Community Health Nursing

Community:
Group of people with common characteristic or interests living together with in a territory or geographical boundary  A social organization that is territorially localized and through which its members satisfy most of their daily needs and deal with most of their common problems


Elements of a community:
1.A population or groups of people 2. An area or territory 3. A sense of interrelatedness or social interaction 4. Sharing of common ties or a bond - the essence of a community lies in the relationships within it - as a social organization, it has a dynamic phenomenon within different statuses and roles - roles in the community are patterned for the performance of functions - members of the community carry on their respective roles to enhance common goals

Health state of complete physical, mental, and social well-being, wellnot merely the absence of disease or infirmity Community Health- part of paramedical or medical intervention/ Healthapproach which is concerned on the health of the whole or population Public Health-the science and art of preventing disease, prolonging Healththe efficiency thru organized community effort to:  sanitation of the environment  control of communicable diseases  the education of the individual in personal hygiene  the organization of medical and nursing service for the early diagnosis and preventive treatment of disease  the development of social machinery to ensure every one a standard of living, adequate for the maintenance of health to enable every citizen to realize his birth right of health and longevity. longevity. - Dr. C. Winslow

Priorities in public health:

1.the survival of human species 2. the prevention of conditions which lead to the destruction of retardation of human function and potential in the early years of life 3. the achievement of the human potential 4. prevention of the loss of productivity of young adults and those in the middle period of life 5. improvement of quality of life, especially in later years

ECOECO-SYSTEM influences the OLOF

FACTORS:  Political  Behavioral  Heredity  Health care delivery system  Environment  Socioeconomic influence

Community Health Nursing - learned practice discipline with the ultimate goal of contributing, as individual and in collaborative with others, to the promotion of the clients optimum level of functioning through teaching and delivery of care Public Health Nursing  -a special field of nursing that combines the skills of nursing, public health and some phases of social assistance for the promotion o health, the improvement of conditions in the social and physical environment, rehabilitation, prevention of illness and disability. - The WHO Expert Committee of Nursing

Concepts in Public Health Nursing

populationpopulation-based  community focused  multi-disciplinary approach multi man as an open system


Philosophy
The family is the smallest unit in a democratic society  Values and changes in the society it serves as well as the advances in medicines, philosophy, sociology must be considered  Family and community are the patient of public health nurse  Community Health Nurse has a unique identity within the professions is dealing with the individual, family and community


Concepts of Community Health Nursing



The primary focus of community health nursing practice is on health promotion. promotion. The community health nurse, by the nature of her work, has the opportunity and responsibility for evaluating the health status of people and groups and relating them to practice. Community health nursing practice is extended to benefit not only the individual but the family and community Community health nurses are generalists in terms of their practice throughout lifes continuum its full range of health problems and needs. Contact with the client and/or family may continue over a long period of time which includes all ages and all types of health care. The nature of community health nursing practice require that current knowledge derive from the biological and social sciences, ecology, clinical nursing and community health organization be utilized. The dynamic process of assessing, planning, implementing and intervening, provide periodic measurements of progress, evaluation and a continuum of the cycle until the termination of nursing is implicit in the practice of community health nursing.

   

Principles


    

CHN services is based on recognized needs and problems of communities, families, groups and individuals. The Community Health Nurse must understood fully the objectives and policies of the agency he/she represents In CHN, the family is the unit of service. CHN must be available to all regardless of race, creed, and socio-economic status socioHealth teaching is a primary responsibility of the Community Health Nurse. The community health nurse works as a member of the health team. There must be a provision for periodic evaluation of community health nursing services

    

Opportunities for continuation staff execution program nurses must be provided by the community health nursing agency. The community health nurse also has responsibility for his/her own professional growth. The community health nurse utilizes already existing active organized groups in the community. There must be provision for educative supervision in CHN. The community health nurse make use of available community health resources There should be accurate recording and reporting in CHN The CHN does not provide material relief but refers the patient and family to appropriate community resources for necessary financial, social assistance.

