CHN (lec)

• Dr. C.E Winslow: 'Public Health is directed towards assisting every citizen to realize his birth rights and longevity.'
• Public Health


  The science and art of preventing disease, prolonging life and efficiency through organized community effort for:

  • The sanitation of the environment
  • The control of communicable infections
  • The education of the individual in personal hygiene
  • The organization of medical and nursing services for the early diagnosis and preventive treatment of disease
  • The development of a social machinery to ensure every one a standard of living, adequate for maintenance of health to enable every citizen to realize his birth right of health and longevity
• Roles of the PUBLIC HEALTH NURSE

  • Clinician
  • Health Educator
  • Facilitator
  • Supervisor
  • Health Advocator
  • Advocator
  • Collaborator
• Community Health Nursing Process

  A systematic, scientific, dynamic, on-going interpersonal process in which the nurses and the clients are viewed as a system with each affecting one and another and both being affected by the factors within the behavior
• Key concepts of the community health nursing process


  • The nursing process provides a framework for the practice of nursing. It involves both art and science.
  • The nursing process refers to a series of planned steps and actions directed at meeting the needs and solving the problems of patients.
  • The nursing process is a deliberative problem-solving approach that requires cognitive, technical, and interpersonal skills and is directed to meeting the needs of the patient.
  • The nursing process is a goal-oriented humanistic and systemic plan of individualized care that is both effective and efficient.
  • The nursing process is a problem-solving process that addresses community health problems at all aggregate levels and aims to prevent illness.
  • The nursing process is a deliberate intellectual activity whereby the practice of nursing is approached in a dynamic, systematic manner to patient care in a dynamic, continuous method to assist the patient to achieve and maintain health.
  • The nursing process is dynamic and continuous. It provides blueprint care and responds to the client's needs in a timely and reasonable manner to improve or maintain the client's level of health.
• Importance or Implications of Community Health Nursing process

  • The nursing process helps to identify the client's health care needs, determine priorities, establish goals and expected outcomes of care establish and communicate a client-centered plan of care, and provide nursing interventions designed to meet client outcomes and goals.
  • The nursing process involves scientific reasoning. The nurse makes inferences about the meaning of a client's functional state of health. The nursing makes the process is simply one variation of scientific reasoning that allows nurses to organize, systemize, and conceptualize nursing practice. It is a general approach to the client system of individuals, families, groups, or communities.
  • The nursing process approach allows nurses to differentiate their practice from that of physicians and other health care professionals. When nurses think critically, the client becomes an active participant and the ultimate outcomes are a comprehensive, individualized approach to care.
  • The nursing process forms the basis for nursing judgments in the form of diagnosis, nursing care plan, implementation, and evaluation. Conceptual frameworks such as pain management or theoretical models give a basis for determining the information to be collected, diagnostic areas to be considered and nursing goals and therapies.
• Characteristics of Community Health Nursing process

  • The process is deliberative (purposefully, rationally, and care throughout the care. This requires judgment. The situation demands independent thinking and difficult decision making).
  • The process is adaptable (This dynamic nature enables the community health nurse to adjust appropriately to each situation to be flexible in applying the process to the individual needs. The nurse adapts individual service to each community client).
  • The process is cyclical (The actions are in constant progression. The nurse in any given situation engages continual interaction, data collection, analysis, intervention, and evaluation. Steps are repeated over and over in the nurse-client relationship continuously).
  • Client-focused (Nurses use this process to help clients, directly or indirectly to achieve and maintain health).
  • The process is interactive (Nurses and clients are engaged in the process of ongoing interpersonal communication. Giving and receiving accurate information is necessary to promote understanding between nurse and client and foster effective use of the nursing process. The client-nurse relationship can and should be a partnership called ''peer practice'').
  • Need- oriented (Application of this nursing process in community health to the anticipation of needs and prevention of problems assumes additional significance. This focus is needed if we are to realize the goals of community health to protect promote and restore people's health).
• Typology of Nursing Problem

  • Presence of Wellness Condition
  • Health Threats
  • Health Deficits
  • Anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources
  • Inability to recognize the presence of the condition or problem
• Wellness Condition


  Potential or Readiness - a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on client's performance, current competencies, or performance, clinical data or explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance.
• Examples of Wellness Condition

