Subtitle

1. Subtitle Responsibilities of CHN

2. Community health nursing: is a synthesis of nursing practice and public health practices applied to promoting & preserving the health of populations. • The practice is general and comprehensive. It is not limited to a particular age group or diagnosis, and it is continuing, not episodic. • The dominant responsibility is to the population as a whole; nursing directed to individuals, families, or groups contributes to the health of the total population. • The focus of community health nursing is on the prevention of illness, the promotion & maintenance of health

3. Public health nursing: is the practice of promoting & protecting the health of populations using knowledge from nursing, social, and public health sciences. • It includes assessment and identification of subpopulations that are at risk for injury, disease, threat of disease or poor recovery & focusing resources so that services are available and accessible. • The goal of public health nursing is the prevention of diseases and disability for all people through the creation of conditions in which people can be healthy.

4. The Educational preparation for beginning practitioners in public health nursing should include: (1) Epidemiology, statistics, & research (2) Orientation to health care systems (3) Identification of high-risk populations (4) Application of public health concepts to the care of groups of culturally diverse persons (5) Interventions with high risk populations (6) Orientation to regulations affecting public health nursing. • Population- focused means that care is aimed at improving the health of one or more populations.

5. Where is C H N employed? • Home health & hospice agencies "37%" of CHN work in to provide nursing care to ill, injured, or disabled individuals & their families • Almost 1\4 CHN are employed by local & state health departments or rural health centers • Other CHN work with populations associated with a specific age group or type of organization; youth in public and schools

6. Visions & Commitments • Visions“ broad statements describing that which we desire something to be like. They drive from the ability of human beings to imagine what doesn’t currently exist. • Commitments “agreement we make with ourselves that pledge our energies for or toward our vision. • Nursing provides & assist individuals developmentally, especially at the time of birth and death

7. Contribution of CHN through adding to our commitments. These include ensuring: • An equitable distribution of health care • A basic standard of living supports the health and well being of all persons • A healthful physical environment

8. Commitment of Nursing • Patterning an environment of safety & asepsis that promotes health • Promoting healthy individuals by caring for them when they are not able todo for themselves because of age, illness, disability • Calling forth the client's commitment to his\her own well-being & wholeness • Promoting health for individuals & support for families related to developmental stages " pregnancy, labor and delivery" • Promoting wellness and integration during illness, disability and dying • Treating clients equitably without related bias related to age, race gender, socioeconomic class, religion

10. Distinguishing Features of Community & Public Health Nursing

11. Empowerment is the process of assisting others to use their inherent abilities, strength, wholeness & spirit & it depends on the presence of hope Major Goals for Community \Public Health Nursing • Care of the ill, disabled, & suffering in non hospital settings • Support of development and well being throughout the life cycle • Promotion of human relatedness and mutual caring • Promotion of self-responsibilities regarding health and well being • Promotion of relative safety in the environment while conserving resources

12. Nursing Theory

13. Self – Care • Self care is the production of actions directed to self or to the environment in order to regulate one's functioning in the interests of one's life, integrated functioning & well being. • Self care depends on knowledge resources and actions. The concept of self care is consistent with the community nursing focus on empowerment of persons and groups to promote health and to care for themselves.

14. Public Health Theory • Public health theory is concerned with the health of population of human beings. Public health is a practice discipline that applies knowledge from physical, biologic and social science to promote health and to prevent diseases, injury disability and premature death. • Betty Neumann • Clients continuously interact with people and other environmental forces and seek to defend themselves against threats. Health is balance and harmony within the whole person

15. Population and Risk • Population ; people residing in an area and a group or set of persons under statistical study. The word group is used here to mean a set engage in face to face interactions. • Riskis a statistical concepts based on probability. CHN is a concerned with human risk of diseases, disability or premature death. Therefore, community nurses work with persons within the population to reduce their risk for developing a health conditions • Aggregate is a synonym for population. Aggregates are people who don’t have the relatedness necessary to constitute an interpersonal group "system" but who have one or more characteristics in common such as pregnant teenagers

