Module 1 Community Health Nursing Concepts Community Health - is the identification of needs, along with the protection and improvement of collective health, within a geographically defined area. - refers to 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 holing common rights and privileges (e.g., citizens of a town), sharing common interests (e.g., a community of farmers), or living under the same laws and regulations (e.g., a prison community). The term "community health nursing" is composed of three major concepts: ● Community •Client ● Health. •Goal ● Nursing •The means Concept of Health 1. Biomedical concept 2. Ecological concept 3. Psychosocial concept 4. Holistic concept 1.Biomedical concept - Health is "absence of disease" ie if one is free from disease than he is considered healthy. - Based on germ theory of disease - Question - malnutrition, chronic disease, accidents, drug abuse, mental illness, environmental pollution etc which lead to ecological concept 2. Ecological concept - Ecologists health is dynamic equilibrium between man and his environment, and disease is maladjustment of the human organism to his environment. - "Health implies the relative absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function" - Raised two questions →Imperfect man →Imperfect environment - History shows that improvement in human adaptation to natural environment can lead to longer and better quality of life- even with the absence of modern health delivery services. 3. Psychosocial concept ● ● ● ● ● - Development in social science → Health is not only a biomedical phenomenon, but it is influenced by social, psychological, cultural, economic and political factors of the people concerned, "Health is both a biological and social phenomenon" Philosophy of community health nursing: 1.Philosophy of individual's right of being healthy. - Health is believed to be one of the right of all human being nationally and internationally according to WHO charter. - Goal of health for all is based on the philosophy of individuals right of being healthy - This philosophy encompasses all the aspect of the society e.g. socio cultural, economic aspects that there is no hindrance of any kind to attain this rights. 2. Philosophy of working together under a competent leader for the common good. - It is from the primitive ages of human ages, man has learnt to live together to meet their needs. - The basis of modern community health nursing is to share responsibility of helping each other. - When it comes to considering a Organisation, equal participation of the people working through the community group /people with the people, for the people for their mutual benefit, change in behaviour and health practices. - A democratic team Functioning is essential for effective delivery of Health care services. 3. Philosophy that people in the community have the potential for continuous development and are capable of dealing with their own problems if educated and helped. - An individual with average intelligence can learn and deal with his or her own his or her lifestyles adjust to his or her changing environment and solve the problems. - On the basis of philosophy, Emphasis is placed on health education projected towards individual in home, Health Centre, place of work, School, community places or Hospital. - This helps to modify their behavior Respective to health. 4. Philosophy of socialism - Socialism is one of the social system in the community has control over production and distribution example for housing material production of all kinds education transportation etc. 12 Principles of CHN: The recognized need of individuals, families and communities provides the basis for CHN practice. Its primary purpose is to further apply public health measures within the framework of the total CHN effort. 1. Knowledge and understanding of the objees and policies of the agency facilities goal achievement. 2. CHN considers the family as the unit of service. 3. Respect for the values, customs and beliefs 4. CHN integrated health education and counseling as vital parts of functions 5. Collaborative work relationships with the co-workers and members of the health team facilities accomplishments of goals. 6. Periodic and continuing evaluation provides the means for assessing the degree to which CHN als and objectives are being attained. 7. Continuing staff education program quality services to client and are essential to upgrade and maintain sound nursing practices in their setting. 8. Utilization of indigenous and existing community resources maximizing the success of the efforts of the Community Health Nurses. 9. Active participation of the individual, family and community in planning and making decisions for their health care needs, determine, to a large extent, the success of the CHN programs. 10. Supervision of nursing services qualified by CHN personnel provides guidance and direction to the work to be done. 11. Accurate recording and reporting serve as the basis for evaluation of the progress of planned programs and activities and as a guide for the future actions. Features of CHN Eight characteristics of community health nursing: 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 responsibilities and self-care. 6. It uses aggregate measurement and analysis. 7. It uses principles of organizational theory. 