CHN 2 Module 1: Introduction to Community Health Nursing 2

Community

is a group of people living in a particular area with common belief, values, and tradition

important attributes of a community

1. geographical boundaries

2. shared believe system or culture

Types of community

1. rural

2. urban

3. suburban

4. metropolitan

Rural community

agricultural, household are less dense

urban community

industrialized, household are dense

suburban community

semi industrialized, semi agricultural

metropolitan community

highly industrialized

health

• is more than a state of well-being

• it is multidimensional reality that includes, political, socio-economic, behavior, heredity, environment & healthcare delivery system

Nursing

• is traditionally defined as art and science of caring

• its body of knowledge is grounded on the works of theorist or philosophers

The philosophical and ethical underpinnings

• the practice of community and public health nursing is anchored on the primacy of worth and dignity of man - Margareth Shetland

Public Health - Charles Edward Winslow

• is a science and art of preventing disease, prolonging life, promoting health

• to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize the birth right to health and longevity

Public Health - World Health Organization

• it is the art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number

• for the promotion of health, the improvement of conditions in the social and physical environment, rehabilitation of illness and disability

Community Health Nursing - Ruth Freeman

• is a service rendered by a professional nurse with communities, groups, families, individuals at home in health centers, in clinic, schools, in places of works for the promotion of health prevention of illness, care of the sick at home and rehabilitation

Community Health Nursing - Jacobson

• is a nursing practice in a wide variety of community services and consumer advocate areas in a variety roles, at times including independent practice

• not confined to public health nursing agencies

Community Health Nursing - Araceli Maglaya

• is the utilization of the nursing process in the different levels of clientele; individuals, families, population groups, and communities

CHN Philosophy

• system of belief that provides basis for guided action

• provides direction an describes the what, the why, and how of the activities within a profession

Levels of clientele

1. individual

2. family

3. population groups

4. community

Individuals

• client is a biophysical and spiritual being

• person is the unit of care

• also considered the entry point

Family

• collection of people who are integrated, interactive, and interdependent

• interact with each other and health problem of family members affects the whole family

• basic unit of care

Population groups

• people who shared common characteristics, developmental stage, common exposure resulting to a common heal problem

• know as aggregate group

Community

• is considered as an active partner

• Goal of CHN - achieved multi-sectoral efforts

• part of healthcare system and the larger human services system

specialized field of CHN

1. community mental health nursing

2. occupational health nursing

3. school health nursing

4. home health nursing

5. hospice home care nursing

6. correctional nursing

Community mental health nursing

clinical process which included an integration of concepts from nursing, mental health, social psychology, community networks, and the basic sciences

Occupational health nursing

application of nursing principles and procedures conserving the health workers in all occupation

school health nursing

application of nursing theories and principles in the care of the school population

home health nursing

practice involves providing nursing care to individuals and families in their own places of residences mainly to minimize the effects of illness and disability

correctional nursing

specialized subset of forensic nursing. it requires a significant amount of knowledge as well as understanding awareness of the unique needs and perspective of the clients served

Roles of nurse in CHN

1. clinician

2. health educator

3. coordinator & collaborator

4. supervisor

5. leader & change agent

6. manager

7. researcher

Clinician

utilized the nursing process in the care of the client in the home setting through home units and in public healthcare facilities

Health educator

• utilized teaching skills to improve the health, knowledge, skills, and attitude

• conducts health information campaigns for health promotion and disease prevention

Coordinator & Collaborator

establish linkages and collaborative relationships to address health problems

Supervisor

• monitor and supervises the performance of midwives and auxiliary health workers

• formulation of staff development and training program for midwives

Leader & Change agent

influences people to participate in the overall process of community development

Manager

• organizes the nursing services component of the local health agency or local government unit

• responsible for the delivery of package of services provided by the health program to target clientele

Researcher

participates in the conduct of research and utilizes research findings in practice

Responsibilities of Community health nurse

1. be part of developing an overall health plan

2. provide quality nursing services to 4 level clientele

3. maintain coordination & linkages with health team, NGO & government agency

4. conduct researches relevant to CHN services

5. provide opportunities for professional growth and continuing education for staff development

health promotion model

• each person has a unique personal characteristic and experience that affect subsequent action

• should result in improved health, enhanced functional ability, and better quality of life at all developmental stages

health promoting behavior

desired behavioral outcome and is the endpoint in the health promotion model

Major concepts of Health Promotion Model

1. health promotion

2. health protection

3. individual characteristics & experiences

4. behavior-specific cognition and affect’

5. behavior outcomes

health promotion

• is defined as behavior motivated by the desire to increase well-being and actualize human health potential

• is an approach to wellness

health protection

• illness prevention

• behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within illness constraint

individual characteristics & experiences

prior related behavior and personal factor

behavior-specific cognition and affect

perceived benefits of actions, perceived barrier to action, perceived self efficacy activity related affect, interpersonal influences, and situational influences.

behavior outcomes

commitment to plan of action, immediate competing demands and preferences, & health promoting behavior

Social learning theory

• is the imitation of observed learning in a social setting

• Bandura (theorist) - believed we absorb information by first observing the behavior of others in a social setting

• after observation, we then decide to imitate the behavior, but only, if we believe that this will produces a reward

4 basic principles of social learning theory

1. observation

2. imitation

3. reward

4. cognition

attention

circumstances surrounding the observed event can affect our attention level which in turn affects our ability to learn and imitate the behavior

Retention

even if observer pays doses attention to the behavior, if they are compromised in their ability to retain information, or if they don’t reproduce behavior soon enough, it will be forgotten

ability to imitate

even if the observer pays close attention and retains a vivid memory of the behavior if they are unable to reproduce the behavior because of physical and/or cognitive limitations, then the prospect of the new behavior will be abandoned

