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Jhessie Abella RN,RM,MAN,CPSO

The document discusses the key concepts of community health nursing including defining a community, health, and nursing; it describes the focus, clients, scope, and skills of community health nursing; and it explains the nursing process used in community health nursing from assessment of communities, families, and individuals to planning, implementation, and evaluation of care.

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COMMUNITY HEALTH NURSING 12/05/12 1
12/05/12 2
Community Health Nursing: The 3 Broad Concepts 1. 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 – The community is the object or focus of care in CHN, with the family as the unit of service. 12/05/12 3
FACTS of CHN Focus : promotion and preservation of health Area of Content: skills and knowledge relevant to both nursing and public health Clients : general populations (individuals, families, communities) Time : continual, not limited to episodic care Scope : comprehensive and general, not limited to a particular age or group 12/05/12 4
Concepts on Community Health Nursing:  CLIENTS of Community Health Nurse  Composed of different levels of clientele: Individual, family, population group, and community • Community as a SETTING for CHN PRACTICE  School Health Nursing- School  Occupational Health Nursing- Workplace  Public Health Nursing-Home 12/05/12 5
2. What Is Health? A state of complete physical, mental, and social well- being and not merely the absence of disease and infirmity (WHO, 1995). 12/05/12 6
What is Health? •It carries the mandate that health is a basic human right. •It is seen as a spectrum or a continuum •The modern concept of health refers to Optimum Level of Functioning (OLOF) of individuals, families, and communities, which is influenced by the ecosystem through a myriad of factors. 12/05/12 7
What influences OLOF? • Behavioral (culture, habits, mores, ethnic customs) • Socio-economic (employment, education, housing) • Political (safety, oppression, people, empowerment) • Hereditary (genetic endowment, familial, racial) • Health Care Delivery System (promotive, preventive, curative, rehabilitative) • Environment (air, food, water, wastes, noise, radiation, pollution, congestion)
3. What is Nursing?  The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980).  Nursing, together with public health, is one of the helping professions in the health care system which operates at three levels of clientele – individuals, families or groups, and communities 12/05/12 9
It operates within the realm of health care both independently and interdependently. The objective of nursing is to assist clients to achieve, maintain, or recover a high level of functioning. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness (Henderson) 12/05/12 10
The PHILOSOPHY of CHN • is based on the worth and dignity of man (Shetland)
•Concepts and Principles pertaining to CHN
Knowledge-base of CHN • Biological and social sciences • Ecology • Clinical Nursing 12/05/12 13
• Utilizes COMMUNITY HEALTH ORGANIZATIONS
• it is population-focused – “the greatest good for the greatest number” > Community diagnosis > Vital statistics > Priority setting • it is a promotive-preventive service – adheres to Primary Health Care > Health education > Preventive treatment • It is a generalist practice – deals with all 12/05/12 cases 15
The ULTIMATE GOAL of CHN • By: RAISE the  help communities and families cope with discontinuities in health and level of health threats  Maximize their potential for of high level wellness  Promote reciprocally supportive relationship citizenry… between people and their physical and social 12/05/12 environment 16
The PRIMARY FOCUS of CHN health promotion wherein health teaching is the primary responsibility of the community health nurse, who is a generalist in terms of practice 12/05/12 17
Principles of CHN E – ducation as primary tool and responsibility M – ade available to all regardless of race, creed and socio-economic status P – olicies and objectives of the agency is fully understood by the nurse O – rganizing for health, with the family as the unit of service W – orks as a member of the health team (PHN) E – xisting active organizations are utilized R – ecording and reporting are accurate M – onitoring and evaluation of services is periodically done E – xisting indigenous resources of the community is used N – eeds of clienteles is recognized and serves as basis for CHN T – raining and development as opportunities for continuing staff education programs 12/05/12 18
REMEMBER that in CHN: 1. The patient in CHN is the Community which is composed of different population groups and several families (the basic unit of care), and In turn compose of individuals. 2. Client is ACTIVE and NOT PASSIVE recipient of care 3. CHN practice is affected by any changes in society and environment 4. Multi-sectoral effort is the key to goal achievement 5. CHN is a part of health care system and the larger human services system. 12/05/12 19
Quick Review Exercises (QRX) 12/05/12 20
QRX In terms of CHN practice, the nurse in the community is trained as a. Certified in public health b. Specialist in CHN c. 4-year BSN graduate d. Generalist in nursing 12/05/12 21
Ans: d. Generalist in nursing
QRX The thrusts of CHN must be embodied in the hearts of health care providers. Which one strengthens the health care system? a. Supporting conditions for healthy habits b. Increasing opportunities to be healthy c. Letting the people manage their own health d. Financing health care program Ans: c.Letting the people manage their own health 12/05/12 23
Ans: c.Letting the people manage their own health
QRX As a Public Health Nurse, what is your primary function or responsibility? a. Reporting of cases b. Health Promotion c. Community Diagnosis d. Health Teaching 12/05/12 25
