HEALTH NURSING INTRODUCTION Forces affecting health care in the future will also affect the role of the nurse. One can only speculate about what that future will be. Some broad changes can almost certainly be predicted. Nurses will seek to lea from the past and to avoid known pitfalls, even as they seek successful strategies to meet the complex needs of today’s vulnerable populations. As plans for the future are made, as the public health challenges that remain unmet are acknowledged, it is the vision of what nursing can accomplish that sustains these nurses. CURRENT STATUS OF COMMUNITY HEALTH NURSING In India Even after 67 years of independence, we do not have a health care system that can efficiently look after the health status of our people. India has a large share of poor, illiterate, and malnourished of the world. Majority of our people do not have basic health care facilities. There is always the dichotomy between the affluent opting for five stars - treatment at institutions having world class infrastructure, while the poor go to over -crowded public care facilities where no adequate care is provided forcing them to leave everything to fate. Health care is expensive and beyond their reach. ‘A deep analysis of the lifestyle of people would help in assessing some aspects of the prevailing public health situation in India. With the ever - increasing life expectancy, the epidemiological tran jon points towards greater incidence of non-communicable ot life style diseases. India is an exception to other countries in that nearly 4/5 th of its health care expenditure is out of pocket. Communicable and non communicable diseases have still to be brought under effective control as well as eradicated. Blindness, leprosy and tuberculosis continue to have a high incidence. HIV/ AIDS pandemic make the situation worse.Communicable and non communicable diseases have still to be brought under effective control as well as eradicated. Blindness, leprosy and tuberculosis continue to have a high incidence, HIV/ AIDS pandemic make the situation worse. High incidence of diarthocal disease as well as other preventive and infectious disease, especially among infants and children, lack of clean and safe drinking water, poor hygiene and sanitation, poverty and ignorance are among the major contributory causes of the high incidence of disease and mortality. Only 31% of the rural population has access to potable water and only 0.5% of people enjoy basic sanitation, In Tamilnadu ‘Trends in Health Status in Tamil Nadu The demography and vital statistics provide the base information on the health status of any region or community, Life Expectancy at Birth (LEB), Infant Mortality Rate (IMR), Crude Birth Rate (CBR) and Crude Death Rate (CDR) are the important indicators that reflect the health status and human development. The comparison of these health indicators for Tamil Nadu and All India average reveal the advantageous position of the state, Life Expectancy Birth — Ratd Death Ratd at birth live births (per 1000) (per 1000) (2007- 12) Male | Female | Male | Female | total Tamil 67.00 | 69.75 | 46 43 44 18.5 14 Nadu All India| 63.87 | 66.91 | 62 65 63 25 8.1 Goals of Puducherry State Health Mission by 2012 for improving Health Status: National Level Puducherry To reduce Infant Mortality Rate to Achieved 25 /1000 live births 30/1000 live births To reduce Maternal Mortality Ratio MMR achieved 18 7 1 lakhto 100/1,00,000 live births population Total Fertility Rate reduced to 2.1 Total Fertility Rate — 1.6 Malaria Mortality reduction rate 50% upto 2010, additional 10% by 2012 No Malarial Death reported in UT Filaria / Micro Filaria reduction rate 70% by 2010, 80% by 2012 and Achieved 0.06%, climination will be declared as non endemic state elimination by 2015 for fil is Dengue Mortality reduction rate $0% No mortality due to dengue by 2010 and sustained at that level until 2012 Cataract operation increasing to 46 Achieve more than the annual lakhs per year until 2012 target form Cataract operations Leprosy prevalence rate reduce from 1.8 / 10000 in 2005 to less than 1 / 10000 there after Achieved Leprosy elimination by March 2005, prevalence Rate 0.31 / 10,000 population Tuberculosis DOTS Services: Achieved 85% cure rate Maintain 85% cure rate through entire mission period Upgrading Community health Being implemented Centres to Indian Public Health Standards CURRENT TRENDS IN COMMUNITY NURSING Forces affecting health care in the future will can only speculate about wl also affect the role of the nurse. One hat that future will be. Some broad changes can almost certainly be predicted. These include: emphasis on cost containment resulting from market-driven economic policy; advancements in technology; knowledge explosion; expanded use of alternative and complementary therapies; and demographic shift‘The future of nursing care Nurses must be prepared to used critical thinking skills to solve problems and make independent clinical