nur 473: primary health care nursing foundations of community health nursing 1 1

Nur 473: primary health care nursing

Foundations of Foundations of Community Health Community Health

Nursing Nursing

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Chapter OneChapter One

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Opportunities and Opportunities and Challenges of Community Challenges of Community

Health NursingHealth Nursing

What is Community What is Community Health Nursing Health Nursing

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ObjectivesObjectives

After completion the lecture the students enable to:

•Define community health and distinguish from public health

•Explain the concept of the community

•Describe three types of communities

•Diagram the health continuum

•Differentiate among the three levels of prevention

•Analyze the six components of community health practice

•Describe the eight characteristics of community health nursing

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Nursing 473: primary health nursing – lecture 1

To understands what is the community health nursing

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Nursing 473: primary health nursing – lecture 1

We should answer these questions

•What are the goals of the community health nursing (CHN)

•Who is the client of the CHN

•What are the setting of the CHN

•What are the salient role provided by CHN

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Nur 473: Primary Health Care Nursing

Introduction

The communities in which we live and work have a profound influence on our collective health and well-being. (Example: both smoking and passive exposure to tobacco smoke are directly associated with serious negative health effects )the health of a community is more than the sum of the health of its individual citizens.Community health, as a field of practice, seeks to provide organizational structure, a broad set of resources, and the collaborative activities needed to accomplish the goal of an optimally healthy community.

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Introduction

In acute care, the health of an individual is the primary focus. Community health broadens that focus to concentrate on families, populations, and the community at large. The community becomes the recipient of service, and health becomes the product. Although many believe that health and illness are individual issues, evidence indicates that they also are community issues. The spread of the HIV pandemic, nationally and internationally, is a dramatic and tragic case in point

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Introduction

Communities can influence the spread of disease, provide barriers to protect members from health hazards, organize ways to combat outbreaks of infectious disease, and promote practices that contribute to individual and collective health.Many different professionals work in community health to form a complex teamThe city planner designingThe social workerThe physicianAnd other

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Introduction

The professional nurse is an integral member of this team, a linchpin and a liaison between physicians, social workers, government officials, and law enforcement officers. Community health nurses work in every conceivable kind of community agency, from a state public health department to a community-based advocacy group.

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Introduction

Their duties range from examining infants in a well-baby clinic, or teaching elderly stroke victims in their homes, to carrying out epidemiologic research or engaging in health policy analysis and decision making.Despite its breadth, however, community health nursing is a specialized practice. It combines all of the basic elements of professional clinical nursing with public health and community practice.

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Introduction

Community health and public health share many features.Both are organized community efforts aimed at the promotion, protection, and preservation of the public’s health. Historically, as a field of practice, public health has been associated primarily with the efforts of official or government entities—for example, federal, state, or local tax supported health agencies that target the whole range of health issues. In contrast, private health efforts, such as those of the American Lung Association or the American Cancer Society, work toward solving selected health problems. The latter augments the former. Currently, public health practice encompasses both approaches and works collaboratively with all health agencies and efforts, public or private, that are concerned with the public’s health.

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THE CONCEPT OF COMMUNITY

A community is a collection of people who share some important feature of their lives. A collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging. •It can be a society of people holding common rights and privileges (eg, citizens of a town), •sharing common interests (eg, a community of farmers), •living under the same laws and regulations (eg, a prison community). The function of any community includes its members’ collective sense of belonging and their shared identity, values, norms, communication, and common interests and concerns 12


Geographic Community

A community often is defined by its geographic boundaries and thus is called a geographic community. A city, town, or neighborhood is a geographic community. (Consider the community of Gaza city)In community health, it is useful to identify a geographic area as a community a community demarcated by geographic boundries, such as city or county, become clear target for analysis health needs Available data, morbidity mortality and population density can augment assessment studies to form the basis for planning health programs

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Geographic Community

media campaigns and other health education efforts can readily intended audiences. Example :Distribution educational information on the danger of smoking, importance's of breast feeding, risk factor for diabetes and hypertension and the danger of substance abuse

a geographic community is easily mobilized for action. Groups can be formed to carry out intervention and prevention efforts that address needs specific to that community

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Common-Interest Community

A community also can be identified by a common interest or goal. A collection of people, even if they are widely scattered geographically, can have an interest or goal that binds the members together.Example the members of a national professional organizationwomen who have had mastectomies are all common-interestcommunities.