• Ans: d. Health Teaching
QRX The philosophy of CHN practice is based on the belief that the family is the smallest unit in a democratic society. Which age group should be the priority of the nurses in the community? a. Older persons and terminally ill b. Adolescents and adults c. Infants and children d. All ages regardless of status 12/05/12 27
Ans: d. All ages regardless of status
HIGHLIGHTS in CHN Concepts •CHN is based on the recognized needs of communities, families, groups, ands individuals. •CHN is a unique blend of nursing and public health practice, and is oftentimes used interchangeably with the term “Public Health Nursing”. 12/05/12 29
Philosophy of Public Health Health and longevity as birthrights Longevity – average lifespan or life expectancy • 50 years – Swaroop’s Index • Untimely death – person died without reaching the average lifespan Combined (M/F) – 69.6 y/o Male – 66.74 y/o Female – 72.61 y/o 12/05/12 30
Objectives of Public Health 3 P’s: Promote health Prevent Disease Prolong Life 12/05/12 31
Basic Public Health Services • Environmental Sanitation • Health Education • Prevention of Communicable Diseases • Medical Services • Nursing Services • Vital Statistics • Public Health Laboratories • Maternal and Child Health Services 12/05/12 32
Basic Competencies Needed by the Public Health Nurse • Teaching • Management • Critical Thinking • Physical Caregiving • Application of the Nursing Process • Application of the Epidemiological Process • Documentation 12/05/12 33
Functions of the PHN Manager > Planner, Programmer, Supervisor, Coordinator of services Health Care Provider > Direct nursing care Researcher > Epidemiologist, Health Monitor, Recorder, Statistician Community Organizer > Change Agent Trainer > Health Educator, Counselor Role Model 12/05/12 34
In the care of the families: Provision of primary health care services  Developmental/Utilization of family nursing care plan in the provision of care 12/05/12 35
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 12/05/12 36
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, the standards ser for CHN practice – maintain coordination/linkages with other health team members, NGO/government agencies in the provision of public health services – conduct researches relevant to CHN services to improve provision of health care – provide opportunities for professional growth and continuing education for personal growth thru staff development 12/05/12 37
CHN Process 1. Establishing a working relationship with the client • Initiating contact • Communicating interest in the client’s welfare • Showing willingness to help with expressed need of the client • Maintaining a two-way communication with the client 12/05/12 38
CHN Process 2. Assessment of needs, taking into consideration personal, environmental and psycho-socio- cultural factors influencing health • Situation and trends revealed in personal, socio- economic and environmental history • Physical, emotional, intellectual ability to perform a function • Attitudes, knowledge and perceptions of health and illness • Health behavior and patterns of health care • Resources available to meet own needs • Other factors affecting health 12/05/12 39
A. Collection of Data A. Community  Demographic data  Vital statistics  Community Dynamics  Disease surveillance  Economic, cultural , and environmental characteristics  Health service utilization B. Family and Individual - Health status/ education - Socio-cultural factors - Occupation - Family dynamics - Environment - Patterns of coping 12/05/12 40
B. Categories of Health Problem A. Wellness State B. Health Deficit C. Health Threat D. Foreseeable Crisis 12/05/12 41
CHN Process 3. Planning of care • Summarizing problems and needs • Establishing priorities of care • Setting objectives of care • Determining approaches or strategies to meet identified objectives 12/05/12 42
CHN Process 4. Implementation of care • Actual delivery of care • Institution of planned interventions • Application of coordination, supervision, social mobilization, health education, therapeutic communication 12/05/12 43
CHN Process 5. Evaluation of care • Monitoring of status • Systematic documentation of results • Analysis of effectiveness of care provided (Structural elements, Process Elements, and Outcome elements) 12/05/12 44
Levels of Clientele Individual • Basic approaches in looking at the individual: – Atomistic – Holistic 12/05/12 45
Family Models: Developmental Stages of Family Development Stage 1 – The Beginning Family Stage 2 – The Early Child-bearing Family Stage 3 – The Family with Preschool Children 12/05/12 46
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 12/05/12 47
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 12/05/12 48
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 in health maintenance (disease, disability, developmental lag) Stress points/ Foreseeable crisis situation:  anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources Wellness State/ Potential 12/05/12 49
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 12/05/12 50
Problem Prioritization: Nature of the problem Wellness State Health deficit Health threat Foreseeable Crisis Preventive potential High Moderate Low 12/05/12 51
• Modifiability Easily modifiable Partially modifiable Not modifiable • Salience High Moderate Low 12/05/12 52 *Family Service and Progress Record
Population Group • Vulnerable Groups: Infants and Young Children School age Adolescents Mothers Males Old People 12/05/12 53
CHN Process Community Diagnosis • Determining the health status of the populations in the community as well as the factors that directly or indirectly affect their health status • It is an integral part of the assessment phase of the CHN Process • It is also known as community assessment or situational analysis 12/05/12 54
