Unit 1 COMMUNITY HEALTH NURSING: AN OVERVIEW  Defining Community Health Nursing

What is a 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

What is health? 1. 2. 3. 4. 5. 6. 7. Health-illness continuum High-level wellness Agent-host-environment Health belief Evolutionary-based Health promotion WHO definition

What is 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

What is nursing? - assisting sick individuals to become healthy and healthy individuals achieve optimum wellness

What is 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 What is 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: a. the sanitation of the environment b. the control of communicable infections c. the education of the individual in personal hygiene d. the organization of medical and nursing services for the early diagnosis and preventive treatment of disease


The development of a social machinery to ensure every one a standard of living, adequate for maintenance of health to enable every citizen to realize his birth right of health and longevity - Winslow

> 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 care recipient of

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

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 MHO’s 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 meds…etc.

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 NGO/government agencies in the provision of public health services members,

conduct researches relevant to CHN services to improve provision of health care provide opportunities for professional growth and continuing education for staff development

Unit 2 LEVELS OF CLIENTELE  Individual



Basic approaches in looking at the individual: 1. Atomistic 2. Holistic Perspectives in understanding the individual: 1. Biological a. unified whole b. holon c. dimorphism 2. Anthropological a. essentialism b. social constructionism c. culture 3. Psychological a. psychosexual b. psychosocial c. behaviorism d. social learning 4. Sociological a. family and kinship b. social groups  Family Models: 1. Developmental Stages of Family Development Stage 1 – The Beginning Family Stage 2 – The Early Child-bearing Family

Stage 3 – The Family with Preschool Children Stage 4 – The Family with School Age Children Stage 5 – The Family with Teen-agers Stage 6 – The Family as Launching Center Stage 7 – The Middle-aged Family Stage 8 – The Aging Family 2. Structural-Functional Initial Data Base • • • • • Family structure and Characteristics Socio-economic and Cultural Factors Environmental Factors Health Assessment of Each Member Value Placed on Prevention of Disease

First Level Assessment • Health threats: conditions that are conducive to disease, accident or failure to realize one’s health potential Health deficits: instances of failure developmental lag) in health maintenance (disease, disability,

Stress points/ Foreseeable crisis situation: anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources

Second Level Assessment: • • • • • Recognition of the problem Decision on appropriate health action Care to affected family member Provision of healthy home environment Utilization of community resources for health care

Problem Prioritization: • Nature of the problem Health deficit Health threat Foreseeable Crisis Preventive potential High Moderate Low Modifiability

Easily modifiable Partially modifiable Not modifiable • Salience High Moderate Low

Family Service and Progress Record  Population Group Vulnerable Groups: • • • • • • Infants and Young Children School age Adolescents Mothers Males Old People

Specialized Fields: • 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



 Community Diagnosis - A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies 2 Types of Community Diagnosis Comprehensive Diagnosis Community Problem-Oriented Diagnosis Community

- aims to obtain general information about the community

- type of assessment responds to a particular need

STEPS: • Preparatory Phase 1. 2. 3. 4. 5. 6. 7. • site selection preparation of the community statement of the objectives determine the data to be collected identify methods and instruments for data collection finalize sampling design and methods make a timetable

Implementation Phase

1. 2. 3. 4. 5. 6. 7. 8.

data collection data organization/collation data presentation data analysis identification of health problems priority zation of health problems development of a health plan validation and feedback

• Evaluation Phase  Biostatistics A. Demography -study of population size, composition and spatial distribution as affected by births, deaths and migration. * Sources: Census – complete enumeration of the population 2 Ways of Assigning People

De jure De facto People were assigned to the place where People were assigned to the place they usually live regardless of where they where they are physically present at are at the time of census. the time of census, regardless, of their usual place of residence. COMPONENTS: Population size Population composition * Age Distribution * Sex Ratio * Population Pyramid * Median age age below which 50% of the population fall and above which 50% of the population fall. The lower the median age, the younger the population (high fertility, high death rates). * Age – Dependency Ratio used as an index of age-induced economic drain on human resources * Other characteristics: - occupational groups - economic groups - educational attainment - ethnic groups Population Distribution * Urban-Rural shows the proportion of people living in urban compared to the rural areas * Crowding Index indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host. * Population Density determines congestion of the place B. Vital Statistics the application of statistical measures to vital events (births, deaths and common illnesses) that is utilized to gauge the levels of health, illness and health services of a community. • Fertility Rate

Crude Birth Rate General Fertility Rate • Mortality Rates

Crude Death Rate Specific Mortality Rate Infant Mortality Rate Neonatal Mortality Rate Post-neonatal Mortality Rate Maternal Mortality Rate Proportionate Mortality Rate Swaroop’s Index Case Fatality Rate Cause-of- Death Rate • Morbidity Rates

Prevalence Rate Incidence Rate C. Epidemiology - the study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution - the study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations Basic Concepts: 1. Epidemiologic Triad 2. transmission 3. incubation period 4. herd immunity Factors affecting distribution: 1. PERSON - intrinsic characteristics 2. PLACE - extrinsic factors 3. TIME - temporal patterns Patterns of Disease Occurrence: Epidemic a situation when there is a high incidence of new cases of a specific disease in excess of the expected. - when the proportion of the susceptibles are high compared to the proportion of the immunes Epidemic potential - an area becomes vulnerable to a disease upsurge due to causal factors such as climatic changes, ecologic changes, or socio-economic changes Endemic - habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles e.g. Malaria is a disease endemic at Palawan. - the causative factor of the disease is constantly available or present to the area. Sporadic - disease occurs every now and then affecting only a small number of people relative to the total population - intermittent Pandemic - global occurrence of a disease Types of Epidemiological Study Designs Descriptive Provides information on patterns of disease in terms of person, place and causes characteristics * Correlational * Case Reports VS Test Analytical hypothesis of disease about


Intervention (Experimental)

studies * Ecologic *Case Series *Cross-sectional surveys VS. * Case control * Trials * Cohort Non-Experimental

Experimental With manipulation * Clinical Trials * Field Trials * Community Intervention Trials

Mere observation of study conditions * * * * * Cohort Case Control Proportional-Mortality Studies Cross-sectional Ecologic

Common Epidemiologic Studies:

Retrospective Steps 1. 2. 3. 4.


Prospective Cohort

in EPIDEMIOLOGICAL IVESTIGATION: Establish fact of presence of epidemic Establish time and space relationship of the disease Relate to characteristics of the group in the community Correlate all data obtained

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