ROLES AND SETTING FOR COMMUNITY HEALTH NURSING PRACTICE

1. ROLES AND SETTING FOR COMMUNITY HEALTH NURSING PRACTICE CHAPTER 3

2. Historically, community health nurse have engaged in many roles. From the beginning, nurse in this professional specialty have provided care to the sick, taught positive health habits and self-care, advocated on behalf of needy populations, developed and managed, health programs, provided leadership, and collaborated with other professionals and consumer to implement changes in health services. • The settings in which theses nurses practiced varied, too. The home certainly has been one site for practice, but so too have clinics, schools, factories, and other community-based locations.

3. ROLES OF COMMUNITY HEALTH NURSES • Community health nurses wear many hats while conducting day-to-day practice.The focus of nursing includes not only the individual, but also the family and the community, meeting these multiple needs requires multiple roles.  • The seven major roles of a community health nurse are:

4. 1. Care provider. "Clinician role". • 2. Educator. • 3. Advocate. • 4. Manager. • 5. Collaborator. • 6. Leader. • 7.Researcher.

5. 1. Care Provider "Clinician Role" • The most familiar role of the community health nurse is that of clinician or care provider. The clinician role in community health means that the nurse ensure that health services are provided not just to individuals and families, but also to groups and populations.

6. The role of the clinician or care provider is a familiar one for most people. In community health the clinician views clients in the context of larger systems. The family or group must be considered in totality. The community health nurse provides care along the entire range of the wellness-illness continuum; however, promotion of health and prevention of illness are emphasized. Skills in observation, listening, communication, counseling, and physical care are important for the community health nurse. Recent concerns for environment, sociocultural, psychological, and economic factors in community health have created a need for stronger skills in assessing the needs of populations at the community level.

7. For community health nurses, the clinician role involves certain emphases that are different from those basic nursing. Three clinician emphases, in particular, are useful to consider here: • -Holism. • - Health promotion. • - Skill expansion.

8. Holistic Practice • Holistic nursing care encompasses the comprehensive and total care of the client in all areas, such as physical, emotional, social, spiritual, and economic.

9. Focus on Wellness • The clinician role in community health also is characterized by its focus on promoting wellness. The community health nurse provides services along the entire range of the health continuum but especially emphasize promotion of health and prevention of illness.

10. Nursing service includes seeking out clients who are at risk for poor health and offering preventive and health promotion service, rather than waiting for them to come for help after problems arise. • The community health nurse may help employees of a business learns how to live healthier lives or work with the expected changed behavior, or work with a group of people who want to quit smoking.

11. Groups and populations are identified that may be vulnerable to certain health threats, and preventive and health promoting programs can be designed. Examples includes: • - Immunization of preschoolers. • - Family planning programs. • - Cholesterol screening. • - Prevention of behavioral problems in adolescents. • Protecting and promoting the health of vulnerable population is an important component of the clinician role .

12. Expanded Skills • Many different skills are used in the role of the community health clinician. In the early years of community health nursing, emphasis was placed on physical care skills. With time, skills in observation, listening, communication, and counseling become integral to the clinician role as it grew to encompass an increased emphasis on psychological and sociocultural factors. Recently, environmental and community-wide consideration such as:

13. Problems caused by pollution. • - Violence and crime. • - Drug abuse. • - Unemployment. • - Poverty. • - Homelessness.

14. Have created a need for stronger skills in assessing the needs of groups and populations and intervening at community level. • The clinician role in population-based nursing also requires skills in:- • - Collaboration with consumers and other professionals. • - Use of epidemiology and biostatistics. • - Community organization and development. • - Research. • - Program evaluation. • - Administration and leadership.

15. 2. Educator Role • A second important role of the community health nurse is that of educator or health teacher. Health teaching is one of the major function of the community health nurse. • The educator role is especially usefulness in promoting the public's health for at least two reasons:

16. 1. Community clients usually are not actually ill and can absorb and act on health information. For example: • - A class of expectant parents, unhampered by significant health problems, can grasp the relationship of diet to fetal development. They understand the value of specific exercises to childbirth process, are motivated to learn, and are more likely to perform those exercises. • Thus, the educator has the potential for finding greater receptivity and providing higher-yield results.

17. 2. The educator role in community health nursing is significant because a wider audience can be reached. • With an emphasis on population and aggregates, the educational efforts of community health nursing care appropriately targeted to reach many people.

18. Health education • Providing information and teaching people how to behave safely and in a manner that promotes and maintains their health. • A continuing process of informing people how to achieve and maintain good health; of motivating them to do so; and of promoting environmental and lifestyle changes to facilitate their objective.

