COMMUNITY HEALTH COMMUNITY HEALTH NURSINGNURSING

PUBLIC HEALTH• Science and art of preventing disease, • prolonging life, • promoting health and efficiency through

organized community effort • for the sanitation of the environment, • control of communicable diseases,• education of individuals in personal

hygiene, • organization of medical and nursing

services

• for the early diagnosis and • preventive treatment of disease,• and development of 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 TO HEALTH AND LONGEVITY

• Dr. C.E. Winslow (1920)

WHO• The ART OF APPLYING SCIENCE in the

CONTEXT OF POLITICS so as to REDUCE INEQUALITIES IN HEALTH while ensuring the best health for the greatest number

PUBLIC HEALTH NURSING• The practice of nursing in national and

local government health departments (which include health centers and local health units), and public schools.

• A community health nursing practiced in the public sector

• Standard of Public Health Nursing in the Philippines, 2005

PUBLIC HEALTH NURSING• Special field of nursing that combines the

skills of nursing, public health, and some phases of social assistance and functions as part of the total public health program

• For the promotion of health, the improvement of conditions in the social and physical environment, rehabilitation, and the prevention of illness and disability.

• WHO Expert Committee on Nursing

COMMUNITY HEALTH NURSING

• Service rendered by a professional nurse to communities, groups, families, and individuals at home, in health centers, in clinics, in schools, and in places of work

• For the promotion of health, prevention of illness, care of the sick at home, and rehabilitation.

• Ruth B. Freeman

COMMUNITY HEALTH NURSING

• The utilization of the nursing process in the different levels of clientele-

• Individuals, families, population groups and communities, concerned with the

• Promotion of health, prevention of disease and disability and rehabilitation.

• Dr. Araceli Maglaya, et al.

GOAL - CHN• To raise the level of health of the citizenry

by helping communities and families cope with the discontinuities in and threats to health in such a way as to maximize the potential for high-level wellness

• Nisce, Reyala, et al.

• CHN?• WHO?• WHERE?• FOR/ goal?• Philiosophy?

• “greatest good for the greatest number”

• - CHN believes in the “worth & dignity of man”

CHN• A service rendered by a professional

nurse.• WHO – community, groups, family,

individual at home• WHERE – in health centers, clinics,

schools and places of work.• FOR – the promotion of health, prevention

of illness and rehabilitation of the sick.

• i. The hallmark of community health nursing is that it is population- or aggregate-focused.

• ii. CHN is a synthesis of nursing and public health practice

• 1. emphasis on the importance of the “greatest good for the greatest number”

• 2. assessing health needs planning, implementing and evaluating the impact of health services on population groups

• 3. priority of health - promotive and disease preventive strategies over curative interventions

PRINCIPLES OF CHN• EMPOWERMENT• E – Education – as a primary tool• M – Made available to ALL• P – People’s initiative• O – Organizing for health• W – Works with family as a unit• E – existing organizations of service• R – Recording and Reporting• M – Monitoring and Evaluation• E – Existing indigenous resources• N – Needs recognized by community• T – Team Effort

POLITICAL Safety Oppression People Empowerment

OLOFOLOFIndividualsIndividualsFamily Family groupsgroupsCommunitiesCommunitiesPopulationsPopulations

ENVIRONMENTAirFoodWater Waste Urban/ Rural Noise Radiation Pollution

SOCIOSOCIOECONOMICECONOMICEmploymentEmployment

HEREDITYGenericEndowment-Defects- strengths-Risks-Familial - Ethnic - racial

HEALTH CARE DELIVERY SYSTEMPromotivePreventiveCurativeRehabilitative

BEHAVIORCultureHabitsMoresEthnic Customs

ECO-SYSTEM INFLUENCES ON OPTIMUM LEVEL OF FUNCTIONING (OLOF)

• Modified from (Blum 1974:3) further modified by the community Health Nursing Committee, NLPGN, 2000

• Determinants of Health

Multidimensional nature of health

ROLES OF THE PUBLIC HEALTH NURSE

• 1. CLINICIAN – or health care provider• 2. HEALTH EDUCATOR• 3. COORDINATOR AND

COLLABORATOR• 4. SUPERVISOR• 5. LEADER AND CHANGE AGENT• 6. MANAGER• 7. RESEARCHER

LEVELS OF CLIENTELE• PATIENT – comes from Greek word

“pathein” – which means “to suffer”• Commonly referred to as the person who

is waiting for or is undergoing medical treatment and care.

