Community health nursing


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Community health nursing

  1. 1.
  2. 2. According to American NursingAssociation,“Community health nursing is a synthesis of nursing practiceand public health practice applied in promoting and preservingthe health of populations. the nature of this practice is generaland comprehensive. it is not limited to a particular age ordiagnostic group. It is continuous and not episodic. Thedominant responsibility is to the population as a whole”
  3. 3. DefinitionTherefore Nursing directed to individuals,families or groups contributes to the healthof the total population. Health promotion,health maintenance, health education,coordination and continuity of care areutilized in a holistic approach to themanagement of the individual, family groupand community. The nurse’s actionsacknowledge the need for comprehensivehealth planning, recognize the influences ofsocial and ecological issues, give attention topopulations at risk and utilize dynamic forceswhich influence
  4. 4. Philosophy of CHN Philosophy of individual’s right of beinghealthy Philosophy of working together under acompetent leader for the common
  5. 5. Philosophy of CHN Philosophy that people in the communityhave the potential for continualdevelopment and are capable of dealingwith their own problems if educated andhelped. Philosophy of
  6. 6. Aims of CHNAims: The aim of community health nursingpractice is to promote health andefficiency To prevent and control diseases anddisabilities. To prolong life by providing need based,well balanced comprehensive healthcare services to community at largethrough organized community
  7. 7. Objectives1) To increase the capability of community to dealwith their own health problems.2) To strengthen community resources3) To control and counteract environment4) To prevent and control communicable and non-communicable diseases5) To provide specialised services6) To conduct research7) To prepare health
  8. 8. Principles of CHN1)Recognized needs and functioning withinthe total health programme.2)Clearly defined objectives and purposes forit’s services3)An active organized citizens group of thecommunity group is an integral part of thecommunity health programme.4)Community health nursing services areavailable to the entire
  9. 9. Principles of CHN5)Community health nursing recognized thefamily and community as units of service.6)Health education and counseling for theindividual, family and community are theintegral part of community health nursing.7)Participation in planning relating to goals forthe attainment of health.8)The community health nurse should qualify asa full-fledged nurse.9)Based on the needs of the patient and thereshould be proper continuity of services
  10. 10. Principles of CHN10) Periodic and continuous appraisal and evaluation ofhealth situation11) The community health nurse should function/serveas an important member of the health team.12)There should be provision for qualified nurse tomake supervision for community health services.13)The community health nurse directs the patient toappropriate community resources for necessaryfinancial and social assistance.14)Should not accept gifts or bribes from the
  11. 11. Principles of CHN15)The community health nurse should not belong to oneparticular section or political group.16)Community health agency should provide a continuingeducation programme for nurse17)The nurses assume responsibilities of their own continuingprofessional development through acquiring higher andhigher education and forming and strengthening theprofessional associations18)The community health nursing services should developproper guidelines, in maintaining records and reports.19)There should be proper facilities and job conditions.20)The community health nurse should maintain professionalrelationship with all leaders in the community and maintainethics at all
  12. 12. Quality assurance in CHN Define quality assuranceQuality assurance can be defined as ”thepromise or guarantee that certain standards ofexcellence are being met in care delivered.”
  13. 13. Goals of quality assurance To ensure the delivery of quality clientcare. To demonstrate the efforts of the healthcare provider for the best
  14. 14. Two Approaches of Qualityassurance General Approach Specific
  15. 15. General Approach Licensure Accreditation
  16. 16. Specific Approaches1)Staff review committees(Peer review)2)Utilization review committees3)Research studies4)Client satisfaction surveys5)Malpractice
  17. 17. Model quality assuranceProgrammePurpose:The primary purpose of a qualityassuranceprogramme is to ensure the results of anorganized activity are consistent
  18. 18. Steps in Model Quality Assurance1)identify the sources needed2)Describe the nature of the personnelrequired to handle resources, supplies,equipments, facilities and finance.3)Once the resources are identified, thenpolicies, procedures, job descriptionsshould be clearly laid down for
  19. 19. Process The primary approach used for processevaluation includes the peer groupcommittee and the client satisfactionsurvey. Technique used for process evaluationis direct observation, questionnaire,interview, written audit and videotape ofclient and
  20. 20. Outcome For the purpose of evaluation the nurseuses client’s admission data, acuity of theproblem and discharge data that may pointout changes in the level of dependenceand activity. Direct physical examination and interviewwill help a lot measure the outcome. This will help one to identify the causesand problems associated with health