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Community of Solution

A type of community encountered frequently in communityhealth practice is a group of people who come together to solve a problem that affects all of them. The shape of this community varies with the nature of the problem, the size of the geographic area affected, and the number of resources needed to address the problem. Such a community has been called a community of solution.Example a water pollution problem may involve several counties whose agencies and personnel must work together to control upstream water supply, industrial waste disposal, and city water treatment

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Populations and Aggregates

population refers to all of the people occupying an area, or to all of those who share one or population may more characteristics. In contrast to the community, a population is made up of people who don’t necessarily interact with one anther and don’t necessarily share a sense of belonging to that group A population may be defined geographically, such as the population of the United States or a city’s population. This designation of a population is useful in community health for epidemiologic study and for collecting demographic data for purposes such as health planning. A population also may be defined by common qualities or characteristics, the common characteristic might be any thing that thought to relate to health such as age, sex, race, social class etc

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Populations and Aggregates

Aggregate; are people who don’t have the relatedness necessary to constitute an interpersonal group buy who have one or more characteristics in common Example:Aggregate can be identified by virtue of setting( those enrolled in a well-baby clinic Demographic characteristics ( women)Health status ( smokers, hypertension)

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Risk

Risk: the probability that a disease or other unfavorable health condition will develop

At risk-population:Epidemiologic information is used to identify populations at higher risk for specific preventable health conditions

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THE CONCEPT OF HEALTH

“a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”

Wellness: Is the process of moving towered integrating human functioning and maximizing potential.

Wellness, includes the definition of health incorporates the capacity to develop one's potential to lead fulfilling and productive life; can be measured in terms of quality of life.

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THE CONCEPT OF HEALTH

They also are the beginning to understand the relationship of health to environment ..

-Wellness is the ability to adapt, to relate effectively, and to function at near-maximum capacity and

includes-: -Self-responsibility.

-Nutritional awareness. -Physical fitness.

-Stress management. -Environmental sensitivity.

-Productivity. -Expression of emotion.

-Creativity. -Personal care.

- Home safety. 21


Well-being: a state of positive health or a person's perception concerning positive health.

Influences on HealthMany factors, influence the health including:

-Lifestyle. -Genetics.

-The environment.

-Florence Nightingale, explored the health and illness connection with the environment. She believed that a person's health was greatly influenced by ventilation, noise, light, cleanliness, diet, and restful bed.

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The Health Continuum: Wellness–Illness

Society suggests a polarized or “either/or” way of thinking about health: people either are well or they are ill. Yet wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. There are many levels and degrees of wellness and illness, Because health involves a range of degrees from optimal health at one end to total disability or death at other, it often describes as a continuum.It range from:

-High level wellness.(Optimal Health) -Good health .

-Normal health. -Illness.

-Critical illness.- Total disability or Death.

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This health continuum applies not only to individuals but also to families and communities. A nurse might speak of a dysfunctional family, meaning one that is experiencing a relative degree of illness; or a healthy family might be described as one that exhibits many wellness characteristics, such as effective communication and conflict resolution, as well as the ability to work together and use resources appropriately. Likewise, a community, as a collection of people, may be described in terms of degrees of wellness or illness. The health of an individual, family, group, or community moves back and forth along this continuum throughout life.

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A healthy community, first described by Cottrell (1976) as a competent community, is one in which the various organizations, groups, and aggregates of people making up the community do at least four things:1. They collaborate effectively in identifying the problems and needs of the community.2. They achieve a working consensus on goals and priorities.3. They agree on ways and means to implement the agreed on goals.4. They collaborate effectively in the required action.

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Community health practice ranges over the entire continuum; it always works to improve the degree of health in individuals, families, groups, and communities. In particular, community health practice emphasizes the promotion and preservation of wellness and the prevention of illness or disability..

