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Community Health Nursing Notes Summary
Community Health Nursing Notes Summary
Community Health Nursing Notes Summary
Definitions:
Philosophy of CHN
Ultimate Goal
Objectives of CHN
1.) participate…
2.) conduct researches…
3.) coordinate…
Concepts of CHN
family is the unit of care, community is the patient and the four levels of clientele of CHN are:
o individual
o family
o group
o community
goal of improving community health involves multidisciplinary effort
CHN works not for individual patient, family, group or community. The latter are active partners, not passive-
recipients of care
Practice of CHN is affected by changes in society in general and by developments in health field in particular
CHN is part of community health system, which in turn is part of the larger human services system
History:
Early Christian era: virgins, noblewomen and plebeians took care of sick
Phoebe: 1st visiting nurse
Mr. William Rathbone:
o Philanthropist who first thought of public health nursing
o District nursing service in Liverpool in 1859
o More emphasis on midwifery
o Forerunner of public health nursing system
In the USA:
o Public HN developed from visiting nursing service under missionary societies and visiting nursing
associations
o 1877: women’s board of NY mission established 1st visiting nurses
Babylonians
o Understood need for hygiene
o Developed medical skills
Egyptians
o Developed variety of pharmaceutical preparations
o Constructed earth privies and public drainage system
Hebrew Mosaic Law
o Maternal health, communicable disease control, protection of food, water, waste and sanitary
disposal
Greeks
o Linked health to environment
o Wealthy people value personal cleanliness, exercise, diet and sanitation
Romans
o Viewed medicine from a community health and social medicine perspective
o Emphasized regulation of medical practice
o Provision of pure water
o Sewage systems, public food preparation
o Women visited and cared for the sick
Christianity
o Brought idea of personal responsibility
o Started the care for the sick
Middle Ages
o Poor sanitary conditions
o Increase in communicable diseases (cholera, bubonic plague, smallpox)
o Religious convents and monasteries established hospitals
o Started movement of health education and personal hygiene
Renaissance
o Health practices were influenced by recognition of human dignity and worth
o Elizabeth Poor Law: established 1601, guaranteed medical services to poor and lame individuals
Industrial Revolution
o Advances in transportation
o Religious women started to provide nursing care in institutions and homes
Milestones in history of public health
Definition
1.) World Health Organization: “essential health care made universally accessible to individuals and
families by means acceptable to them, through full participation and at cost that the community and
country can afford at every stage of development.”
Conceptual Framework
Goal: Health for all Filipinos and Health in the hands of th epoeple by the year 2020
Mission: to strengthen the health care system by increasing opportunities and supporting conditions wherein
people will manage their own health care.
Concept: Primary Health Care (PHC) characterized by partnership and empowerment of people shall permeate
as core strategy in effective provision of essential health services
Legal Basis
Letter of Instruction (LOI) 949: signed on Oct. 19, 1979 by then Pres. Ferdinand E. Marcos
Historical Background
o 1974- WHO and UNICEF conducted a joint study
o 1975- World Health Assembly passed a resolution giving priority to the development of PHC
o 1977- World Health Assembly decided that main target of government and WHO is the attainment
of the level of health that would allow or permit them to lead a socially and economically productive
life by year 2000
o September 6-12, 1978- 1st International Conference on Primary Health Care in Alma Ata, USSR
o 1979- WHA launched global strategy to attain health for all
o 1980- PHC endorsed for implementation by respective regional community
Principles of PHC
Strategies of PHC
1.) Education
2.) Locally Endemic Diseases
a. Filariasis
b. Schistosomiasis
3.) Essential basic drugs
a. Cotrimoxazole
b. Amoxicillin
c. Rifampicin
d. Isoniazid
e. Ethambutol
f. Paracetamol
g. Pyrazinamide
h. Oresol
i. Nifedipine
4.) Maternal and Child Health Care
5.) Expanded program of immunization
a. BCG- bacillus calmette guerin
b. OPV- oral polio vaccine
c. AMV- anti-measles vaccine
d. DPT- dyptheria pertussis tetanus
e. Anti-Hep B
6.) Nutrition
a. IDD- iodine deficiency disorder
b. IDA- iron deficiency anemia
c. PEM- protein energy malnutrition
7.) Treatment of common diseases
8.) Safe water supply and sanitation
9.) Prevention and control of leading communicable diseases
10.) Promotion of dental health
11.) Elderly and disabled’s physical and mental health
Intersectoral
o Sectors most closely related to health
o Agriculture, education, public works, local governments, social welfare, population control, private
sectors
Intrasectoral
Rationale
Solutions
3 levels of health care provided by RHU (rural health unit) staff, with referral and supervisory system support
redefinition of roles and relationships among RHU staff
establishment of satellite health centers in selected barangays
1958- RA 1082
o 1st Rural Health Act
o employment of more physicians, dentists, nurses, midwives and sanitary inspectors assigned to
RHU’s
o 1st 81 rural health units
1972- RA 5435
o defined authorities of regional directors for more meaningful decentralization
