Community health nursing


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Community health nursing

  1. 1.
  2. 2. According to American Nursing Association, “Community health nursing is a synthesis of nursing practice and public health practice applied in promoting and preserving the health of populations. the nature of this practice is general and comprehensive. it is not limited to a particular age or diagnostic group. It is continuous and not episodic. The dominant responsibility is to the population as a whole”
  3. 3. Definition Therefore Nursing directed to individuals, families or groups contributes to the health of the total population. Health promotion, health maintenance, health education, coordination and continuity of care are utilized in a holistic approach to the management of the individual, family group and community. The nurse’s actions acknowledge the need for comprehensive health planning, recognize the influences of social and ecological issues, give attention to populations at risk and utilize dynamic forces which influence change.
  4. 4. Philosophy of CHN  Philosophy of individual’s right of being healthy  Philosophy of working together under a competent leader for the common good.
  5. 5. Philosophy of CHN  Philosophy that people in the community have the potential for continual development and are capable of dealing with their own problems if educated and helped.  Philosophy of Socialism.
  6. 6. Aims of CHN Aims:  The aim of community health nursing practice is to promote health and efficiency  To prevent and control diseases and disabilities.  To prolong life by providing need based, well balanced comprehensive health care services to community at large through organized community efforts.
  7. 7. Objectives 1) To increase the capability of community to deal with their own health problems. 2) To strengthen community resources 3) To control and counteract environment 4) To prevent and control communicable and non- communicable diseases 5) To provide specialised services 6) To conduct research 7) To prepare health personnel
  8. 8. Principles of CHN 1)Recognized needs and functioning within the total health programme. 2)Clearly defined objectives and purposes for it’s services 3)An active organized citizens group of the community group is an integral part of the community health programme. 4)Community health nursing services are available to the entire community
  9. 9. Principles of CHN 5)Community health nursing recognized the family and community as units of service. 6)Health education and counseling for the individual, family and community are the integral part of community health nursing. 7)Participation in planning relating to goals for the attainment of health. 8)The community health nurse should qualify as a full-fledged nurse. 9)Based on the needs of the patient and there should be proper continuity of services to patients.
  10. 10. Principles of CHN 10) Periodic and continuous appraisal and evaluation of health situation 11) The community health nurse should function/serve as an important member of the health team. 12)There should be provision for qualified nurse to make supervision for community health services. 13)The community health nurse directs the patient to appropriate community resources for necessary financial and social assistance. 14)Should not accept gifts or bribes from the patients
  11. 11. Principles of CHN 15)The community health nurse should not belong to one particular section or political group. 16)Community health agency should provide a continuing education programme for nurse 17)The nurses assume responsibilities of their own continuing professional development through acquiring higher and higher education and forming and strengthening the professional associations 18)The community health nursing services should develop proper guidelines, in maintaining records and reports. 19)There should be proper facilities and job conditions. 20)The community health nurse should maintain professional relationship with all leaders in the community and maintain ethics at all times.
  12. 12. Quality assurance in CHN  Define quality assurance Quality assurance can be defined as ”the promise or guarantee that certain standards of excellence are being met in care delivered.”
  13. 13. Goals of quality assurance  To ensure the delivery of quality client care.  To demonstrate the efforts of the health care provider for the best possible result.
  14. 14. Two Approaches of Quality assurance  General Approach  Specific Approach
  15. 15. General Approach  Licensure  Accreditation  Certification
  16. 16. Specific Approaches 1)Staff review committees(Peer review) 2)Utilization review committees 3)Research studies 4)Client satisfaction surveys 5)Malpractice litigation
  17. 17. Model quality assurance Programme Purpose: The primary purpose of a quality assurance programme is to ensure the results of an organized activity are consistent with Expectations.
  18. 18. Steps in Model Quality Assurance 1)identify the sources needed 2)Describe the nature of the personnel required to handle resources, supplies, equipments, facilities and finance. 3)Once the resources are identified, then policies, procedures, job descriptions should be clearly laid down for use.
  19. 19. Process  The primary approach used for process evaluation includes the peer group committee and the client satisfaction survey.  Technique used for process evaluation is direct observation, questionnaire, interview, written audit and videotape of client and provider.
  20. 20. Outcome  For the purpose of evaluation the nurse uses client’s admission data, acuity of the problem and discharge data that may point out changes in the level of dependence and activity.  Direct physical examination and interview will help a lot measure the outcome.  This will help one to identify the causes and problems associated with health care.
  21. 21. Evaluation, Interpretation and Action  Interpretation is one of the major components of quality assurance  Evaluation of the process should be carried out at major intervals and periodic reports should be prepared.  Action is the final step in quality assurance model.  The action must be based upon their significance, economic benefits and timeliness.