• A process by which the people in the community and the health team assess the community’s health problems and needs as bases for health program development. • A learning process for the community to identify their own health problems and needs. • A profile that depicts the health problems and potentials of the community. 12/05/12 55
2 types of Community Diagnosis: 1.Comprehensive- provides general health profile of the community 2.Specific or Problem-Oriented- yields a comprehensive profile of a particular health problem 12/05/12 56
STEPS: Preparatory Phase 1. site selection 2. preparation of the community 3. statement of the objectives 4. determine the data to be collected 5. identify methods and instruments for data collection 6. finalize sampling design and methods 7. make a timetable 12/05/12 57
Implementation Phase 1. data collection 2. data organization/collation 3. data presentation 4. data analysis 5. identification of health problems 6. prioritization of health problems 7. development of a health plan 8. validation and feedback Evaluation Phase 12/05/12 58
CHN Process Parts of Community Diagnosis: A. Demographic Variables • Total population and population density • Age and sex composition, Population Pyramid • Sex Ratio • Civil Status • Population movement/patterns of migration • Growth Rate, Life Expectancy 12/05/12 • Crude Birth Rate, Crude Death Rate 59
CHN Process Parts of Community Diagnosis: B. Social Indicators • Literacy Rate • Educational attainment • Communication network • Transportation system • Housing conditions (types, ownership, lighting, ventilation, crowding/congestion) 12/05/12 60
CHN Process Parts of Community Diagnosis: C. Economic Indicators • Dependency Ratio • Occupation • Income • Poverty index • Unemployment Rate • Underemployment Rate • Types of industry present in the community 12/05/12 61
CHN Process Parts of Community Diagnosis: D. Cultural Factors • Ethnicity • Race • Language • Religion • Beliefs (superstitions and traditions) 12/05/12 62
CHN Process Parts of Community Diagnosis: E. Environmental Indicators • Topographical characteristics • Water supply • Garbage disposal/collection system • Excreta disposal • General sanitary condition 12/05/12 63
CHN Process Parts of Community Diagnosis: F. Health Patterns • Food storage • Infant feeding practice • Immunization status • Health seeking behavior • Source of health information • Leading causes of mortality, morbidity, infant mortality, infant morbidity, maternal mortality 12/05/12 64
CHN Process Parts of Community Diagnosis: G. Health Resources • manpower-population ratio • manpower distribution • manpower policies • health budget and policies • sources of health funding • categories of health institutions available 12/05/12 • categories of health services available 65
CHN Process Parts of Community Diagnosis: H. Political and Leadership Patterns • Power structures in the community • Confidence of people to authority • Conditions that cause developmental conflicts • Prevailing issues • Practices that are usually utilized in settling concerns of the community • Stakeholder Analysis 12/05/12 66
CHN Process Steps in Conducting Community Diagnosis: 1. Determining the objectives 2. Defining the study population 3. Determining the data to be collected 4. Developing an instrument • survey questionnaire • interview schedule 12/05/12 67
CHN Process Steps in Conducting Community Diagnosis: 5. Data gathering • Records review • Observation • Surveys • Interviews 6. Data collation 12/05/12 68
CHN Process Steps in Conducting Community Diagnosis: 7. Data presentation 8. Data analysis 9. Identification of CHN Problems • Health status • Health resources • Health-related 12/05/12 69
CHN Process Steps in Conducting Community Diagnosis: 10. Prioritization of CHN Problems • Nature • Magnitude • Modifiability • Preventive potential 12/05/12 • Social concern 70
Biostatistics A. Demography A study of population size, composition, and spatial distribution as affected by births, deaths, and migration 12/05/12 71
SOURCES OF DEMOGRAPHIC DATA: 1.Survey 1. Census- De jure or De facto 2. Sample Survey 2.Continuing Population Registers 3.Other Records and Registration Systems 12/05/12 72
COMPONENTS: Population Size 1. Natural increase 2. Net migration 3. Rate of natural increase Population Composition 1. Age Distribution 2. Median Age 3. Dependency Ratio 4. Sex Ratio 5. Population Pyramid 6. Others: occupational groups, economic groups, educational attainment, and ethnic groups 12/05/12 73
Population Distribution 1. Urban-Rural • Shows the proportion of people living in urban compared to the rural areas 1. Crowding Index • Indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host 1. Population Density • Determines the congestion of the place 12/05/12 74
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 – 12/05/12 General Fertility Rate 75
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 Rate Prevalence Incidence Rate 12/05/12 76
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 12/05/12 77
Basic Concepts: – Epidemiologic Triad – Transmission – Incubation period – Herd immunity 12/05/12 78
Factors affecting distribution: • PERSON – intrinsic characteristics • PLACE – extrinsic factors • TIME – temporal patterns 12/05/12 79
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 susceptible 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 12/05/12 80
• Endemic – habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptible 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 12/05/12 81
THE NATIONAL HEALTH SITUATION  Health Care Delivery System Health Care Delivery System is “the totality of all policies, facilities, equipments, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.” 12/05/12 82
