NURSING CARE MANAGEMENT 113) (COMMUNITY HEALTH NURSING 2) STRICTLY FOR CLASSROOM USE ONLY HANDOUT I: OVERVIEW of COMMUNITY HEALTH NURSING IN THE PHILIPPINES CHN (Philippines) 2 major fields of nursing > Community Health Nursing = Public Health Nursing: Rural Health Units (RHUs) or Health Centers = Community Mental Health Nursing > Specialized Field of Community Health Nursing = Occupational Health Nursing - Company Nurse = School Health Nursing > Emerging Fields of Community Health Nursing COMMUNITY HEALTH NURSING = The utilization of the nursing process in the DIFFERENT LEVELS OF CLIENTELE-INDIVIDUALS, FAMILIES, POPULATION GROUPS & COMMUNITIES, concerned with the PROMOTION OF HEALTH, PREVENTION OF DISEASE & DISABILITY & REHABILITATION (Dr. Aracel/ Maglaya, etal) = Assynthesis of nursing knowledge and practice and the science and practice of public health, implemented via a systematic use of the nursing process and other processes to promote health and prevent illness in population groups (Clark, 2008) + Isa service rendered by a professional nurse with the community, groups, families and individuals at home, in Health centers, in clinics, in school, in places of work for the promotion of Health, prevention of illness, care of the sick at home and rehabilitation (Ruth B. Freeman, 1979)) + a learned practice discipline with the ultimate goal of contributing as individuals and in Collaboration with others to the promotion of the client's optimum level of functioning through teaching and delivery of care (Jacobson, 1969) Nursing practice in a wide variety of community services & consumer advocate areas, & in a variety of roles, at times including independent practice....Community nursing is certainly not confined to public health nursing agencies. (Jacobson, 1975) + Afield that is a blend or synthesis of nursing practice with public health using primary health care as the tool in the delivery of health services (Cecilia Estrada-Castro, 2012) ‘Statements that characterize COMMUNITY HEALTH NURSING 4, 5. 1. Promotion of health and prevention of disease are the goals of professional practice 2 3. There are different levels of clientele — individual, families and population groups and the ‘Community health nursing practice is comprehensive, general, continual and not episodic practitioner recognizes the primacy of the populations a s a whole ‘The nurse and the client have greater control in making decisions related to health care and they collaborate as equals ‘The nurse recognizes the impact of different factors on health and has a greater awareness of his/her clients’ lives and situations (Clark, 2008: 10-13) CHN: CHARACTERISTICS Goals of Professional Practice: + Promotion of health * Prevention of disease CHN practice is Comprehensive © General © Continual and not EpisodicCHN: CHARACTERISTICS Nurse & the client ‘© greater control in making decisions r/t health care * collaborate as equals * recognizes the impact of different factors on health * greater awareness of his/her clients’ lives and situations (Clark, 2008: 10-13) Features of COMMUNITY HEALTH NURING Practice In addition to its preventive approach to health, CHN is characterized by: > population- or aggregate-focused » developmental nature, & existence of a prepayment mechanism for consumers of community health nursing services. > Unlike nurses who work in the hospital settings, CHNs care for different levels of clientele. ‘The essence of nursing is the same even if practiced in different setting. Nursing As An ART - reflected in the nurses’ interaction & communication with clients that are geared towards the improvement not just of their health but also their ability to deal with the determinants and consequences of their health problems. © Responsibility of nursing in society is to guide individuals and families “in choosing Possibilities in changing the health process which is accomplished by intersubjective Participation with people” (George, 2002:439) © ART of nursing is demonstrated by nurses who can maintain the delicate balance between doing things for their clients and doing things with them, thus co-creating a better or more meaningful reality. © Practice of nursing, therefore, entails active interaction partnership between the nurse and the client. Such partnership recognizes the autonomy of both parties and the potential of each one in enriching their relationship. Nursing As A Science - community health nurses should use practice-based and