judgments regarding care based on the most recent evidence. They must be knowledgeable about making age-appropriate referrals to other disciplines and community agencies. Because more acute care will be provided in the home and clinies, nurses must be more technically advanced in their skills, able to practice autonomously, and adept at detailed documentation to ensure payment for services. As a larger number and percentage of the population are living with chronic conditions and managing symptoms at home, there will be a need for competent, skilled nursing practitioners who are comfortable practicing independently in the area of disease management. In home care nursing, this is evidenced by nurse doing venipunctures (a laboratory technician's role) and teaching and monitoring administration of oxygen (a respiratory therapist's role). To prepare for the home care role, nurses must be competent case managers and health educators. In the last decade, our profession has made major process in several areas of public policy. The issue of del ting duties to no licensed personnel has been addressed and continues to need clarification. Today, advanced practice nurses (APNs) can bill directly through Medicare and in most states can prescribe medication. In some states hospitals are mandated to maintain a safe level of staffing registered nurses based on the research on staffing ratio and hospitals mortality. Educational preparation and advanced practice nursing Specialty areas of nurse practitioners have expanded to numerous subspecialties in the last 3 decades. These include adult, gerontologie, neonatal, occupational, pediatric, psychiatric, school or college student, and women’s health, Nurse practitioners work in both rural and urban areas, from rural North Dakota to New York City. They practice in diverse settings such as community health centers, hospitals, college student health clinics, physician offices, nursing homes and hospices, home health care agencies, and nursing schools,Technology and information Computer technology has freed the nurse from some paper work, allowing more time for client care and teaching about self-care. The expanding implementation of computer- based client records allows the preservation of a client’s history from birth to death, Alternative and complementary therapies To follow the holistic perspective, nurses must be knowledgeable about altemative therapies. With such knowledge, they can monitor care and treatment and provide information about benefits and potential harm for clients. In the future, nurses will increasingly be called on to provide knowledge about and use of alternative therapies. Therefore, it is imperative that nurses continue to. build their Knowledge and skill base about alternative therapies. As the population becomes more diverse ethnically, it is anticipated that more methods of promoting health and treating illness will be necessary. Research provides evidence that some alternative therapies enhance health and promote recovery from illness for both the client and family caregivers (Research in Community-Based Nursing Care). While some caregivers still support only Western of health care and continue to ignore or repudiate the value of more traditional or methods alternative methods, the use of these practices has persisted and grown because people find them useful. Shifting demographics The nursing shortage is the latest demographic trend that will impact community-based care in the future, One national survey of RNs indicated that 82% of nurses reported a shortage in their hospital or community. These nurse did not have positive expectations of the impact oF the shortage on work conditions, believing that some tasks currently assigned to murses will shift to other staff. They anticipate the shortage will result in nurses leaving nursing for non- nursing jobs, thus intensifying the shortage. These changes could result in lower quality of care provided. Because community-based nursing practice will be central to the care of a population of aging and chronically ill people, nurses will be confronted will many challenges. In the future, regardless of the nurse’s own ethnic background, the nurse must be proficient at 5 ———————transcultural nursing to be an effective caregiver. Nurses will play a major role in promoting self-care and addressing health promotion and disease prevention issues for elderly clients. Collaboration is even more important when working with diverse populations. Collaboration across disciplines is always challenging, but it is particularly so if the interdisciplinary team members are from several cultural backgrounds. Preventive care Focusing on prevention will be particularly challenging as the percentage of the population ages and is living with chronic conditions. Growing trends in alternative health therapies allow more culturally sensitive options in preventive care. ‘There are different ways that nurses can operationalize the concepts