COMMUNITY HEALTH NURSING
Overview of Community Health Nursing
The term "community health nursing" is composed of three major concepts:
Community - Client
Health - Goal
Nursing -The means
Two Major Fields of Nursing in the Philippines:
1. Hospital Nursing
2. Community Health Nursing
We generally use the terms community health nursing and public health nursing, and community health nurse and public health nurse interchangeably.
Definition of CHN:
“Science and art of preventing disease, prolonging life, promoting health and efficiency, through organized community effort for the sanitation of the environment, control of communicable diseases, the education of individuals 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 ensure 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”
-Dr. C.E. Winslow
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
Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health programme for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability
-WHO Expert Committee of Nursing
Community health nursing practice promotes and preserves the health of populations by integrating the skills and knowledge relevant to both nursing and public health. The practice is comprehensive and general, and is not limited to a particular age or diagnostic group; it is continual, and is not limited to episodic care.
- The American Nurses Association
1. The goal of professional practice is the promotion and preservation of the health of populations
2. The nature of practice is comprehensive, general, continual and not episodic
3. The knowledge base comes from nursing and public health
4. The different levels of clientele— individuals, families and groups
5. The practitioner's recognition of the primacy of the population as a whole.
Community health nursing is a specialized field of nursing practice. Its basic knowledge and skills are anchored on nursing theories and important concepts from the science of public health such as:
1. Emphasis on the importance of the "greatest good for the greatest number"
2. Assessing health needs, planning, implementing and evaluating the impact of health services on population groups
3. Priority of .health-promotive and disease-preventive strategies over curative interventions
4. Tools for measuring and analyzing community health problems
5. Application of principles of management and organization in the delivery of health services to the community.
Basic Concepts and Principles of CHN:
1. The FAMILY is the unit of care, the community is the patient and there are four levels of clientele in CHN
2. The goal of improving community health is realized through multidisciplinary effort
3. The community health nurse works WITH and not FOR the individual patient, family, group or community. The latter are active partners, not passive recipients of care
4. The practice of CHN is affected by changes in society in general and by developments in the health field in particular
5. CHN is part of the community health system which in turn is part of the larger human services system
Roles of the nurse in caring for communities and population groups:
· Clinician – health care provider, taking care of the sick people at home or in the RHU
· Health Educator – aim is towards health promotion and illness prevention through dissemination of correct information; educating people
· Facilitator – establishes multi-sectoral linkages by referral system
· Supervisor – monitors and supervises the performance of midwives
· Supervision and care of women during pregnancy, labor, and puerperium
· Performance of internal examination and delivery of babies
· Suturing lacerations in the absence of the physician
· Provision of first aid measures and emergency care
· Recommending herbal and symptomatic meds.
In the care of the families:
· provision of primary health care services
· developmental/utilization of family nursing care plan in the provision of care
In the care of the communities:
· Community organizing mobilization, community development, and people empowerment
· Case finding and epidemiological investigation
· Program planning, implementation, and evaluation
· Influencing executive and legislative individuals or bodies concerning health and development
Brief history of community health/public Health nursing practice in the Philippines
(Refer to Public Health Nursing in the Philippines pages 8 – 16)
Community Health and Development Concepts, Principles and Strategies
Primary Health Care Approach
Primary Health Care
Essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development - (WHO)
Health in the Hands of the People by the year 2020
To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care
Legal Basis of Primary Health Care
Letter of Instruction No. 949 (October 19, 1979)
· Instructs the Department of Health and all officials and personnel of the Department to design, develop and implement programs which will focus on health development at the community level particularly in rural areas; effectively utilize these system in order to control or eradicate the immediate and specific health problems confronting Filipino communities.
Elements/Components of Primary Health Care:
1. Environmental Sanitation
2. Control of Communicable Disease
4. Health Education
5. Maternal and Child Health and Family Planning
6. Adequate Food and Proper Nutrition
7. Provision of Medical Care and Emergency Treatment
8. Treatment of Locally Endemic Diseases
9. Provision of Essential Drugs
Community organization is a problem solving approach whereby the community is empowered with knowledge and skills to identify and prioritize its needs and problems, harness its resources to deal with the problems and take actions (CSWD-UP, 1987
CO is a process by which a community identifies its needs and objectives, takes action in them; and in so doing extends and develops cooperative and collaborative attitudes and practices in the community (Ross, 1959)
CO is a process that enables people to identify and analyze critically their needs and problems, gets solidly organized and mobilized to act on consensually-agreed upon priority problems, thereby participating in their own social development.
GOALS OF COMMUNITY ORGANIZING
CO is a continuous and sustained process of:
1. Educating the people to understand and develop their critical consciousness of their existing conditions
2. Organizing the people to work effectively and efficiently on their immediate and long term problems
3. Mobilizing them to develop their own capability and readiness to respond and take action on their immediate and long term problems (Ferrer)
PRINCIPLES INVOLVED IN CO:
2. Organizational plan can succeed only when the people who operate it will see values which are compatible personally and not antagonistic professionally
3. Need to represent all people concerned in the planning group and discussion must include people with technical knowledge of health problem
4. Available personnel should be asked in determining what type of organization is desirable
5. Technique of asking questions is often important in developing community organization and group discussion
6. Entire group must decide on major decisions
PHASES OF COMMUNITY ORGANIZING
1. Site Selection
3. Social Investigation/Community Study
4. Spotting potential leaders
5. Core group formation
6. Formation of community
7. Program Planning
8. Program development and Implementation
9. Program Evaluation
CHARACTERISTICS OF A HEALTHY COMMUNITY
a. People’s awareness that “we are community”
b. Conservation of natural resources
c. Recognition, respect for the existence of subgroups
d. Participation of subgroups in community affairs
e. Preparation to meet crisis
f. Ability to solve problems
g. Communication through open channels
h. Resources available to all
i. Setting disputes through legitimate mechanism
j. Wellness of high degree among members
PARTNERSHIP BUILDING AND COLLABORATION
- Working with other people or groups to increase the probability of accomplishing the goals.
AIM: To get people to work together in order to address problems or concerns that affect them.
A. NETWORKING – exchanging information about each other s goals and objectives, services and facilities.
B. INTERDESCIPLINARY COLLABORATION – organizations help each other enhance their capacities in performing their tasks as well as in the provision of services.
C. MULTISECTORAL COLLABORATION – organizations and citizens form a partnership to give priority to the good of the community.
D. ADVOCACY – Empower the people to make decision and carry out actions that have the potential to better lives.
Advocacy work involves:
1. Informing the people about the rightness of the cause.
2. Thoroughly discussing with the people the nature of the alternatives, their content and possible consequences.
3. Supporting people’s right to make a choice and act on their choice.
4. Influencing public opinion.