According to Increasing According to the Type Complexity of the Services of Service Provided Type Service Type Example Primary Health Promotion, Health Information Preventive Care, Continuing Promotion Disseminati Care for common health and illness on problems, attention to Prevention psychological and social care, referrals Secondary Surgery, Medical services by Diagnosis and Screening Specialists Treatment Tertiary Advanced, specialized, Rehabilitation PT/OT diagnostic, therapeutic & rehabilitative care 12/05/12 83
The Health Sector 12/05/12 84
The Health Sector Department of Health Vision: Leader and staunch advocate and model in promoting Health for ALL in the Philippines Mission: Guarantee equitable, sustainable, and quality health for all Filipinos, specially the poor and shall lead the quest for excellence in health 12/05/12 85
3 Major Functions: 1. LEADERSHIP in health  National policy – formulation, monitoring and evaluation  Regulatory institution  Advocates adoption of health policies, plans and programs 2. Enabler and Capacity Builder  Innovate new strategies to improve health programs  Exercise oversight function  Ensure highest achievable standards 3. Administrator of Specific Services  Manage selected national health facilities and hospitals  Administer direct services for emergent health concerns  Administer health emergency response services 12/05/12 86
DOH Programs D – ental Health O – perations for Environmental Sanitation H – ealth Education and Community Organizing P – revention and Control of Communicable Diseases R – eproductive Health O – lder Persons Health Services G – uidelines for Nutrition R – ehabilitation and Management of Non-communicable Dse. A – lternative Health Care Practices (HerbalMeds/Acupressure) M – aternal and Child Health and IMCI S – entrong Sigla Movement 12/05/12 87
Local Government Units (LGU) RA 7160 Local Government Code Private Sector Composed of both commercial and business organizations, non-business organizations Non-Government Organizations Assumes the following roles:  Policy and Legislative Advocates  Organizers, Human Rights Advocates  Research and Documentation  Health Resource Development Personnel  Relief and Disaster Management  Networking 12/05/12 88
PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL Health Promotion and Prevention of Prevention of Illness Prevention Complications thru Disability, etc. Early Dx and Tx Provided at – ► When hospitalization ► When highly- ► Health care/RHU is deemed specialized medical care ► Brgy. Health Stations necessary and referral is is necessary ►Main Health Center made to emergency ► Referrals are made to ►Community Hospital (now district), provincial hospitals and medical and Health Center or regional or private center such as PGH, ►Private and Semi- hospitals PHC, POC, National private agencies Center for Mental Health, and other gov’t private hospitals at the municipal level 12/05/12 89
Primary Health Care WHO: PHC was declared in the ALMA ATA CONFERENCE(USSR) in September 6- 12, 1978, as a strategy to community health development. Philippines: Adopted through LOI 949 signed by President Marcos on October 19, 1979 with the theme- “Health in The Hands of the People by 2020” 12/05/12 90
Primary Health Care 12/05/12 91
Framework 12/05/12 92
How can PHC be possible? Control of Communicable Diseases Offers Health Education Maternal and Child Care Provision of Medical Care and Emergency Treatment Offers “Immunization” Nutrition and Food Supply Environmental Sanitation N “Family Planning” Treatment of Locally Endemic Diseases Supply and Proper Use of Essential Drugs 12/05/12 93
S P S C U E R O P C O M P T P M. O O E R R R P T A A L T R M E T E L C I C I H P H N N A A K O T N A L I I G O O S E G N M S Y 12/05/12 94
PILLARS A. Multi-sectoral approach Intersectoral linkages (population control, private sectors, social welfare, public service, enrironmental, etc.) Intrasectoral linkages (people’s empowerment; within own system) B. Community Participation e.g. Community Organizing 12/05/12 95
C. Appropriate Technology - method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost . Criteria: Safe Acceptable Feasible Effective Scope-wise Affordable Complex 12/05/12 96
10 Medicinal Plants: Bawang-anti cholesterol Ulasimang-Bato-lowers uric acid Bayabas- antiseptic; diarrhea Lagundi-cough, asthma, and colds Yerba Buena- toothache, pain, and arthritis Sambong- renal calculi Ampalaya- diabetes mellitus Niyog-niyogan- anti-helminthic Tsaang-Gubat- diarrhea Akapulko- fungal infection RA 8423: utilization of medicinal plants as alternative for high cost 12/05/12 medications 97
D. Support mechanism made available TYPES OF PRIMARY HEALTH WORKERS Village/Grassroots Intermediate Level Health Personnel of Health Workers First-Line Hospitals Trained Community General Medical Physicians with Health worker; health Practitioners specialty area auxiliary volunteer; Public Health Nurses Nurses Traditional Birth Midwives Dentists Attendant Establish close contact Initial link, 1st contact of 1st source of with the village and 12/05/12 community the professional healthcare intermediate level HW 98
Strategies and Programs: D – ental Health O – perations for Environmental Sanitation H – ealth Education and Community Organizing P – revention and Control of Communicable Diseases R – eproductive Health O – lder Persons Health Services G – uidelines for Nutrition R – ehabilitation and Management of Non-communicable Dse. A – lternative Health Care Practices (Herbal Meds/Acupressure) M – aternal and Child Health and IMCI 12/05/12 99 S – entrong Sigla Movement
Reproductive Health • Exercise of reproductive right & responsibility • Vision: RH practice as a way of life for every man and woman throughout life •Goals: 4 E’s > Every pregnancy should be intended > Every birth should be healthy > Every sex act should be free of coercion > Every family should achieve its desired size 12/05/12 100

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Chn ppt 2011 part 1