evidenced- based methods and tools. They also need to engage in generating evidence to support their practice through research. PHILOSOPHY OF COMMUNITY HEALTH NURSING Is based on the worth & dignity of man (Dr. Margaret Shetiand) GOAL: ‘raise the level of health of the citizenry by helping communities and families to cope with the discontinuities in and threats to health in such way as to maximize their potential for high level of wellness — Nisce, Reyala, et al. assist the individual, family and community in attaining their which is attained through multidisciplinary effort and to promote reciprocally supportive relationship between people and their physical and social environment BASIC PRINCIPLES ‘The COMMUNITY is the PATIENT in CHN: the FAMILY is the UNIT OF CARE: and there are FOUR LEVELS of CLIENTELE: the individual, the family, the population group and the ‘community. In CHI, the CLIENT is considered as an ACTIVE PARTNER, not a passive recipient of care. CCHN practice is AFFECTED BY DEVELOPMENTS IN HEALTH TECHNOLOGY, i particular and CHANGES IN SOCIETY, in general. The goal of CHN is achieved through MULTISECTORAL EFFORTS. CCHN is a part of HEALTH CARE SYSTEM and the LARGER HUMAN SERVICES SYSTEM. CONCEPTS The hallmark of CHN is that it is population or aggregate-focused. The whole community is the patient/client, Emphasis on the importance of the “greatest good for the greatest number”+ Assessing health needs, planning, implementing & evaluating the impact of health services on population groups + Priority of health-promotive & disease-preventive strategies over curative interventions * Tools for measuring & analyzing community health problems + Application of principles of management & organization in the delivery of health services to the community OBJECTIVES + To participate in the development of an over-all Health plan for the community and in it’s implementation and evaluation * To provide quality Nursing Services to individuals, families and communities utilizing as basis, the standards set for Community Health Nursing practice + To coordinate Nursing services with various members of the Health Team, Community Leaders and SOs, GOs and NGOs in achieving the aims of Public Health Services within the community + To Participate in and/or conduct researches relevant to community health & CHN services and disseminate their results for improvement of health care + To provide community health nursing personnel with opportunities for continuing education and professional growth through staff development. FRAMEWORK FOR COMMUNITY HEALTH NURSING 1, Health Care Delivery System (HCDS), with its CHN subsystem 2. The clients (individual, family, population group and community 3. Health which is the goal of the heallth care delivery system 4. The economic, sociocultural, political and environmental factors that affect the HCDS, the practice of CHN and the people’s health 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 According to Maglaya, et al - CHN : Composed of 3 major concepts * community (client); health (goal); & nursing (the means) COMMUNITY HEALTH NURSING IN THE PHILIPPINES ‘+ Most community health nurses in the Philippines work in health centers as public health nurses, industries/companies as occupational health nurses (company nurses) and school nurses + Roles and functions of nurses are defined by: © Philippine Nursing Act of 2002 (RA 9173) * Through the board resolution Number 425, Series of 2003, RULE V, Nursing Practice, Section 28 Scope of Nursing ‘©. Standards developed by professional associations + Philippine Nurses Association (PNA) * Occupational Health Nurses Association of the Philippines (OHNAP) * National League of Philippine Government Nurses (NLPGN) + Agencies ~ Department of Education (DepEd) Section 28. Scope of Nursing + Singly or in collaboration with another, initiates & performs nursing services to individuals, families, & communities in any health care setting + Primarily responsible for the promotion of health, & preventions of illness + Collaborate with other health care providers ‘curative, preventive, & rehabilitative aspects of a care restoration of health alleviation of suffering ‘When recovery is not possible, towards peaceful death ° oooPUBLIC HEALTH ‘+ Is the science & art preventing disease, prolonging life, organized community effort ‘0 sanitation of the environment control of communicable infections ° ‘© education of the individual in personal hygiene © organization