Saleema Gulzar MScN, BScN, BA, RN Aga Khan University, School of Nursing

the history of Community Health Nursing. Explain various roles of community health nurse (CHN). performed roles of CHN at national and international level. Discuss

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earliest history of nursing documented is from the dawn of Islam about fifteen centuries ago. Historically, many Muslim women provided food and care for the injured on the battlefield, during the time of Prophet Muhammad (PBUH). The

Fatimut Zohra, Umaiya Ghafarh and Rufaida al Aslamiya who were the heroes in history of

nursing providing nursing care.3

She

not only provided care to injured soldiers in the battlefield, but also acted as a social leader and educator for women (Jan, 1996) . was an advocate for preventive care and recognized the importance of health education.4

She

She

initiated the tradition of providing health-related education in the Mosque (Jan, 1996) . As Hussein, S. (1981) stated, Rufaida devoted her life to the development and improvement of nursing. She succeeded in laying new rules and traditions as the basis of better nursing.5

She was born in 1820 She is credited with the concept of modern nursing for her role as a nurse in Crimean War (1854-56). Her work demonstrated that early nursing intervention could prevent illness and improve the health of a population at risk. She became a skilful lobbyist for health care reform. She demonstrated how population-focused nursing works for prevention of illness and disease (Allender & Spradley, 2001).

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Community health nursing is the product of centuries of growth of the community and their demands. (Logan & Dawkins, 1986). Early

Home Care Nursing (before mid 1800) The focus of this care was to reduce suffering and promote healing. At that time in England midwives, most of whom had little and no training, resulting in high maternal mortality, delivered babies at home.7

District Nursing (Mid 1800s-1900) William Rathbone, a wealthy philanthropist, in 1859, employed a nurse, Mrs. Mary Robinson to look after his very sick wife at home. He established School of Nursing for visiting nurses and later organized District association of nurses. Public Health Nursing: (Late 19th Century) Lilian Wald introduced and coined the title Public Health Nursing. She felt that a nurse could be most effective if she were independent of any religious agency or attached to one doctor only.

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Community

Health Nursing (1900-1960)

In 1902 New York City Board of Education was the first to

employ school health nurse. 1909 Communicable Disease Nursing was initiated. 1910, faculty at teachers college, Columbia University, USA, developed the first academic program to prepare Community Health Nurses. 1912 Maternal and Child Health was formalized as a nursing specialty. Public Health nurses formed the National organization for Public Health Nursing (NOPHN) with Lillian Wald as the first President. 1920 Community Health Nursing training for Baccalaureate students was first introduced by Yale University SON.9

Community Health Nursing (1900-1960) After the World War II (1939-1945) National

League of Nursing required Community Health Nursing as a component of Baccalaureate nursing curriculum. In response to social problems in urban area, many new types of Community based workers were prepared for participation in community health programs in 1960. (Logan & Dawkins, 1986, p. 8-9).

Community

Health nursing (1970)

All areas of nursing including Parent and Child,

Psychiatric, Medical and Surgical nursing began discovering the role of the Community Health Nurse. The importance of involvement of family in patients care was emphasized. At the same time, clear lines of distinction were drawn of what contributed Public Health nursing and defined its nature, standards and scope (Ruth & Partridge, 1978, p. 625).

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Community

Health nursing (1980s)

From then till the late 1980s, Public Health Nursing

and Community Health Nursing have been used interchangeably. Attempts to differentiate Public Health Nursing over

the years went through a period of growth expanding its scope and developing its horizon with times. Organized public health services were set up and

standard for practice was developed and thus Public Health Nursing has remained a distinct identity.

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In 1947, Pakistan health care system was focused on public health and curative services separately. Health status of the country was low. Government had established Public Health Schools in major cities of the country, (Karachi, Lahore, Peshawar, Quetta, and Hyderabad) to train Lady Health Visitors (LHV). The role of LHV however, was limited to Maternal and Child Health Care while Registered nurses, very small in number, provided curative services (Badruddin 1995).13

In

1980, the Aga Khan University pioneered the introduction of Community Health Nursing curriculum into its new three-year diploma program. In 1985 broke new grounds by hiring diploma and BSN qualified nurses, as Community Health Nurses by CHS, AKU. In 1992, CHN course was introduced in all PNC diploma-nursing curriculum of the country (Badruddin, 1995).