of health promotion and disease prevention in community-based nursing. Nurses can position themselves as the first link between clients and the hospitals, thus developing long-term relationships. This involves developing systems and models of care that require periodically contacting clients with chronic problems. Continuity of care and collaborative care The hospital of the future may be known asa health care organization or an integrated health care system. These systems already exist in many parts of the country, More community-based care programs will come from these integrated systems. Another them used is seamless care, in which all levels of care are available in an integrated form. Continuity allows quality care to be preserved in a changing health care delivery system. Current trends in nursing employment Asa result of cost-containment measures and medical practice modifications, nursing ion of employment has changed over the past several years. The Public Health Service's Di Nursing has chronicled this change in practice settings through periodic survey of Registered Nurses. The 2004 National Sample Survey of Registered Nurses (RNs) discovered the following: * Rate for RNs who is working outside of hospitals 43.8% (up from 33.5% in 1992 and an increase of 2.9% since 2000). * Although the number of RNs working in hospitals increases, the proportion of nurses working in hospitals declined significantly.+ The number of nurses employed in public health and community health settings increased by 128.8%. Community based employment opportunities for registered nurses Ambulatory care > Adult day care centres > Day care centres for ill children > Mental health clinies y Family planning clinics v Cardiac rehabilitation programs v Geriatric clinics Migrant health clinics AIDS clinics v v Diabetes management and education services > Pulmonary clinics (asthma, chronic obstru: ive pulmonary disease, cystic fibrosis) vy Genetic serecning and counselling services Bloodmobiles v > Freestanding diagnostic centers > Diagnostic imaging centers > Mobile mammography centers Health department services > Maternal/child clinics > Family planning clinics > Communicable disease control programs v HIV/AIDS (testing, counselling, and treatment)> Tuberculosis (testing, treatment, and surveillance) v Sexually transmitted diseases (testing, counselling, and treatment) Immunization clinics v v Mobile clinics serving disenfranchised populations v Substance abuse programs > Jails and prisons > Indian health service (American Indians and Alaska natives) Home health care services > Skilled nursing care > Intravenous therapy > High-risk pregnancy/neonate care > Maternal/child newborn care > Private duty (hourly care) > Respite care > Hospice care Long-term care > Skilled nursing facilities > Hospital-based facilities > Freestanding/nursing home-based facilities > Hospice facilities > Nursing homes > Skilled nursing care > Assisted livingOther community health settings > School health programs v Occupational health programs v Parish nursing programs > Summer camp programs > Childbirth education programs CHALLENGES OF COMMUNITY HEALTH NURSING Rural community health nurse have the opportunity to use autonomy in daily practice. ‘Nurses must rapidly assume independent and interdependent decision-making roles because of the small workforce and large workload. Rural community health nurses learn to prioritize tasks quickly and work efficiently with others to “get the job done”. Referrals to other rural providers are facilitated because providers frequently know one another. ‘The rural community health nurse has an advantage over urban nurses in that the rural health care system is smaller and easier to influence and change. “Always a Nurse”: Anonymity is not easy for the rural community health nurse, who is always “on duty”. A trip to the grocery store on a Saturday morning may include interactions with rural clients and their families about their pressing health concerns. Rural community health nurses may have confidentiality and personal/professional boundary issues that need to be addressed. However, rural community health nurses are often respected, known, and trusted by the populations they serve. Funding for Education: Some of the educational loans available to you at the under-graduate and graduate levels may be reduced or forgiven if you practice in a rural community after graduation. You should inquire through your nursing program about the possibility. It is also possible tocontact a specific rural commu ity as to whether they can offer some monetary support in retum for a pledge to return to the host community to work for several years. Isolation: Rural community health nurses may experience the challenge of physical isolation from personal and professional opportunities associated with urban area, Travel to cities for basic and continuing education can be a barrier, Rural nurses may also feel isolated in their clinical