Chapter 5 the public health nurse (2003 format)

PUBLIC HEALTH NURSE

Roles Functions

1. Planner/ Programmer

-Identifies priorities and problems of individuals, families and community.-formulates nursing component of

health plans. In doctorless area, she/he is responsible for the formulation of the

municipal health plan.

-interprets and implements the nursing plan, program policies, memoranda and circulars for the concerned staff/

personnel.

-provides technical assistance to rural health midwives in health matters like

target setting, etc.

Roles and Functions

Roles Functions

2. Provider of Nursing Care

-provides direct nursing care to the sick, disabled in the home, clinic,

school or place of work.

-Develops the family’s capability to take care of the sick, disabled or dependent

member.

-provides continuity of patient care.

Roles and Functions

Roles Functions

3. Manager/Supervisor

-formulates individual, family, group and community centered care plan.

-interprets and implements program policies, memoranda and circulars.

-organizes work force, resources, equipments and supplies and delivery of

health care at local levels.

-requisitions, allocates, distributes materials (medicine and medical supplies, records

and reports equipment.)

-provides technical and administrative support to Rural Health Midwife (RHM)

-Conducts regular supervisory visits and meetings to different RHMs and gives

feedback on accomplishments/performances.

Roles Functions

4. Community Organizer

-responsible for motivating and enhancing community participation in

terms of planning, organizing and implementing and evaluating health

programs/services.

-initiates and participates in community development activities.

Roles and Functions

Roles Functions

5. Coordinator of Services

-coordinates with individuals, families, and groups for health and related

health services provided by various members of health team and other

Government Organizations (Gos) and Non-Government Organizations

(NGOs).

-Coordinates nursing program with other health programs as

environmental sanitation, health education, dental health and mental

health

Roles and Functions

Roles Functions

6. Trainer/Health Educator/Counselor

-facilitates training for BHWs

-organizes orientation/training of concernes groups including non-

government organizations

-acts as a resource speaker/person on health and health related services

-participates in the development and distribution of Information Education and Communication (IEC) materials

-initiates the use of tri-media: radio/TV and cinema plugs, print ads, and other

indigenous resources for health education purposes.

-conducts pre-marital counseling

Roles Functions

7. Health Monitor

-detects deviation from health of individuals, families, groups of the

community through contact/visits with them.

-uses symptomatic and objective observation and other forms of data

gathering like morbidity, registry, questionnaire, checklist, and anecdo-

report/record to monitor growth ad development and health status of

individuals, families and communities.

Roles and Functions

Roles Functions

8. Role model -provides good example/model of healthful living to the public/community.

9. Change Agent

-motivates changes in health behavior of individuals, families, group and

community including lifestyle in order to promote and maintain health.

10. Recorder/Reporter/Statistician

-prepares and submits required reports and records

-Maintains adequate, accurate and complete recording and reporting.

-reviews, validates, consolidates, analyzes and interprets all records and

reports.

Roles and Functions

Roles Functions

-prepares statistical data/charts and other data presentations for display

and for presentation in staff meetings conferences and seminars/workshops.

11. Researcher

-partipates/assists in the conduct of surveys studies and researches on nursing and health related subjects

-coordinates with government and non-government organization in the

implementation of studies/research.

Roles and Functions

Competencies/SkillsCOMMUNITY HEALTH NURSING PROCESS

EPIDEMIOLOGY

HEALTH PROMOTION

HOME CARE

COMMUNITY HEALTH NURSING PROCESS

• the nursing process is a systematic, scientific, dynamic, on-going iterpersonal process in which the nurses and the clients are viewed as a system with each affecting the other and both being affected by

the factors within the beahivior.

• It includes:ASSESSMENT

-provides an estimate of the degree to which a family, group or community is achieving the level of health possible for them, identifies specific deficiencies or

guidance needed and estimates the possible effects of the nursing interventions

-the process of assessment includes: intensive fact finding, the application of ping the professional judgement in

estimating the meaning and importance of these facts to the family and the comunity, the availability of nursing

resources that can be provided, and the degree of change which nursing intervention can be expected to effect.

