Community Health Nursing Special field of nursing that combines the skills of nursing, public health and some

e phases of social assistance and functions as part of the total public health program 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) Principles of CHN 1. The need of the community is the basis of community health nursing. 2. The community health nurse must understand fully the objectives and policies of the agency she represents. 3. The family is the unit of service. 4. CHN must be available to all regardless of race, creed and socioeconomic status. 5. The CHN works as a member of the health team. 8. There must be provision for periodic evaluation of community health nursing services. 7. Opportunities for continuing staff education programs for nurses must be provided by the community health nursing agency and the CHN as well 8. The CHN makes use of available community health resources. 9. The CHN taps the already existing active organized groups in the community. 10. There must be provision for educative supervision in community health nursing. 11. There should be accurate recording and reporting in community health nursing. 12. Health teaching is the primary responsibility of the community health nurse. Standards of CHN I. Theory - Applies theoretical concepts as basis for decisions in practice II. Data Collection - Gathers comprehensive, accurate data systematically

III. Diagnosis - Analyzes collected data to determine the needs/ health problems of IFC. IV. Planning - At each level of prevention, develops plans that specify nursing actions unique to needs of clients. V. Intervention - Guided by the plan, intervenes to promote, maintain or restore health, prevent illness and institute rehabilitation. VI. Evaluation - Evaluates responses of clients to interventions to note progress toward goal achievement, revise data base, diagnoses and plan. VII. Quality Development Assurance & Professional

- Participates in peer review and other means of evaluation to assure quality of nursing practice. - Assumes professional development. -Contributes to development of others VIII. Interdisciplinary Collaboration - Collaborates with other members of the health team, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health. IX. Research

- Indulges in research to contribute to theory and practice in community health nursing Philippine System Health Care Delivery

Types of Clientele

1. INDIVIDUALS 2. FAMILIES 3. COMMUNITIES 4. POPULATION GROUPS - Aggregate of people who share common characteristics, developmental stage or common exposure to particular environmental factors thus resulting in common health problems (Clark)

E.g. children. Elderly, women, workers etc. Philippine System Health Care Delivery

that level of CHN practice directed to the FAMILY as the unit of care with HEALTH as the goal and NURSING as the medium, channel or provider of care TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE FIRST-LEVEL ASSESSMENT

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 cost that the community can afford at every stage of development. PRINCIPLES OF HEALTH CARE 1. 4 As Accessibility, Affordability & Acceptability Availability, PRIMARY

I. Presence of Wellness Condition Wellness potential is a nursing judgment on wellness state or condition based on clients performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on clients current competencies or performance, clinical data explicit expression of desire to achieve a higher level of state or function in specific area on health promotion and maintenance.

2. COMMUNITY PARTICIPATION - Heart and soul of PHC 3. People are the center, object and subject of development. 4. SELF-RELIANCE 5. Partnership between the community and the health agencies in the provision of quality of life. 6. Recognition of interrelationship between the health and development. 7. SOCIAL MOBILIZATION 8. DECENTRALIZATION 8 Essential Health Services in Primary Health Care (ELEMENTS) E Education for Health L Locally endemic disease control E Expanded program for immunization M Maternal and Child Health including responsible parenthood E Essential drugs N Nutrition T Treatment of communicable and noncommunicable diseases S - Safe water and sanitation FAMILY HEALTH NURSING I.

Example: 1. Potential for Capability for: Enhanced

Healthy lifestyle e.g. nutrition/diet, exercise/ activity Health Maintenance

Parenting Breastfeeding 2. Readiness for Enhanced Capability for: Healthy Lifestyle Health Maintenance Parenting Breastfeeding Spiritual Well-being Presence of Health Threats

Conditions that is conducive to disease, accident or failure to realize ones health potential. Example: 1. Family history of hereditary condition, e.g. diabetes

2. Threat of cross infection from a communicable disease case III. Presence of Health Deficits of failure in health

(Wellness state, health deficit, health threat, foreseeable crisis) b. Modifiability of the condition or problem (Easily, partially, not modifiable) C. Preventive Potential (high, moderate, low)

Instances maintenance. Example:

1. Illness states, regardless of whether it is diagnosed or by medical practitioner 2. Failure to thrive/ develop according to normal rate 3. Disability whether congenital or arising from illness; temporary IV. Presence of stress Points/ Foreseeable Crisis Situations anticipated periods of unusual demand of the individual or family in terms of family resources.

d. Salience (needs immediate attention, not immediate, not perceived as a problem) Community Organizing Participatory Research (COPAR) Is a process by which people, health service & agencies of the community are brought together to Learn about the common problems Identify these problems as their own Plan the kind of action to solve problems Act on this basis

Example: Loss of job Hospitalization Death of a family member Additional family member Second Level Assessment Focus on determining familys capacity to perform the health tasks Statements on family health nursing problem:

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 community and society. Phases of the COPAR Process I. Preparation Phase Area selection, Profiling of community, Entry & integration

a. Inability to recognize the presence of the condition or problem b. Inability to make decisions with respect to taking appropriate health action c. Inability to provide adequate nursing care to the sick, disabled , dependent or vulnerable member of the family d. Inability to provide a home environment conducive to health maintenance or personal development e. Failure to utilize community resources for health care Scale for Ranking Health Conditions and Problems according to priorities

II. Organization Phase Social preparation, Spotting & developing potential leaders, Core group formation, Setting up community organization

a. Nature of the condition or problem presented

III. Training & Education Phase - Community dx, Training health workers, Health services mobilization, Leadership formation activities, Training health workers, Health services mobilization, Leadership formation activities IV. Collaboration Phase - Intersectoral collaboration, Sourcing out external resources, Coordination w/ external institutions, agencies & people V. Phase-out Phase - Gradual preparation for turnover of work, planning for monitoring, Follow up Public Health Programs COMPREHENSIVE MATERNAL CHILD HEALTH PROGRAM 1. EPI (Expanded Immunization) Program & on

2. CDD (Control of Diarrheal Diseases) 3. CARI (Control of Acute Respiratory Infections) 4. UFC (Under-Five Clinics) 5. MC (Maternal Care) 6. BF (Breastfeeding) 7. MRP (Malnutrition Program) Rehabilitation

8. VAD ( Vitamin A Deficiency) 9. IDD/IDA (Iodine Deficiency Disorders/ Iron Deficiency Anemia) 10. FP (Family Planning)

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