practices because of the scarcity of professional colleagues. Many rural community health nurses overcome these barriers and learn to appreciate the henefits of clinical practice in a rural setting by discussing their concerns with peers and seeking ways to combat isolation. Dollars and “Sense”: The rural community health nurse often receives a salary that is lower than that of urban nurses in comparable positions, However, there are benefits to rural mu ing. Housing, costs are usually less than in larger cities, and long commutes to and from work on congested highways are avoided. Rural commu jes are great places to live and raise a family. The slower pace of life, open spaces, clean air, and friendly atmosphere may make more “sense” Possibili Many The smaller system of health care in a rural community can be an advantage to the community health nurse. It may be easier to “understand the system” and initiate planned change. For example, if a rural nurse wants to continue his or her education, ¢ college of nursing could be contacted to offer the needed classes. There are many possibilities to enhance rural nursing practice, including continuing education by satellite or Internet, partnerships with larger medical centres and invitations to clinical experts to provide on-site workshops. Grants can be written to facilitate these endeavours. Challenges in the area of demographic and mortality Profile our country: Large population base and tapering top in the age pyramid is a typical sign of under developed country. 32% of the population between 0-14 years in the base of the pyramid reflects the need for Health care services in abundance as morbidity and mortality among them are high in our country. 10Ageing Population In the rapidly growing world were 8 % of the current population are elderly healthy ageing has become a vital need in the country. The country will face a heavy double burden of infectious and non-communicable diseases with existing lack in significant resources including comprehensive ageing pol to cope. Fertility related challenges: Fertility rate of 2.8 per women (2007) is comparatively high than that of the developed countries. The combination of high fertility rate along with a 34 % of non-literate population and a Adolescent fertility rate of 45 per 1000 women when compared to 4 and 7 in the developed countries are all considered the major leads for population explosion. The challenge reflected here is high birth rate and declining death rate [9.4% to 7.5 % (2004)] in our country which is a vicious cycle not very easy to break. Hence population explosion is the greatest challenge for the health care sector to match the resources with need. Climate change and communicable discascs: the challenge ahead The global warming induced by climate change has added a new dimension to the burgeoning problem of communicable diseases in particularly in South-East Asin Region. The countries of this Region must be prepared to respond to this challenge. The changes in weather will have direct and indirect health consequences such as greater morbidity and mortality resulting from heat stroke, skin and eye diseases An increase vector borne, water borne and respiratory diseases besides eye and skin diseases are expected to rise. Diarrhoea is the second most common cause of death among children under the age of five in the developing world.India is major contributor to the global discase burden, We don't have to look back too Iong to see what happened during the Plague outbreak in Surat (Gujarat) in India in 1994 where strong monsoon following an immense heat wave, led to intense animal and human interface. a+ The onset of Chicken guinea in India is the result of climate changes. + Droughts can lead to malnutrition and starvation, + This can affect the growth and development of children. Reduced crop yields are bound to put farmers and their families into difficult circumstances and cause psychological stress as they may not be able to pay their debts during extended and repeated droughts. Changes in the frequency of extreme weather events as heat waves, cold spells, hurricanes, floods, cyclones and storms can cause loss of life, injuries and lifelong disabilities BIBLIOGRAPHY 1. Kamalam §. Essentials in community health nursing practice. 2 edition, New Delhi. Jaypee brothers medical publishers; 2012: 340-1. 2. Park K, Preventive and social medicine. 24" edition. Jabalpur. Banarasidas bhanot; 2017: 493-4, 3. Veerbhadrappa GM. The short textbook of community health nursing. New Delhi. The health sciences publisher; 2016: 50-52. 4, Govt. of India. National Population Policy 2000. Government of India Minisiry of Health & Family welfare. 5. Lal Sundar, Adarsh, Pankaj. Textbook of community medicine. Preventive & social medicine. 3" edition. New Delhi. CBS publisher;2011: 165-9. 6. Kishore J. National health Programs of India, National Policies and legislation related to health. 11" edition. New Delhi; 637-45. Lh 12