PLANNING NURSING ACTIONS/CARE-the plan for nursing action or care is bassed on the

actual and potential problems that were identified and prioritized. Planning nursing actions include the

following steps:

a. Goal setting- a goal is a declaration of purpose or intent that gives essential direction to action.

Specific objectives of care made with the individual/family in terms of activities of daily living,

and adaptive functioning based on remaining capabilities resulting from this condition and

capability to cope with stress associated with his/her disease condition or environment.

b. Contructing a Plan of Action-the planning phase of community health nursing process is concerned with choosing from among the possible courses of action, selecting the appropriate types of nursing intervention,

identifying appropriate and available resources for care and developing an operational plan.

c. Developing an Operational Plan- to develop an operational paln, the community heal;th nurse must establish priorities, phase and coordinate activities.

IMPLEMENTATION OF PLANNED CARE-in community health nursing, implementation involves

various nursing interventions which have been determined by the goals/objectives which have

been previously set.-the community health nurses monitor the health

services provided, make proper referrals as necessary and supervise midwives and BHWs.

-documentation is an important function of the community health nurses.

EVALUATION OF CARE AND SERVICES PROVIDED

-evaluation is interwoven in every nursing activity and evry step of the community health nurse. There are 3

classic frameworks from which nursing care is delivered.

a. Structural elements-include the physical settings, instrumentalities and conditions through which

nursing care is given such as philosphy, objectives, building, organixational structure, financial

resources such as budget, equipment and staff.

b. Process elements-include the steps of the nursing process itself assessing, palnning, implementing and evaluating: such as taking the family health

data base; performing physical examination; making a nursing diagnosis; determining nursing goals; writing a nursing care plan; performing the

necessary nursing interventions and coordination of services and measuring success of nursing actions.

c. Outcome elements-are changes in the client’s health status that result from nursing intervention. These changes include modification of symptom, signs, knowledge, attitudes, satisfaction, skill level and

compliance with treatment regimen.

BACK

EPIDEMIOLOGY

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-is the study of the distribution and determinants of health-related states or events (including disease),

and the application of this study to the control of diseases and other health problems.

Uses of Epidemiology

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According to Morris, uses of epidemiology include the ff:

• to diagnose the health of the community and the condition of people; to measure the distribution and dimension of illness in terms of incidence, prevalence, disability and mortality; to set

health problems in perspective and to define their relative importance; and to identify groups needing special attention.

New methods of monitoring must be constantly sought.

• to study the history of the health populations and the rise and fall of disease and changes in their character.


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• to study the working of health services with a view of improving them.

• to estimate the risks of diseases, accident, defect and the chances of avoiding them.

• to complete the clinical picture of chronic disease and describe their natural history

• to identify syndromes by describing the distribution and association of clinical phenomena in the population


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• to search for causes of health and disease by comparing the experience of groups that are clearly defined by their composition, inheritance, experience, behavior and

environments.

EPIDEMIOLOGICAL TRIAD

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The best known, but most dated

model ofcommunicable disease is the Epidemiologic

Triad

-This model comprises a

susceptible host (the person at risk for thedisease), a disease agent (the proximate

cause), and an environmental context for theinteraction between host and agent.

Outline of Plan for Epidemiological Investigation

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1. Establish fact of presence of Epidemic• Verify diagnosis• Reporting• Is there an unusual prevalence of the disease

2. Establish time and space relationship of the disease• Are the cases limited to or concetrated in any

particular geographical subdivision of the affected community?


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• Relation of cases by days of onset to onset of the first known cases-may be done by days, weeks or months (in general, by weeks gives best overall picture).

3. Relations to characteristic of the group of community:

• Relation of cases to age groups, sex, color, occupation, school attendance, past immunization, etc.


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• Relation of sanitary facilities, especially water supply, sewerage disposal, general sanitation of homes, and relation to animal or insect vectors.

• Relation to milk and food supply.• Relation of cases to other cases and known

carriers if any.


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4. Correlation of all data obtained• Summarize data clearly with the aid of such tables and

charts are necessary to give a clear picture of the situation.

• Build up the case for the finalconclusion carefully utilizing all the evidence available.

• Establish the source of the epidemic and the manner of the spread, if possible.

• Make suggestions as to the control, if disease is still present in community and as to prevent of future outbreaks.