  21. 21. Evaluation, Interpretation andAction Interpretation is one of the majorcomponents of quality assurance Evaluation of the process should becarried out at major intervals andperiodic reports should be prepared. Action is the final step in qualityassurance model. The action must be based upon theirsignificance, economic benefits
  22. 22. Health provider evaluation It is essential to determine the individualservice provider’s contribution to the qualityassurance programme . Punctuality and performance are needed toevaluate the individual based on traditionaltrait ratings. Objective oriented action tools are developedin consultation with supervisor and the
  23. 23. Nursing Audit Staff review committees are the mostcommon review committees designed toassess the clent-specific aspects ofcertain levels of care. The audit is the major tool used toascertain the quality of
  24. 24. Process of Nursing Audit Selection of a topic for study. Selection of a explicit criteria for qualitycare. Review of records whether criteria are met. Peer review of all the cases that do notmeet the criteria. Specific recommendations to correct theproblems. Follow-up to determine whether problemshave been
  25. 25. Types of Nursing Audit1)Concurrent Audit2)Retrospective
  26. 26. Concurrent AuditConcurrent audit is used by Medicare andMedicaid to evaluate care being receivedby public health/home health
  27. 27. Advantages Identification of the problems. Provision of a mechanism for identifyingand meeting client needs during care. Implementation of measures to fulfillprofessional responsibilities. Provision of a mechanism forcommunicating on behalf of the
  28. 28. Disadvantages1) Time consuming2) Less cost efficient than retrospective Audit.3)It does’t represent the total picture of thecare that the client will ultimately
  29. 29. Retrospective AuditRetrospective audit or outcome auditevaluatesthe quality of care through appraisal of thenursing process after the client’s dischargefromthe health care
  30. 30. Advantages1) Comparison of actual practice tostandard of care2) Analysis of actual practice findings3) A total picture of the care given.4) More accurate date for planningcorrective
  31. 31. Disadvantages1) Focus of evaluation is directed away fromongoing care.2) Client problems are identified afterdischarge,so corrective action can be only used toimprovethe care of the
  32. 32. Community Nursing
  33. 33. Precede ModelThe model PRECEDE is an acronym forpredisposing, reinforcing and enabling causes ineducational diagnosis and evaluation.Two basic propositions underscore the outcomeoriented PRECEDE model.1)Health and health behavioursare caused bymultiple factors.2)Health education designed to influence thebehavior must be
  34. 34. Health Belief ModelIt has 3 major components:1)Individual Perception2)Modifying Factors3)Variables affecting the likelihood of
  35. 35. Contributory factors in Health Belief Model Age Sex Race Ethnicity Personality Social class Pressure Reference
  36. 36. Health promotion modelPender (1987) developed this model to be usedas a complement to health protecting modelslike Health Belief Model.Determinants of health promotion behavior areorganized into: Cognitive-Perceptual factorsThey include factors like: Importance of health Perceived self-efficacy Definition of health Barriers to health-promoting
  37. 37. CONCEPTUAL MODELSA conceptual framework refers to global idesabout individuals, groups, situations andeventsof interest to a discipline. A conceptual modelprovides a reference platform for members ofadiscipline to guide their thinking, observationand
  38. 38. Models applicable in CHN1) System model2)Developmental Model3)Interaction
  39. 39. System Model It is postulated by Von Bertalanffy(1952) It focuses on the organization,interaction, interdependency andintegration of parts and
  40. 40. Characteristics-System Model Wholeness Organisation Openness Boundary Entropy
  41. 41. Application to Community Health Nursing The community is a social system madeof interrelated subsystems. The subsystems include economic,educational, religious, health care,political, welfare. law enforcement,energy and recreational systems They are interrelated and have aspecific orientation towards each
  42. 42. Developmental Model It is a way of thinking how changes occurbased on theories of development of thehuman organization. According to Lewis,the change may beboth reactive and structural. The reactive theory emphasizes theinfluence of environment in developmentprogrammes,and the structural theoryemphasizes the genetically determinedprogramme for
  43. 43. Application to CHN It is useful in working with infants andchildren,because the major role of anurse working with them is to assess thedevelopmental progress and to promoteoverall growth and
  44. 44. Interaction Model These models are based upon theories thatstem from philosophical writings such as thoseof Cooley(1969) and Mead(1934). The major concepts used in interaction modelsare communication, perception, role playingand self
  45. 45. Application to CHN Communication Self-Conception
  46. 46. Bibliography Lucita M. Public health and communityhealth nursing in the new millennium. 1sted. Chennai: B.I Publications PrivateLimited; 2006. p.88-93,136-43. Gulani KK.Community health nursing:principles and practices. 1st ed. Delhi:Kumar Publishing House; 2008.p.33-46. Stanhope M,Lancaste J. CommunityHealth Nursing:promoting health ofaggregates,families and individuals. 4th ed.St.Louis:Mosby;