Presented by: Rosafe E.

Peralta, RN EXPANDING ENVIRONMENT OF NURSING PROFESSION

Community Health Nursing

DEFINITION OF TERMS Community a group of people with common characteristics or interests living together within a territory or geographical boundary place where people under usual conditions are found Derived from a latin word comunicas which means a group of people. Health A state of being well and using every power the individual possesses to the fullest extent. (Nightingale, 1860/1969) A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmary. (WHO, 1948) OLOF (Optimum Level of Functioning) Health-illness continuum High-level wellness Agent-host-environment Health belief Evolutionary-based Health promotion Community Health Part of paramedical and medical intervention/approach which is concerned on the health of the whole population Aims: 1. Health promotion 2. Disease prevention 3. Management of factors affecting health Nursing Both profession & a vocation. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness 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. ( Maglaya, et al) Goal: To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness ( Nisce, et al) 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 the conditions in the social and physical environment, rehabilitation of illness and disability ( WHO Expert Committee of Nursing)

A learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the clients optimum level of functioning thru teaching and delivery of care (Jacobson) A service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools , workplace for the promotion of health, prevention of illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman)

Public Health

Public Health is directed towards assisting every citizen to realize his birth rights and longevity.The science and art of preventing disease, prolonging life and efficiency through organized community effort for: 1. The sanitation of the environment 2. The control of communicable infections 3. The education of the individual in personal hygiene 4. The organization of medical and nursing services for the early diagnosis and preventive treatment of disease 5. The development of a social machinery to ensure everyone a standard of living, adequate for maintenance of health to enable every citizen to realize his birth right of health and longevity (Dr. C.E Winslow)

Mission of CHN Health Promotion Health Protection Health Balance Disease prevention Social Justice Philosophy of CHN The philosophy of CHN is based on the worth and dignity on the worth and dignity of man. (Dr. M. Shetland) Basic Principles of CHN 1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems e.g. children, elderly), and the community. 2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care 3. CHN practice is affected by developments in health technology, in particular, changes in society, in general 4. The goal of CHN is achieved through multi-sectoral efforts 5. CHN is a part of health care system and the larger human services system. Roles of the PUBLIC HEALTH NURSE

Clinician, who is a health care provider, taking care of the sick people at home or in the RHU Health Educator, who aims towards health promotion and illness prevention through dissemination of correct information; educating people Facilitator, who establishes multi-sectoral linkages by referral system Supervisor, who monitors and supervises the performance of midwives Health Advocator, who speaks on behalf of the client Advocator, who act on behalf of the client Collaborator, who working with other health team member

*In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions or is not available, the Public Health Nurse will take charge of the MHOs responsibilities. Other Specific Responsibilities of a Nurse, spelled by the implementing rules and Regulations of RA 7164 (Philippine Nursing Act of 1991) includes: Supervision and care of women during pregnancy, labor and puerperium Performance of internal examination and delivery of babies Suturing lacerations in the absence of a physician Provision of first aid measures and emergency care Recommending herbal and symptomatic medsetc. In the care of the families: Provision of primary health care services Developmental/Utilization of family nursing care plan in the provision of care In the care of the communities: Community organizing mobilization, community development and people empowerment Case finding and epidemiological investigation Program planning, implementation and evaluation Influencing executive and legislative individuals or bodies concerning health and development Responsibilities of CHN be a part in developing an overall health plan, its implementation and evaluation for communities provide quality nursing services to the three levels of clientele maintain coordination/linkages with other health team members, NGO/government agencies in the provision of public health services conduct researches relevant to CHN services to improve provision of health care provide opportunities for professional growth and continuing education for staff development Standards in CHN 1. Theory o Applies theoretical concepts as basis for decisions in practice 2. Data Collection o Gathers comprehensive, accurate data systematically 3. Diagnosis o Analyzes collected data to determine the needs/ health problems of IFC 4. Planning o At each level of prevention, develops plans that specify nursing actions unique to needs of clients 5. Intervention o Guided by the plan, intervenes to promote, maintain or restore health, prevent

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illness and institute rehabilitation Evaluation o Evaluates responses of clients to interventions to note progress toward goal achievement, o revise data base, diagnoses and plan Quality Assurance and Professional Development o Participates in peer review and other means of evaluation to assure quality of nursing practice o Assumes professional development o Contributes to development of others Interdisciplinary Collaboration o Collaborates with other members of the health team, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health Research o Indulges in research to contribute to theory and practice in community health nursing