o 13 regional health offices
1974
o IBRD- RHCDS implemented RHM were sent to BHS to man BHS
o Midwives were trained and roles expanded
1982- EO 851
o integrated public health and hospital systems with emphasis on importance of putting together
promotive, preventive, curative and rehabilitative components of health care
o utilization of BHW
o implementation of DOH impact programs
Referral- intervention to direct client to another healthcare facility to continue his/her treatment
Population
Physician
1.) Traditional
a. E.g. client provider
2.) Non-Traditional
a. Holistic Health Centers
i. Believes that time, space and encouragement can help people find strength to deal with
problems confronting them
ii. Spiritual, physical and psychological care
iii. Acts:
1. Pastoral counseling
2. Stress reduction
3. Parenting
4. Dietary conditioning
b. Faith Healing
i. Believes that disease is a state of mind so one can alter his state of mind so he will be healed
c. Chiropractic
i. System of manipulation treatment which teaches that all diseases are caused by impringement
on spinal column and corrected by spinal adjustment
ii. Daniel Palmer- founder
d. Acupuncture
i. Insertion of needles into selected body parts to control pain
e. Acupressure
i. Finger pressure to control pain in body parts
f. Kinesiology
i. Study of movement which applies principles of anatomy to movement
g. Reflexology
i. Systematic massage of soles of feet
ii. Applies same principles as applied in acupressure
h. Massage
i. Relieves tension, enhances flexibility and creates coordination between mind and body
i. Homeopathy
i. Use of variety of herbs, drugs and chemicals that when used in small quantities can cure or
prevent disease caused by same substance in larger doses
Health Promotion
Defintion
o WHO- “Health promotion includes encouraging healthy lifestyles, creating supportive environments
for health, strengthening community action, reorienting health services to place primary focus on
promoting health and preventing disease, and building healthy public policy.”
o Pender, 1996- “Health promotion is a behavior motivated by the desire to increase well being and
actualize human health potential.”
Health promotion includes any activity that helps people to change or maintain lifestyles that support a state
of optimal health or balance of physical, emotional, social, spiritual and intellectual health.
Prominence of health promotion came about as a result of changing patterns of health and corresponding
emphasis on “lifestyle” as a factor.
PHE (Public Health Education) can only have impact on PH only if joined other sectors and brought multiples
social forces to bear.
Green- “Behavioral changes that health education is able to effect can only be maintained if supportive
environment were provided via: political, economic, social, biological and other sectors.”
1st use of term, health promotion- 1945, Henry E. Sigerist
o Defined 4 major tasks of medicine
Promotion of health
Prevention of illness
Restoration of the sick
Rehabilitation
o Sigerist: “Health is promoted by providing a good labor condition, education, physical culture and
means of rest and recreation.”
Concepts used and found in Ottawa Charter for Health Promotion which occurred 40
years later
1986, WHO, Health and Welfare Canada and Canadian Public Health Association organized an International
Conference on Health Promotion
o later known as Ottawa Charter
o Guiding principle in health promotion efforts currently
“Process of enabling people to increase control over and to improve their health”
To reach a state of complete physical, mental and social well-being , an individual or group must be able to
identify and to realized aspiration; to satisfy needs and to change and cope with environment
Health promotion is not just a responsibility of the health sector, but goes beyond healthy lifestyles to well-
being.
Prerequesite for Health
o Peace
o Shelter
o Education
o Food
o Income
o A stable eco-system
o Sustainable resources
o Social Justice
o Equity
In order to operationalize the concept of Health Promotion, the Charter recommended the following areas.
o Build Health Public Policy
Coordinated action that leads to health, income and social policies that foster greater
equity
o Create Supportive Environment
Societies are complex and interrelated
Overall guiding principle is the need to encourage reciprocal maintenance to take care of
each other, our communities and our natural environment
Conservation of natural resources throughout world should be emphasized as a global
responsibility
Changing patterns of life; work and leisure leave a significant impact on health
Systematic assessment of health impact of rapidly changing environment, especially in
areas of technology, works, energy production and urbanization
o Strengthen Community Action
Setting priorities, making decisions, planning strategies and implementing
Heart of this process is Empowerment of communities
Community development helps to enhance self-help and social support, to develop
flexible system for strengthening public participation in and direction of health matters
o Develop Personal Skills
Through providing information, education for health and enhancing life skills
Enabling people to learn throughout life, to prepare themselves for all of its stages and to
cope with chronic illnesses and injuries
o Reorient Health Services
Health services are shared among individuals; community groups, health service
institutions and government