Qualifications of a Public Health Nurse:

Professional Qualifications: BSN, RN  Personal Qualifications  Good physical and mental health  Interest and willingness to work in the community  Capacity and ability to: - relate practice with ongoing community health activities -work cooperatively with other disciplines and community members -take actions needed to improve self and service -analyze combination of factors that influence health -apply nursing process in meeting health and nursing needs of the community -mobilize resources in the community  Leadership potential  Resourcefulness and creativity  Honesty and integrity  Active membership to professional working organizations


Functions of the Public Health Nurse:

Management Function  nurse organizes the nursing services of the local health agency  involves preparation of the nursing service plan as well as the overall municipal health plan  involves program management: the delivery of package services provided by the program to the target clientel Supervisory Function  generally supervises midwives and auxiliary health workers  formulates supervisory plan and conducts supervisory visits for implementation Nursing Care Function  the inherent function of a nurse  makes use of knowledge and skills in nursing process  home visits are visible manifestations of her caring function  involves referrals to appropriate levels of care when indicated

Collaborating and Coordinating Function  bringing activities and group of activities systematically into  proper relation or harmony with each other  establish linkages and collaborative relationships with other agencies and health professionals Health Promotion and Education Function  health teachings and health information campaigns  involves understanding of the multidimensional level of health essential in planning and promoting interventions for communities  educator: involves providing clients with information that allows them to make healthier choices and practices Training Function  initiates formulation of staff development and training program for midwives and other auxiliary health worker  community organizing Research Function  - participates in conducting research and utilization of research findings in practice  - disease surveillance: continuous collection and analysis of data cases and deaths

Primary Health Care

Essential Health made universally accessible to individuals and families in the community by means acceptable to them thru their full participation and at cost that the community and country can afford at every stage of development. Strategies to promote equity in health priorities:  vulnerable group  marginalized


Mission

To strengthen the health care system by increase opportunities and supporting the conditions wherein people will manage their own health Alma Ata Conference  First conference on Primary Health Care was held in Alma Ata, USSR  Legal Basis: Letter of Instruction 949 signed on October 19, 1979 by Pres. Marcos a year after Alma Ata Conference  PHC was declared in the ALMA ATA CONFERECE in September 6-12, 1978 as a strategy to community 6health development.


It is a strategy aimed to provide essential health care that is (concept):  Community-based ommunity Accessible  Part and parcel of the total sociosocioeconomic development effort of the nation  Acceptable  Sustainable at an affordable cost

Accessibility, acceptability, availability and affordability of health services Strategies:  Health services are delivered where people live and work  Development of indigenous/ resident volunteer health workers to provide health care  Use of socially acceptable, appropriate and affordable low cost technology sustainable by the community  Combined utilization of traditional medicines

Partnership between the community and health agencies in the provision of quality, basic and essential health services Strategies:  Community needs and priorities are bases for planning health services and activities  Inter/intra sectoral collaboration. Collaboration among all sectors (community, health , environment, social, political, economic, business, education, religious, private and public organizations)

Community participation Strategies:  Awareness building and consciousness raising on health and development issues  Community building and community organizing  Planning, implementation, monitoring, and evaluation done by the people  Community discussions done through small group discussions  Selection of community health workers by the community  Formation of health committee  Establishment of community health organization  Mass health campaigns and community mobilization  Community health workers are given competency training  Attitudes, knowledge and skills developed by CHW s are on promotive, preventive, curative and rehabilitative health care  Regular supervision and periodic evaluation of CHW s performance by the health staff and community  Recognition of the rile of traditional healers in the delivery of care

Self reliance Strategies:  Income generating projects and activities  Use of local indigenous resources available in the community  Training of community leaders on management skills  The community generates support for local health care 5. Recognition of interrelationship between health and development Strategies:  Convergence of health, food, nutrition, water, sanitation, and population services  Integration of PHC into national, provincial, municipal And barangay development plans  Coordination of activities with economic planning, education, agriculture, trade and industry, housing, public works, communication and social services

Mobilization  Strategies:  Establishment of an effective health referral system  Multi sectoral and inter disciplinary linkages  IEC support using multi media channels  Collaboration among government agencies, NGO s and community groups 7. Decentralization  Strategies:  Reallocation of budgetary resources  Advocacy for political will and support from the national leadership to the barangay level  RE orientation of health professional and other sectors regarding PHC

Department of Health (DOH) Legal Framework:  R.A. 7160 (1991) Local Government Code  -Provided for the decentralization of the entire government.  -All structures, personnel, and budgetary allocations from the provincial health level down to the barangays were devolved to the local government units (LGUs) to facilitate health service delivery  -LGUs are now responsible for the delivery of basic health services (implementation function)  -DOH (governance function)

E.O. 102 (1999) The Department of Health is the national authority on health, providing technical and other resource assistance to local government units, people s organization, and other members of the civic society in effectively implementing programs, projects, and services that will  (a) promote the health and well-being of every wellFilipino,  (b) prevent and control diseases among population at risks,  (c) protect individuals, families, and communities exposed to hazards and risks that could affect their health, and  (d)treat, manage, and rehabilitate individuals affected by diseases and disability

