Unit IUnit IIntroduction to community

Health Nursing By

Maghan DasStudent

Dow university of Health Sciences 1

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Objectives • At the completion of this unit , students will be able to

1. define the terms

1.1 community

1.2 community health and

1.3 community health nursing

1.4 urban and rural communities

2. Discuss the historical back ground of community health nursing from public health nursing.

3. Describe the philosophy of community health Nursing .

4. Discuss the concept of health , wellness, illness and disease.

5. Discuss the roles of the community health nurse in community settings .

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Community:

• A social group of any size whose members reside in a specific locality, share government, and often have a common cultural and historical heritage

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OR

• is a social group determined geographical boundaries and or common values and interest its member know and interact each other.

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Community Health

• Is the science and art of preventing disease, prolonging life and promoting health and efficiency through organized efforts.

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Community health nursing

• Community health nursing is synthesis of nursing practice and public health practice applied to promoting and preserving the health of population.

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History of Community Health Nursing

Before mid 1800s-Early Home Care with focus in Sick and Poor individual.

Orientation: curative agencies: lay & religious orders *St. Phoebe

Mid 1800s to 1900-district Nursing with focus in Sick and poor individual

Orientation: curative/less in prevention agencies: voluntary & some government *William Rathbone

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History of Community Health Nursing

1900-1970 public health nursing- Pubic Health Needs, focus in family and orientation in Curative and Prevention

agencies: government & some voluntary

*Lilliam Wald

1970 to present-Community Health Nursing, focus in total community and oriented to population health, services address

health promotion; illness prevention

agencies: many kinds; some independent practice

*Ruth Freedman9

Public Health Nursing Development in China

• Early Stages: 1925 Beijing Union Hospital-Public Health Agency (Dr. Gland).

1930 rural Health Education

2000 Pay attention to city and rural areas community center development and practice model

2006-2007 Government emphasize the importance of Community health, improve community health centers, functions, farmer health insurances 。

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Public Health DefinitionPublic health is the Science and Art of :

• preventing disease,

• prolonging life,

• promoting health and efficiency through organized community effort.

(Winslow, 1920)

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Definition of Community Health (ANA,2000 ）

• Community health nursing is a synthesis of nursing and public health practice applied to promoting and preserving the health of populations.

• Treat “ Population as a Whole”

• Focus on individual, family, groups, community

• Utilizing Health promotion, health maintenance, health education, and management, coordination, and continuity of care for meeting population needs.

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Characteristics of Community Health Nursing • It is a field of nursing• It combines public health and nursing• It focus in population and environment

factors that may impact to people’s health• It emphasize in health promotion, illness

prevention, and wellness

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Characteristics of Community Health Nursing

• It promotes client responsibility and self-care

It uses aggregate measurement and analysis

It use principle of organizational theory

• It involves inter-professional collaboration.

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Pubic Health is for: • The sanitation of environment,• The control of communicable infections,• The education of the individual in personal hygiene,• The organization of medical and nursing services for The

early diagnosis and preventive treatment of disease, and• The development of the social machinery to insure

everyone a standard of living adequate for the maintenance of health ,

Healthy Life Style and Longevity .

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Community Health Practice

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Roles of Community Health Nurses

Researcher

Leadership

Collaborator

Manager

Advocate

Educator

Clinician

Nurses

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Clinician Role

• Care provider: The nurse ensures that health services are not only provided to individuals and families but also provided to groups and populations

• The clinician role has emphasis on holism, health promotion and skill expansion.

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Examples at the clinics & Schools

• Immunization of infants and pre-schoolers• Family planning programs• Cholesterol screening• Prevention of behavioural problems in

adolescentsExpanded skills in observation, listening,

communication and counseling are integral to your role as a CHN with emphasis on psychological and socio-cultural factors

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Educator Role

• Health teacher: one of the major functions of the CHN (Breckon et.al. 1998)

Important role because• Community clients are NOT usually acutely

ill and can not observe and act on health information

• The public has a higher level of health consciousness (client self-education is facilitated by the nurse. Based on the concept of self-care, clients are encouraged to use appropriate health resources

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Advocate Role

• Based on clients’ rights: Every patient or client has the right to receive just, equal, and humane treatment.

