Community Health Nursing Notes

Concepts of Health, Community Health and Community Health Nursing

Health in Different Perspectives

  • Health is derived from "hal," meaning hale, sound, whole.
  • It is a socially, historically, and culturally located understanding.
  • Health can be:
    • A personal belief.
    • An adjective describing a service (e.g., health visitor).
    • A description of something you can buy (e.g., health drink).
    • A broad community (e.g., community health).
    • The world (e.g., world health).
  • Health is a highly individualized perception and an ongoing process.
  • Definitions vary based on experience, expectations, age, and sociocultural influences.

People’s Experiences of Health (Cross-cultural studies)

  • Feeling vital.
  • Having good social relationships.
  • Experiencing a sense of control over one’s life and environment.
  • Being able to do things one enjoys.
  • Having a sense of purpose in life.
  • Experiencing a connectedness to community.

Definition of Health

  • WHO (1948): "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

Changing Concepts of Health

Biomedical Concept
  • Health is the absence of disease.
  • The body is seen as a machine; disease is a fault in the machine, and the doctor is the repairer.
  • Criticism: Ignores social, environmental, psychological, and cultural determinants of health.
Ecological Concept
  • Health is a dynamic equilibrium between humans and their environment.
  • Disease is an imbalance between humans and the environment.
  • Human ecological and cultural adaptations determine disease occurrence, food security, and population explosion.
  • Man-made environmental changes (urbanization, industrialization, deforestation) create new health problems.
Psychological Concept
  • Health includes social, economic, psychological, cultural, and political well-being.
  • These factors must be considered while measuring health.
Holistic Concept
  • A sound mind in a sound body in a sound family and environment.
  • Combines all other concepts of health.
  • Focuses on the impact of social, political, and environmental challenges on health.
  • Uses a multidimensional approach to well-being within the environment.
  • All parts/segments/sectors of society influence health.
  • All departments focusing on health promotion and protection play important roles (agriculture, industry, education, etc.).
  • Environmental and ecological factors are crucial for disease prevention.
Right to Health
  • Universal Declaration of Human Rights (1948): "Everyone has the right to a standard of living adequate for the health and well-being of himself and his family."
  • WHO constitution affirms that the highest attainable standard of health is a fundamental right.
  • Encompasses right to medical care, responsibility for health, healthy environment, food, procreation choices, and rights regarding death.

Wellness, Illness, and Health Continuum

  • Wellness and illness are relative concepts with many levels.
  • Community health emphasizes wellness, which includes developing a person’s potential for a fulfilling and productive life.
  • Health ranges from optimal health to total disability or death.
  • The level of illness increases toward disability/death, and wellness increases toward optimal health.

Prerequisites for Health

  • Peace
  • Shelter
  • Education
  • Food
  • Income
  • A stable ecosystem
  • Sustainable resources
  • Social justice and equity

Dimensions of Health

Physical Dimension
  • Routines: Inculcation of good habits (balanced diet, avoid tobacco, drugs, alcohol). A good physical routine is key.
  • Wellness: Recognize health-related warning signs, seek medical care.
  • Good physical health: A sense of esteem, self-actualization, sense of well-being.
  • Signs of good physical health: Good complexion, clear skin, bright eyes, lustrous hair, body well-clothed, firm flesh, not too fat, sweet breath, a good appetite, sound sleep, regular activity of bowels and bladder, smooth easy coordinated movement of the body, all organs of the body are of unexceptional size and function normally, all the special senses are intact, The resting pulse rate, blood pressure and exercise tolarance are all within the range of normality for individuals age and sex.
Mental Dimension
  • Respond to experiences with flexibility and purpose.
  • Mental health is a state of balance between the individual and the surrounding world.
  • Psychological factors can induce diseases.
  • Characteristics of a mentally healthy person: Free from internal conflicts, well-adjusted, strong sense of self-esteem, knows self, good self-control, able to solve problems intelligently.
Social Dimension
  • Interpersonal ties, community involvement.
  • Contribute to one’s environment and community.
  • Realizing one’s importance in society.
  • Realizing the importanc of the interdependability of others and nature.
  • Personal relationships and friendships, and a healthy lifestyle all are important for a healthy comunity.
Intellectual Dimension
  • Creative, innovative, and motivating mental activities.
  • Expand knowledge and share it with others.
  • Exploring issues realted to problem solving, creativity, and decision-making
Spiritual Dimension
  • Explore the meaning and purpose of life.
  • Appreciate the natural forces and God’s creations on this universe.
  • Have a peace and balance between feelings and hard stretches of life path.
Emotional Dimension
  • Awareness and acceptance of one’s feelings.
  • Feeling positive and enthusiastic about self and life.
  • Manage feelings and related behaviors.
  • Maintain statisfying relationship with others.
Vocational Dimension
  • Personal satisfaction and enrichment through work.
  • Contributing one’s own unique gifts, skills, and talents to his or her work.
  • Satisfaction and career ambitions.
Environmental Dimension
  • Balance between home and work life.
  • Individual’s relationship with nature and community resources.

