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8/2/2019 com CHN Standard
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Ns. TAENA, S.Kep
Community Health Nursing
Standards of Practice
(CHN Standards)
Thomas Aquino Erjinyuare Amigo
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Standar Praktik Kep
Masyarakat mempunyai kebutuhan dan harapan
untuk hidup lebih sehat dan umur panjang
Menyarankan & mendukung pasien untuk
menentukan pilihan yg positif tentang status
kesehatan terutama dalam hal manajemen diri
Memampukan masyarakat utk melakukan
perawatan di dalam keluarga secara terpadu &
manajemen diri terhadap penyakit jangka
panjang
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Standar Perawatan
Cara lain yang digunakan oleh profesi
keperawatan dalam memastikan bahwa
praktisi keperawatan kompeten & amanutk berpraktik adalah melalui penetapan
standar prakti k (Blois, Hayes, Kozies, & Erb,
2006)
Standar digunakan utk m¶evaluasi kualitas
perawatan yg dibrikan oleh perawat
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Standards of Practice is«
a published set of behavioral and
professional expectations of certificate
holders (Mildon, Betker, & Underwood,
2011)
K omitment profesi keperawatan dlm
melindungi masyarakat terhadap
praktek yg dilakukan oleh profesi
(DPP.PPNI,1999)
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Standard Praktik Keperawatan Klinis(ANA, 1998)
M¶cerminkan nilai & prioritas profesi
keperawatan
M¶brikan arahan utk praktik keperawatan
profesional M¶brikan kerangka kerja utk evaluasi praktik
keperawatan
M¶definisikan tanggung gugat profesi thdpmasyarakat & hasil akhir yg mjd tanggung
jawab perawat
(Blois, Hayes, Kozies, & Erb, 2006)
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Laverack (2004), identifies four characteristics of community
(Sines, Saunders, Forbes-Burford, 2009,p.50):
Dimensi spasial, yaitu tempat atau lokasi
Kepentingan, masalah, identitas yang
menghubungkan kelompok-kelompok lain yangheterogen
Berbagi kebutuhan dan kekhawatiran yang dapat
dicapai melalui kegiatan kelompok
Interaksi sosial dan hubungan yang mengikat orang
bersama-sama
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Skills Required For Community Development(Sines, Saunders, Forbes-Burford, 2009,p.58)
Building relationships with key partners
Appropriate organisational and leadership styles
Communication with people at different levels
Humility (rendah hati) Maintaining confidentiality
Flexibility negotiating skills
Awareness of equal opportunities
Accountability Advocacy/lobbying
Evaluation skills Research awareness Team working
Interpersonal skills Health promoter
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Family roles include, but are notlimited to, the following:(DeLaune & Ladner, 2011,p. 299):
Nurturance (mengasuh) and support
Allocation of resources Development of life skills
Division of labor (pembagian kerja)
Socialization of members (Antai-Otong,2007)
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Beberapa Sifat Kesehatan Keluarga(DeLaune & Ladner, 2011,p. 299)
Supporting members (mendukung anggotakeluarga)
Teaching respect for others (mengajarkanuntuk m·hormati org lain)
Helping with problem solving (m·bantu dlm
pemecahan masalah)
Communicating (berkomunikasi)
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Setting Praktik Perawatan kesehatanMasyarakat (Perkesmas):
(DeLaune & Ladner, 2011,p. 303)
Schools Workplaces (tempat kerja)
Public health units
Family
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Dalam rangka mempromosikan kesehatanmasyarakat, perkesmas melakukan fungsi:
(DeLaune & Ladner, 2011,p. 304)
Prevention of epidemics and spread of disease(Pencegahan epidemi dan penyebaran penyakit)
Protection against environmental hazards(Perlindungan terhadap bahaya lingkungan)
Prevention of injuries (Pencegahan cedera)
Promotion of health behaviors (Promosi
perilaku kesehatan) Response to disasters (Respon terhadap
bencana)
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Why are CHN Standards
important?
1. Define scope & depth of CHN (community health
nurse) practice / Menentukan lingkup &
kedalaman praktek CHN (perawat kesehatan
masyarakat)2. Establish criteria and expectations for acceptable
practice and safe ethical care / Menetapkan
kriteria dan harapan untuk praktek danperawatan yang dapat diterima dan aman
3. Provide criteria for measuring performance /
Menyediakan kriteria untuk mengukur kinerja
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Why are CHN Standards
important?
