The organization of medical and nursing services for the early diagnosis and preventive treatment of disease The development of a social machinery to ensure everyone a standard of living, adequate for maintenance of health to enable every citizen to realize his birth right of health and longevity (Dr. C.E Winslow,1982) COMMUNITY HEALTH- is a field of public health that focuses on studying, protecting, or improving health within a community. It does not focus on a group of people with the same shared characteristics, like age or diagnosis, but on all people within a geographical location or involved in specific activity. PUBLIC HEALTH NURSING- is a systematic process by which the health and health care needs of a population are assessed in order to identify subpopulations, families and individuals who would benefit from health promotion or who are at risk of illness, injury, disability or premature death. COMMUNITY HEALTH NURSING- is a synthesis of nursing and public health practice applied to promote and protect the health of the population. It combines all the basic elements of professional, clinical nursing with public health and community practice. PRIMARY HEALTH CARE- is a essential care based on practical, scientifically- sound and socially-acceptable methods and technology made universally accessible to all individuals and families in the community through their full participation and at a cost that the community can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. POPULATION GROUP- is a discrete assemblage of people with identifiable characteristics with the objective of analysis and data collection. Title of the Lesson: Philosophy and Principles (Lesson 2) The individuals in the community can be assessed by asking very basic questions about the nature of human thought, the nature of the living, and the connections between them. As a community health care provider, they will be guided by important philosophies and principles of the community health practice which includes: PHILOSOPHY OF CHN “The philosophy of CHN is based on the worth and dignity of men.” (Dr. M. Shetland as cited by Castro, 2012) This philosophy is based on the belief that care focused first to the individual, the family, and the group contributes to the health care of the people in the community. PRINCIPLES OF CHN In the Community Health Nursing: The community is the client, 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. The client is considered as an ACTIVE partner NOT PASSIVE recipient of care. The practices are affected by developments in health technology, in particular, changes in society, in general. It respects the values, customs and beliefs of the clients that contribute to the effectiveness of care to the client and services must be available, sustainable and affordable to all regardless of race, creed, color or socio-economic status. It integrates health education and counseling as vital parts of functions. These encourage and support community efforts in the discussion of issues to improve the people’s health. There is a collaborative work relationship with the co-workers and members of the health team facilitating accomplishments of goals. Each member is helped to see how his/her work benefits the whole enterprise. There is a periodic and continuing evaluation that provides the means for assessing the degree to which the CHN goals and objectives are being  attained. Clients are involved in the appraisal of their health program through consultations, observations and accurate recording. There is a utilization of indigenous and existing community resources to maximize the success of the efforts of the Community Health Nurses by the use of local available ailments. Linkages with existing community resources, both public and private, increase the awareness of what care they need and what they are entitled. There is an active participation of the individual, family and community in planning and making decisions for their health care needs, determining, to a large extent, the success of the CHN programs. Organized community groups are encouraged to participate in the activities that will meet community needs and interests. There is an accurate recording and reporting that serves as the 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 the community as these are utilized in studies and researches and as legal documents Title of the Lesson: Features of CHN (Lesson 3) Features of Community Health Nursing includes: CLINIC VISIT- is where the clients visit the Health Clinic to avail all the services there to be offered by the facility primarily for consultation of matters that bothers them physically. But in changing times, close interaction between health care providers and patients has been intensified with other health programs prior to actual nurse-patient contact such as enhanced health education and promotion on health care of the family in totality. BLOOD PRESSURE MEASUREMENT- is the measuring and the monitoring of blood pressure. It is one of the most used features of CHN practice because it compasses the early detection of hypertension and other physiologic problems. HOME VISIT- is a family nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities to meet the needs of the client and achieve the best results of desired outcomes. BAG TECHNIQUE- is a tool which the nurse, during her visit, will enable his/her to perform a nursing procedure with ease and deftness, to save time and effort, with the end view of rendering effective nurse care to clients. NURSING CARE IN THE HOME- is giving to the individual client the nursing required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself, or die peaceful in dignity. COMMUNITY ORGANIZING- is the study that have undergone some key elements of the community which may be reactivated to bring social and behavioral change which includes social organizations (relationships, structures, resources), ideology (knowledge, beliefs and attitudes) and change agents through empowerment or building the capacity of people for future community action. HEALTH PROMOTION AND EDUCATION- is the result of the changing patterns of health and corresponding emphasis on lifestyle through education as a factor. The behavioral change that health is able to effect can only be maintained if supportive environments were provided through the effort of other sectors- political, economic, social, biomedical etc. EPIDEMIOLOGY- is a study of occurrences and distribution of disease as well as the distribution and determinants of health states or events in specified population, and the application of the study to control of health problems and emphasizes not only with deaths, illness and disability, but also with more positive health states and with means to improve health.  