Determinants of Health

  • Factors that influence health.
Biological and Genetic Makeup
  • Genes determine lifespan, health status, and risk of illnesses.
  • Inherited genetic predispositions affect responses.
Income and Status
  • Income influences living conditions and access to resources.
  • Societies with equitable wealth distribution are the healthiest.
Social Support Networks
  • Family, friends, and communities provide support.
  • Sense of belonging, love, affection, caring support, self-respect enhance well-being.
Education
  • Education improves employment and income.
  • Contributes to the social standing.
Employment
  • Unemployment and stressful jobs negatively influence health.
  • Employees work under great pressure and develop stress-related illnesses
Social Environments
  • Social networks and community strength influence health for various reasons (e.g: Diversity, effective communication, safe environments).
Physical Environments
  • Safe water, clean air, standard housing improves health, and are major determinant. Contaminated water, air, poor living conditions and working environment increases the risk of diseases.
Personal Health Practices
  • Ability to promote health, prevent disease, become self-sufficient, develop coping skills.
Healthy Child Development
  • Early childhood development influences health in later life.
Health Services
  • Preventive, promotive, curative, and rehabilitative services.
  • Health services must be accessible and affordable.
Gender
  • Gender roles influence health.
  • Prime importance is given to male with many facilities.
    *The gender-based discrimination is found among families.
Culture
  • Cultural beliefs and practices affect health.
  • Some of the cultural beliefs and practices affect the health of a person.

Concepts of Public Health, Community Health, Population Health, Community

Public Health
  • Winslow (1923): The science and art of preventing disease, prolonging life, and promoting health through organized community efforts.
  • IOM: Organized community efforts aimed at preventing disease and promoting health.
Community Health
  • Identification of needs, protection, and improvement of collective health within a defined area.
Population Health
  • Similar to community health, but refers to people not organized or having an identified group status.
Community
  • Collection of people who interact and share common interests or characteristics.
Elements of the Community
  • A sense of membership
  • Common symbol systems; common values
  • Reciprocal influence
  • Common needs and a commitment to meeting them
  • History ֿ
Types ofCommunities
  • Geographic Community: City, town, neighborhood.
  • Common-Interest Community: Members of an organization.
  • Community Of Solution: Group coming who come together to solve problem that affect them.
Healthy Community
  • Organizations, groups, and aggregates collaborate effectively to identify problems.
  • Achieve consensus on goals and priorities.
  • Agree on ways to implement goals.
  • Collaborate effectively in the required actions.
Factors That Affect the Health of a Community
  • Physical factors (geography, environment, community size, industrial development).
  • Social and cultural factors (beliefs, traditions, prejudices, economy, politics, religion, social norms, socioeconomic status).
  • Community organization and individual behaviors.