  • Potential for Enhanced Capability for: Healthy lifestyle, Healthy maintenance/health management, Parenting, Breastfeeding, Spiritual well-being
  • Readiness for Enhanced Capability for: Healthy lifestyle, Health maintenance/health management, Parenting, Breastfeeding, Spiritual well-being
• Examples of Health Threats

  • Presence of risk factors of specific diseases, Threat of cross infection from communicable disease case, Family size beyond what family resources can adequately provide, Accident hazards, Faulty/unhealthful nutritional/eating habits or feeding techniques/practices, Stress Provoking Factors, Poor Home/Environmental Condition/Sanitation, Unhealthy Lifestyle and Personal Habits/Practices, Unsanitary Food Handling and Preparation, Inherent Personal Characteristics, Health History, Inappropriate Role Assumption, Lack of Immunization/Inadequate Immunization Status, Family Disunity
• Examples of Health Deficits

  • Illness states, Failure to thrive/develop according to normal rate, Disability-whether congenital or arising from illness; transient/temporary or permanent
• Examples of anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources

  • Marriage, Pregnancy, labor, puerperium, Parenthood, Additional member, Abortion, Entrance at school, Adolescence, Divorce or separation, Menopause, Loss of job, Hospitalization of a family member, Death of a member, Resettlement in a new community, Illegitimacy
• Examples of Inability to recognize the presence of the condition or problem

  • Lack of or inadequate knowledge, Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
• Leg amputation secondary to diabetes, blindness from measles, lameness from polio

  Examples of anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources
• Examples of anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources

  • Marriage
  • Pregnancy, labor, puerperium
  • Parenthood
  • Additional member-e.g. newborn, lodger
  • Abortion
  • Entrance at school
  • Adolescence
  • Divorce or separation
  • Menopause
  • Loss of job
  • Hospitalization of a family member
  • Death of a member
  • Resettlement in a new community
  • Illegitimacy
• Stress points/foreseeable crisis situations


  Presence of
• Inability to recognize the presence of the condition or problem

  Due to:

  Lack of or inadequate knowledge

  Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically:

  Social-stigma, loss of respect of peer/significant others

  Economic/cost implications

  Physical consequences

  Emotional/psychological issues/concerns

  Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
• Inability to make decisions with respect to taking appropriate health action


  Due to:

  Failure to comprehend the nature/magnitude of the problem/condition

  Salience of the problem/condition

  Feeling of confusion, helplessness and/or resignation brought about by perceive magnitude/severity of the situation or problem, i.e. failure to breakdown problems into manageable units of attack

  Lack of/inadequate knowledge/insight as to alternative courses of action open to them

  Inability to decide which action to take from among a list of alternatives

  Conflicting opinions among family members/significant regarding action to take

  Lack of/inadequate knowledge of community resources for care

  Fear of consequences of action, specifically:

  Social consequences

  Economic consequences

  Physical consequences

  Emotional/psychological consequences

  Negative attitude towards the health condition or problem-by negative attitude is meant one that interferes with rational decision-making

  Inaccessibility of appropriate resources for care, specifically:

  Physical Inaccessibility: constraints or economic/financial inaccessibility

  Lack of trust/confidence in the health personnel/agency

  Misconceptions or erroneous information about proposed course(s) of action
• Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family

  Due to:

  Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management)

  Lack of/inadequate knowledge about child development and care

  Lack of/inadequate knowledge of the nature or extent of nursing care needed

  Lack of the necessary facilities, equipment and supplies of care

  Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of care (i.e. complex therapeutic regimen or healthy lifestyle program)

  Inadequate family resources of care specifically:

  Absence of responsible member

  Financial constraints

  Limitation of luck/lack of physical resources

  Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which his/her capacities to provide care

  Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member

  Member's preoccupation with on concerns/interests

  Prolonged disease or disabilities, which exhaust supportive capacity of family members

  Altered role performance, specify:

  Role denials or ambivalence

  Role strain

  Role dissatisfaction

  Role conflict

  Role confusion

  Role overload
• Inability to provide a home environment conducive to health maintenance and personal development


  Due to:

  Inadequate family resources specifically:

  Financial constraints/limited financial resources

  Limited physical resources-e.i. lack of space to construct facility

  Failure to see benefits (specifically long term ones) of investments in home environment improvement

  Lack of/inadequate knowledge of importance of hygiene and sanitation

  Lack of/inadequate knowledge of preventive measures

  Lack of skill in carrying out measures to improve home environment

  Ineffective communication pattern within the family

  Lack of supportive relationship among family members

  Negative attitudes/philosophy in life which is not conducive to health maintenance and personal development

  Lack of/inadequate competencies in relating to each other for mutual growth and maturation (e.g. reduced ability to meet the physical and psychological needs of other members as a result of family's preoccupation with current problem or condition
• Failure to utilize community resources for health care

  Due to:

  Lack of/inadequate knowledge of community resources for health care

  Failure to perceive the benefits of health care/services

  Lack of trust/confidence in the agency/personnel

  Previous unpleasant experience with health worker

  Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically:

  Physical/psychological consequences

  Financial consequences

  Social consequences

  Unavailability of required care/services

  Inaccessibility of required services due to:

  Cost constrains

  Physical inaccessibility

  Lack of or inadequate family resources, specifically

  Manpower resources, e.g. baby sitter

  Financial resources, cost of medicines prescribe

  Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness, AIDS, etc.

  Negative attitude/ philosophy in life which hinders effective/maximum utilization of community resources for health care
• How to compute


  1. Decide the score for each of the criteria

  2. Divide the score by the highest possible score and multiply the respective weight (Ex: 3 / 3 x 1 = 1)

  3. Add up the score for all criteria. The highest score if five (5), which is equivalent to the total weight

  Remember:

  The higher the score of the given problem must be the prioritized.

  With the given or available scores, we need to rank the problem
• HOW TO FORMULATE A FAMILY NURSING CARE PLAN

  The family nursing process is the same nursing process as applied to the family, the unit of care in the community. These are the common assessment cues and diagnoses for families in creating Family Nursing Care Plans.

  FNCP/NCP is a formal process that includes correctly identifying existing needs, as well as recognizing potential needs or risks. Care plans also provide a means of communication among nurses, their patients, and other healthcare providers to achieve health care outcomes. Without the nursing care planning process, quality and consistency in patient care would be lost.

  The following are the goals and objectives of writing a nursing care plan:

  Promote evidence-based nursing care and to render pleasant and familiar conditions in hospitals or health centers.

  Support holistic care which involves the whole person including physical, psychological, social and spiritual in relation to management and prevention of the disease.

  Establish programs such as care pathways and care bundles. Care pathways involve a team effort in order to come to a consensus with regards to standards of care and expected outcomes while care bundles are related to best practice with regards to care given for a specific disease.

  Identify and distinguish goals and expected outcome.

  Review communication and documentation of the care plan.

  Measure nursing care.
• Family Nursing Care Plan (FNCP)


  Is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care (goals and objectives) and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods and tools.
• Features FNCP


  • The nursing care plan focuses on actions which are designed to solve or minimize existing problem. The plan is a blueprint for action. The cores of the plan are the approaches, strategies, activities, methods and materials which the nurse hopes will improve the problem situation.

  The nursing care plan is a product of a deliberate systematic process. The planning process is characterized by logical analyses of data that are put together to arrive at rational decisions. The interventions the nurse decides to implement are chosen from among alternatives after careful analysis and weighing of available options.

  The nursing care plan, as with all plans, relates to the future. It utilizes events in the past and what is happening in the present to determine patterns. It also projects the future scenario if the current situation is not corrected.

  The nursing care plan is based upon identified health and nursing problems. The problems are the starting points for the plan, and the foci of the objectives of care and intervention measures.

  The nursing care plan is a means to an end, not an end in itself. The goal in planning is to deliver the most appropriate care to the client by eliminating barriers to family health development.

  Nursing care planning is a continuous process, not a one-shot-deal. The results of the evaluation of the plan's effectiveness trigger another cycle of the planning process until the health and nursing problems are eliminated.
• Steps in Making Family Nursing Care Plan

  The prioritized condition/s or problems

  2. The goals and objectives of nursing care

  the plan of interventions

  3. The plan of evaluating care
• Sample FNCP