COMMUNITY HEALTH NURSING

FOCUS: Promotion and Preservation of the health of populationsNATURE OF PRACTICE: comprehensive, general, continual and not episodicKNOWLEDGE BASE: from nursing and public healthLEVELS OF CLIENTELE: individuals, family, population groups and community as a wholeCOMMUNITY - 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 environmentExamples:

Safety Oppression People empowerment

HEALTH CARE DELIVERY SYSTEM - One component of this factor is the primary health care which is a partnership approachGoal: Effective provision of health services that are community-based and accessibleComponents:

Promotive Preventive Curative Rehabilitative

BEHAVIORALComponents

Culture Habits Ethnic customs

Examples Smoking Intake of alcoholic drinks

Substance abuse Lack of exercise

SOCIOECONOMIC INFLUENCESComponents

Employment Education Housing

ENVIRONMENTAL INFLUENCESComponents

Air Food Water waste Urban/rural noise Radiation Pollution

HEREDITYComponents

Genetic endowment Defects Strengths Risks:

Familial Ethnic Racial

PUBLIC HEALTH NURSINGPublic 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

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Ultimate Goal : contribute to the promotion of client’s optimum level of functioningThrough teaching and delivery of care. (Jacobson)

Community health nursing is a service rendered by a professional nurse with the community, groups, families and individualsGOAL: 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 NURSINGClinician – 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 PROCESSASSESSMENT - Process of collecting and

processing data/information about the clientSTEPS: Initiate contact Demonstrate caring attitudes Develop mutual trust and confidence 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

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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 PROBLEMSHEALTH 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 potentialExamples: 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 PROBLEMSNATURE OF THE PROBLEM – categorized into health deficit, health threat and foreseeable crisisHealth deficit 3Health threat 2Foreseeable crisis 1

MODIFIABILITY OF THE PROBLEM – refers to the probability of success in minimizing, alleviating or totally eradicating the problem through interventionEasily modifiable 2Partially modifiable 1Not modifiable 0

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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 considerationHigh 3Moderate 2Low 1

SALIENCE – refers to the family’s perception and evaluation of the problem in terms of seriousness and urgency of attention neededA serious problem, immediate attention needed 2A problem, but not needing immediate attention 1Not 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 givenComponents:

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 interventionsCOMPONENTS

modification of signs and symptoms Knowledge Attitude Satisfaction Skill level of client Compliance with treatment regimen

NURSING PROCEDURESPRE-CONSULTATION CONFERENCE

1. Greet and make client at ease2. Take clinical history3. Take temperature, blood pressure, height and weight4. Perform physical assessment5. Do laboratory examinations6. Write findings on client records

MEDICAL EXAMINATION1. Assist client before, during and after examination by physician2. Inform physician of relevant findings gathered in pre-conference3. Work with the physician during the examination4. Ensure privacy, safety and comfort of patient throughout procedure5. Observe confidentiality of examination results

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Nursing Intervention:1. Carry out physician’s orders as giving medication or injection2. Explain and reinforce physician’s orders and advises3. Teach patient measures to promote and maintain health as proper diet, exercise and Personal hygiene. 4. Seek information regarding health status of other family members5. Counseling

PRE-CONSULTATION CONFERENCE1. Explain findings and needed care or intervention2. Refer patient to other health worker/agency3. 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

- 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

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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 SERVICESGOAL : Health for all Filipinos and Health in the Hands of the People by the year 2020MISSION : To strengthen the health care system wherein people will manage their own health careCONCEPT : partnership and empowerment of the peopleLEGAL 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 SERVICESPRIMARY

Barangay Health Station Private Practitioners Community Hospitals Rural Health Unit

SECONDARY Emergency/District Hospitals

Provincial/City HospitalsTERTIARY

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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