Definitions: Community Health Nursing and Public Health Nursing

Community Health Nursing
  • Synthesis of nursing and public health practice applied to promote and protect health of the population. Focuses on planning and providing care to a population with identification of population-based solutions for problem.
Public Health Nursing
  • Prevention of disease and disability by creating conditions where people can be healthy (ANA, 1999).
Characteristics of Community Health Nursing
  • Planning and executing services to the community.
  • Emphasize on maintenance, preservation, promotion of health
  • Rendering care in the community at all three levels of prevention.
Principles of Community Health Nursing
  • The nurse build expertise in a specialty working with these principles:promote, protect, and preserve health, working with a high degree of autonomy.
Essential Elements of Community Health Nursing (ANA, 1999; Williams, 1977,2000)

History and philosophy of public health and priority of protective strategies, all to improve population.

Community Health Nurses and Their Education in India

  • Community health nursing serves as a core subject in various nursing coursses.
    *There are qualified, experienced nurses in field of community.
    *As per Indian Nursing Council, PhD is the desirable qualification to function as principal or vice principal in nursing college.

Scope of Community Health Nursing

  • The WHO recommends that basic nursing education for community health practice should prepare nurses to identify, assess, plan, implement, and evaluate the population at risk.
  • Practice exists in many settings (hospitals clinics … etc.).
  • The WHO states that the community health care system of many developing nations includes five layers: individual care, family care, care and support by neighbors and known groups, support from health care providers and healers, and support by local governments and community welfare organizations.
Roles of Community Health Nurses
  • Nurse clinician
  • Nurse educator
  • Nurse advocate
  • Nurse manager
  • Nurse collaborator
  • Nurse leader
  • Nurse researcher
Worksites of Community Health Nurse
  • Home care centers.
    *School Health nurse
  • Industries

Natural History of the Disease

  • Disease evolves over a period of time from prepathogenesis phase to its termination, as recovery, disability or death. it is described in two phases:
Prepathogenesis Phase
  • Presence of factors that influence occurrence of the disease."
  • Epidemiologic triad—interaction between external agent, a susceptible host, and an environment
Pathogenesis Phase
  • Causative agent enters the host and multiples causing S/S

Agent Factors

Agent factors cause disease

  • Disease agents are classified as:
    • Biological
    • Nutrtients
    • Physical, Chemical, mechanical and Social factors

Host Factors

Factors related to host are called an intrinsic risks

  • Factors classidfied as demographic, biological, socioeconomic features and lifestyle

Environmental Influences (Extrinsic)

The environment affects the interplay between host and agent.

  • Two typed of environment: (1) Intrinsic and (2) Extrinsic.
    *The external environment includes all factors, external to either the susceptible host or the infected source, that may assist or impede the exposure to, or transmission of, the infectious agent from the infected source to the susceptible host - is divided into Physical- Biological and Psychosocial Environment

Risk Factors

Is any attribute or exposure that is significantly associated with the development
of A disease.

Levels of Prevention

Primordial Prevention
  • The prevention of risk factors in which they have never appeared before.
Primary Prevention
  • Removing likelihood of a disease occurrence (health promotion and specific protection).
Secondary Prevention
  • Early Identify individuals in early stage of disease
Tertiary Prevention
  • Restoration and rehabilitation with the goal of returning the individual to an optimum level of functioning.
    It attempts to reduce the extent and severity of a health problem to its lowest possible level, so as to minimize disability and restore or preserve function

Modes of Intervention

Five modes of intervention corresponding to the natural history:

  1. Health promotion
  2. Specific protection
  3. Early diagnosis and treatment
  4. Diability and lmitataion
  5. Rehabilitation

Public Health Evolution: World

  • Modern public health system took shape 150 years ago.
  • Includes ancient societies-ecological concept etc.
From ancient civilizations on the wheel
  • Early evidence reveals the evidence of sanitary practice, anatomical science, baths and medicine across cultures

Evolution of Community health Nursing Global Perspective

  • The first roles began in family members, then through middle ages and the renaissance and into the 21st century.

Indian pre-and post Independence influences on public care

Key changes in health have been charted along the journey toward more advanced care.

Twenty-First-Century Challenges for Community Health Nursing

  • Includes: Evidenced-Based Practice, growing interactions among culture and health.

National Health Problems in India

  • Includes: Environmental factors, national response to diseases such as HIV. With special response to non cominible such as heart disease.