  • 1. COMMUNITY HEALTH NURSING 12/05/12 1
  • 3. Community Health Nursing: The 3 Broad Concepts 1. 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 – The community is the object or focus of care in CHN, with the family as the unit of service. 12/05/12 3
  • 4. FACTS of CHN Focus : promotion and preservation of health Area of Content: skills and knowledge relevant to both nursing and public health Clients : general populations (individuals, families, communities) Time : continual, not limited to episodic care Scope : comprehensive and general, not limited to a particular age or group 12/05/12 4
  • 5. Concepts on Community Health Nursing:  CLIENTS of Community Health Nurse  Composed of different levels of clientele: Individual, family, population group, and community • Community as a SETTING for CHN PRACTICE  School Health Nursing- School  Occupational Health Nursing- Workplace  Public Health Nursing-Home 12/05/12 5
  • 6. 2. What Is Health? A state of complete physical, mental, and social well- being and not merely the absence of disease and infirmity (WHO, 1995). 12/05/12 6
  • 7. What is Health? •It carries the mandate that health is a basic human right. •It is seen as a spectrum or a continuum •The modern concept of health refers to Optimum Level of Functioning (OLOF) of individuals, families, and communities, which is influenced by the ecosystem through a myriad of factors. 12/05/12 7
  • 8. What influences OLOF? • Behavioral (culture, habits, mores, ethnic customs) • Socio-economic (employment, education, housing) • Political (safety, oppression, people, empowerment) • Hereditary (genetic endowment, familial, racial) • Health Care Delivery System (promotive, preventive, curative, rehabilitative) • Environment (air, food, water, wastes, noise, radiation, pollution, congestion)
  • 9. 3. What is Nursing?  The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980).  Nursing, together with public health, is one of the helping professions in the health care system which operates at three levels of clientele – individuals, families or groups, and communities 12/05/12 9
  • 10. It operates within the realm of health care both independently and interdependently. The objective of nursing is to assist clients to achieve, maintain, or recover a high level of functioning. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness (Henderson) 12/05/12 10
  • 11. The PHILOSOPHY of CHN • is based on the worth and dignity of man (Shetland)
  • 13. Knowledge-base of CHN • Biological and social sciences • Ecology • Clinical Nursing 12/05/12 13
  • 14. • Utilizes COMMUNITY HEALTH ORGANIZATIONS
  • 15. • it is population-focused – “the greatest good for the greatest number” > Community diagnosis > Vital statistics > Priority setting • it is a promotive-preventive service – adheres to Primary Health Care > Health education > Preventive treatment • It is a generalist practice – deals with all 12/05/12 cases 15
  • 16. The ULTIMATE GOAL of CHN • By: RAISE the  help communities and families cope with discontinuities in health and level of health threats  Maximize their potential for of high level wellness  Promote reciprocally supportive relationship citizenry… between people and their physical and social 12/05/12 environment 16
  • 17. The PRIMARY FOCUS of CHN health promotion wherein health teaching is the primary responsibility of the community health nurse, who is a generalist in terms of practice 12/05/12 17
  • 18. Principles of CHN E – ducation as primary tool and responsibility M – ade available to all regardless of race, creed and socio-economic status P – olicies and objectives of the agency is fully understood by the nurse O – rganizing for health, with the family as the unit of service W – orks as a member of the health team (PHN) E – xisting active organizations are utilized R – ecording and reporting are accurate M – onitoring and evaluation of services is periodically done E – xisting indigenous resources of the community is used N – eeds of clienteles is recognized and serves as basis for CHN T – raining and development as opportunities for continuing staff education programs 12/05/12 18
  • 19. REMEMBER that in CHN: 1. The patient in CHN is the Community which is composed of different population groups and several families (the basic unit of care), and In turn compose of individuals. 2. Client is ACTIVE and NOT PASSIVE recipient of care 3. CHN practice is affected by any changes in society and environment 4. Multi-sectoral effort is the key to goal achievement 5. CHN is a part of health care system and the larger human services system. 12/05/12 19
  • 20. Quick Review Exercises (QRX) 12/05/12 20
  • 21. QRX In terms of CHN practice, the nurse in the community is trained as a. Certified in public health b. Specialist in CHN c. 4-year BSN graduate d. Generalist in nursing 12/05/12 21
  • 22. Ans: d. Generalist in nursing
  • 23. QRX The thrusts of CHN must be embodied in the hearts of health care providers. Which one strengthens the health care system? a. Supporting conditions for healthy habits b. Increasing opportunities to be healthy c. Letting the people manage their own health d. Financing health care program Ans: c.Letting the people manage their own health 12/05/12 23
  • 24. Ans: c.Letting the people manage their own health
  • 25. QRX As a Public Health Nurse, what is your primary function or responsibility? a. Reporting of cases b. Health Promotion c. Community Diagnosis d. Health Teaching 12/05/12 25
  • 26. • Ans: d. Health Teaching
  • 27. QRX The philosophy of CHN practice is based on the belief that the family is the smallest unit in a democratic society. Which age group should be the priority of the nurses in the community? a. Older persons and terminally ill b. Adolescents and adults c. Infants and children d. All ages regardless of status 12/05/12 27
  • 28. Ans: d. All ages regardless of status