Roles and Functions: DOH 1. Leadership in Health  -national policy and regulatory institution where LGUs and NGOs will base their direction for health 2.Enabler and Capacity Builder  -innovates new strategies in health to improve effectiveness of health programs  - ensures highest achievable standards of quality health care 3. Administrator of Specific Services  -manage selected national health facilities that shall serve as national referral centers  -administers health emergency response services

Vision: Health for all Filipinos  DOH is the leader, staunch advocate, and model in promoting Health for All in the Philippines  Mission: Ensure accessibility and quality health Mission: care to improve the quality of life of Filipinos, especially the poor  DOH shall guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor, and shall lead the quest in excellence for health

The Local Health System  RA 7160 (1991) - made local government executives responsible to operate local health care services Provincial Governments - local government executive: governor - operate provincial and district hospitals City/ Municipal Governments - local government executive: city or municipal mayor - operate Health Centers, Rural Health Units, and Barangay Health Stations

International Organizations

World Health Organization (WHO): -the directing and coordinating authority for health within the United Nations system World Health Assembly- the supreme decisionAssemblydecisionmaking body for WHO. It meets each year in May in Geneva, and is attended by delegations from all 193 Member States. Executive Board- composed of 34 members Boardtechnically qualified in the field of health. Members are elected for three-year terms threeObjective: The attainment by all peoples of the highest possible level of health

Core functions:  Providing leadership on matters critical to health and engaging in partnerships where joint action is needed  Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge  Setting norms and standards and promoting and monitoring their implementation  Articulating ethical and evidence-based policy options; evidence Providing technical support, catalysing change, and building sustainable institutional capacity  Monitoring the health situation and assessing health trends

United Nations Children s Fund (UNICEF) -the United Nations (UN) body responsible for the rights of children Roles: - required by the UN Convention to promote the effective implementation and to encourage international cooperation for the benefit of children. -UNICEF is represented during UN Conventions and may be invited to provide expert advice on the implementation of the convention

Global Structure of UNICEF: -International offices: New York and Geneva -Specialised offices: CopenhagenCopenhagen- Supply Division which manages the supply centres that are essential in emergencies FlorenceFlorence- Innocenti Research Centre well- known wellfor its authoritative publications on children

Funding: -The UN does not fund UNICEF -Relies on voluntary donations to fund its work for children worldwide -Raises funds for programs through donations, gifts, the sale of cards and gifts, partnerships with companies and special events

Development multimulti-dimensional process involving major changes in social structures, populations, attitudes, and national institutions, as well as the acceleration of economic growth, reduction if inequality and eradication of absolute poverty. The goal of development is to have a better life. Community development organized effort of the people to improve the conditions of community life and the capacity of the people for participation, selfselfdirection and integrated efforts in community affairs. It advocates the principle of self-help and the selfvoluntary participation and cooperation of people of the community, but usually couples them with technical assistance for the government or voluntary organizations.

Community Organization
a process by which people, health services and agencies of the community are brought together to:

learn about the common problems  identify these problems as their own  plan the kind of action needed to solve these problems  act on this basis


Definitions of COPAR: A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community. A collective, participatory, transformative, liberative, sustained and systematic process of building people s organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference)


-A collective, participatory, transformative, liberative, sustained and systematic process of building people s organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference

A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community (Ross 1967) A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively and efficiently on their immediate and long-term longproblems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs towards solving their long-term problems (CO: A manual longof experience, PCPD)


A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively and efficiently on their immediate and long-term longproblems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs towards solving their long-term problems (CO: A manual longof experience, PCPD)

The process and structure through which members of a community are/or become organized for participation in health care and community development activities

Importance of COPAR:  COPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities.  COPAR prepares people/clients to eventually take over the management of a development programs in the future.  COPAR maximizes community participation and involvement; community resources are mobilized for community services

 

COPAR could be an alternative in situations wherein health interventions in Public Health Care do not require direct involvement of modern medical practitioners COPAR gets people actively involved in selection and support of community health workers Through COPAR, community resources COPAR, are mobilized for selected health services COPAR improves both projects effectiveness during implementation

Emphasis of COPAR: COPAR:  Community working to solve its own problem  Direction is established internally and externally  Development and implementation of a specific project less important than the development of the capacity of the community to establish the project  Consciousness raising involves perceiving health and medical care within the total structure of society

Principles of COPAR:  1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change.  2. COPAR should be based on the interest of the poorest sectors of society  3. COPAR should lead to a self-reliant selfcommunity and society.

