Community health nursing

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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”

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.


Philosophy of CHN

Philosophy of individual’s right of being

healthy

Philosophy of working together under a

competent leader for the common good.


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.


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.


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


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


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.


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


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.


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.”


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.


Two Approaches of Quality

assurance

General Approach

Specific Approach


General Approach

Licensure

Accreditation

Certification


Specific Approaches

1)Staff review committees(Peer review)

2)Utilization review committees

3)Research studies

4)Client satisfaction surveys

5)Malpractice litigation


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.


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.


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.


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.


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.


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.


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:


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.


Types of Nursing Audit

1)Concurrent Audit

2)Retrospective Audit


Concurrent Audit

Concurrent audit is used by Medicare and

Medicaid to evaluate care being received

by public health/home health clients.


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.


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.


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.


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.


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.


Community Nursing Theories


Precede ModelThe 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.


Health Belief Model

It has 3 major components:

1)Individual Perception

2)Modifying Factors

3)Variables affecting the likelihood of initiating

action.


Contributory factors in Health Belief Model

Age

Sex

Race

Ethnicity

Personality

Social class

Pressure

Reference group


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.


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.


Models applicable in CHN

1) System model

2)Developmental Model

3)Interaction Model


System Model

It is postulated by Von Bertalanffy(1952)

It focuses on the organization,

interaction, interdependency and

integration of parts and elements.


Characteristics-System Model

Wholeness

Organisation

Openness

Boundary

Entropy

Feedback


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.


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


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.


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.


Application to CHN

Communication

Self-Conception

Perception


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


Health & Medicine

Community health nursing