  • 29. HIGHLIGHTS in CHN Concepts •CHN is based on the recognized needs of communities, families, groups, ands individuals. •CHN is a unique blend of nursing and public health practice, and is oftentimes used interchangeably with the term “Public Health Nursing”. 12/05/12 29
  • 30. Philosophy of Public Health Health and longevity as birthrights Longevity – average lifespan or life expectancy • 50 years – Swaroop’s Index • Untimely death – person died without reaching the average lifespan Combined (M/F) – 69.6 y/o Male – 66.74 y/o Female – 72.61 y/o 12/05/12 30
  • 31. Objectives of Public Health 3 P’s: Promote health Prevent Disease Prolong Life 12/05/12 31
  • 32. Basic Public Health Services • Environmental Sanitation • Health Education • Prevention of Communicable Diseases • Medical Services • Nursing Services • Vital Statistics • Public Health Laboratories • Maternal and Child Health Services 12/05/12 32
  • 33. Basic Competencies Needed by the Public Health Nurse • Teaching • Management • Critical Thinking • Physical Caregiving • Application of the Nursing Process • Application of the Epidemiological Process • Documentation 12/05/12 33
  • 34. Functions of the PHN Manager > Planner, Programmer, Supervisor, Coordinator of services Health Care Provider > Direct nursing care Researcher > Epidemiologist, Health Monitor, Recorder, Statistician Community Organizer > Change Agent Trainer > Health Educator, Counselor Role Model 12/05/12 34
  • 35. In the care of the families: Provision of primary health care services  Developmental/Utilization of family nursing care plan in the provision of care 12/05/12 35
  • 36. 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 12/05/12 36
  • 37. 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, the standards ser for CHN practice – maintain coordination/linkages with other health team members, NGO/government agencies in the provision of public health services – conduct researches relevant to CHN services to improve provision of health care – provide opportunities for professional growth and continuing education for personal growth thru staff development 12/05/12 37
  • 38. CHN Process 1. Establishing a working relationship with the client • Initiating contact • Communicating interest in the client’s welfare • Showing willingness to help with expressed need of the client • Maintaining a two-way communication with the client 12/05/12 38
  • 39. CHN Process 2. Assessment of needs, taking into consideration personal, environmental and psycho-socio- cultural factors influencing health • Situation and trends revealed in personal, socio- economic and environmental history • Physical, emotional, intellectual ability to perform a function • Attitudes, knowledge and perceptions of health and illness • Health behavior and patterns of health care • Resources available to meet own needs • Other factors affecting health 12/05/12 39
  • 40. A. Collection of Data A. Community  Demographic data  Vital statistics  Community Dynamics  Disease surveillance  Economic, cultural , and environmental characteristics  Health service utilization B. Family and Individual - Health status/ education - Socio-cultural factors - Occupation - Family dynamics - Environment - Patterns of coping 12/05/12 40
  • 41. B. Categories of Health Problem A. Wellness State B. Health Deficit C. Health Threat D. Foreseeable Crisis 12/05/12 41
  • 42. CHN Process 3. Planning of care • Summarizing problems and needs • Establishing priorities of care • Setting objectives of care • Determining approaches or strategies to meet identified objectives 12/05/12 42
  • 43. CHN Process 4. Implementation of care • Actual delivery of care • Institution of planned interventions • Application of coordination, supervision, social mobilization, health education, therapeutic communication 12/05/12 43
  • 44. CHN Process 5. Evaluation of care • Monitoring of status • Systematic documentation of results • Analysis of effectiveness of care provided (Structural elements, Process Elements, and Outcome elements) 12/05/12 44
  • 45. Levels of Clientele Individual • Basic approaches in looking at the individual: – Atomistic – Holistic 12/05/12 45
  • 46. Family Models: Developmental Stages of Family Development Stage 1 – The Beginning Family Stage 2 – The Early Child-bearing Family Stage 3 – The Family with Preschool Children 12/05/12 46
  • 47. 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 12/05/12 47
  • 48. 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 12/05/12 48
  • 49. 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 in health maintenance (disease, disability, developmental lag) Stress points/ Foreseeable crisis situation:  anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources Wellness State/ Potential 12/05/12 49
  • 50. 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 12/05/12 50
  • 51. Problem Prioritization: Nature of the problem Wellness State Health deficit Health threat Foreseeable Crisis Preventive potential High Moderate Low 12/05/12 51
  • 52. • Modifiability Easily modifiable Partially modifiable Not modifiable • Salience High Moderate Low 12/05/12 52 *Family Service and Progress Record
  • 53. Population Group • Vulnerable Groups: Infants and Young Children School age Adolescents Mothers Males Old People 12/05/12 53
  • 54. CHN Process Community Diagnosis • Determining the health status of the populations in the community as well as the factors that directly or indirectly affect their health status • It is an integral part of the assessment phase of the CHN Process • It is also known as community assessment or situational analysis 12/05/12 54
  • 55. • A process by which the people in the community and the health team assess the community’s health problems and needs as bases for health program development. • A learning process for the community to identify their own health problems and needs. • A profile that depicts the health problems and potentials of the community. 12/05/12 55