Goals of advocacy:1.Help clients gain more independence

and self-determination2.Make the system more responsive and

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Manager Role• Nurse directs and administers care to meet goals by:

1. Assessing client needs

2. Planning and organizing to meet those needs

3. Directing and leading to achieve results

4. Controlling and evaluating the progress to make sure that the results are met

• Nurse oversees client care as:1. A case manager

2. Supervising ancillary staff

3. Managing case loads

4. Running clinics

5. Conducting community health needs assessment projects

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Nurse as Planner

• Sets the goals for the organisation• Sets the direction• Determines the means (strategies) to

achieve them• It includes defining goals and objectives• It may be strategic ( long-term broader

goals)23

Nurse as Organiser• Designing a structure for people + tasks to function to reach the desired objectives• It includes assignments and schedulingIt includes: 1. Deciding what tasks to be done2. Who will do them3. How to group the tasks4. Who reports to whom5. Where decisions will be made (Robbins 1997)Questions to be addressed by the organiser1. Is the clinic, program providing the needed services?2. Are the clients satisfied?3. Are the services cost-effective?

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Nurse as Leader

• The nurse directs, influences, or persuades others to make change to positively influence people’s health.

• Includes persuading and motivating people, directing activities, effective two-way communication, resolving conflicts and coordinating the plan

• Coordination: Bringing people and activities together to function in harmony to achieve desired objectives

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Nurse as Controller and Evaluator

• Controller: Monitors the plan and ensures that it stays on course. • Sometimes plans do not proceed as intended

and need to be adjusted • Monitoring, comparing and adjusting are

activities of controlling• Comparing performance and outcomes

against set goals and standards = Evaluator role

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Collaborator Role• Means working jointly with others on a common project to cooperate as partnersWho?

• Clients• Other nurses and physicians• Teachers and health educators• Social workers• Physical therapists• Nutritionists• Psychologists• Epidemiologists and Biostatisticians• Secretaries • City Planners and legislators

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Health :

Health is a state of complete physical ,mental, social and spiritual well being

and ability to function ,not merely an

absence of disease or infirmity.

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Human Health

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ENVIROMENT

HEALTH CARE SYSTEM

WAYS OF LIFE OF THE COMMUNITY

HUMAN BIOLOGY

• Disease : A condition in which body health is impaired (Webster).

• A state in which the individuals is no longer in a state of equilibrium with forces in his external and internal environment (Belend).

• Illness :Is failure or disturbance in the growth, development, function and adjustment of the organism as a whole or any of its system (Engel)

1. Acute 2. Chronic

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Purposes of community health

• A certain the nature and extent of disease and disability in the community.

Take suitable measure to • Promote healthful living,• Prevent disabilities, correct remedial

defects, treat illness.• Evaluate the progress and success of

current programs.31

MAJOR GOALS OF COMMUNITY HEALTH

NURSING1. Care of ill, disabled and suffering in

non-hospital setting2. Support of development and well

being through out the life style.3. Promotion of human relatedness and

mutual caring.

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Major goals continued

5. Promotion of self responsibility regarding health and well being.

6. Promotion of relative safety in the environment while conserving resources.

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Settings for CHN Practice

1. Homes2. Community health centers3. Schools4. Occupational health settings (business

and industry)5. Residential institutions: Older age

residences6. charitable mosques related organizations7. Community at large

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Health Prevention

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Tertiary Prevention Tertiary Prevention

Secondary Prevention Secondary Prevention

Primary Prevention Primary Prevention

Primary Prevention for Health Promotion

• Health Education• Adequate Nutrition• Individual Development• Adequate working environment and

recreation, resting• Pre-marriage counseling and education• Genetic Counseling• Regular Physical Examination

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Primary Prevention for Health Protection

• Comply with immunization• Individual hygiene • Improve environment sanitary • Occupational Safety• Prevent Accident in all ages• Adequate nutrition• Avoid cancer cause agents• Avoid allergic

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Secondary Prevention

• Identify cases in the community• Screen and test• Conduct special physical examination• Treat and prevent the progress of illness• Avoid the spreading of disease• Reduce the disability time

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Tertiary Prevention

• Treat and stop the disease progress and avoid complication and side effect

• Limit the chance for disability• Provide rehabilitation for physical and

psychological well-being, occupational therapy, availability of long-term care

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Characteristics of community health

nursing• it is a field of nursing• it combines public health with nursing• it is population-focused• it emphasizes wellness• it involves interdisciplinary collaboration• it promotes clients’ responsibility and self care

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Setting for community health nursing practice

• homes• ambulatory service settings• schools• occupational health setting• residential institutions• the community at large

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Philosophy of CHN

• THE Philosophy of CHN is based on the worth and dignity on the worth and dignity of man.

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Opportunity for Future Community Health Nursing

• Chronic Disease management• Home Care• Extended care from Acute care setting • Elderly care • Rehabilitation care in different population• Health promotion in every level• Health system referral, emphasize individual

role and function of community health sector43

References

• Ansari.I.M.,(2003) community medicine and public health.(6th ed)

• Clarke.j.,(1999) revising the concepts of community care and community health nursing standards .10 34-35

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