Community Health Nursing

COMMUNITY HEALTH NURSING FOCUS: Promotion and Preservation of the health of populations NATURE OF PRACTICE: comprehensive, general, continual and not episodic KNOWLEDGE BASE: from nursing and public health LEVELS OF CLIENTELE: individuals, family, population groups and community as a whole COMMUNITY - A group of people sharing common geographic boundaries and common values and interests. HEALTH- state of complete physical, mental and social well-being, not merely the absence of disease or infirmity WORLD HEALTH ORGANIZATION - Optimum level of individuals, families and communities MODERN CONCEPT OF HEALTH - This factor pertains to the power and authority to regulate the environment

FACTORS AFFECTING LEVEL OF FUNCTIONING POLITICAL - This factor pertains to the power and authority to regulate the environment Examples:  Safety  Oppression  People empowerment HEALTH CARE DELIVERY SYSTEM One component of this factor is the primary health care which is a partnership approach Goal: Effective provision of health services that are community-based and accessible Components:  Promotive  Preventive  Curative  Rehabilitative BEHAVIORAL Components  Culture  Habits  Ethnic customs Examples  Smoking

 Intake of alcoholic drinks  Substance abuse  Lack of exercise SOCIOECONOMIC INFLUENCES Components  Employment  Education  Housing ENVIRONMENTAL INFLUENCES Components  Air  Food  Water waste  Urban/rural noise  Radiation  Pollution HEREDITY Components  Genetic endowment  Defects  Strengths  Risks:  Familial  Ethnic  Racial

PUBLIC HEALTH NURSING

Public health as the science and art of preventing disease, prolonging life and efficiency to enable every citizen to realize his birthright of health and longevity ( Winslow) Public health is dedicated to the common attainment of the highest level of physical, mental and social well-being and longevity GOAL: contribute to the most effective total development and life of the individual and his society. (Hanlon) ______________________________________________________________

Community health nursing is a learned practice discipline Ultimate Goal : contribute to the promotion of client’s optimum level of functioning Through teaching and delivery of care. (Jacobson) Community health nursing is a service rendered by a professional nurse with the community, groups, families and individuals GOAL: promotion of health, prevention of illness, care of the sick at home and rehabilitation (Freeman) Philosophy of community health nursing is based on the worth and dignity of man. (Shetland)

CONCEPTS OF COMMUNITY HEALTH NURSING  HEALTH PROMOTION – primary focus of community health nursing practice  Practice is extended to benefit not only the individual but the whole family and community  Community health nurses are GENERALISTS

PRINCIPLES OF COMMUNITY HEALTH NURSING  Community health nursing is based on recognized needs of communities, families, groups and individuals  The community health nurse must understand fully the objectives and policies of the agency she represents  FAMILY – unit of service  Community health nursing must be available to all  HEALTH TEACHING – primary responsibility of the community health nurse  The community health nurse works as a member of the health team  There must be periodic evaluation  Opportunities for continuing staff education program must be provided  PRINCIPLES OF COMMUNITY HEALTH NURSING  Make use of available community health resources  Utilize existing active groups in the community  Educative supervision  Accurate recording and reporting ULTIMATE GOAL: Raise the level of health of the citizenry

ROLES OF THE NURSE IN COMMUNITY HEALTH NURSING

Clinician – focus on the health of the individuals on the larger context of the community Advocate – promote self-care and self-determination Collaborator – brings together strengths and weaknesses of people involved toward a common goal Researcher – utilizes data to predict future phenomenon and modify interventions Counselor – key tasks include listening and providing feedback and information Case Manager – oversees all aspects of care to facilitate delivery of cost-efficient care; to individualize and coordinate care Educator – provide knowledge, skills and attitudes that people need to make appropriate choices or decision Hospice Care – providing care skills in a home and other settings and balancing client’s needs

THE NURSING PROCESS

ASSESSMENT - Process of collecting and processing data/information about the client STEPS:

 Initiate contact  Demonstrate caring attitudes  Develop mutual trust and confidence

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 Collect data from all possible sources  Identify problems  Analyze and interpret data

PL PLANNING - formulation of steps to be undertaken to achieve desired end STEPS:  Prioritize needs  Establish goals based on needs and capabilities  Construct action and operation plan  Devise evaluation parameters  Revise plan as needed

IMPLEMENTATION translation of care plan into action STEPS:

Put nursing plan to action Coordinate care / services Utilize community resources Delegate and supervise Monitor health services provided  Provide health education and training  Document responses to nursing action     

EVALUATION - process of making judgments as to the extent the objectives are met STEPS:  Care outcomes  Performance appraisal  Estimate cost benefit ratio  Assessment problems  Identify needed alterations  Revise plans as necessary

CATEGORIES OF HEALTH PROBLEMS

HEALTH DEFICIT  A gap between actual and achievable health status  Instances of failure in health maintenance  Possible precursors of health deficit:  History of repeated infections or miscarriages  No regular health check-up Examples:  ILLNESS states, diagnosed or undiagnosed  Failure to thrive/develop  Disability  Transient (aphasia or temporary paralysis after a CVA) Permanent (leg amputation secondary to diabetes, blindness from measles, lameness from polio) HEALTH THREAT - conditions that are conducive to disease, accident or failure to realize one’s potential Examples:  Family history of hereditary disease  Threat of cross infection  Accident hazards  Faulty eating habits  Poor environmental sanitation  Unhealthy lifestyle/personal habits FORESEEABLE CRISIS - anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources Examples:  Marriage  Pregnancy  Parenthood  Divorce or separation  Loss of job  Menopause  Death ______________________________________________________________