• Implies that the person is ill or has a disease

• Person passively accepts the decision and care of health professionals.

• CLIENT • A person who may or may not be sick but

who engages the advice or services of a health professional.

• Presents the client as a collaborator in his/ her care and not as a passive receiver of health services.

• Assumes an active role in health care

CLIENTS OF CHN• 1. INDIVIDUAL• Sick or well – on a daily basis• 2. FAMILY• VERY important social institution that

performs two major functions – reproduction and socialization.

• It is generally considered as the basic unit of care in community health nursing for many reasons.

• 3. COMMUNITY• Group of people sharing common

geographic boundaries and/ or common values and interests.

• It functions w/in a particular sociocultural context, which means that no two communities are alike.

• 4. POPULATION GROUP• - or “aggregate” (clark, 1999:5) is a group

of people who share common characteristics, developmental stage or common who exposure to particular environmental factors, and consequently common health problems.

FAMILY• I. The Family and Family Health• 1. Concepts/ Definition of family• 2. Family structure and functions• 3. Universal characteristics of families• 4. Characteristics of a healthy family• 5. Family stages and tasks• 6. Levels of Prevention in Family Health

FAMILY• A small social system and primary

reference group made up of two or more persons living together who are related by blood, marriage or adoption or who are living together by arrangement over a period of time

• Murray and Zentner (1997)

Types of families• BASED ON COMPOSITION• 1. NUCLEAR FAMILY• 2. EXTENDED FAMILY• 3. BEANPOLE FAMILY• 4. SINGLE-PARENT FAMILY• 5. STEP FAMILY/ BLENDED FAMILY/

RECONSTITUTED FAMILY• 6. SINGLE STATE• . SAME-SEX OR HOMOSEXUAL FAMILY• 8. COHABITING OR COMMUNAL FAMILY

BASED ON LOCUS OF POWER

• 9. PATRIFOCAL OR PATRIARCHAL FAMILY

• 10. MATRIFOCAL OR MATRIARCHAL • 11. EGALITARIAN• 12. MATRICENTRIC

BASED ON PLACE OF RESIDENCE

• 13. PATRILOCAL• 14. MATRILOCAL• 15. BILOCAL• 16. NEOLOCAL• 17. AVUNCULOCAL

BASED ON DESCENT

• 18. PATRILINEAL• 19. MATRILINEAL• 20. BILATERAL

STAGES OF FAMILY DEVELOPMENT

• 1. INITIAL OR ESTABLISHEMENT STAGE• courtship and engagement precede the

establishment of the family unit.• Developmental tasks:• Contending w/ partner selection pressure from

parents• Giving over autonomy while retaining some

independence• Preparing for marriage• Becoming free of parental domination.

• 2. EXPECTANT STAGE• Pregnancy• Couple is expected to learn to assume

new roles – father/ mother• Couple – expected to think as a family

and not just as a pair.

• PARENTHOOD OR EXPANSION STAGE

• Characterized by birth or adoption of a child

• DISENGAGEMENT OR CONTRACTION STAGE

• Occurs when the children leave and the couple must rework their separateness

• Retirement planning• Preparation for the spouse’s death • Eventual bereavement - loneliness

Health care delivery system

• The PHCDS – defined as the totality of all policies, facilities, equipment, products, human resources and services which address the health needs, problems, and concerns of the people.

NATIONAL health situation

• Different conditions prevailing in the communities – health picture of each varies

• Ex: goiter – prevalent in Cordillera• Schistosomiasis – endemic in Leyte

Major players• 1. PUBLIC SECTOR• Largely financed through a tax-based

budgeting system at both the national and local levels

• Where health care is generally given for free at the point of service

• National and local government agencies• DOH – national level – mandated as the

lead agency in health.

