community health nursingcommunity health nursing

Rahmatullah Vinjhar Lecturer Nursing ION DUHS.

Introduction to Course

Prerequisites

Health AssessmentCulture Health and societyCulture, Health and societyIntroduction to Biostatistics

h /Teaching/Learning

Community

People living in one place, district, or country, considered as a whole.The condition of sharing, having things in common or being a like in some way (i.e. feeling of sharing the same attitude intrests etc.)The term community suggests a shard pattern of feelings, behaviors and life style together within close and frequent personal relationship with other ( Little wood 1985)with other. ( Little wood,1985)

According to WHO community is a social group determined by geographical boundaries and common values and interests.A group of inhabitants living together in a some what localized area under the same general regulation and having common interests, function, needs and organizations.

Society

A system in which people live together in organized communities.organized communities.Organization of the people formed for a particular purpose ( A club anparticular purpose. ( A club, an association i-e the school debating society modern industrial society a co-society, modern industrial society, a co-operative society etc.

History of community health nursing

Ruth FreedmanEarly home care stage

( 1800s)focus: sick poor

William rathbone public health nursing(1900-1970)

Focus: needy publicnursing orientation:

individualsservice: curative

y pNursing orientation: familiesService: curative; preventive

St. PhoebeDistrict nursing (1800s to

1900)focus: sick poor

i i t ti

Lilliam waldcommunity health nursing(1970 to present)Focus: total community

nursing orientation: individuals

service: curative/preventive↓

yNursing orientation: populationService: health promotion; illness prevention

Public Health & CommunityPublic Health & Community Health

“Health care is vital to all of us some of the

time, but public health is vital to all of us all is vital to all of us all

of the time.”— C. Everett Koop

Public health (Winslow, 1920)

Public health is the Science and Art of (1)preventing disease, (2)prolonging life, and (3)promotinghealth and efficiency through organized (3)p o ot g ea t a d e c e cy t oug o ga edcommunity

The public health nurse effort for:The sanitation of environment.Th t l f i bl i f tiThe 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 diseasediagnosis and preventive treatment of disease.The development of the social machinery to insure everyone a standard of living adequate for the maintenance of health.

So organizing these benefits as to enable every citizen to realize his birthright of health and longevity.

Community health nursingCommunity health nursing (ANA, American Nurses’ Association, 1980)

Community health nursing is a synthesis of nursing and public health practice applied gto promoting and preserving the health of populations. The practice is general and comprehensive. It is not limited to acomprehensive. It is not limited to a particular age group or diagnosis, and is continuing, not episodic.continuing, not episodic.

The dominant responsibility is to the population as awhole; nursing directed to individuals, families, or groups contributes to the health of the totalgroups contributes to the health of the total population.

F t H lth ti h lth i tFocus to Health promotion, health maintenance, health education, and management, coordination, and continuity of care are utilized in a holistic approach to th t f th h lth f i di id lthe management of the health care of individuals, families and groups in a community.

Brief History of Public Health 1854 – Florence Nightingale

1887 – Hygiene1893 – Lillian Wald – Nurse’s Settlement1906 P F d d D A t

1854 Florence Nightingale

1906 – Pure Food and Drug Act1925 - TB Vaccinations1929 - Penicillin Discovered1940’s – Penicillin used to combat disease1940 s Penicillin used to combat disease

1955 – Polio Vaccine Released

1970’s – WHO declares Smallpox eradicated

1975 – Nurse Training Act1975 Nurse Training Act1990’s – HIV/AIDs

Greatest Public HealthGreatest Public Health Achievements

Vaccination Safer workplaces Control of infectious diseasesControl of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planningFamily planning Safe drinking water Recognition of tobacco use as a health ghazard

PreventionPrevention

Levels of Prevention:Primary Prevention refers to those measures that focus on prevention of health problems before they occurSecondary Prevention begins when pathology isSecondary Prevention begins when pathology is involved and is aimed at early detection through diagnosis and prompt treatment Tertiary Prevention is the treatment of an established disease

Nurse’s Role in PreventionNurse s Role in Prevention(Assignment-16th April 2008)

Conceptual framework for communityConceptual framework for community health nursing (White, 1982)

1.Practice prioritiesPromotion, protection, preventionPromotion, protection, prevention“primary prevention, secondary prevention ,tertiary prevention”

2.PracticeEducation, engineering, enforcement

3.scope of practicefrom individual to worldwide aggregategg g

Cont….

4.Health determinants (resolve) (Canadian government, 1974)

Human biological determinants, environmental determinants, medical -technological-organizationalmedical -technological-organizational determinants, psycho-socio-culture determinants (life style)

5.Community health nursing dynamicsNursing process and valuing process

Characteristics of community healthCharacteristics of community health nursing

It is a field of nursingb bl h l h hIt combines public health with nursing

It is population-focusedIt emphasizes wellnessIt involves interdisciplinary collaborationIt involves interdisciplinary collaborationIt promotes clients’ responsibility and self carecare

Mastery of progress

awareness . . .to knowledge . . .to knowledge . . .

to proficiency. . .

which is on a continuum.