PRIORITIZING HEALTH PROBLEMS NATURE OF THE PROBLEM – categorized into health deficit, health threat and foreseeable crisis Health deficit 3 Health threat 2 Foreseeable crisis 1 MODIFIABILITY OF THE PROBLEM – refers to the probability of success in minimizing, alleviating or totally eradicating the problem through intervention Easily modifiable 2 Partially modifiable 1 Not modifiable 0 PREVENTIVE POTENTIAL –refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration High 3 Moderate 2 Low 1 SALIENCE – refers to the family’s perception and evaluation of the problem in terms of seriousness and urgency of attention needed A serious problem, immediate attention needed 2 A problem, but not needing immediate attention 1 Not a felt need / problem 0

EVALUATION OF CARE AND SERVICES PROVIDED STRUCTURAL ELEMENTS - include the physical settings, instrumentalities and conditions through which nursing care is given Components:  Philosophy  Objectives  Building  Organizational structure  Financial resources (budget, equipment, staff) PROCESS ELEMENTS - steps of the nursing process ( assessment, planning, implementing and evaluating) Components:  Taking the family health database  Performing physical examination  Making a nursing diagnosis  Determining nursing goals  Writing a nursing care plan  Performing nursing interventions  Coordination of services  Measuring success of nursing actions OUTCOME ELEMENTS - changes in the client’s health status that result from nursing interventions COMPONENTS  modification of signs and symptoms  Knowledge  Attitude  Satisfaction  Skill level of client  Compliance with treatment regimen ______________________________________________________________

NURSING PROCEDURES PRE-CONSULTATION CONFERENCE 1. Greet and make client at ease 2. Take clinical history 3. Take temperature, blood pressure, height and weight 4. Perform physical assessment 5. Do laboratory examinations 6. Write findings on client records MEDICAL EXAMINATION 1. Assist client before, during and after examination by physician 2. Inform physician of relevant findings gathered in pre-conference 3. Work with the physician during the examination 4. Ensure privacy, safety and comfort of patient throughout procedure 5. Observe confidentiality of examination results Nursing Intervention: 1. Carry out physician’s orders as giving medication or injection 2. Explain and reinforce physician’s orders and advises 3. Teach patient measures to promote and maintain health as proper diet, exercise and Personal hygiene. 4. Seek information regarding health status of other family members 5. Counseling PRE-CONSULTATION CONFERENCE 1. Explain findings and needed care or intervention 2. Refer patient to other health worker/agency 3. Make appointment for next clinic/home visit

DEPARTMENT OF HEALTH VISION: Health for all Filipinos MISSION: Ensure accessibility of health care to improve the quality of life of the Filipinos especially the poor NATIONAL HEALTH OBJECTIVES  Improve the general health status of the population  Reduce morbidity, mortality, disability and complications  Eliminate the following diseases as public health problems (schistosomiasis, malaria, filariasis, leprosy, rabies, measles, tetanus, diphtheria, pertussis, vitamin A and iodine deficiency)  Eradicate poliomyelitis  Promote healthy lifestyle  Promote health and nutrition of families and special populations  Promote environmental health and sustainable development BASIC PRINCIPLES TO ACHIEVE IMPROVEMENT IN HEALTH  Ensure universal access to basic health services  Epidemiological shift from infectious to degenerative disease must be managed  Enhance the performance of the health sector  Ensure the prioritization of the health and nutrition of vulnerable groups PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS  Support for frontline health workers and local system development  Assurance of health care  Increasing investment for primary health care ______________________________________________________________

 Development of national standards and objectives for health -

Dental health program Osteoporosis prevention Health education and community organizing

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Primary health care Reproductive health Older persons health service Guidelines for good nutrition Respiratory Infection Control Alternative health care Maternal and child care Sentrong Sigla Movement PRIMARY HEALTH CARE

 Essential health care made universally acceptable to individuals and families in the community  By means acceptable to them and through their full participation  At a cost that the community and country can afford at every stage of development

ESSENTIAL HEALTH CARE SERVICES

GOAL : Health for all Filipinos and Health in the Hands of the People by the year 2020 MISSION : To strengthen the health care system wherein people will manage their own health care CONCEPT : partnership and empowerment of the people LEGAL BASIS:  Letter of Instruction 949  President Ferdinand Marcos  October 19, 1979  First International Conference on Primary Health care  Alma Ata, USSR  September 6-12, 1978  Sponsored by the World Health Organization and UNICEF ELEMENTS/COMPONENTS of PHC - Education for Health - Locally Endemic Disease Control - Expanded Program on Immunization - Maternal and Child Health - Essential Drugs and Elderly Care - Nutrition - Treatment of CD and Non-CD - Sanitation: Water and Environment ORGANIZATIONAL STRATEGY  Framework for meeting the goal of primary health care  Calls for active and continuing partnership among the communities, private and government agencies in health development LEVELS OF HEALTH CARE SERVICES PRIMARY  Private Practitioners  Barangay Health Station  Community Hospitals ______________________________________________________________

 Rural Health Unit SECONDARY  Emergency/District Hospitals  Provincial/City Hospitals TERTIARY

 Regional Medical Centers and Training Hospitals  National Medical Centers  Teaching and Training Hospital

TWO LEVELS OF PHC WORKER  VILLAGE / BARANGAY HEALTH WORKERS (V/BHWs) - Trained community health workers - Health auxiliary volunteer - Traditional birth attendant or healer  INTERMEDIATE LEVEL HEALTH WORKERS - General medical practitioner - Public health nurse - Rural sanitary inspector - Midwives

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