  • 56. 2 types of Community Diagnosis: 1.Comprehensive- provides general health profile of the community 2.Specific or Problem-Oriented- yields a comprehensive profile of a particular health problem 12/05/12 56
  • 57. STEPS: Preparatory Phase 1. site selection 2. preparation of the community 3. statement of the objectives 4. determine the data to be collected 5. identify methods and instruments for data collection 6. finalize sampling design and methods 7. make a timetable 12/05/12 57
  • 58. Implementation Phase 1. data collection 2. data organization/collation 3. data presentation 4. data analysis 5. identification of health problems 6. prioritization of health problems 7. development of a health plan 8. validation and feedback Evaluation Phase 12/05/12 58
  • 59. CHN Process Parts of Community Diagnosis: A. Demographic Variables • Total population and population density • Age and sex composition, Population Pyramid • Sex Ratio • Civil Status • Population movement/patterns of migration • Growth Rate, Life Expectancy 12/05/12 • Crude Birth Rate, Crude Death Rate 59
  • 60. CHN Process Parts of Community Diagnosis: B. Social Indicators • Literacy Rate • Educational attainment • Communication network • Transportation system • Housing conditions (types, ownership, lighting, ventilation, crowding/congestion) 12/05/12 60
  • 61. CHN Process Parts of Community Diagnosis: C. Economic Indicators • Dependency Ratio • Occupation • Income • Poverty index • Unemployment Rate • Underemployment Rate • Types of industry present in the community 12/05/12 61
  • 62. CHN Process Parts of Community Diagnosis: D. Cultural Factors • Ethnicity • Race • Language • Religion • Beliefs (superstitions and traditions) 12/05/12 62
  • 63. CHN Process Parts of Community Diagnosis: E. Environmental Indicators • Topographical characteristics • Water supply • Garbage disposal/collection system • Excreta disposal • General sanitary condition 12/05/12 63
  • 64. CHN Process Parts of Community Diagnosis: F. Health Patterns • Food storage • Infant feeding practice • Immunization status • Health seeking behavior • Source of health information • Leading causes of mortality, morbidity, infant mortality, infant morbidity, maternal mortality 12/05/12 64
  • 65. CHN Process Parts of Community Diagnosis: G. Health Resources • manpower-population ratio • manpower distribution • manpower policies • health budget and policies • sources of health funding • categories of health institutions available 12/05/12 • categories of health services available 65
  • 66. CHN Process Parts of Community Diagnosis: H. Political and Leadership Patterns • Power structures in the community • Confidence of people to authority • Conditions that cause developmental conflicts • Prevailing issues • Practices that are usually utilized in settling concerns of the community • Stakeholder Analysis 12/05/12 66
  • 67. CHN Process Steps in Conducting Community Diagnosis: 1. Determining the objectives 2. Defining the study population 3. Determining the data to be collected 4. Developing an instrument • survey questionnaire • interview schedule 12/05/12 67
  • 68. CHN Process Steps in Conducting Community Diagnosis: 5. Data gathering • Records review • Observation • Surveys • Interviews 6. Data collation 12/05/12 68
  • 69. CHN Process Steps in Conducting Community Diagnosis: 7. Data presentation 8. Data analysis 9. Identification of CHN Problems • Health status • Health resources • Health-related 12/05/12 69
  • 70. CHN Process Steps in Conducting Community Diagnosis: 10. Prioritization of CHN Problems • Nature • Magnitude • Modifiability • Preventive potential 12/05/12 • Social concern 70
  • 71. Biostatistics A. Demography A study of population size, composition, and spatial distribution as affected by births, deaths, and migration 12/05/12 71
  • 72. SOURCES OF DEMOGRAPHIC DATA: 1.Survey 1. Census- De jure or De facto 2. Sample Survey 2.Continuing Population Registers 3.Other Records and Registration Systems 12/05/12 72
  • 73. COMPONENTS: Population Size 1. Natural increase 2. Net migration 3. Rate of natural increase Population Composition 1. Age Distribution 2. Median Age 3. Dependency Ratio 4. Sex Ratio 5. Population Pyramid 6. Others: occupational groups, economic groups, educational attainment, and ethnic groups 12/05/12 73
  • 74. Population Distribution 1. Urban-Rural • Shows the proportion of people living in urban compared to the rural areas 1. Crowding Index • Indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host 1. Population Density • Determines the congestion of the place 12/05/12 74
  • 75. 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 – 12/05/12 General Fertility Rate 75
  • 76. 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 Rate Prevalence Incidence Rate 12/05/12 76
  • 77. 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 12/05/12 77
  • 78. Basic Concepts: – Epidemiologic Triad – Transmission – Incubation period – Herd immunity 12/05/12 78
  • 79. Factors affecting distribution: • PERSON – intrinsic characteristics • PLACE – extrinsic factors • TIME – temporal patterns 12/05/12 79
  • 80. 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 susceptible 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 12/05/12 80
  • 81. • Endemic – habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptible 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 12/05/12 81
  • 82. THE NATIONAL HEALTH SITUATION  Health Care Delivery System Health Care Delivery System is “the totality of all policies, facilities, equipments, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.” 12/05/12 82