Outline on the Operational Procedure During a Disease Outbreak

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1. Organization of Team• Coordination of personnel• Orientation/demonstration on the methodology to

be emplyed• Area Assignment of Teams• Check-list on the team’s paraphernalia• Pooling of data and resource-record keeping


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2. Epidemiologic al Investigation• Active case finding• Carriers and contact control• Surveillance3. Collection of Laboratory Specimens• Rectal swabbing• Food Sampling• Other that are relevant to the disease


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4. Treatment of Patients and Contacts• Analgesics/antipyretics• Antibiotics• Parenteral fluids• Supportive drugs• Emergency drugs• Isolation of patient “cordon sanitaire”• Boiling and disinfection of fomites• Conduction of patient to hospital


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5. Immunization• Type of vaccine• Dosage, schedule, technique• Areas to be covered• Target population• Consolidation and evaluation of data


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6. Environmental Sanitation (During the survey)• Water• Toilets and surroundings• Garbage disposal• Insect and Vermin control• Food sanitation


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7. Health Education• Individual approach• Community approach and meetings• Schools P.T.A. , church and other congragations8. Involvement of other Agencies9. Reporting• Telegraphic report• Written

Functions of the Nurse in Epidemiology

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• Maintains surveillance of the occurrence of notifiable disease.

• Coordinates with other members of the health team during a disease outbreak.

• Participates in casefinding and collection of laboratory specimens.

• Isolates cases of communicable diseases.• Renders nursing care teaches and supervises

giving care.

Functions of the Nurse in Epidemiology

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• Performs and teach housefold members methods concurrent and terminal disinfection.

• Give health teaching to prevent further spread of disease to individuals and families.

• Follow up cases and contacts.• Organize, coordinate and conduct community

health education campaign/meetings.• Refers cases when necessary.• Coordinates with other concerned community

agencies.

MULTIPLE CAUSATION OF DISEASE

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MORBIDITY: 10 LEADING CAUSESRate/100,000 Population

PHILIPPINES, 19981. Diarrheas 6. TB Respiratory2. Pneumonias 7. Malaria3. Bronchitis 8. Diseases of the heart4. Influenza 9. Dengue fever5. Hypertension 10.Chickenpox


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MORTALITY: 10 LEADING CAUSESNumber and Rate/100,000 Population

PHILIPPINES, 19951. Diseases of the Heart2. Diseases of the Vascular System3. Pneumonias4. Malignant Neoplasms5. Tuberculosis. All forms


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MORTALITY: 10 LEADING CAUSESNumber and Rate/100,000 Population

PHILIPPINES, 19956. Accidents7. Chronic Obstructive Pulmonary Disease & Allied

Conditions8. Other diseases of the Respiratory System9. Diabetes Mellitus10. Nephritis, Nephrotic Syndrome and Nephrosis


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INFANT MORTALITY: 10 LEADING CAUSESPHILIPPINES, 1995

1. Pneumonias2. Respiratory Condition of Fetus and Newborn3. Congenital Anomalies4. Birth Injury & Difficult Labor5. Diarrheal Diseases


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INFANT MORTALITY: 10 LEADING CAUSESPHILIPPINES, 1995

6. Septicemia7. Meningitis8. Avitaminoses & Other Nutritional Deficiency9. Other Diseases of the Respiratory System10. Measles


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MATERNAL MORTALITY: BY MAIN CAUSEPHILIPPINES, 1995

1. Complications related to pregnancy occurring in the course of labour, delivery & puerperium

2. Hypertension complicating pregnancy, childbirth and puerperium

3. Postpartum hemorrhage4. Pregnancy with abortive outcome5. Hemorrhages related to pregnancy


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NOTIFIABLE DISEASES• Diarrheas• Pneumonias• Bronchitis/Bronchiolitis• Influenza• Measles• TB respiratory• TB meningitis• TB other forms

• Diseases of the Heart• Malignant Neoplasms• Chickenpox• Dengue Fever• Malaria• Cholera• Typhoid &

Paratyphoid fever• Viral hepatitis


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NOTIFIABLE DISEASES• Rabies• Diphtheria• Tetanus Neonatrum• Tetanus• Poliomyelitis• Whooping cough• Gonorrhea• Syphilis

• AIDS/ HIV Infection• Leprosy• Schistosomiasis• Filiriasis• Meningitis/

Encephalitis• Leptospirosis• Poisoning• Hypertension

IMMUNITY HERD

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-describes a form of immunity that occurs when the vaccination of a significant portion of a population (or herd) provides a

measure of protection for individuals who have not developed immunity.