of medical & nursing services for the early diagnosis & preventive promoting health & efficiency through treatment of disease © development of the social machinery eoPmsure everyone a standard of living adequate for the maintenance of health, 250 organizing these benefits as to enable every citizen to realize his birthright of health & longevity (Dr. CE. Winslow) 4s 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 (World Health Organization) OF PREVENTING DISEASE, PROLONGING LIFE, AND PROMOTING fhrough organized community effort for the sanitation of the Unironment, control of communicable diseases, education of individuals in personal hyglenés Sraanization of medical and nursing services forthe early diagnosis and preventive treatment ofSigease, and development of social machinery to ensure everyone a standard of rg Suequate for the maintenance of health, so organizing these benefits as TO ENABLE EVERY aaa EN TO REALIZE HIS BIRTHRIGHT TO HEALTH AND LONGEVITY (Dr. CE, Winslow) + THE SCIENCE AND ART HEALTH and efficiency tt PUBLIC HEALTH NURSING «The practice of nursing in national & local government health departments (HCs & RHUs), & public schools. It is Community health nursing practiced in the public sector (Standards of Public Health Nursing in the Philippines, 2005) + “a special field of nursing that combines the skills of nursing » public health and some phases of encial assistance and functions as part of the total public Health prograr™ for the promotion of Health, the improvement of the conditions in the social and physical environment, Fehabiitation of illness and disability (WHO Expert Committee on ‘Mursing) OBJECTIVES OF PUBLIC HEALTH: CODES C- Control of Communicable Diseases © - Organization of Medical and Nursing Services D - Development of Social Machineries E - Education on personal Hygiene Health Educ is the essential task of every health worker § - Sanitation of the environment ING IN THE PHILIPPINES 2006 pine Government Nurses, Inc. (NLPGN) STANDARDS OF PUBLIC HEALTH NURSI nity health nursing Formulated by National League of Philip | More specific in focus, that is public health nursing not commu 1. ORGANIZATION & MANAGEMENT 2. Anursing service is organized in a local health agency to ensttt the effective delivery of nursing services & nursing component of public health programs B, The nursing service is headed by a qualified chief nurse a. Chief Nurse - Qualifications: 1) BSN, RN 2) 5 years experience in general nursing servi 3) Master's degree in nursing, preferably In put health nursing | 4) Member of good standing of the accredited professional organization of nurses b, The supervising PHN who heads a nursing unit should 1) BSN, RN 2) 5 years supervi 3) Master's degree In nursing, preferably In publ (major In nursing administration ice administration blic health or community have the ff: sory experience in public health ic health or nursing4) Member of good standing of the accredited professional organization of nurses: C. The nursing service has a written vision, mission, philosophy, goals & objectives D. The nursing service formulates/reviews & implements the nursing service plan, ‘manual of policies & nursing standards. E. The Nursing Service participates in planning for the health agency's physical facilities, equipment & supplies & in monitoring their use F. The nursing service participates in the offical recruitment, selection, promotion, & discharge process at all levels involving nursing personne! (nurses & midwives) & in making decisions involving nurses & midwives & nursing practice. G. The Nursing Service initiates / strengthens mechanisms within the agency that enhance nursing & midwifery contribution to the overall community health goals, TI. QUALIFICATIONS & FUNCTION of the PUBLIC HEALTH NURSE ‘A. The PHN has the professional, personal & other qualifications that are appropriate to her/his Job responsibilities, Is a graduate of Bachelor of Science in Nursing (BSN) & a registered nurse (RN) Has the following personal qualities & professional competencies: Good physical & mental health Interest & willingness to work in the community Capacity & abilty to: a. Relate the practice with ongoing community health & health related activities b. Work cooperatively with other disciplines & members of the community . Accept & take actions needed to improve self & service . Analyze combinations of factors & conditions that influence health of populations e. Apply nursing