16. Prevention • The natural history of a disease involves a pre-symptomatic period, a symptomatic period, & a resolution "death, disability, complications\ recovery". • The goal of primary prevention is the prevention of the occurrence of the diseases. Activities in primary prevention include environmental protection such as asepsis and personal protection such as immunization and avoiding smoking. • Secondary prevention is the detection "screening" & treatment of the diseases as early possible as early as possible during the natural history of the disease e.g.. Pap smears allow cervical cancer • Tertiary prevention is geared toward preventing disability. Complication & death from the disease, includes rehabilitation.

17. Responsibilities of C|PHN • Providing care to the ill & disabled in their homes • Maintaining healthful environments • Teaching about health promotion and prevention of diseases & injury • Identifying those with inadequate standard of living and untreated illnesses and disabilities and referring them for services • Preventing and reporting neglect or abuse • Advocating for adequate standards of living and health care services • Collaborating to develop appropriate, adequate, acceptable health care services • Caring for one self & participating in professional development activities • Ensuring quality nursing care and engaging in nursing research

18. Promotion & understanding complete definition of health • Contribution to identifying & meeting the main health needs of the community. • Accessible, available and affordable services based on principles of social justice and equity. • Comprehensive service delivery and program content that includes treatment, early identification & intervention and health promotion. • The participation and consultation of people and communities about health issues and their own health care. • Multidisciplinary approaches.

19. Referral & Advocacy • Referralis the process of directing someone to another source of assistance. The CHN is expected to make assessment with clients, explore the meaning of the experience. • To facilitate a match between the client's need & the available resources, the CHN must be aware of the channels for accessing that help. Assessing the presence & quality of other health & social resources is a skill that CHN learns

20. Four characteristics required for successful advocacy are (1) assertiveness, (2) willingness to take crises, (3) good communication skills and (4) ability to identify sources of power • CHN have the option of advocating for the client. Advocacy is an instance of speaking or writing on behalf of someone else and using persuasion in support of another. This requires the skills of assertive communication & the knowledge of communication channels within & among organization

21. TEACHING • Teaching is the process of imparting cognitive knowledge, skills, and values. Nurses have information and skills that make them specialists in caring for the ill; preventing disease, illness, disability, suffering, & premature death; & promoting well-being. • Self- determination, independence, and choice in decision-making in health matters is of highest regard to nurses. Because CHN work with people in various stages of wellness, CHN have special opportunities to foster human development and capabilities through client education

22. Preventing Illness & Injury • Individuals have choices that affect their risks. These depend on the existing knowledge about natural history of disease, epidemiology, modalities for early detection and treatment, methods of protection and prevention and determinants of human behaviour. • A basic truth about the teaching learning process is that information alone is not sufficient to change human behaviour. • Telling someone what to do or how to do it will not result in modified behaviour unless the person can relate the behaviour to his or her values , goals and believes that the behavior change will contribute to the achievement of aspiration.

23. MONITORING & EVALUATION • Monitoring is the verification of the state or condition of health, & evaluationis the determination of the significance or value of this information. • Assessmentalso denotes determination of the site of health & involves the collection & analysis of data; reassessment might occur at a later time. • A distinction between monitoring & re-assessment is that monitoring implies either a continuous process or short intervals between episodes of data collection & evaluation

24. When providing family-centered care, the CHN determines the frequency of monitoring based on the health status of the family, the preferences of the family, and agency policy. • Monitoring the health of groups, aggregates, & communities involves collecting and evaluating information about populations. Demographic & epidemiologic data are used to determine age distributions, mortality, morbidity, and risky behavior of populations

25. ENFORCEMENT • Because our culture values, individual autonomy and because nursing & public health both value human growth & self-actualization, most health-related interventions do not involve coercion. • However, there are instances in which the rights of the majority take precedence over the rights of individuals. To protect the health of the family or community, individual autonomy might be limited.