  22. 22. Health provider evaluation  It is essential to determine the individual service provider’s contribution to the quality assurance programme .  Punctuality and performance are needed to evaluate the individual based on traditional trait ratings.  Objective oriented action tools are developed in consultation with supervisor and the nurse.
  23. 23. Nursing Audit  Staff review committees are the most common review committees designed to assess the clent-specific aspects of certain levels of care.  The audit is the major tool used to ascertain the quality of care:
  24. 24. Process of Nursing Audit  Selection of a topic for study.  Selection of a explicit criteria for quality care.  Review of records whether criteria are met.  Peer review of all the cases that do not meet the criteria.  Specific recommendations to correct the problems.  Follow-up to determine whether problems have been eliminated.
  25. 25. Types of Nursing Audit 1)Concurrent Audit 2)Retrospective Audit
  26. 26. Concurrent Audit Concurrent audit is used by Medicare and Medicaid to evaluate care being received by public health/home health clients.
  27. 27. Advantages  Identification of the problems.  Provision of a mechanism for identifying and meeting client needs during care.  Implementation of measures to fulfill professional responsibilities.  Provision of a mechanism for communicating on behalf of the client.
  28. 28. Disadvantages 1) Time consuming 2) Less cost efficient than retrospective Audit. 3)It does’t represent the total picture of the care that the client will ultimately will receive.
  29. 29. Retrospective Audit Retrospective audit or outcome audit evaluates the quality of care through appraisal of the nursing process after the client’s discharge from the health care system.
  30. 30. Advantages 1) Comparison of actual practice to standard of care 2) Analysis of actual practice findings 3) A total picture of the care given. 4) More accurate date for planning corrective action.
  31. 31. Disadvantages 1) Focus of evaluation is directed away from ongoing care. 2) Client problems are identified after discharge, so corrective action can be only used to improve the care of the future.
  32. 32. Community Nursing Theories
  33. 33. Precede Model The model PRECEDE is an acronym for predisposing, reinforcing and enabling causes in educational diagnosis and evaluation. Two basic propositions underscore the outcome oriented PRECEDE model.1)Health and health behaviours are caused by multiple factors. 2)Health education designed to influence the behavior must be multi-dimensional.
  34. 34. Health Belief Model It has 3 major components: 1)Individual Perception 2)Modifying Factors 3)Variables affecting the likelihood of initiating action.
  35. 35. Contributory factors in Health Belief Model  Age  Sex  Race  Ethnicity  Personality  Social class  Pressure  Reference group
  36. 36. Health promotion model Pender (1987) developed this model to be used as a complement to health protecting models like Health Belief Model. Determinants of health promotion behavior are organized into:  Cognitive-Perceptual factors They include factors like:  Importance of health  Perceived self-efficacy  Definition of health  Barriers to health-promoting behavior.
  37. 37. CONCEPTUAL MODELS A conceptual framework refers to global ides about individuals, groups, situations and events of interest to a discipline. A conceptual model provides a reference platform for members of a discipline to guide their thinking, observation and interpretation.
  38. 38. Models applicable in CHN 1) System model 2)Developmental Model 3)Interaction Model
  39. 39. System Model  It is postulated by Von Bertalanffy(1952)  It focuses on the organization, interaction, interdependency and integration of parts and elements.
  40. 40. Characteristics-System Model  Wholeness  Organisation  Openness  Boundary  Entropy  Feedback
  41. 41. Application to Community Health Nursing  The community is a social system made of interrelated subsystems.  The subsystems include economic, educational, religious, health care, political, welfare. law enforcement, energy and recreational systems  They are interrelated and have a specific orientation towards each other.
  42. 42. Developmental Model  It is a way of thinking how changes occur based on theories of development of the human organization.  According to Lewis,the change may be both reactive and structural.  The reactive theory emphasizes the influence of environment in development programmes,and the structural theory emphasizes the genetically determined programme for development
  43. 43. Application to CHN  It is useful in working with infants and children,because the major role of a nurse working with them is to assess the developmental progress and to promote overall growth and development.
  44. 44. Interaction Model  These models are based upon theories that stem from philosophical writings such as those of Cooley(1969) and Mead(1934).  The major concepts used in interaction models are communication, perception, role playing and self conception.
  45. 45. Application to CHN  Communication  Self-Conception  Perception
  46. 46. Bibliography  Lucita M. Public health and community health nursing in the new millennium. 1st ed. Chennai: B.I Publications Private Limited; 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. Community Health Nursing:promoting health of aggregates,families and individuals. 4th ed. St.Louis:Mosby;1996.p.225-27