SURVEILLANCE- is the continuous collection and analysis of data of cases and death and monitoring the progress of the disease reduction initiatives which encompasses as the anchor of other features of CHN. VITAL STATISTICS- is the systematic study of vital events such as births and illnesses, and deaths. Statistics of the disease (morbidity) and death (mortality) indicate the state of health of a community and the success of failure of health work. FIELD HEALTH SERVICES AND INFORMATION SYSTEM (FHSIS) - is the summary of data on health services delivery and selected program accomplished indicators at the barangay, municipality, districts, provincial, regional and national levels and the standard facility level data based for a more indepth studies. Title of the Lesson: Theoretical Models/ Approaches (Lesson 4) Theoretical models in the community health practice describes a type of object or system by attributing to it what might be called an inner structure, composition, or mechanism, reference to which will explain various properties that can contribute to health of the persons in the community. Theoretical models include: 1. HEALTH BELIEF MODEL (HBM) - is a social psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. Mental processes are severe constituents of cognitive theories that are seen as expectancy value models, because they propose that behavior is a function of the degree to which people value a result and their evaluation of the expectation, that a certain action will lead that result and in terms of the health-related behaviors, the value is avoiding sickness. The expectation is that a certain health action could prevent the condition for which people consider they might be at risk. KEY TERMS on in the HEALTH BELIEF MODELS includes: a. DEMOGRAPHIC VARIABLES AND PSYCHOSOCIAL CHARACTERISTICS- are individual characteristics, including demographic (class, gender, age), psychosocial (personality, peer group pressure), and structural variables, can affect perceptions (i.e., perceived seriousness, susceptibility, benefits, and barriers) of health-related behaviors.  b. PERCEIVED SUSCEPTIBILITY- refers to subjective assessment of risk of developing a health problem in which it predicts that individuals who perceive that they are susceptible to a particular health problem will engage in behaviors to reduce their risk of developing the health problem. c. PERCEIVED SEVERITY- refers to the subjective assessment of the severity of a health problem and its potential consequences that individuals who perceive a given health problem as serious are more likely to engage in behaviors to prevent the health problem from occurring (or reduce its severity). d. PERCEIVED BENEFITS- refers to an individual's assessment of the value or efficacy of engaging in a health-promoting behavior to decrease risk of disease in which an individual believes that a particular action will reduce susceptibility to a health problem or decrease its seriousness, then he or she is likely to engage in that behavior regardless of objective facts regarding the effectiveness of the action. e. PERCEIVED BARRIERS- refers to an individual's assessment of the obstacles to behavior change in which even if an individual perceives a health condition as threatening and believes that a particular action will effectively reduce the threat, barriers may prevent engagement in the health-promoting behavior. In other words, the perceived benefits must outweigh the perceived barriers in order for behavior change to occur. APPLICATION: The HBM has been used to develop effective interventions to change health- related behaviors by targeting various aspects of the model's key constructs. Interventions based on the HBM may aim to increase perceived susceptibility to and perceived seriousness of a health condition by providing education about prevalence and incidence of disease, individualized estimates of risk, and information about the consequences of disease (e.g., medical, financial, and social consequences). Interventions may also aim to alter the cost-benefit analysis of engaging in a health- promoting behavior (i.e., increasing perceived benefits and decreasing perceived barriers) by providing information about the efficacy of various behaviors to reduce risk of disease, identifying common perceived barriers, providing incentives to engage in health-promoting behaviors, and engaging social support or other resources to encourage health-promoting behaviors. Furthermore, interventions based on the HBM may provide cues to action to remind and encourage individuals to engage in health- promoting behaviors. Interventions may also aim to boost self-efficacy by providing training in specific health-promoting behaviors, particularly for complex lifestyle changes (e.g., changing diet or physical activity, adhering to a complicated medication regimen). Interventions can be aimed at the individual level (i.e., working one-on-one with individuals to increase engagement in health-related behaviors) or the societal level (e.g., through legislation, changes to the physical environment). 