Process

Orientation tools1. Orientation tools reviewed for content

2. Ideas shared from each othercounty competency projecty p y p j

3. Language adapted for Project implementation and competenciesimplementation and competencies

Implementing Tool Program Areas

C i bl Di C t l (CDC)Communicable Disease Control (CDC)Surveillance, Immunizations, Resource PHN

Maternal Child Health (MCH)Prenatal Plus, Partners for Healthy Families, Health Care Program for Children with Special NeedsCare Program for Children with Special Needs

Clinic Services F il Pl i STD HIV Ad l H l h CFamily Planning, STD, HIV, Adult Health, Cancer Control

Setting for community healthSetting for community health nursing practice

HomesAmbulatory service settingsAmbulatory service settingsSchools

l h l hOccupational health settingResidential institutionsThe community at large

Community Health Nursing

Community Health NursingCommunity Health NursingCommunity Health NursingCommunity Health Nursing

Quick Facts:Mission ( Nurses in Community Health)Mission ( Nurses in Community Health)Community Service Clinics

Offer free or low-cost services to all communityOffer free or low cost services to all community membersNever deny services

Community Health NursingCommunity Health NursingServices Include:

Family Planning, Education, Counseling and Treatment;Treatment; Health Education; Cancer Screening; Immunizations; Well-Child Examinations and Healthy Kid Screenings; Sexually Transmitted Disease Education, Counseling, and Treatment; HIV/AIDS Counseling Education and Testing;HIV/AIDS Counseling, Education and Testing; Communicable Disease Investigation; Tuberculosis Screening and Education; School Health Promotion and Education; andSchool Health Promotion and Education; and Children's Special Health Care Needs referrals

Community Health yNursing

Scope of Practice?

Impact of Nurses?

Community Health NursingCommunity Health NursingLevels of Priority

Communicable Diseases ~ Casual

Transmission

Least

Frequency o

Communicable Diseases ~ Non-Casual (Intimate) Transmission

C i bl I f ti &

of Services

Communicable Infection & Disease Prevention

Other Prevention Activities and Primary Care Greatesty

In order to best address population health, it is essential to understand the order of priority p yfor delivering services.

Communicable diseases that can be spreadCommunicable diseases that can be spread through casual transmission, such as active tuberculosis or chick pox, are of the highest priority and must be treated immediately.and must be treated immediately. Diseases that can be transmitted casually can infect numerous people within a short period of time. Though these cases are rare, it is important to treat g , pthem as soon as possible. Though the use of treatment in tertiary prevention is used for the individual with the infection, it is also ,primary prevention for the population. Communicable diseases that are spread through intimate contact, such as sexually transmitted di f h d hi h i idiseases, are of the second highest priority.

These diseases, such as HIV/AIDS, can spread quickly if p q yinfected individuals are having intimate contact, but they do not spread at a rate as fast as casually transmitted diseases.\

It is extremely important to make sure that individuals with casually and non-casually transmitted diseases

i th f ll t t t f di ti f th i di ireceive the full treatment of medication for their disease in order to ensure it is completely eradicated and does not become treatment resistant.

The third priority level is communicable infection and disease prevention.prevention. This would include utilizing immunizations for diseases and infections that are available and education when a vaccine is unavailable (HIV)unavailable (HIV).

The final level of priority consists of all other p yactivities that the community health nurse conducts such as family planning, screening, and physical exams. These activities are essential for a p yhealthy community, but these services are designed for individuals more so than populations. The priority level decrease as you move down theThe priority level decrease as you move down the pyramid, but the frequency of services increases as you move down. Prevention Activities and Primary Care ill be the b lk of the ser ices that theCare will be the bulk of the services that the Community Health Nurse will encounter. The most effective way a CHN can impact the community is th h di t i ith i di id lthrough direct services either on an individual or group level.

Reporting Refer to the Standard of Care Guidelines and

Majority of PatientsMajority of Patients

Protocols

Majority of PatientsMajority of PatientsIf Standard of

Care

Unique CasesUnique Cases

Guidelines do not apply to a particular case

or you need Unique CasesUnique Cases or you need clinical advice,

contact a CHN, supervisor or

OffHealth Officer

Public Health Process

PatientDisease Disease

I ti tiI ti ti

Office of EpidemiologyDisease InvestigatorDiagnosis Diagnosis

InvestigationInvestigation

TreatmentTreatment

Community Health NurseCommunity Health Nurse

Private Provider

gg

FollowFollow--upupPrivate Provider

Emergency Room or Other

Office of EpidemiologyDisease Investigator

Helpful Information

Administration:Organizational ChartDistribution of FundsFunding SourcesMeeting Needs

Community ResourcesEqually distribution of taskEqually distribution of task.

OTHERS IF YOU WANT DISCUSS…….