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Health as a State of Being

Health refers to a state of being, including many differentqualities and characteristics. An individual might be described in terms such as energetic, outgoing, enthusiastic, beautiful, caring, loving, and intense. Together, these qualities become the essence of a person’s existence; they describe a state of being. Similarly, a specific geographic community, such as a neighborhood, has many characteristics. It might be characterized by the terms congested, deteriorating, unattractive, dirty, and disorganized. These characteristics suggest diminishing degrees of vitality

Health balance

Is a state of well-being that results from healthy interaction between a person’s body , mind, spirit and environment

individuals want to avoid illness and its consequences. 28


Health as a State of Being

Health involves the total person or community. All of the dimensions of life affecting everyday functioning determine an individual’s or a community’s health, including physical, psychological, spiritual, economic, and sociocultural experiences. All of these factors must be considered when dealing with the health of an individual or community. The approach should be holistic. A client’s placement on the health continuum can be known only if the nurse considers all facets of the client’s life, including not only physical status but also the status of home, family, and work.

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Subjective and Objective Dimensions of Health

Health involves both subjective and objective dimensions;that is, it involves both how people feel (subjective) and how well they can function in their environment (objective).Healthy people are full of life and vigor, capable of hysical and mental productivity. They feel minimal discomfort and displeasure with the world around them. Again, people experience varying degrees of vitality and well-being.Health also involves the objective dimension of ability to function. A healthy individual or community carries outnecessary activities and achieves enriching goals. unhealthypeople not only feel ill but are limited, to some degree, intheir ability to carry out daily activities. Indeed, levels of illness or wellness are measured largely in terms of ability to function (Roach, 2000)

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Subjective and Objective Dimensions of Health

The subjective dimension (feeling well or ill) and the objective dimension (functioning) together provide a clearer picture of people’s health. When they feel well and demonstrate functional ability, they are close to the wellness end of the health continuum. Even those with a disease such as arthritis or diabetes may feel well and perform well within their capacity. These people can be considered healthy or closer to the wellness end of the continuum. Figure 1–3 depicts the relationships between the subjective and objective views of health.

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Definition

Community health is the identification of needs and the protection and improvement of collective health within a geographically defined area.ANA definition:CHN is a synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations. The practice is general and comprehensive. It continuing not episodic. The dominant responsibility is to population as a whole, nursing directed to individuals, families or group contributes to the total population … the focus of CHN is on the prevention of illness and the promotion and maintenance of health

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Definition

Public health is the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the 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, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity

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Definition

One of the challenges community health practice faces is to remain responsive to the community’s health needs. As a result, its structure is complex; numerous health services and programs are currently available or will be developed. Examples include health education, family planning, accident prevention, environmental protection, immunization, nutrition, early periodic screening and developmental testing, school programs, mental health services, occupational health programs, and the care of vulnerable populations.

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Major goals for community health nursing1.Care of ill, disabled and suffering 2.Support development and well-being throughout the lifecycle 3.Promotion of human relatedness and mutual caring 4.Promotion of self responsibility regarding health and well-being 5.Promotion of relative safety in the environment while conversing resources

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COMPONENTS OF COMMUNITY HEALTH PRACTICEMission of the CHN

These components are (1)Promotion of health, (2)prevention of health problems, (3)treatment of disorders, (4) rehabilitation, (5) evaluation, and (6) research

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(1)Promotion of health

Definition:

1. action related to lifestyles and choices that maintain or enhance a populations health (WHO)

2. "Any combination of educational, organizational, economic, and environmental supports for behavior and conditions of living conductive to health".

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(1)Promotion of healthPromotion of health is recognized as one of the most

important components of public health and community health

practice Health promotion includes all effortsthat seek to move people closer to optimal well-beingor higher levels of wellness. Nursing, in particular, has a socialmandate for engaging in health promotion Health promotion programs and activities includemany forms of health education—for example, teaching thedangers of drug use, demonstrating healthful practices suchas regular exercise, and providing more health-promotingoptions such as heart-healthy menu selections.

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(1)Promotion of healthCommunity health promotion, then, encompasses the

development and management of preventive health care services that are responsive to community health needs. Wellness programs in schools and industry are examples; they are useful when they are accompanied by desire, opportunity, and resources that encourage more healthful practices.

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Health promotion programs and activities includes many forms of health education- for example-:

-Physical activity and fitness . -Nutrition.