2. MILIO'S FRAMEWORK FOR PREVENTION- is the assertion that health deficits occur when there is an imbalance between the community's health needs, and its health-sustaining resources with basic treatise that behavioral patterns of the population and individuals are develop through the selection of choices and to examine the determinants of a community health and to influence perception through degrees of prevention. PRIMORDIAL→ PRIMARY→ SECONDARY→ TERTIARY PREVENTION PREVENTION PREVENTION PREVENTION KEY TERMS in the Milio's Framework for Prevention includes: a. PRIMORDIAL PREVENTION- aims to prevent the emergence or development of risk factors that have not yet appeared with efforts towards discouraging children from adopting harmful lifestyles. Examples are:  Improving sanitation (so that exposure to infectious agents does not occur).  Establishing healthy communities.  Promoting a healthy lifestyle in childhood (for example, through prenatal nutrition programs and supporting early childhood development programs such as smoking cessation. b. PRIMARY PREVENTION- aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Examples are:  Legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets).  Education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking).  Immunization against infectious diseases. c. SECONDARY PREVENTION- aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems. Examples are:   regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer).  daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes.  suitably modified work so injured or ill workers can return safely to their jobs. d. TERTIARY PREVENTION- aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples are:  cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.)  support groups that allow members to share strategies for living well  vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible. APPLICATION: Prevention, as it relates to health, is really about avoiding disease before it starts. It has been defined as the plans for, and the measures taken, to prevent the onset of a disease or other health problem before the occurrence of the undesirable health event and with the three distinct levels of prevention, the client will be able to properly address his/her deficit through proper selection of level of prevention.  3. NOLA PENDER'S HEALTH PROMOTION- is the theory that believes in health as a positive dynamic state rather than simply the absence of disease. Health promotion is directed at increasing a patient’s level of well-being through describing the multidimensional nature of persons as they interact within their environment to pursue health. KEY TERMS in the NOLA PENDER'S HEALTH PROMOTION includes: a. INDIVIDUAL CHARACTERISTICS AND EXPERIENCES- is the prior related behavior and personal factors (biological, psychological, sociocultural). b. BEHAVIOR-SPECIFIC COGNITION AND AFFECT- perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences (family, peers, providers), situational influences (options, demand characteristics, aesthetics), commitment to a plan of action, and immediate competing demands and preferences. c. BEHAVIORAL OUTCOMES- health promoting behaviors including the desired behavioral end point or outcome of health decision-making and preparation for action. APPLICATION: The theory behind the HPM is that you have personal experiences that affect your actions. There are three main focuses of the HPM: individual experiences, behavior-specific knowledge and affect, and behavioral outcomes. The factors that are associated with the HPM are mainly an individual's lifestyle, outlook, psychological health, social and cultural traits, as well as biological factors. Health-promoting behavior is the ideal behavioral outcome, making it the end point in the HPM.  4. LAWRENCE GREEN'S PRECEDE- PROCEED MODEL (PRECEDE= PREDISPOSING, REINFORCING, ENABLING CONSTRUCTS IN EDUCATIONAL DIAGNOSIS AND EVALUATION) (PROCEED=POLICY, REGULATORY AND ORGANIZATIONAL CONSTRUCTS IN EDUCATIONAL AND ENVIRONMENTAL DEVELOPMENT)- is the theory that provides a comprehensive structure for assessing health and quality of life needs, and for designing, implementing and evaluating health promotion and other public health programs to meet those needs with the purpose and guiding principle to direct initial attention to outcomes, rather than inputs. It guides planners through a process that starts with desired outcomes and then works backwards in the causal chain to identify a mix of strategies for achieving those objectives. KEY TERMS in the PRECEDE- PROCEED MODEL includes: a. PRECEDE (PREDISPOSING, REINFORCING, ENABLING CONSTRUCTS IN EDUCATIONAL DIAGNOSIS AND EVALUATION)- is based on the premise that, just as a medical diagnosis precedes a treatment plan, an educational diagnosis of the problem is very essential before developing and implementing the intervention plan. b. PROCEDE (POLICY, REGULATORY AND ORGANIZATIONAL CONSTRUCTS IN EDUCATIONAL AND ENVIRONMENTAL DEVELOPMENT) - is the growing recognition of the expansion of health education to encompass policy, regulatory and related ecological/environmental factors, in determining health and health behaviors. PLANNING PHASES The PRECEDE–PROCEED planning model consists of four planning phases, one implementation phase, and 3 evaluation phases PRECEDE phases PROCEED phases Phase 1 – Social Diagnosis Phase 5 – Implementation Phase 2 – Epidemiological, Behavioral & Environmental Phase 6 – Process Diagnosis Evaluation Phase 3 – Educational & Ecological Diagnosis Phase 7 – Impact Evaluation Phase 4 – Administrative & Policy Diagnosis Phase 8 – Outcome Evaluation PHASE 1 – SOCIAL DIAGNOSIS The first stage in the program planning phase deals with identifying and evaluating the social problems that affect the quality of life of a population