8. It involves inter professional collaboration. MODULE 2: THEORETICAL FOUNDATIONS OF COMMUNITY HEALTH NURSING PRACTICE Introduction • Disease management in the community is challenging as illnesses are interwoven with social, economic, genetic and environmental risks in ways that are difficult to understand and more dificult to change. • In the face of these challenges, how can nurses succeed in their goal to improve public health? Nursing Theories • Theories or parts of theoretical frameworks to guide practice best achieves the goal of improving nursing practice- including that of public health. • A theory is like a map of a ter..cory as opposed to an aerial photograph. The map does not give the full terrain (i.e., the full picture); instead it picks out those parts that are important for its given purpose -Barnum, 1998 Historical Perspectives on Nursing Theory ● Era of Florence Nightingale - First nurse to formulate a conceptual foundation for nursing practice - Believed that clean water, clean linens, access to adequate sanitation, and quiet would improve health outcomes, and she put these beliefs into practice during the Crimean War ● 1980 onwards Several nursing theorists, Dorothy Johnson, Sister Callista Roy, Imogene King, Betty Neuman, and Jean Watson among them, have included community perspectives in their definition of health. General Systems Theory ● Viewed as an "open system," the client is considered as a set of interacting elements that exchange energy, matter, or information with the external environment to exist. ● This concept is particularly useful when analyzing interrelationships of the elements within the client, as well as those of the client and the environment. Open Systems The basic structures of a family that is found in all open systems: ● Boundaries ● Environment ● Inputs ● Outputs ● Processing (throughput) ● Feedback ● Subsystems Health Belief Model ● Provides the basis for much of the practice of health education and health promotion. ● Developed by a group of social psychologists to explain why the public falled to participate in screening for tuberculosis. ● "Behavior is based on current dynamics confronting an individual rather than prior experiences "-Kurt Lewin Constructs of the Health Belief Model ● ● ● ● ● ● Perceived severity/ seriousness Perceived susceptibility Perceived benefits Perceived barriers Cues to action Self-efficacy Health Belief Model ● Limitations of the model: It places the burden of action exclusively on the client. - It assumes that only those clients who have distorted or negative perceptions of the specified disease or recommended health action will to act. - It focuses the nurse's energies on interventions designed to modify the client's distorted perceptions, without acknowledging the health professional's responsibility to reduce or alter health care barriers other than patients' perspectives Milio's Framework for Prevention ● Provides a complement to the Health Belief Model ● Provides a mechanism for directing attention "upstream." ● Provides for the inclusion of economic, political, and environmental health determinants; therefore, the nurse is given broader range in the diagnosis and interpretation of health problems. ● Encourages the nurse to understand health behaviors in the context of their societal milieu. Milio's Propositions ● Population health results from deprivation and/or excess of critical health resources. ● Behaviors of populations result from selection from limited choices; these arise from actual and perceived options available as well as beliefs and expectations resulting from socialization, education and experience. ● Organizational decisions and policies (both governmental and non-governmental) dictate many of the options available to individuals and populations and influence choices. Pender's Health Promotion Model ● Explores the many biopsychosocial factors that influence individuals to pursue health promotion activities. ● Contains seven variables relate to health behaviors, as well as individual characteristics that may influence a behavioral outcome. ● Does not include threat as a motivator, as threat may not be a motivating factor for clients in all age groups. Seven Variables of Pender's Health Promotion Model ● Prior related behaviors ● Personal factors ● ● ● ● ● Behavior specific cognition and affect Perceived benefits of action Perceived barriers to action Perceived self-efficacy Activity-related affect Interpersonal influences Situational influences Commitment to a plan of action Immediate competing demands and preferences Health-promoting behavior Transtheoretical Model ● Combines several theories of intervention, thus the name "transtheoretical". ● Based on the assumption that behavior change takes place over time,ogressing through a sequence of stages.z ● Assumes that each of the stages is both stable and open to change. Constructs of the Transtheoretical Model ● Stages of Change - Precontemplation - Contemplation - Preparation - Action - Maintenance ● Decisional Balance - Pros - Cons Precede-Proceed Model ● Developed by Dr. Lawrence W. Green and colleagues. ● Provides a model for community assessment, health education planning and evaluation. Precede-Proceed Model ● Predisposing factors refer to people's characteristics that motivate them towards health-related behavior. ● Enabling factors refer to cond ions in people and the environment that facilitate or impede health-related behavior. ● Reinforcing factors refer to feedback given by support persons or groups resulting from the performance of the health-related behavior.