• 2. PRIVATE SECTOR• Largely market-oriented and where health

care is paid for through user fees at the point of service.

Devolution of health services

• October 10, 1991• RA 7160 – LOCAL GOVERNMENT CODE • Provided for the decentralization of the

entire government• The local health system is now run by

LGUs.• AIM - to build the capabilities of local

governments for self-governance and to develop them as fully self-reliant communities.

devolution• Refers to the act by which the

national government • confers power and authority upon

the various local government units • to perform specific functions and

responsibilities, • including the provision and

delivery of basic health services.

• Provincial and district hospitals – under the provincial government

• City/ municipal government – manages the health centers/ rural units and barangay health stations in every province, city or municipality

Primary health care • As a strategy• PHC

THE NATIONAL HEALTH SITUATION

• GIVES us an idea of the health situation in the communities where nurses work.

• Different conditions – the health picture expected to be varied

• Ex – goiter – highly prevalent in the Cordillera

• Schistosomiasis – endemic in Leyte

Demographic profile• Philippines – is one of the most populous

country in the world.• 2000 – population was 75.3 million• Projected to increase to 82,636,689 in

2004• 1999 – LIFE EXPECTANCY • 68.6 – 71.28 – for females• 66.03 – for males• Up from 61.6 years in 1980

• Country’s population – very young• 39% - of the total population in 1994 was

estimated to be in the 0 - 14 age group.• Only 5% were 60 years old and above.• Dependency ratio – 79• (0 - 14 years & 60 y/o and above) –

dependent• 15 - 59 y/o – productive age group

• About 249 people for every square kilometer of Philippine territory.

• Metro Manila – has the highest population density (16,051)

• CAR – has the lowest (75)• High density population density –

facilitates the transmission of infectious and communicable diseases.

• The greater need for social services: decent housing, transportation, communication, education and health services

• High level of stress in highly congested areas leads to the disintegration of moral values and social institutions

• Contributes to the incidence of a number of health problems, including mental health problems.

Causes of morbidity & mortality• 1997 – causes of mortality among Filipinos• 1. diseases of the heart• 2. diseases of the vascular system• 3. pneumonias• 4. malignant neoplasm• 5. TB, all forms• 6. accidents• 7. chronic obstructive & pulmonary diseases• 8. other diseases of the respiratory system• 9. diabetes mellitus• 10. diarrheal diseases

Leading causes of morbidity• 1. diarrheas• 2. pneumonias• 3. bronchiolitis• 4. influenza• 5. TB• 6. malaria • 7. chickenpox• 8. diseases of the heart• 9. measles• 10. dengue H-fever

Infant mortality• 1. respiratory conditions of the fetus & NB• 2. pneumonias• 3. congenital anomalies• 4. birth injury and difficult labor• 5. diarrheal diseases• 6. septicemia• 7. measles• 8. meningitis• 9. other diseases of the respiratory system• 10. avitaminosis & other nutritional deficiency

CONCEPTUAL FRAMEWORK

FOCUS OF PHC APPROACH• PHC GOAL• LEGAL BASIS OF PHC• 5 A’s OF HEALTH CARE

• II. The Family Health Nursing Process• 1. Definition of family health nursing &

family nursing process• 2. Principles of family nursing process• 3. Steps of the family health nursing

process• 4. Initial Assessment/data base for Family

Nursing Practice• 5. Family

structure/characteristics/dynamics• 6. Social, economic & cultural factors

• 7. Health status of each family member• 8. Values & practices on health promotion

• III. Methods of Data Gathering• 1. Health assessment of each family

member• 2. Observation• 3. Interview• 4. Review of records/reports & laboratory

results• 5. Assessment of home & environment• 6. Tools used in family assessment:

genogram, ecomap, initial• database, family assessment guide

LEVELS OF PREVENTION:• 1ST LEVEL• 2ND LEVEL• 3RD LEVEL