COMMUNITY HEALTH NURSING

FOCUS
: Promotion and Preservation of the health of populations
NATURE OF PRACTICE
: comprehensive, general, continual and not episodic
KNOWLEDGE BASE
: from nursing and public health
LEVELS OF CLIENTELE
: individuals, family, population groups and community as awhole
COMMUNITY
- A group of people sharing common geographic boundaries andcommon values and interests.
HEALTH
- state of complete physical, mental and social well-being, not merely theabsence of disease or infirmity
WORLD HEALTH ORGANIZATION
- Optimum level of individuals, families andcommunities
MODERN CONCEPT OF HEALTH
- This factor pertains to the power and authorityto regulate the environment
FACTORS AFFECTING LEVEL OF FUNCTIONING
POLITICAL -
This factor pertains tothe power and authority to regulatethe environmentExamples:

Safety

Oppression

People empowerment
HEALTH CARE DELIVERY SYSTEM -
One component of this factor is theprimary health care which is apartnership approach
Goal:
Effective provision of healthservices that are community-basedand accessible
Components:

Promotive

Preventive

Curative

Rehabilitative
BEHAVIORALComponents

Culture

Habits

Ethnic customs
Examples

Smoking

Intake of alcoholic drinks

Substance abuse

Lack of exercise
SOCIOECONOMIC INFLUENCESComponents

Employment

Education

Housing
ENVIRONMENTAL INFLUENCESComponents

Air

Food

Water waste

Urban/rural noise

Radiation

Pollution
HEREDITY Components

Genetic endowment

Defects

Strengths

Risks:

Familial

Ethnic

Racial
PUBLIC HEALTH NURSING
Public health
as the
science and art
of preventing disease, prolonging life andefficiency
to enable every citizen to realize his birthright of health and longevity
( Winslow)
P
ublic health
is dedicated to
the common attainment of the highest level of physical, mental and social well-being and
longevity

GOAL:
contribute to the most effective total development and life of the individualand his society.
(Hanlon)
______________________________________________________________
Community health nursing
is a
learned practice discipline

Ultimate Goal :
contribute to the promotion of client’s optimum level of functioning Through teaching and delivery of care.
(Jacobson)Community health nursing
is a
service rendered by a professional nurse
with the
community, groups, families and individualsGOAL:
promotion of health, prevention of illness, care of the sick at home andrehabilitation
(Freeman)Philosophy
of
community health nursing
is based on the
worth and dignity of man. (Shetland)
CONCEPTS OF COMMUNITY HEALTH NURSING

HEALTH PROMOTION
– primary focus of community health nursing practice

Practice is extended to benefit not only the individual but the whole familyand community

Community health nurses are

GENERALISTS
PRINCIPLES OF COMMUNITY HEALTH NURSING

Community health nursing is based on

recognized needs
of communities,families, groups and individuals

The community health nurse must understand fully the

objectives andpolicies
of the agency she represents

FAMILY
– unit of service

Community health nursing must be

available to all

HEALTH TEACHING
– primary responsibility of the community health nurse

The community health nurse works as a

member of the health team

There must be
periodic evaluation

Opportunities for
continuing staff education
program must be provided
PRINCIPLES OF COMMUNITY HEALTH NURSING

Make use of
available community health resources

Utilize
existing active groups
in the community

Educative supervision

Accurate
recording and reportingULTIMATE GOAL: Raise the level of health of the citizenry
ROLES OF THE NURSE IN COMMUNITY HEALTH NURSING
Clinician –
focus on the health of the individuals on the larger context of thecommunity
Advocate
– promote self-care and self-determination
Collaborator
– brings together strengths and weaknesses of people involvedtoward a common goal
Researcher –
utilizes data to predict future phenomenon and modify interventions
Counselor
– key tasks include listening and providing feedback and information
Case Manager
– oversees all aspects of care to facilitate delivery of cost-efficientcare; to individualize and coordinate
care
Educator
– provide knowledge, skills and attitudes that people need to makeappropriate choices or decision
Hospice Care
– providing care skills in a home and other settings and balancingclient’s needs

THE NURSING PROCESS

A
SSESSMENT
- Process of collectingand processing data/information aboutthe client
STEPS:

Initiate contact

Demonstrate caringattitudes

Develop mutual trust andconfidence

______________________________________________________________

Collect data from allpossible sources

Identify problems

Analyze and interpret data

P
L PLANNING
- formulation of steps to beundertaken to achieve desired end
STEPS:

Prioritize needs

Establish goals based onneeds and capabilities

Construct action andoperation plan

Devise evaluationparameters

Revise plan as needed

I
MPLEMENTATION
-translation of care plan intoaction
STEPS:

Put nursing plan to action

Coordinate care / services

Utilize community resources

Delegate and supervise

Monitor health servicesprovided

Provide health educationand training

Document responses tonursing action

E
VALUATION -
process of making judgments as to the extent theobjectives are met
STEPS:

Care outcomes

Performance appraisal

Estimate cost benefit ratio

Assessment problems

Identify needed alterations

Revise plans as necessary

CATEGORIES OF HEALTH PROBLEMS
HEALTH DEFICIT

A gap between actual and achievable health status

Instances of failure in health maintenance

Possible precursors of health deficit:

History of repeated infections or miscarriages

No regular health check-upExamples:

ILLNESS states, diagnosed or undiagnosed

Failure to thrive/develop

Disability

Transient (aphasia or temporary paralysis after a CVA)

Permanent (leg amputation secondary to diabetes, blindnessfrom measles, lameness from polio)
HEALTH THREAT -
conditions that are conducive to disease, accident or failure torealize one’s potentialExamples:

Family history of hereditary disease

Threat of cross infection

Accident hazards

Faulty eating habits

Poor environmental sanitation

Unhealthy lifestyle/personal habits

FORESEEABLE CRISIS
- anticipated periods of unusual demand on the individualor family in terms of adjustment/family
resourcesExamples:

Marriage

Pregnancy

Parenthood

Divorce or separation

Loss of job

Menopause

Death ______________________________________________________________

PRIORITIZING HEALTH PROBLEMSNATURE OF THE PROBLEM

– categorized into health deficit, health threat andforeseeable
crisisH e a l t h d
e f i c i t 3 Health threat 2Foreseeable
crisis 1
MODIFIABILITY OF THE PROBLEM
– refers to the probability of success inminimizing, alleviating or totally eradicating the problem through
interventionE a s i l y m o d i f i a b l e 2 Parti
ally modifiable 1N o t m o d i
f i a b l e 0
PREVENTIVE POTENTIAL
–refers to the nature and magnitude of future problemsthat can be minimized or totally prevented if
intervention is done on the problemunder
considerationH i g h 3 M o
d e r a t e 2 Low 1
SALIENCE
– refers to the family’s perception and evaluation of the problem interms of seriousness and urgency of
attention
neededA s e r i o u s p r o b l e m , i m m e d
i a t e a t t e n t i o n n e e d e d 2 A p r o b l
e m , b u t n o t n e e d i n g i m m e d i a t e a t t e n t i o
n 1 Not a felt need / problem 0
EVALUATION OF CARE AND SERVICES PROVIDED
STRUCTURAL ELEMENTS -
include the physical settings, instrumentalities andconditions through which nursing care is
givenComponents:

Philosophy

Objectives

Building

Organizational structure

Financial resources (budget, equipment, staff)

PROCESS ELEMENTS -
steps of the nursing process ( assessment, planning,implementing and evaluating)Components:

Taking the family health database

Performing physical examination

Making a nursing diagnosis

Determining nursing goals

Writing a nursing care plan

Performing nursing interventions

Coordination of services

Measuring success of nursing actions

OUTCOME ELEMENTS -
changes in the client’s health status that result fromnursing interventionsCOMPONENTS