19. Goals of Health education: • 1. The rational for health education is to equip people with the knowledge, attitude, and behaviors to live the fullest life possible for the greatest length of time. • 2. Clients anticipate achieving their maximum life span. • 3. The nurse develops partnerships with a client to achieve a behavior change that • promotes, maintains, or restore health. • 4. Teaching is a specialized communication process in which desired behavior changes are achieved.

20. Teaching at Three Levels of Prevention • Nurses should develop teaching programs that coincide with the level of prevention needed by the client. The three levels primary, secondary and tertiary. • Ideally , the nurse focuses teaching at the primary level. If nurses were able to reach more people at this level, it would help to diminish the years of morbidity and limit subsequent infirmity. • Many people experience disabilities that might have been prevented if primary prevention behaviors had been incorporated into their daily activities.

21. Because the primary level of prevention is not possible in all cases, a significant share of the nurse's time is spent teaching at the secondary or tertiary. • An example is an 88-years- old women with a fractured hip who has returned home after 3 weeks of physical therapy at a skilled nursing facility. The nurse assesses the client's environment, gait, functional limitations, safety, and adherence to medication and initiates needed referrals. The teaching focuses on rehabilitation and prevention of secondary problem that may affect the healing process and the client's health and safety in general.

22. Teaching – Learning Principles • Teaching in community health nursing means to influence, motivate, and act as catalyst in the learning process. Nurses bring information and learns together and stimulate a reaction that leads to a change. • Nurses facilitate learning when they make it as easy as possible for clients to change. To do this, the nurse needs to understand the basic principles underlying the art and science of teaching-learning process and use of appropriate materials to influence learning.

23. Seven Principles for Maximizing the Teaching –Learning Process 1. Client readiness • Clients' readiness to learn influences teaching effectiveness. The community health nurse must assess the clients for: • 1. Emotional readiness. • 2. Educational background.

24. 2. Client Perception • Clients' perception also affect their learning, individual perceptions help people interpret and attach meaning to things. A wide range of variables affects human perception. Theses variables includes: • - Values. • - Past experience. • - Culture. • - Religion. • - Personality. • - Developmental stage

25. - Educational level. • - Economic level. • - Surrounding social forces. • - Physical environment. • For example: The nurse working with adolescents to educate them about the dangers of smoking should understand that adolescents seeking independence need to feel that they have options and choices and don’t want to be told what to do.

26. Frequently, clients use selective perception. They screen out some statements and pay attention to those that fit their values or personal desires. • For example:- • A nurse is teaching a client the various risk factors in coronary disease; the individual screens out the need to quit smoking and lose weight, paying attention only to factors that would not require a drastic change in lifestyle. • Nurse must know their clients, understand their backgrounds and values, and learn about their perceptions before health teaching can influence their behavior.

27. 3. Educational Environment • The setting in which the educational endeavor takes place has a significant impact on learning. • Students properly have had the experience of sitting in a cold room and trying to concentrate during a lecture or of being distracted by noise, heat, or uncomfortable seating.

28. Physical conditions such as ventilation, lighting, decor, room temperature, view of the speaker, and whispering need to be controlled to provide the environment most conductive to learning. • Equally important for learning is an atmosphere of mutual respect and trust. The nurse needs to convey this attitude both verbally and nonverbally. The way the nurse address clients, shows courtesies, and give recognition makes a considerable difference in establishing client's respect and trust.

29. Both nurse and clients need to be mutually helpful and considerate of one another's needs and interests. • All participants in the educational experience should feel free to express ideas, should know that their views will be heard, and feel accepted despite differences of opinion and perspective.

30. 4. Client Participation • The degree of participation in the educational process directly influences the amount of learning. • When the nurse work with clients in a learning context, one of the first question to discuss is. What does the client wants to learn?

31. The amount of learning is directly preoperational to the learner's involvement. • For example, a group of senior citizens attended a class on nutrition and aging, yet made few changes in eating patterns. It was not until the members became actively involved in the class, encouraged by the nurse to present problems and solutions for food purchasing and preparation on limited budget, that any significant behavioral changes occurred.

32. 5. Subject Relevance. • Subject matter that is relevant to the client is learned more readily and retained longer than information that is not meaningful. • Learners gain the most from subject matter is immediately useful to their own purposes. • Relevance also influences the speed of learning . • For example: - Diabetics who must give themselves daily injections of insulin to live learn that skill quickly.

33. - This is also seen in the short period of time that is takes families to learn the skill needed to provide home care for a family member in need. • When the subject matter is relevant to the learner, there also is greater retention of knowledge.