4. Support the ongoing development of CHN
(Mendukung pengembangan berkelanjutan
terhadap CHN)
5. Promote CHN as a specialty (Promosikan CHNsecara khusus)
6. Inspire excellence in & commitment to CHN
practice (Mempunyai keunggulan & komitmendlm praktek CHN)
7. Set a benchmark for new community health
nurses (Menetapkan patokan bagi CHN baru)
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COMMUNITY HEALTH NURSINGIncludes: Nurses promoting health of individuals, groups &
communities and an environment that supports health
Home Health (HHN)1. Focus on prevention,
health restoration,maintenance & palliation
2. Focus on clients &families3. Practice in homes,
schools or workplace andintegrates health
promotion, teaching &counseling with provisionof care
4. Educational preparation:gelar sarjana
Public Health (PHN)
1. Focus on health promotion,illness prevention &population health
2. Link individual & familyhealth experiences into thepopulation health frameworkand links population healthto families and individuals
3. Practice in diverse settingsex. Community healthcenters, schools, streets,nursing stations
4. Educational preparation:gelar sarjana
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Unique Characteristics of Community Health
Nursing
View health as aresource & focus
on capacities
CHNs promote,protect & preserve
the health of individuals,
families, groups,communities & populations«
«wherever people live,work, learn, worship &
play«.
«in a continuous versusepisodic process
Have a uniqueunderstanding of the influence of
the environmentalcontext of health
Work at ahigh level of autonomy
Buildpartnerships
based onprimary healthcare principles,
caring & empowerment
Combinespecialized
nursing, socialand public
health sciencewith
experientialknowledge
Marshal resourcesto support healthby coordinatingcare & plan Nsg
services, programs& policies
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Components of Professional
Practice Model
Individuals, families, groups,
communities, populations,
systems
Code of Ethics
Community Health Nurse Community Health Nursing
Standards
Delivery Structure and Process
Determinants of Health
Discipline specific
competencies: Public Health,
Home Health
Government support
Management practices Professional relationships and
partnerships
Professional Regulatory
Standards
Theoretical Foundation Values and principles
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The Community Health Nursing Process(Anderson & McFarlane, 2004)
1. Assessment2. Diagnosis & Planning
3. Intervention (action)
4. Evaluation
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1. Promoting Health
a. Health Promotion
b. Prevention and Health Protection
c. Health Maintenance, Restoration and
Palliation
2. Professional Relationships
3. Capacity Building
4. Access and Equity (keadilan)
5. Professional Responsibility and Accountability
CCHN Standards of Practice
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Parts of each Standard: Description & Indicators
Description of Standard is provided in initial paragraph
Indicators: begin with the heading ³The community
health nurse...´ and define the specific activities that
CHNs are expected to perform to achieve the Standard.
The indicators begin with assessment type activities,
move to planning, action and end with evaluation
activities.
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Standard 1- Health Promotion
Melibatkan penduduk secara keseluruhan dalam konteks
kehidupan sehari-hari mereka daripada berfokus hanya
pada orang beresiko
Apakah proses menangani ketidaksetaraan kesehatan dan
memungkinkan orang untuk meningkatkan kontrol atas &untuk meningkatkan kesehatan mereka.
Membawa bersama-sama orang yang menyadari bahwa
sumber daya dasar & kondisi untuk kesehatan (misalnya
faktor sosial dan lingkungan dari kesehatan) sangat penting. Bekerja terbaik ketika semua tingkat-individu, kelompok,
komunitas, masyarakat (pemerintah, media) dan beberapa
pendekatan yang digunakan
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EXAM PLES from practice - Health Promotion
PHNs work with a community toadvocate for a smoke-free town or municipality
PHNs promote physical activity andhealthy eating through programs suchas the In-Motion, Supermarket Safariand the Schools Awards Program.
HHNs encourage families dealing witha chronic illness to participate inregular physical and social activities
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Standard 2- Prevention & Health
Protection
Para CHN menerapkan kegiatan untuk
meminimalkan terjadinya penyakit atau
cedera dan akibatnya.
Strategi perlindungan kesehatan sesuai
dengan program dan kebijakan
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EXAMPLES f rom practice
Prevention & Health Protection
PHN track immunization schedules for each childso that when a child is overdue for vaccine theycan be contacted. (CHNAC)
A CHN observes high rates of smoking within aparticular client group. The concern is raised withthe practice team and a plan is developed to findways to address the issue.
PHN work with a parent¶s organization and thepolice to promote proper installation of car seatsthrough the media and conduct several clinics toprovide one-on-one assessment and teaching.
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Utk masalah kesehatan yg akut, kronik, paliatif
(HHNs) health teaching & counseling for health
maintenance or dealing with acute, chronic or terminal illness (HHNs and PHNs).
Links people to community resources &
facilitates/coordinates care needs & supports
(koordinasi dengan berbagai pihak)
Standard 3-
Health Maintenance, Restoration & Palliation
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E xamples from practice-
Health Maintenance, Restoration & Palliation
HHNs care for disabled studentsin the classroom: Communicationis required with the child¶s
guardian, teacher and/classroomassistant
CHNs provides ongoing nursingcare to families with seniors whoare experiencing difficulties. The
care may be provided directly or through unregulated workers.This may include telephonefollow-up, home visits or community referrals.