  • 83. According to Increasing According to the Type Complexity of the Services of Service Provided Type Service Type Example Primary Health Promotion, Health Information Preventive Care, Continuing Promotion Disseminati Care for common health and illness on problems, attention to Prevention psychological and social care, referrals Secondary Surgery, Medical services by Diagnosis and Screening Specialists Treatment Tertiary Advanced, specialized, Rehabilitation PT/OT diagnostic, therapeutic & rehabilitative care 12/05/12 83
  • 85. The Health Sector Department of Health Vision: Leader and staunch advocate and model in promoting Health for ALL in the Philippines Mission: Guarantee equitable, sustainable, and quality health for all Filipinos, specially the poor and shall lead the quest for excellence in health 12/05/12 85
  • 86. 3 Major Functions: 1. LEADERSHIP in health  National policy – formulation, monitoring and evaluation  Regulatory institution  Advocates adoption of health policies, plans and programs 2. Enabler and Capacity Builder  Innovate new strategies to improve health programs  Exercise oversight function  Ensure highest achievable standards 3. Administrator of Specific Services  Manage selected national health facilities and hospitals  Administer direct services for emergent health concerns  Administer health emergency response services 12/05/12 86
  • 87. DOH Programs D – ental Health O – perations for Environmental Sanitation H – ealth Education and Community Organizing P – revention and Control of Communicable Diseases R – eproductive Health O – lder Persons Health Services G – uidelines for Nutrition R – ehabilitation and Management of Non-communicable Dse. A – lternative Health Care Practices (HerbalMeds/Acupressure) M – aternal and Child Health and IMCI S – entrong Sigla Movement 12/05/12 87
  • 88. Local Government Units (LGU) RA 7160 Local Government Code Private Sector Composed of both commercial and business organizations, non-business organizations Non-Government Organizations Assumes the following roles:  Policy and Legislative Advocates  Organizers, Human Rights Advocates  Research and Documentation  Health Resource Development Personnel  Relief and Disaster Management  Networking 12/05/12 88
  • 89. PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL Health Promotion and Prevention of Prevention of Illness Prevention Complications thru Disability, etc. Early Dx and Tx Provided at – ► When hospitalization ► When highly- ► Health care/RHU is deemed specialized medical care ► Brgy. Health Stations necessary and referral is is necessary ►Main Health Center made to emergency ► Referrals are made to ►Community Hospital (now district), provincial hospitals and medical and Health Center or regional or private center such as PGH, ►Private and Semi- hospitals PHC, POC, National private agencies Center for Mental Health, and other gov’t private hospitals at the municipal level 12/05/12 89
  • 90. Primary Health Care WHO: PHC was declared in the ALMA ATA CONFERENCE(USSR) in September 6- 12, 1978, as a strategy to community health development. Philippines: Adopted through LOI 949 signed by President Marcos on October 19, 1979 with the theme- “Health in The Hands of the People by 2020” 12/05/12 90
  • 93. How can PHC be possible? Control of Communicable Diseases Offers Health Education Maternal and Child Care Provision of Medical Care and Emergency Treatment Offers “Immunization” Nutrition and Food Supply Environmental Sanitation N “Family Planning” Treatment of Locally Endemic Diseases Supply and Proper Use of Essential Drugs 12/05/12 93
  • 94. S P S C U E R O P C O M P T P M. O O E R R R P T A A L T R M E T E L C I C I H P H N N A A K O T N A L I I G O O S E G N M S Y 12/05/12 94
  • 95. PILLARS A. Multi-sectoral approach Intersectoral linkages (population control, private sectors, social welfare, public service, enrironmental, etc.) Intrasectoral linkages (people’s empowerment; within own system) B. Community Participation e.g. Community Organizing 12/05/12 95
  • 96. C. Appropriate Technology - method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost . Criteria: Safe Acceptable Feasible Effective Scope-wise Affordable Complex 12/05/12 96
  • 97. 10 Medicinal Plants: Bawang-anti cholesterol Ulasimang-Bato-lowers uric acid Bayabas- antiseptic; diarrhea Lagundi-cough, asthma, and colds Yerba Buena- toothache, pain, and arthritis Sambong- renal calculi Ampalaya- diabetes mellitus Niyog-niyogan- anti-helminthic Tsaang-Gubat- diarrhea Akapulko- fungal infection RA 8423: utilization of medicinal plants as alternative for high cost 12/05/12 medications 97
  • 98. D. Support mechanism made available TYPES OF PRIMARY HEALTH WORKERS Village/Grassroots Intermediate Level Health Personnel of Health Workers First-Line Hospitals Trained Community General Medical Physicians with Health worker; health Practitioners specialty area auxiliary volunteer; Public Health Nurses Nurses Traditional Birth Midwives Dentists Attendant Establish close contact Initial link, 1st contact of 1st source of with the village and 12/05/12 community the professional healthcare intermediate level HW 98
  • 99. Strategies and Programs: D – ental Health O – perations for Environmental Sanitation H – ealth Education and Community Organizing P – revention and Control of Communicable Diseases R – eproductive Health O – lder Persons Health Services G – uidelines for Nutrition R – ehabilitation and Management of Non-communicable Dse. A – lternative Health Care Practices (Herbal Meds/Acupressure) M – aternal and Child Health and IMCI 12/05/12 99 S – entrong Sigla Movement
  • 100. Reproductive Health • Exercise of reproductive right & responsibility • Vision: RH practice as a way of life for every man and woman throughout life •Goals: 4 E’s > Every pregnancy should be intended > Every birth should be healthy > Every sex act should be free of coercion > Every family should achieve its desired size 12/05/12 100