Motivation level

• observer wishes to practice the new behavior can influence the strength of their incentive

• if the possible reward is greater than the possible punishment, they will be motivated to practice the behavior

health belief model

• attempts to explain and predict health behaviors

• used to determine or forecast human behaviors toward health

• focusing on the attitudes and beliefs of individuals

Major components of Health belief system

1. individual perception

2. modifying factors

3. likelihood of action

perceived barrier to preventive action

individual assessment of the obstacles to behavior change

1. perceived inconvenience

2. expense

3. danger (side effects of a medical procedure)

4. discomfort (pain, emotional upset)

perceived benefits must outweigh the perceived barriers in order for change to occur

Cues to action

necessary for prompting engagement in health promoting behavior

1. internal - physiological cues (pain symptoms)

2. external - events or information from others, the media, or healthcare providers promoting engagement in health-related behaviors.

self-efficacy

refers to an individual’s perception of his or her competence to successfully perform a behavior

perceived threat

• the combination of perceived seriousness and perceived susceptibility

• higher factor = higher livelihood of engagement in health promoting behavior

perceived benefits of preventive action

• an individual’s assessment of the value or efficacy of engaging in health-promoting behavior to decrease risk of disease

Modifying factors

• individual characteristics can affect perceptions of health-related behaviors

• demographic variables (ages, sex, etc.)

• psychosocial variable (social class, peers)

• Structural variables (knowledge on given disease)

perceived susceptibility

• subjective assessment of risk of developing a health problem

• predicts that individuals who perceived that they are susceptible to a particular health problem will engage in behaviors to reduce their risk of developing the health problem

Perceived severity

• subjective assessment of the severity of health problem and potential consequences

• individuals who perceive a given health problem as serious are more likely to engage in behaviors to prevent the health problem from occurring

Milio Framework for prevention

• a framework that includes concepts of community-oriented, population-focused care

• behavioral patterns of populations and individuals who make up populations - result of habitual selection from limited choices

• neglected role of community health nursing - examine the determinants of community’s health ad attempt to influence those determinants through public policy

Transtheoretical model or stages of change model

• health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination

• developed by Prochaska and DiClemente

• focuses on the decision-making of the individual and is a mode, of intentional change

Precontemplation

• is the stage, people do not intent to take action in the foreseeable future

• people are often unaware that their behavior is problematic

• people place too much emphasis on the cons of changing behavior

contemplation

• in this stage, people are intending to start the healthy behavior in the foreseeable future (next 6 months)

• people recognize that their behavior may be problematic, and considered pros and cons equally

preparation (determination)

• in this stage, people are already to take action within the next 30 days

• people believe changing their behavior can lead to a healthier life

Action

in this stage, people have recently changed their behavior and intend to keep moving forward with that behavior change

maintenance

in this stage, people have sustained their behavior change for a while

people in this stage work to precent relapse to earlier stages

Termination

in this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse

Precede-Proceed Model

is a comprehensive structure for assessing health needs for designing, implementing, and evaluating health promotion and other public health program meet those needs

Precede

provides the structure for planning a targeted and focused public health program

Proceed

• provides the structure for implementing and evaluating the public health program

• stands for policy, regulatory, and organizational constructs in educational and environmental development. it involves the identification of desired outcomes and program implementation

phase 1 - Social assessment/diagnosis

• determine the social problems and needs of a given population and identify desired results

• assess the client’s perception of social problems and linking them to health-related problems

• focuses on the client’s interest and priority health concerns

phase 2 - Epidemiological assessment

• Identify the health determinants of the identifies problems and set priorities and goals

• identifies the program objectives

phase 3 - Behavioral and Ecological assessment

• analyze behavioral and environmental determinants that predispose, reinforce, and enable the behaviors and lifestyles are identified

• risk factors

• it focuses on the topmost problem

phase 4 - educational and organizational diagnostic

• factors that predispose to, reinforce, and enable the behaviors and lifestyles are identified

• focuses on indirect causes of the problems or the causes of the direct causes of the problem

• basis for sub-objectives

predisposing factors

• this is the initial reason/cause of the behavior

• it includes anything about the individual - knowledge, existing skills, and attitude, values and beliefs

Enabling factors

• these are factors particularly things that are outside the individual except the motivation and the absence of skills

• it includes presence or absence, accessibility, availability of a facilities

Reinforcing factors

• this either rewards or punishes a behavior

• it includes media, peers, and parents the quality of manpower or services

phase 5 - administrative and policy diagnosis

• involves ascertaining which health promotion, health education and/or policy related interventions would best be suited to encourage the desired changes in the behaviors or environments and in the factors that support those behaviors and environment.

administrative diagnosis

analysis of policies, resources, and circumstances prevailing organizational situations that could hinder or facilitate the development of the health program

policy diagnosis

to assess the compatibility of program goals and objectives with those of the organizational and its administration

phase 6 - implementation

• interventions identified in phase five are implemented

• selection of methods and strategies of the intervention, for example, education &/ or other resources

phase 7 - process evaluation

• entails process evaluation of those interventions

• measure achievement of sub-objectives

• used to evaluate the process by which the program is being implemented

• measurements of implementation to control, assure, or improve the quality of the program

phase 8 - impact evaluation

• involves evaluating the impact of the interventions on the factors supporting behavior, and on behavior itself

• measure the program effectiveness in terms of objectives

• immediate observable effects of program

phase 9 - outcome evaluation

• measure the goal of the program and beyond

• includes measuring the life expectancy and quality of life

• long term effect of program