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G roup w ork
Introductions: Your name, where you live, where you
work, focus of your practice (change for student
groups)
Each person in turn (no discussion) describes their experience
Recorder takes down main points of each experience
Discuss and determine which of the first three
Standards is most relevant for each experience.
Decide which example from your group could be used
in the reporting session at the end.
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Standard 4. Professional Relationships
Built on the principles of connecting & caring
Relationships may be with clients and/or with
organizations/stakeholders
Relationships built on mutual respect and on an
understanding of the power inherent to the CHN
position.
Unique to CHN is building a network of relationships & partnerships ± occurs within a
complex environment for both PHNs and HHNs.
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Examples from practiceProfessional Relationships
A HHN working in palliative care listens to the
concerns of stressed and exhausted
caregivers and supports them in making
decisions about respite and hospice care.
A group of PHN working with families
experiencing child care difficulties identify
that post natal visits based on issues or tasksmoves them around too much to be able to
develop a continuing relationship with
families. They bring their concern to the
attention of management.
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Standard 5. Capacity Building
Peningkatan kapasitas kemampuan individu /
masyarakat untuk mendefinisikan, menilai,
menganalisis & bertindak pada masalah kesehatan.
Aktif terlibat dalam mengatasi masalah yang kritis CHN bekerja sama dg orang-orang yang
berpengaruh mengontrol sumber daya & dalam
masalah kesehatan
CHNs menilai tahap kesiapan untuk perubahan &
prioritas tindakan.
CHNs membangun kekuatan yang ada.
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E xamples from practice
Capacity Building
A HHN encourages a mother and teens to workout a schedule for ROM exercises for thegrandmother. The family is happy that they wereable to work out the problem together.
A PHN encourages a school to mobilize a schoolhealth committee that includes students, parents,teachers, administration, and community partners.Committee members identify the schoolcommunity¶s strengths and needs, and prioritize,
plan, implement, evaluate and celebrate action for a healthier school. The school community¶scapacity to take its own action for health isenhanced via a sustainable structure (thecommittee). The PHN is a partner in the process.
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Standard 6. Access & Equity
CHNs megidentifikasi fasilitas umum sertasumber dan pelayanan yang dapat dijangkau
CHNs memfasilitasi semua tingkatan didalam masyarakat untuk mendapatkanpelayanan yang tepat
CHNs bekerjasama dg pelayanan dan sektor
lain utk pelayanan yang komperehensif padaklien dan memperoleh hasil yang optimal
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Ex amples f rom practice
Access & Equity
A PHN identifies that one ethnic group
does not use health care services
(including prenatal classes) outside their
area. The PHN works with a champion
from this group to organize local prenatal
classes delivered by a PHN and translated
by a woman from the community.
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Standard 7. Professional Responsibility &
Accountability
CHNs bekerja dengan tingkat otonomi
yang paling tinggi yang mempunyai
tanggung jawab atas kompetensinya CHNs bekerja di lingkungan yang paling
kompleks dengan bertanggungjawab
terhadap berbagai otoritas CHNs menghadapi dilema etika yang
unik
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Ex amples f rom practice-
Professional Responsibility and Accountability
HHN diminta oleh keluarga untuk melepaskansemua peralatan yang terpasang pada pasien yangtelah koma 1 minggu. Jika dilepaskan maka pasientersebut akan meninggal. Perawat harus
mendiskusikan dg keluarga apa yang membuatkeluarga membuat keputusan seperti itu
PHN adalah ditugaskan untuk bekerja dalamprogram pertukaran jarum suntik didasarkan pada
pengurangan bahaya. Dia memiliki kesulitanmenerima prinsip-prinsip pengurangan dampakburuk dan menggunakan praktik reflektif pribadi dandengan atasannya untuk memahami dan mengubah
asumsi-asumsi.
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REFERENSI
Anderson, E. T., & McFarlane, J. (2004). C ommunity As Partner.
Philadelphia: Lippincott Williams & Wilkins.
Blois, K. K., Hayes, J. S., Kozies, B., & Erb, G. (2006). Praktik
K eperawatan Profesional: K onsep & Perspektif. Jakarta: EGC.
DeLaune, S. C., & Ladner, P. K. (2011). Fundamentals of Nursing:S tandards & Practice. New York: Delmar Cengage Learning.
Mildon, B., Betker, C., & Underwood, J. (2011). S tandards of Practice
in C ommunity Health Nursing: A Literature Review Undertaken to
Inform Revisions to the C anadian C ommunity Health Nursing
S tandards of Practice. Ottawa: Community Health Nurses of Canada.
Sines, D., Saunder, M., & Forbes-Burford, J. (2009). C ommunity
Health C are Nursing. United Kingdom: Wiley-Blackwell.
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