COMMUNITY HEALTH NURSE ROLES AND FUNCTIONS Qualifications 1. Bachelor of Science in Nursing 2. Registered Nurse of the Philippines Planner/Programmer 1. Identifies needs, priorities, and problems of individuals, families, and communities 2. Formulates municipal health plan in the absence of a medical doctor 3. Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel 4. Provides technical assistance to rural health midwives in health matters Provider of Nursing Care 1. Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace 2. Develops the familys capability to take care of the sick, disabled, or dependent member Community Organizer 1. Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services 2. Initiates and participates in community development activities Coordinator of Services 1. Coordinates with individuals, families, and groups for health related services provided by various members of the health team 2. Coordinates nursing program with other health programs like environmental sanitation, health education, dental health, and mental health Trainer/Health Educator 1. Identifies and interprets training needs of the RHMs, Barangay Health Workers (BHW), and hilots 2. Conducts training for RHMs and hilots on promotion and disease prevention 3. Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health and health related services 4. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education purposes

5. Conducts pre-marital counseling Health Monitor 1. Detects deviation from health of individuals, families, groups, and communities through contacts/visits with them Role Model 1. Provides good example of healthful living to the members of the community Change Agent 1. Motivates changes in health behavior in individuals, families, groups, and communities that also include lifestyle in order to promote and maintain health Recorder/Reporter/Statistician 1. Prepares and submits required reports and records 2. Maintain adequate, accurate, and complete recording and reporting 3. Reviews, validates, consolidates, analyzes, and interprets all records and reports 4. Prepares statistical data/chart and other data presentation Researcher 1. Participates in the conduct of survey studies and researches on nursing and health-related subjects 2. Coordinates with government and non-government organization in the implementation of studies/research LEVELS OF CLIENTELE IN CHN 1. Individual Basic approaches in looking at the individual: 1. Atomistic the whole is equal to sum of its parts 2. Holistic the whole is NOT equal to the sum of its parts; traces mans relationship in the suprasystem of society 2. 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) 3. Population Groups a group of people sharing the same characteristics, developmental stage or common exposure to particular environmental factors thus resulting in common health problems (Clark, 1999 as cited in Maglaya) Vulnerable Groups: Infants and Young Children School age Adolescents Mothers Males Old People 4. Community a group of people sharing common geographic boundaries and /or common values and

interest (Maglaya, 2004) SPECIALIZED FIELDS OF CHN: Community Mental Health Nursing A unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, psychology, community networks, and the basic sciences Occupational Health Nursing The application of nursing principles and procedures in conserving the health of workers in all occupations School Health Nursing The application of nursing theories and principles in the care of the school population NURSING PROCEDURES IN THE COMMUNITY Clinic Visit process of checking the clients health condition in a medical clinic Home Visit a professional face to face contact made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency Bag Technique a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort with the end in view of rendering effective Thermometer Technique to assess the clients health condition through body temperature reading Nursing Care in the Home giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in dignity Isolation Technique in the Home Done by: 1. Separating the articles used by a client with communicable disease to prevent the spread of infection: 2. Frequent washing and airing of beddings and other articles and disinfections of room 3. Wearing a protective gown, to be used only within the room of the sick member 4. Discarding properly all nasal and throat discharges of any member sick with communicable disease 5. Burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering Intravenous Therapy Insertion of a needle or catheter into a vein to provide medication and fluids based on physicians written prescription

can be done only by nurses accredited by ANSAP

THEORIES USED IN COMMUNITY HEALTH NURSING 1. Nightingales Theory of Environment Nursing is related to the environment of the individual The individuals health is related to his environment Nursing is related to the health of the individual through its relationship with the environment. 2. Madeliene Leiningers Transcultural Nursing Focuses on the fact that different cultures have different caring behaviors and different health and illness values, beliefs, and patterns of behaviors. Awareness of the differences allows the nurse to design culture-specific nursing interventions. 3. Hilgegard Peplaus Interpersonal Theory Phase of Nurse-Client Relationship: a. Orientation Phase b. Identification Phase c. Exploration Phase d. Resolution Phase 4. Orems Self-Care Model Specifies when nursing is needed Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self care Theory of Self-care Theory of Self care deficit Theory of nursing 5. Neuman: Health Care System Model Theory of optional client stability Theory of prevention as intervention: Primary, Secondary, Tertiary 6. Rogers Model of the Science and Unitary Man Believes that it is only through the knowledge of man/ environment and their interaction that nursing can truly understand clients and assist them to achieve health. 7. Roys Adaptation Model Holistic person as an adaptive system, with input, output and a feedback process. Adaptation is a process that occurs within living system in their interaction with their environment for the purpose of survival, growth and development.