-Tobacco use . -Teaching the dangers of alcohol and drug use.

-Family planning. -Mental health and mental disorders.

-Violent and abusive behavior.- Educational and community-based programs.

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(1)Promotion of healthThe goal of health promotion is to raise levels of wellnessfor individuals, families, populations, and communities.Community health efforts accomplish this goal through athree-pronged effort to:1. Increase the span of healthy life for all citizens2. Reduce health disparities among population groups3. Achieve access to preventive services for everyone

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(2) prevention of health problemsPrevention of health problems constitutes a major part ofcommunity health practice. Prevention means anticipatingand averting problems or discovering them as early as

possible to minimize potential disability and impairment. It is practiced on three levels in community health: (1) primary prevention, (2) secondary prevention, and (3) tertiary prevention(Neuman, 2001).

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(2) prevention of health problemsI. Primary Prevention: Any effort done before or to

prevent the problem to occurII. Primary prevention obviates the occurrence of a health

problem; it includes measures taken to keep illness or injuries from occurring. It is applied to a generally healthy population and precedes disease or dysfunction.

Example

Genetic counseling

Immunization

Health diet and healthy lifestyle

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(2) prevention of health problems, primary prevention Examples ofprimary prevention activities by a community health nurseinclude encouraging elderly people to install and use safetydevices (eg, grab bars by bathtubs, hand rails on steps), toprevent injuries from falls; teaching young adults healthylifestyle behaviors so that they can adopt changes for a

lifetime, for themselves and their children; or working through

a local health department to help control and prevent communicable diseases such as rubeola, poliomyelitis, or varicella by providing regular immunization programs.

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(2) prevention of health problems II. secondary preventioninvolves efforts to detect and treat existing health problems at

the earliest possible stage when disease or impairment already exist. Hypertension and cholesterol screening programs in many communities help to identify high-risk individuals and encourage early treatment to prevent heart attacks or stroke. Other examples are teaching breast and testicular self-examination, encouraging regular mammograms

and Pap smears for early detection of possible cancer, and providing skin testing for tuberculosis (in infants at 1 year of age and periodically throughout life, with increasing frequency

for high-risk groups). 45



(2) prevention of health problems II. secondary preventionSecondary prevention attempts to discover a health problem

at a point when intervention may lead to its control or eradication. This is the goal behind testing of water and soil samples for contaminants and hazardous chemicals in the field of community environmental health. It also prompts community health nurses to watch for early signs of child abuse in a family, emotional disturbances in a group of widows, or alcohol and drug abuse among adolescents.

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(2) prevention of health problems III. Tertiary PreventionTertiary prevention attempts to reduce the extent andseverity of a health problem to its lowest possible level, so asto minimize disability and restore or preserve function.

Examples include treatment and rehabilitation of persons after

a stroke to reduce impairment, postmastectomy exercise programs to restore functioning, and early treatment and management of diabetes to reduce problems or slow their

progress..

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(3) treatment of disordersThe third component of community health practice is treatmentof disorders. It focuses on the illness end of the continuumand is the remedial aspect of community health practice.This occurs by three methods:(1) direct service to people with health problems, eg. home

visits, provides an educational program and support group for people

wanting to stop smoking or lose weight(2) indirect service that helps people to obtain treatment, and

(3) development of programs to correct unhealthy conditions.

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(3) treatment of disorders(2) indirect service that helps people to obtain treatment eg. assisting people with health problems to obtain treatment.A young woman with postpartum bleeding, assisted by the

community health nurse, can obtain an immediate appointment with a physician at the local clinic.

(3) development of programs to correct unhealthy conditionsOne community with a high incidence of alcoholism and drugabuse initiated a chemical dependency counseling and

treatment center.

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(4) Rehabilitationinvolves efforts to reduce disability and, as much as possible,

restore function.

(5) evaluation is the process by which that practice is analyzed, judged,and improved according to established goals and standards.Evaluation of health and health care should be an integralpart of every kind of health service, from individual practiceto national and international programs.

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(6) Researchis systematic investigation to discover facts affecting

community health and community health practice, solve problems, and explore improved methods of health service.