COPAR Process: A progressive cycle of action-reflection action which actionbegins with small, local and concrete issues identified by the people and the evaluation and the reflection of and on the action taken by them. Consciousness through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. COPAR is participatory and mass-based because it is massprimarily directed towards and biased in favor of the poor, the powerless and oppressed. COPAR is group-centered and not leader-oriented. Leaders groupleaderare identified, emerge and are tested through action rather than appointed or selected by some external force or entity.

Phases of COPAR  Pre-Entry Phase Pre The initial phase of the organizing process where the community / organizer looks for communities to serve / help.  It is considered to be the simplest phase in terms of actual outputs, activities and strategies and time spent for it.  Designing a plan for community development including all its activities and strategies for care / development  Designing criteria for the selection for the site.  Actual Selecting the site for community cares

Preparation of the Institution

Train faculty and students in COPAR. Formulate plans for institutionalizing COPAR. Revise/enrich curriculum and immersion program. Coordinate participants of other departments.

Site Selection
Initial networking with local government. Conduct preliminary special investigation. Make long/short list of potential communities. Do ocular survey of listed communities.

Criteria for Initial Site Selection

Must have a population of 100-200 families. 100Economically depressed. No strong resistance from the community. No serious peace and order problem. No similar group or organization holding the same program.

 

Identifying Potential Municipalities

Make long/short list.

Identifying Potential Barangay

Do the same process as in selecting municipality. Consult key informants and residents. Coordinate with local government and NGOs for future activities.

Choosing Final Barangay

Conduct informal interviews with community residents and key informants. Determine the need of the program in the community. Take note of political development. Develop community profiles for secondary data. Develop survey tools. Pay courtesy call to community leaders. Choose foster families based on guidelines.

Identifying Host Family

House is strategically located in the community. Should not belong to the rich segment. Respected by both formal and informal leaders. Neighbors are not hesitant to enter the house. No member of the host family should be moving out in the community.

2. Entry Phase - sometimes called the social preparation phase. Is crucial in determining which strategies for organizing would suit the chosen community. Success of the activities depend on how much the community organizers has integrated with the community. Guidelines for Entry
Recognize the role of local authorities by paying them visits to inform their presence and activities. Her appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role model. Avoid raising the consciousness of the community residents; adopt a low-key profile. low-

Activities in the Entry Phase

Integration - establishing rapport with the people in continuing effort to imbibe community life.
 living with the community  seek out to converse with people where they usually congregate  lend a hand in household chores  avoid gambling and drinking

Deepening social investigation/community study

 verification and enrichment of data collected from initial survey  conduct baseline survey by students, results relayed through community assembly

3. Community Study/diagnosis Phase (Research Phase)  Selection on the research team  Training on Data Collection methods and techniques; capabilitycapability-building (includes development of data collection tools)  Planning for the actual gathering of data  Data-gathering Data Training on data validation (includes tabulation and preliminary analysis of data)  Community validation  Presentation of the community study / diagnosis and recommendations  Prioritization of community needs / problems for action

4. Organization-building Phase (Community OrganizationOrganization and Capability Building Phase)  Entails the formation of more formal structure and the inclusion of more formal procedure of planning, implementing, and evaluating community-wise activities. communityIt is at this phase where the organized leaders or groups are being given training (formal, informal, OJT) to develop their style in managing their own concerns/programs.  Key Activities
Community Health Organization (CHO)
 preparation of legal requirements  guidelines in the organization of the CHO by the core group  election of officers

Research Team Committee Planning Committee Health Committee Organization Others Formation of by-laws by the CHO by-

5. Community Action Phase  Organization and training of community health workers  * development criteria for the selection of CHW  * selection of CHW  * training of CHW  Setting up of linkages/network referral systems  PIME of health services/intervention schemes and community development projects  Initial identification and implementation of resource mobilization schemes

6. Sustenance and Strengthening Phase  Occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At communitythis point, the different committees setup in the organizationorganization-building phase are already expected to be functioning by way of planning, implementing and evaluating their own programs, with the overall guidance from the community-wide organization. community Key Activities:
Training of CHO for monitoring and implementing of community health program. Identification of secondary leaders. Linkaging and networking. Conduct of mobilization on health and development concerns. Implementation of livelihood projects.