-proposes that, in contagious diseases that are transmitted from individual to individual, chains of infection are likely to

be disrupted when large numbers of a population are immune or less susceptible to the disease.

-The greater the proportion of individuals who are resistant, the smaller the probability that a susceptible individual will

come into contact with an infectious individual.

IMMUNITY HERD

IMMUNITY HERDEstimated Herd Immunity thresholds for vaccine preventable diseases

Disease Transmission R0Herd immunity

threshold

Diphtheria Saliva 6–7 85%

Measles Airborne 12–18 83–94%

Mumps Airborne droplet 4–7 75–86%

Pertussis Airborne droplet 12–17 92–94%

Polio Fecal-oral route 5–7 80–86%

Rubella Airborne droplet 5–7 80–85%

Smallpox Social contact 6–7 83–85%

BACK

HEALTH EDUCATION- is a process whereby knowledge, attitude and

practice of people are changed to improve individual, family and community health.

- Is a means of improving the health of the people by employing various methods of scientific

procedures to show the most healthful ways of living.

Principles of Health Education1. Health education considers the health status of the

people.2. Health Education is learning.3. Health education involves motivation, experience

and change in conduct and thinking.4. Health education should be recognized as a basic

function of all health workers.5. Health education takes place in the home, in the

school and the community.

Principles of Health Education

6. Health education is a cooperative effort.7. Health education meets needs, interests and

problems of the people affected.8. Health education is achieved by doing.9. Health education is a slow continuous process.10. Health education makes use of supplementary aids

and devices.

Principles of Health Education

11. Health education utilizes resources.12. Health education is a creative process.13. Health education helps people attain health

through their own efforts.14. Health education makes careful evaluation of the

planning.

Health Education Teaching Methods and Strategies

• Interviewing• Counseling• Lecture-discussion• Open forum• Workshop• Case Study• Role play• Symposium

• Group work-buzz sessions

• Use of Publication• Nominal Group

Technique• Laboratory Training• Use of IEC

(information, education and communication)

Qualities of a Good Health Educator

• Knowledgeable/mastery of the subject matter

• Credible• Good Listener• Can emphasize with

other• Posses teaching skills• Flexible

• Patience• Creative and

immovative• Effective motivator• Ability to rephrase• Encourages group

participation• Good sense of

humor

BACK

HOME CARE- giving to the individual patient the nursing care required by his/her specific illness or trauma to

help him/her reach a level of functioning at which he/she can maintain himself/herself, or die

peacefully in dignity.

Principles in Nursing Care

1. Nursing care utilizes a medical plan of care and treatment.

2. The performance of nursing care utilizes skills that would give maximum comfort and security to the individual.

3. Nursing care given at home should be used as a teaching opportunity to the patient or to any responsible member of the family.

Principles in Nursing Care

4. The performance of nursing care should recognize dangers in the patient’s over-prolonged acceptance and comfort.

5. Nursing care is a good opportunity for detecting abnormal signs and symptoms, observing patient’s attitude towards care given and the progress exhibited by the patient.

Isolation Technique in the HomeGenerally, strict isolation technique is difficult to carry out in the homes where houses are small and occupy a large number of people.1.All articles used by the patient should not be mixed with the articles used by the rest of the members of the household.2.Frequent washing and airing od beddings and other articles and disinfection of room are imperative. Abundant use of soap, water, sunlight and some chemical disinfectants is necessary.

Isolation Technique in the Home3. The one caring for the sick member should be provided with a protected gown that should be used only within the room of the sick.4. All discharges, especially from the nose and throat of a communicable disease patient, should be carefully discarded.5. Articles soiled with dischages should first be boiled in water 30 minutes before laundering. Those could be burned, should be burned.

Prepared by:Group 3

“J-roy and the Piklets”