process in meeting the health & nursing needs of the ‘community f. Mobilize resources in the community With leadership potential Resourcefulness & creativity Honesty & Integrity ‘Active membership to professional organizations B, The PHN performs functions & activities in accordance with the dominant values of PHNs, within the profession's ethico-legal framework & in accordance with the needs of the client & available resources for health care 1. The functions & activities of the PHN which are related to management training, supervision, provision of nursing care, health promotion & education & coordination are consistent with the Nursing Law (RA 9173) & program policies formulated by the Department of Health & the local health agency C. The PHN, in accordance with the faculty of colleges of nursing, Participates in teaching, guidance & supervision of students in nursing & midwifery for their related learning experience (RLE) in the community setting, D. The PHN participates in the conduct of research & utilizes research findings in his/her nursing practice eee PEna + PHN CAN ONLY PERFORM HIS/HER FUNCTIONS EFFECTIVELY IF HE/SHE : Has the necessary KSA in dealing with the health needs & problems of his/her clients * Familiar with the structure & dynamics of the health care system & its broader sociocultural, economic & political context * Knowledgeable of laws & policies affecting the health care system in general & nursing Practice in particular & of nursing & program standardsETHICO-LEGAL ASPECTS OF NURSING PRACTICE IN THE COMMUNITY ‘* Guided by a number of legal and ethical principles that center on the welfare of clients & protection of their rights. + CHNs are in the position to influence others to respect and protect these rights ‘+ Nursing practice is legal if the practitioner works within the bounds of law; it is ethical if the nurse upholds ethical principles such as: © autonomy beneficence/nonmaleficence Justice fidelity veracity oo00 * Theoretical Models/ Approaches 1, The Health Belief Model - developed by social psychologists to explain why the public failed to participate in screening for tuberculosis (Hochbaum, 1958). model explains and predict individual changes in health behaviors © one of the most widely used models for understanding health behaviors. Used to explain behavior change and maintenance of behavior change to guide health promotion interventions (Janz et al.,2002 Health Belief Model (Becker, 1974, 1988; Janz & Becker, 1984) INDIVIDUAL PERCEPTIONS MODIFYING FACTORS LIKELIHOOD OF ACTION 2. Nancy Millio Framework for Prevention ~ Outlined Six propositions relating to health promotion and disease prevention. asserted that health deficits occur when there Is an imbalance between a ‘community's health needs, and its health-sustaining resources. All human beings make health choices that are the easiest for them to make, most of the time, Millo’s Framework for Prevention ~ Model describes as neglected role of community health nursing to examine the determinants of a community's health and attempt to Influence those determinants through public policy. ~ _ model includes concepts of community—oriented, population—focused care.Basic treatise was that behavioral eet helps tiermelrici ner 3. Nola Pender - Health Promotion Model (HPM) Explores many biopsychosocal factors that influence individuals to pursue heath Promotion activities. depicts the complex multidimensional factors with which people interact as they work to achieve optimum health. health as @ positive dynamic state rather than simply the absence of disease. focuses on helping people achieve higher levels of well-being ~ Focuses on three areas such as individual characteristics and experiences, behavior-specific cognitions, affect and behavioral outcomes. ee | ; = | | == | Figure 1 Disgram ofthc health promotion manict ~ Portales = 3002 4. Lawrence Green's - Precede-Proceed Model - Provide for community assessment, health education planning, and evaluation. - PRECEDE: which stands for PREDIPOSING, REINFORCING and Enabling Constructs in educational Diagnosis and Evaluation, is used for community diagnosis. PROCEED: an ACRONYM for POLICY, REGULATORY, and ORGANIZATIONAL CONSTRUCT in EDUCATIONAL and ENVIRONMENTAL DEVELOPMENT, is 2 model for implementing and evaluating health programs based on PRECEDE. PRECEDE-PROCEED Framework press 5 Phases phases Kirwicrave Eatin Sahara PAZ Phage t racy Ectopea Ener Assessment Assessment Assessment Laan