of interest. Social assessment is the application, through broad participation, of multiple sources of information, both objective and subjective, designed to expand the mutual understanding of people regarding their aspirations for the common good. During this stage, the program planners try to gain an understanding of the social problems that affect the quality of life of the community and its members, their strengths, weaknesses, and resources; and their readiness to change. This is done through various activities such as developing a planning committee, holding community forums, and conducting focus groups, surveys, and/or interviews. These activities will engage the beneficiaries in the planning process and planners will be able to see the issues just as the community sees them. PHASE 2 – EPIDEMIOLOGICAL, BEHAVIORAL, AND ENVIRONMENTAL DIAGNOSIS EPIDEMIOLOGICAL DIAGNOSIS- deals with determining and focusing on specific health issue(s) of the community, and the behavioral and environmental factors related to prioritized health needs of the community. Based on these priorities, achievable program goals and objectives for the program being developed are established. Epidemiological assessment may include secondary data analysis or original data collection — examples of epidemiological data include vital statistics, state and national health surveys, medical and administrative records, etc. Genetic factors, although not directly changeable through a health promotion program, are becoming increasingly important in understanding health problems and counseling people with genetic risks, or may be useful in identifying high-risk groups for intervention. BEHAVIORAL DIAGNOSIS- is the analysis of behavioral links to the goals or problems that are identified in the social or epidemiological diagnosis. The behavioral ascertainment of a health issue is understood, firstly, through those behaviors that exemplify the severity of the disease (e.g. tobacco use among teenagers); secondly, through the behavior of the individuals who directly affect the individual at risk (e.g. parents of teenagers who keep cigarettes at home); and thirdly, through the actions of the decision-makers that affects the environment of the individuals at risk (e.g. law enforcement actions that restrict teens' access to cigarettes). Once behavioral diagnosis is completed for each health problem identified, the planner is able to develop more specific and effective interventions. ENVIRONMENTAL DIAGNOSIS- is a parallel analysis of social and physical environmental factors other than specific actions that could be linked to behaviors. In this assessment, environmental factors beyond the control of the individual are modified to influence the health outcome. For example, poor nutritional status among children may be due to the availability of unhealthful foods in school. This may require not only educational interventions, but also additional strategies such as influencing the behaviors of a school's food service managers. PHASE 3– EDUCATIONAL AND ECOLOGICAL DIAGNOSIS Once the behavioral and environmental factors are identified and interventions selected, planners can start to work on selecting factors that, if modified, will most likely result in behavior change, as well as sustain it. These factors are classified as: 1. PREDISPOSING FACTORS- are any characteristics of a person or population that motivate behavior prior to or during the occurrence of that behavior. They include an individual's knowledge, beliefs, values, and attitudes. 2. ENABLING FACTORS- are those characteristics of the environment that facilitate action and any skill or resource required to attain specific behavior. They include programs, services, availability and accessibility of resources, or new skills required to enable behavior change. 3. REINFORCING FACTORS- are rewards or punishments following or anticipated as a consequence of a behavior. They serve to strengthen the motivation for a behavior. Some of the reinforcing factors include social support, peer support, etc. PHASE 4 – ADMINISTRATIVE AND POLICY DIAGNOSIS This phase focuses on the administrative and organizational concerns that must be addressed prior to program implementation. This includes assessment of resources, development and allocation of budgets, looking at organizational barriers, and coordination of the program with other departments, including external organizations and the community. ADMINISTRATIVE DIAGNOSIS- is the assessment of policies, resources, circumstances and prevailing organizational situations that could hinder or facilitate the development of the health program. POLICY DIAGNOSIS- is the assessment of the compatibility of program goals and objectives with those of the organization and its administration. This evaluates whether program goals fit into the mission statements, rules and regulations that are needed for the implementation and sustainability of the program. PHASE 5 – IMPLEMENTATION OF THE PROGRAM PHASE 6 – PROCESS EVALUATION This phase is used to evaluate the process by which the program is being implemented. This phase determines whether the program is being implemented according to the protocol, and determines whether the objectives of the program are being met. It also helps identify modifications that may be needed to improve the program. PHASE 7 – IMPACT EVALUATION This phase measures the effectiveness of the program with regards to the intermediate objectives as well as the changes in predisposing, enabling, and reinforcing factors. Often this phase is used to evaluate the performance of educators. PHASE 8– OUTCOME EVALUATION This phase measures change in terms of overall objectives as well as changes in health and social benefits or quality of life. That is, it determines the effect of the program in the health and quality of life of the community. Title of the Lesson: Different Fields