26. Environmental management “ the control of those things in the immediate surroundings to protect human beings from diseases and injury or the promotion of a place conducive to healing and well-being. • It includes the conservation of resources & limitation of pollution in the environment. Providing asepsis & safety are basic ethical & legal responsibilities of all nurses in managing the physical aspects of environment. • Interpersonal and social environments

27. Community Environments • Health professionals are recognizing that the social environment is especially important when considering such concerns as teenage pregnancy, poverty. • CHN are exploring ways to strengthen human connectedness, promote a basic standard of living, and reduce dependence on violence as a means of conflict resolution.

28. Institutional Environment • Some community health nurses are employed by local or state governments to inspect daycare centers (for children and adults), nursing homes and residents care settings as part of quality control of the environment. School nurse's employed by loyalty departments or school boards • Home Environment • CHN who make home visits and those who work in clinics have special responsibility for assisting families to provide safe home environments • Clean, orderly physical environments and safe, adequate food, water and waste disposal are to be provided in hospitals and other institutions.

29. COORDINATION OF CARE & DELEGATION • Coordinationis bringing together the parts or agents of a plan or process into a common whole. CHN work within complex community networks of resources to coordinate care for clients in a variety of ways. • Case management “the development & coordination of a plan of care for a selected client, usually an individual or family. This is similar to the concept of primary nursing in the hospital. Case management depends on the nurse's ability to accurately assess client needs & community resources.

30. Caseload management refers to the coordination of care for a number of clients for whom the CHN is accountable. Caseload management involves the community health nurse's self-management, time management, and resources management for numerous clients during a specified period. • Site management refers to the coordination of nursing effort at a specific geographic place, such as a clinic, school, or office for CHN where nursing care is planned and provided

31. PARTNERSHIP|COLLABORATION • Collaboration “working together & denotes that the participants have relatively equal influence”. Collaboration can occur informally or formally; it takes place among nursing peers, community members, & interdisciplinary professional teams • Networking “ the establishment & maintenance of relationships with other professionals & community leaders for the purpose of solving common problems creating new projects or programs” • Skills required for successful collaboration are: (1) Communication skills (2) Assertiveness (3) Consultant skills

32. CONSULTATION • Consultation “ the seeking of advice especially from an expert or professional. CHN are experts in CHN by virtue of education & experience. • CHN also are experts on the health status & needs of families, population groups, aggregates, and the community with which they work; this is especially true in regard to the needs for nursing care services.

33. Change within Existing Power structures • Change is a continuous process. There is room for change within the existing organizations & governmental strictures. • Assessment of unmet health needs • Creation of nursing services through social planning is one example. Identification of population groups at special risk • Development of outreach, screening & educational programs for them is another example. Nurses are influence to promote change

34. Such changes can also be encouraged trough political & economic strategies. Political action depends on the use of power to influence decisions. Governments make many public health decisions. • Nurses can also influence the development of legislation and administrative rules and regulations. • This can be done by testifying at hearings, participating on task forces, supplying written testimony, & personally visiting legislators. Initiating law- suits can be attempts to influence judicial decisions.

35. Becoming Part of Power Structure • Obtaining membership in decision-making groups is another influence. Nurses in political office and as members of planning bodies increase the influence of the nursing profession's voice. • During the past 20 years, nurses have become better educated in business and economic areas so that they can participate as full partners in the business of health care.

36. Changing the Power Structure • The values underlying health for a community should include equity, empowerment, & cooperation. Although these values are inherent in care & responsibility, they aren't dominant values in our culture. • The process of enabling people to increase control & to improve their health represents a mediating strategy between people & the environments in which they live synthesizing personal choice & social responsibility to create a healthier-future.

37. Empowerment & Creativity • Empowerment involves the creation of a vision of what is desired & the development of a plan to work toward the vision. • It depends on the presence of hope or an expectation that what isn't could actually be. • It provides creation of new ways of being and doing & for transformation that is, going beyond the next obvious step to radical shifts. • Is blocked by magical thinking, in which a desire or wish itself is held as the solution to a problem