Overview Of Community Health Nursing PDF

# Overview Of Community Health Nursing ## Introduction Communities are an essential and permanent feature of the human experience. The communities we live in and work have a profound degree of influence on our collective health and well-being. Just as a whole is greater than the sum of its parts,...

# Overview Of Community Health Nursing ## Introduction Communities are an essential and permanent feature of the human experience. The communities we live in and work have a profound degree of influence on our collective health and well-being. Just as a whole is greater than the sum of its parts, the health of a community is more than the sum of the health of its individual citizens. Community health, as a field of practice, seeks to provide organizational structure, a broad set of resources, and the collaborative activities needed to accomplish the goal of an optimally healthy community. In acute care, the health of an individual is the primary focus. Community health broadens that focus to concentrate on families, populations, and the community at large. ## Four Stages Mark the Development of Community Health Nursing ### 1. Early Home Care Nursing (Before mid-1800s) * For many centuries, the sick were tended at home by female family members and friends. The focus of this care was to reduce suffering and promote healing. * In 1634, the ladies and sisters under supervision promoted the goal of teaching people to help themselves as they visited the sick in their homes. * From the late 1600s to the mid-1800s, babies continued to be delivered at home by midwives, most of whom had little or no training. * Concern over high maternal mortality rates led to one midwifery program being begun in Paris in 1720 and another in London in 1741. * Much of the foundation for modern community health nursing practice was laid through Florence Nightingale. Her work further demonstrated that capable nursing intervention could prevent illness and improve the health of a population at risk, which included a continuing interest in the population of the sick at home. ### 2. District Nursing (mid-1800s to 1900) * The next stage in the development of community health nursing was the formal organization of visiting nursing or district nursing. * The work of district nurses focused on visiting the sick poor in their homes and teaching them proper hygiene to prevent illness. * District nurses recorded temperatures, pulse rates, and gave simple treatments to the sick poor under the immediate direction of a physician. * They also instructed family members in personal hygiene, diet, healthful living habits, and the care of the sick. ### 3. Public Health Nursing (1900 to 1970) * The public health nursing stage was characterized by services to the public with the family targeted as a primary unit of care. * Official health agencies, which placed greater emphasis on disease prevention and health promotion, provided the chief institutional base. ### 4. Community Health Nursing (1970 to the Present) * Community Health Nursing provides direct care to individuals, families, and groups in the community for Health promotion and disease prevention. * Many agencies provide CHNg practice e.g Hospital-based programs reaching to the community, private agencies, and school nurses, and health educators provide Home visits. ## Definitions * **Health:** * A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. * **Community:** * 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. * **Public Health** * Is the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts. * **Community Health:** * It refers to the health status of the members of the community, to the problems affecting their health, and to the totality of the health care provided for the community. * **Community Health Nursing:** * Is a synthesis of Nursing practice and public Health applied to promote and preserve health of population. ## Aims Of Community Health Nursing 1. Promote health and efficiency. 2. Prevention and control diseases and disabilities. 3. Identify need-based health care to prolong life. ## Objectives of Community Health Nursing * Provide antenatal, intranatal, and postnatal care to ensure safe pregnancy and delivery. * Immunization. * Provide under five years children care. * Health education. * Improve the ability of the community to deal with their own health problems. * Strengthen the community resources. * Prevent and control communicable and non-communicable diseases. * Provide specialized services. * Conduct research. ## Principles of Community Health Nursing * It should be planned based on the needs of the community. * It is based on identified needs and functions. * Integration of Health education, guidance, and supervision with community health nursing services. * Health services should be realistic in terms of available resources. * Community is the focus which is the unit of health care services. * Professional relationship with etiquette and dignity. * Community participation is the integral part of the community health services. * Individual and family members participation in decision making. * Health services must be continuous. * Proper records and reports are essential. * Proper evaluation of health services. * Health services must be available to all without any difference. ## Factors influencing on community health nursing's development ### 1. Advanced Technology * Advanced technology has contributed in many ways to shape the practice of CHNg. E.g., technologic innovation has greatly improved health care, nutrition, & lifestyle. ### 2. Progress in Casual Thinking * Causal thinking relates disease, or illness, to its cause. Progress in the study of causality, particularly in epidemiology, has significantly affected the nature of CHNg. E.g., the germ theory of disease causation, was the first real break-through in control of communicable disease. ### 3. Changes in Education * Changes in nursing education have had an important influence on community health nursing practice. The wealth of information relevant to CHNg practice means that nursing students have more content to participate in CHNg. For the learner, education has led to more responsibility. ### 4. Changing Role of Women * Changing roles of women have profoundly affected CHNg. The women's rights movement made considerable progress. Women achieved the right to vote and gained a greater economic independence by moving into to labor force. Women's movement has contributed to CHNg's gains in assuming leadership roles. ### 5. Consumer Movement and Changing Demographics * Consumers become more aggressive in demanding quality services and goals, and they need to participate in decisions that affect them. Changing demographics, such as immigration, number of births, or deaths affect CHNg planning and programming. ### 6. Economic Forces * Economics have affected community health nursing practice. E.g., unemployment, the rising costs of living, and health care costs. ## Characteristics of CHNg ### 1. It is a Specialty Field of Nursing * The two characteristics of any specialized nursing practice are: * specialized knowledge and skills * focus on a particular set of people * These two characteristics are true for community health nursing. ### 2. Combines Public Health with Nursing * Community health nursing is grounded in both public health science and in nursing science, which makes the nature of its practice unique. ### 