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CHN

wear many hats while conducting day-today practice in the community. A community health nurse may practice at variety of setting such as; Home, Health care centers/PHC centers/Ambulatory care

clinic, School/collage Organization as an occupational nurse (Spradley, 1985).

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The major roles of community health nurse include: care provider, educator, advocate, Manager: Planning, Organizing & Coordinating. collaborator, leader, and researcher. (Allender & Spradley, 2001).

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HEALTH PROMOTER CASE MANAGER CARE PROVIDER COMMUNITY LIAISON STUDENT ADVOCATE/COUNSCELOR EDUCATOR

Empowerment through education

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International Exposure

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International Exposure

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The manager role at times involves other

functions such as leading, staffing, supervising, motivating, and controlling service activities. While motivating and controlling services and thus performing all these functions, the community health nurses most often become Participate Managers; that is they participate with clients, staff, or both, in planning and carrying out services (Allender & Spradley, 2001).

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Community

Health Nurse uses many different skills as a care provider. observation, listening, communication and counseling become an integral part of that role. There is being an increased emphasis on

psychological and sociocultural factors.

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A field of nursing that is a blend of primary health care and nursing practice with public health nursing. The community health nurse conducts a continuing and comprehensive practice that is preventive, curative, and rehabilitative. The philosophy of care is based on the belief that care directed to the individual, the family, and the group contributes to the health care of the population as a whole. The community health nurse is not restricted to the care of a particular age or diagnostic group. Participation of all consumers of health care is encouraged in the development of community activities that contribute to the promotion of, education about, and maintenance of good health. These activities require comprehensive health programs that pay special attention to social and ecologic influences and specific populations at risk. (Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.)

A field of nursing that is concerned with the health needs of the community as a whole. Public health nurses may work with families in the home, in schools, at the workplace, in government agencies, and at major health facilities. A home care nursing service is provided by nurses who have special education in public health and are employed by such voluntary agencies as the Visiting Nurses Association or Visiting Nurse Service, or Victorian Order of Nurses for Canada. Public health nurses enter practice through a baccalaureate program accredited in the United States by the National League for Nursing accrediting commission or the American Association of Colleges of Nursing, which prepares them to work as generalists. Additional recognition is offered through a certification program sponsored by the Division of Community Health Nursing of the American Nurses Association. (Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.)

Planning CycleSituation Analysis

Evaluation

Priority Setting

Monitoring

Setting Objectives

Planning Activities7

What

is important attribute as nurse leader one should posses to work effectively in the community?

Decision Making ProcessThe decision maker faces conditions of...

CertaintyLow

RiskModerate

UncertaintyHigh

Level of ambiguity, chance of making a bad decision

1. Analyzing

and prioritizing the

problems 2. Establishing goals and criteria 3. Formulating alternative solutions 4. Selecting solution considered best to solve the problem (Yura&walsh)5/18/2011

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Divide Article

into four groups

reading Role play Discussion on role play 20

minutes including presentation

Privacy:

Counseling should take place in a

private and quiet place. Confidentiality: Keep

information with you.

Non-judgmental, accepting, and caring atmosphere.

Language: Language

should be simple and

understandable.37

Important messages should be discussed first (correct method).

Be brief, simple, and specific. (Repeat, Repeat, and repeat)

Always verify that the client has understood

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Allender, J.A.& Spradley, B. W. (2001). Community health nursing: Concepts and practice. Philadelphia: Lippincott. Badruddin, G. Fazal, S. & Gonsalves, A. (1995). Education development of community health nursing in Pakistan. Unpublished document presented in Aga Khan University, Karachi & Amman University, Jordan. Harnar, R., Burns, J., Marshall, P., & Karmaliani, R. (1994). Communitybased nursing education in Pakistan. Journal of Continuing Education in Nursing, 25, (3), 130-32. Hussein, S. (1981). Rufida Al-Asalmia. Islamic Medicine,1 (2), 261-262. Jan, R. (1996). Rufaida Al-Asalmiya: The first Muslim nurse. Image Journal of Nursing Scholarship.28 (3): 267-268. Logan, B. B. & Dawkins, C. E. (1986). Family centered nursing in the community. California: Addison.

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KISS

KEEP

IT STAIGHT AND SIMPLE