modification of signs and symptoms

Knowledge
Attitude

Satisfaction

Skill level of client

Compliance with treatment

regimen ______________________________________________________________

NURSING PROCEDURES
PRE-CONSULTATION CONFERENCE
1 . G r e e t a n d m a k e c l i e n t a t e a s e 2 . T a k e c l i n i c a l h i s t o r y 3.Take
temperature, blood pressure, height and weight4 . P e r f o r m p h y s i c a l a s s e s s m e n t 5 . D o
laborator y examinations6.W rite findings on client records
MEDICAL EXAMINATION
1.Assist client before, during and after examination by physician2.Inform physician of
relevant findings gathered in pre-conference3.W ork with the physician during
the examination4.Ensure privac y, safety and comfort of patient throughout
procedure5.Observe confidentiality of examination results
Nursing Intervention:
1.Carry out physician’s orders as giving medication or injection2.Explain and reinforce physician’s orders
and advises3.Teach patient measures to promote and maintain health as properdiet, exercise
andPersonal hygiene.4.Seek information regarding health status of other family
members5 . C o u n s e l i n g
PRE-CONSULTATION CONFERENCE
1.Explain findings and needed care or intervention2.Refer patient
to other health worker/agenc y3.Make appointment for next clinic/home visit
DEPARTMENT OF HEALTH
VISION:
Health for all Filipinos
MISSION:
Ensure accessibility of health care to improve the quality of life of theFilipinos especially the poor
NATIONAL HEALTH OBJECTIVES

Improve the general health status of the population

Reduce morbidity, mortality, disability and complications

Eliminate the following diseases as public health problems (schistosomiasis,malaria, filariasis, leprosy,
rabies, measles, tetanus, diphtheria, pertussis,vitamin A and iodine deficiency)

Eradicate poliomyelitis

Promote healthy lifestyle

Promote health and nutrition of families and special populations

Promote environmental health and sustainable development

BASIC PRINCIPLES TO ACHIEVE IMPROVEMENT IN HEALTH

Ensure universal access to basic health services

Epidemiological shift from infectious to degenerative disease mustbe managed

Enhance the performance of the health sector

Ensure the prioritization of the health and nutrition of vulnerablegroupsPRIMARY

STRATEGIES TO ACHIEVE HEALTH GOALS

Support for frontline health workers and local system development

Assurance of health care

Increasing investment for primary health care

______________________________________________________________

Development of national standards and objectives for health

-
D
ental health program
-
O
steoporosis prevention
-
H
ealth education and community organizing
-
P
rimary health care
-
R
eproductive health
-
O
lder persons health service
-
G
uidelines for good nutrition
-
R
espiratory Infection Control
-
A
lternative health care
-
M
aternal and child care
-
S
entrong Sigla Movement
PRIMARY HEALTH CARE
Essential health care made universally acceptable to individuals andfamilies in the
community

By means acceptable to them and through their full participation

At a cost that the community and country can afford at every stageof development
ESSENTIAL HEALTH CARE SERVICES
GOAL :
Health for all Filipinos and Health in the Hands of the People by the year2020
MISSION :
To strengthen the health care system wherein people will manage theirown health care
CONCEPT :
partnership and empowerment of the people
LEGAL BASIS:

Letter of Instruction 949

President Ferdinand Marcos

October 19, 1979

First International Conference on Primary Health care

Alma Ata, USSR

September 6-12, 1978

Sponsored by the World Health Organization and UNICEF

ELEMENTS/COMPONENTS of PHC
-
E
ducation for Health
-
L
ocally Endemic Disease Control
-
E
xpanded Program on Immunization
-
M
aternal and Child Health
-
E
ssential Drugs and Elderly Care
-
N
utrition
-
T
reatment of CD and Non-CD
-
S
anitation: Water and Environment
ORGANIZATIONAL STRATEGY
Framework for meeting the goal of primary health care

Calls for active and continuing partnership among the communities,private and government agencies
in health development
LEVELS OF HEALTH CARE SERVICESPRIMARY

Barangay Health Station

Private Practitioners

Community Hospitals ______________________________________________________________

Rural Health Unit

SECONDARY

Emergency/DistrictHospitals

Provincial/City Hospitals
TERTIARY

Regional Medical Centersand Training Hospitals

National Medical Centers

Teaching and TrainingHospital

TWO LEVELS OF PHC WORKER

VILLAGE / BARANGAY HEALTH WORKERS (V/BHWs)

- Trained community health workers- Health auxiliary volunteer- Traditional birth attendant or healer

INTERMEDIATE LEVEL HEALTH WORKERS

- General medical practitioner- Public health nurse- Rural sanitary inspector- Midwive