3. Population Focused * CHNg has an essential feature that is population focused, which also means that it is concerned with the health study of population groups and their environment. ### 4. Emphasizes Prevention, Health Promotion, & Wellness * This includes services for *mother*, *infant*, and *school programs*. ### 5. Promotes Client Responsibility and Self-Care * CHNg can encourage individuals participation rather than permitting a dependency. ### 6. Uses Aggregate Measurements and Analysis * The need to examine data after collection for the entire population under study before making intervention decisions is fundamental to CHNg. E.g. analysis of health state and environmental factors ### 7. Uses Principles of Organizational Theory * The community health nurses carefully assess group and community needs, establish priorities, and plan, implement, and evaluate services. They use the organizational principles. ### 8. Involves Inter-Professional Collaboration * Community health nurses plan and work with a team of professionals, including physicians, social workers, physical therapists, and teachers. ## Function of Community Health Nursing * Community health nurses work as partners within a team of professionals in public health and other disciplines to improve the *health of populations*. The various roles and settings for practice include three primary fuctions of *public health*: ### 1. Assessment * Refers to measuring and monitoring the health status and needs of a designated community or population. * It is a continuous process of collecting data and information about *health, diseases, injuries, air and water quality, food safety, and available resouces*. ### 2. Policy Development * This is the formation of a guide for action which determines present and future decisions affecting the public's health. * It builds on data from the assessment function. * It provides leadership and administration for the development of health *policy and planning.* ### 3. Assurance * Is the process of translating established policies into services. * This function ensures that population-based services are provided, whether by public health agencies or private sources. * It also monitors the quality of and access to those services. ## Components of Community Health Practices * **Community Health Practices:** * It is part of the larger *public health effort* that is concerned with preserving and promoting the health of specific populations and communities. * Community health practice incorporates six basic elements: ### 1. Promotion of Health * This includes all efforts that seek to move people closer to optimal well-being or a higher level of wellness. * It is the combination of educational and *environmental supports* for action and conditions of living conducive to health. ### 2. Prevention of Health Problems * This means anticipating or discovering problems as early as possible to minimize possible *disability and impairment*, through the three levels of prevention: - **Primary Prevention** * Measures taken to keep illness or injuries from occurring, ex. local health departments help control and prevent communicable disease by providing regular *immunization programs*. - **Secondary Prevention** * This involves efforts to detect and treat existing health problems. * It attempts to discover a health problem at a point when intervention may lead to its control or eradication . - **Tertiary Prevention** * This attempts to reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function. ### 3. Treatment of Disorders * This focuses on the illness end of a continuum and is the remedial aspects of community health practice. * It is practiced by: - **Direct service to people with health problems** : E.g., home visits for elderly peoples, chronic illnesses, etc. - **Indirect Service**: E.g. assisting people with health problems to obtain treatment and referral. - **Development of programs to correct unhealthy conditions**: E.g., alcoholism, drug abuse, etc. - **Rehabilitation** * In community health, the need to *reduce disability and restore function* applies equally to *families, groups, individuals, and the community.* ### 4. Evaluation * This is the process by which the practice is analyzed, judged according to established goals and standards. ### 5. Research * A systemic investigation to discover facts affecting community health and Community health practice, solve problems, and explore improved methods of health services. ## Settings (Scopes of CHNg) * The types of places in which community health nurses practice are increasingly varied, including a growing number of non-traditional settings and partnerships with non-health groups. These settings are grouped into six categories: 1. Homes 2. Schools 3. Ambulatory service settings, example MCH, family planning centers. 4. Occupational health settings. 5. Residential institutions example, camping for poliomyelitis, hospices care 6. The community at large. ## Roles of Community Health Nurses * Community health nurses assume a variety of roles while conducting practice, These roles are: ### 1. Clinician Role * The most familiar Community health nurse role is that of the *clinician or provider of care*. * The *clinician role* in community health means that the nurse ensures health services are provided, not just to individuals and families but also to groups and populations. * The clinician role emphasizes *holism, health promotion, and skill expansion.* * **Holistic Practice:** * A *holistic approach* means considering the broad range of interacting needs that affect the collective health of the client as a larger system. E.g., considering relationships, age, education, developmental needs, peer influence, environment. * **Focus on Wellness** * Community health nursing identifies people who are interested in achieving a higher level of health and work with them to accomplish that goal. They also identify groups and populations that may be vulnerable to certain health threats and design preventative and promotive Health programs. * **Expanded Skills** * The community health nurse uses different skills, E.g., *physical care skills, observation, listening, communication, and counseling*, There are also other stronger skills as *collaborative skills, use of epidemiology and biostatistics, community organization, research program evaluation*. ### 2. Educator Role * It is widely recognized that *health teaching* is a part of good nursing practice and one of the major functions of a community health nurse. * The educator role is especially useful in promoting the public's health, for at least two reasons: 1. It has the potential for finding *greater receptivity* and providing *higher yield results*. 2. It is significant because a *wider audience* can be reached. * The emphasis throughout the health teaching process continues to be placed on illness *prevention and health promotion.* ### 3. Advocate Role * The issue of *clients' rights* is important in health care today. * Every patient or client has the right to receive just, *equal, and humane* treatment. * However, our present health care system is often characterized by *fragmented and depersonalized* services. * The Community health nurse often must act as *advocate for clients* pleading the cause, or acting on behalf of the client group. There are times when health care clients need someone to explain what services to expect and which services they ought to receive.