Community health practitioners conduct and use scientific investigations at all levels, from federal agencies such as the U. S. Public Health Service to state and local groups conducting research. Epidemiology (the study of health and disease determinants and distribution in populations) and biostatistics (the science of statistically measuring population

health conditions) are the primary public health measurementand analytic sciences underlying community health practice.

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(6) What the deffrences between the health promation and health protection

Individual in health protection want to avoid illness and its consequences .

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goal of the community health nursing

Community health nursing preserves and improves the health of population and communities worldwide by meeting the collective needs of the community and societies

Goals

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CHARACTERISTICS OF COMMUNITY HEALTH NURSING

CHARACTERISTICS OF COMMUNITY HEALTH NURSING

Eight characteristics of community health nursing are particularly salient to the practice of this specialty: (1)it is a field of nursing; (2)it combines public health with nursing; (3)It is population focused; (4) it emphasizes prevention, health promotion, and wellness;(5) it promotes client responsibility and self-care; (6) it uses aggregate measurement and analysis; (7) it uses principles of organizational theory; and(8) it involves interprofessional collaboration..

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CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(1)it is a field of nursing;The two characteristics of any specialized nursing practiceare (1) specialized knowledge and skills, and (2) focus on aparticular set of people receiving the service. These two

characteristics are true for community health nursing. As a specialty field of nursing, community health nursing adds public health knowledge and skills that address the needs and

problems of communities and aggregates and focuses care oncommunities and vulnerable populations.

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(2)it combines public health with nursing;Community health nursing, then, as a field of nursing,combines nursing science with public health science to

formulate a community-based and population-focused practice

(Williams, 2000). It “synthesizes the knowledge from thepublic health sciences and professional nursing theories”(ANA, 1999, 2000) to improve the health of communitiesand vulnerable populations.

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Knowledge of the following elements of public health is essential to community health nursing (ANA, 1999)1. History and philosophy of public health, including emphasison the greatest good for the greatest number2. Concept of aggregates—assessing needs, planning and providing services, and evaluating services’ impact on population groups—including aggregate-level decision-making3. Priority of preventive, protective, and health-promotingstrategies over curative strategies4. Means for measurement and analysis of communityhealth problems, including epidemiologic concepts andbiostatistics5. Influence of environmental factors on aggregate health6. Principles underlying management and organization forcommunity health, because the goal of public health is accomplished through organized community efforts7. Public policy analysis and development8. Health advocacy and the political process

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(3)It is population focused; The central mission of public health practice is to improvethe health of population groups. Community health nursingshares this essential feature: it is population focused,

meaning that it is concerned for the health status of population groups and their environment.

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(4) it emphasizes prevention, health promotion, and wellness;

In community health nursing, the promotion of health andprevention of illness are of first-order priority. There is lessemphasis on curative care.These include services to mothers and infants, preventionof environmental pollution, school health programs, seniorcitizens’ fitness classes, and “workers’ right-to-know”legislation that warns against hazards in the workplace.

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(5) it promotes client responsibility and self-care; The goal of public health, “to increase quality and years ofhealthy life and eliminate health disparities” (UDHHS,2000), requires a partnership effort.Clients’ health status and healthbehavior will not change unless people accept and apply theproposals (developed in collaboration with clients) presentedby the community health nurse.

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(5) it uses aggregate measurement and analysis; Community health nursing uses aggregate measurement andanalysis. The need to collect and examine data on the entirepopulation under study before making intervention decisionsis fundamental to community health nursing in a publichealth practice. Health states, environmental factors, healthrelated services, economic patterns, and social policy are among the many foci of community health research and evaluation,

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(7) it uses principles of organizational theory;Community health nursing uses principles from organizationaltheory to provide effective administration of health careservices. Public health has long been defined as the protection

and improvement of community health through organized community efforts.

As community health nurses carefully assess group andcommunity needs, establish priorities, and plan, implement,and evaluate services, they are using public health

management and organizational principles.

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(8) it involves interprofessional collaboration..Community health nurses must work in cooperation withother team members, coordinating services and addressingthe needs of population groups. This interprofessional collaboration among health care workers, other professionals, and clients is essential for establishing effective services and programs.

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nur 473: primary health care nursing foundations of community health nursing 1 1

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