34. 6. Client Satisfaction • Clients must derive satisfaction from learning to maintain motivation and increase self-direction. Learners need to feel a sense of steady progress in the learning process obstacles, frustrations, and failure along the way discourage and impede learning. • Realistic goals contribute to learner satisfaction. Objectives should be set within the learner's ability, thereby avoiding the frustration resulting from a task that is too difficult and there loss of interest resulting from one that is too easy.

35. For Example: • On school nurse led a class for obese adolescents, and together they set the goal of weight loss. The nurse helped the group to design a plan that included:- • - Counting calories. • - Reducing fat in their diets. • - Increasing physical activity. • - Buddy system to bring about the behavior change. • As members in the group achieved monthly goals, they were encouraged to reward themselves. • These students found this learning experience satisfying because goals were attainable and their progress was rewarded.

36. 7. Client Application • Learning is reinforced through application. Learners need as many opportunities as possible to apply the learning in daily life. If such opportunities arise during the teaching-learning process, client can try out new knowledge and skills under supervision.

37. For example: • - A prenatal class .The learning only begins with explanations of proper diet, exercise, breathing techniques, hygiene, avoidance of alcohol and tobacco. • More learning occurs as the group members discuss these issues and apply them intellectually, exploring ways to practice them at home. • Additional reinforcement comes by demonstrating how to do these activities. • Sample diets, demonstration of exercises, posters, pamphlets, or models may be used.

38. The group can begin application in the classroom by making:- • - Diet plans. • - Exercising. • - Role-playing parenting behavior. • - Engaging in group problem-solving.

39. Teaching Process • The process of teaching in community health nursing follows steps similar to those of the nursing process:

40. 1. Interaction • Reciprocal communication must take place between nurse and client. It is essential in helping relationship and requisite to effective use of the nursing process. • Community health nurses need to develop good questioning techniques and listening skills to determine client's learning needs and level of readiness.

41. 2. Assessment and diagnosis. • Determine client's present status and identify clients' needs for teaching. • Assessing educational needs may be accomplished in several ways: • - The nurse can use surveys. • - Interviews. • - Open forums. • The principles to remember is that clients should be involved in identifying what they want to learn.

42. - For example: • - When a need to learn something, such as the importance of immunizing children, is identified by the nurse rather than by the clients, the nurse need to "sell" clients on the importance of the topic. Nurses need to use approaches that assist clients toward their own awareness of the need.

43. 3. Setting goals and objectives. • Once a need has been clearly identified, the nurse and clients can establish mutually agreed-on goals and objectives. • Goals : are broad statement of desired end outcomes. • Objectives: are more specific descriptions of intended outcomes.

44. For Example: • The nurse may have identified group's desire to stop smoking. • The need and teaching goals might be stated as follows: • Need: A group smokers wish to stop their addiction to nicotine. • Short-term goal: All members of the group will stop smoking within 1 month. • Long-term goal: 90% of group members will remain tobacco-free for 6months.

45. 4. Planning. • Design a plan for the learning experience that meets the mutually developed objectives: • The plan should include the following: • 1. Subject: Content to be covered, sequence of the topics. • 2. Intended audience. • 3. Dates, times, and places. • 4. Short- and long term goal statements. • 5. Teaching –learning methods. • 6. Activities and assignments. • 7. Course outline of topics. • 8. Evaluation methods and criteria. • A written plan is best; it may part of the written nursing care plan.

46. 5. Teaching. • The class, seminar, workshop, or small-group teaching should be conducted according to the plan. Even one-on-one teaching, each eight steps should be planned in advance, because each client has: • - A different cultural background. • - Education. • - Intellectual level. • - Learning needs. • Use of a variety teaching methods addresses the unique needs of learners and makes the teaching interesting. Include the combine each methods as lectures, discussions, role-playing, demonstrations, and videos.

47. 6. Evaluation. • Determine whether learning objectives were met and if not, why not. • Evaluation measures progress toward goals. Effectiveness of chosen teaching methods, or future learning needs.

48. Teaching Methods and Materials • Teaching occurs on many levels and incorporates various types of activities. • It can be formal or informal, planned or unplanned. • - Formal presentations, such as lecture with groups, usually are planned and fairly structured. • Some teaching is less formal but still planned and relatively structured, as in group discussions in which questions stimulate exploration of ideas and guide thinking. • - Informal levels of teaching, such as counseling or anticipatory guidance:-in which the client is assisted in preparing for a future role or development stage, require the teacher to be prepared, but there is no defined plan of presentation.

49. There are four teaching methods: • 1. Lectures. • 2. Discussion. • 3. Demonstration. • 4. Role ply.

50. 1. Lecture • The Community health nurse sometimes presents information to a large group. The lecture method, a formal kind of presentation, may be the most efficient way to communicate general health information. However, lectures tend to create a passive learning environment for the audience unless strategies are devised to involve the learners.