of Nursing (Lesson 5) Nurses are in every community – large and small – providing expert care from birth to the end of life. Nurses' roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems. Specific fields of nursing present in the community includes: 1. SCHOOL HEALTH NURSING- is a type of public health nursing that focuses on the promotion of health wellness of the pupils/students, teaching and non-teaching personnel of the schools by assisting young people in making choices for a healthy lifestyle, reduce risk taking behavior and focus on issues such as prevention of drug and substance abuse, teenage pregnancy, sexually transmitted infection, malnutrition, and communicable and noncommunicable diseases. FUNCTIONS OF A SCHOOL HEALTH NURSE A. Conducting School Health and Nutrition Survey for the assessment of the current nutritional status of school children, situation in health facilities as well as the actual health status of health education activities undertaken by teachers and school personnel. B. Putting a Functional Clinic for the treatment of minor ailments and attendance to emergency cases. C. Conducting Health Assessment that aims to discover the signs of illness and physical defects in order to correct them, check on the health habits of pupils and to prevent the progress of those who cannot be corrected. D. Provide screening role on Standard Vision Testing for School Children in helping with visual appraisal and continuous observation for satisfactory evaluation of students visual health status. E. Provide screening role in detection of Ear Examination in helping attain effective treatment and rehabilitation. F. Facilitating on Height and Weight Measurement and Nutritional Status Determination to oversee the nutritional status of school children. G. Recommendations on Medical Referrals if the existing condition of students need further assessment and intervention. H. Attendance to Emergency Cases that need further treatment and management. I. Providing Student Health Counselling when presenting signs and symptoms of physical or emotional problems. J. Acts as a resource person on any Health and Nutrition Education Activities. K. Organization of School-Community Health and Nutrition Councils to address the school community health related problems and concerns  L. Assists in Communicable Disease Control upon recognition of contagious and infectious disease. M. Establishment of Data Bank on School Health and Nutrition Activities to provide accurate and up to date health records. N. Facilitating School Plant Inspection for Health Environment to provide a healthful environment and safety in schools. O. Conducting Rapid Classroom Inspection for routine checking of students’ health needs. P. Conducting Home Visitation as necessary as follow-up care for students. 2. OCCUPATIONAL HEALTH NURSING- is a type of public health nursing that focuses in the health of the people in the workplace specifically on the work setting that many individuals spend a quarter to almost a third of their working lives in which each person faces certain conditions and develop certain patterns on the job that affect their health. FUNCTIONS OF AN OCCUPATIONAL HEALTH NURSE A. Lead the Sanitary and Industrial Hygiene of all Industrial establishments including hospitals to determine their compliance with the sanitation codes’ implementing rules and regulations B. Recommends to Local Health Authority the issuance of license/business permits and suspensions or revocation of the same for any violation of the condition upon which said licenses or permits has been issued, pursuant to existing rules and regulations. C. Coordinates with other government agencies relative to the implementation of the implementing rules and regulations D. Attends to complaints of all establishments in the area of assignment related to industrial hygiene and recommends appropriate measures for immediate compliance E. Participate to provide, install and maintains in good condition all control facilities and protective barriers for potential and actual hazards F. Informs all affected workers regarding the nature of hazards and the reasons for control measures and protective equipment G. Informs all affected workers regarding the nature of hazards and the reasons for the control measures and protective equipment H. Makes a periodic testing for physical examination of the workers and other health examinations related to worker’s exposure to potential or actual hazards in the workplace I. Provides control measures to reduce noise, dust, health and other hazards. J. Ensure strict compliance on the regular use and proper maintenance of Personal Protective Equipment (PPE) K. Provide employees/workers an occupational health services and facilities  L. Refers or elevates to higher authority all unsolved issues in relation to occupational and environmental health problems M. Prepare and submit yearly reports to the Local and National Government 3. COMMUNITY MENTAL HEALTH NURSING- is a type of public health nursing that focuses on the application of specialized knowledge to populations and communities to promote and maintain mental health, and to rehabilitate populations at risk that continue to have residual effects on mental illness. FUNCTIONS OF AN COMMUNITY MENTAL HEALTH NURSE A. Establish long term therapeutic relationship to the client through home visit. B. Develop comprehensive plan of care for client and support system with attention to sociocultural needs including setting of boundaries. C. Encourage compliance with medication regimen. D. Teach and support adequate nutrition and self-care with referrals as needed. E. Assist client in self-assessment with referrals for health needs in community as needed. F. Use creative strategies to refer client to positive social activities G. Communicate regularly with family/support system to assess and improve level of functioning.