Community-Health-Nsg-Approaches-Chapter-6encrypted.pdf

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1. Community Health
Nursing Approaches,
Concepts, Roles and
Responsibilities of
Community Health
Nursing Personnel

2. Vision

COMMUNITY HEALTH NURSING APPROACHES

Nursing care was only focused on the physical health in the past. A
person who is physically healthy seems to be a healthy individual but
now trends has been changed. Now the health follows the holistic care
approach, where overall health of an induced is the target. Holistic
approach is a multidimensional approach in which every factor is
considered to help an individual for getting in overall health. This
concept was given by Florence Nightingale who had introduced the
concept of modern nursing.

3. Vision

There are various health approaches that are used to provide health care
to the community. Some examples of them are as follows:

QNursing process

QEvidence-based approaches
QEpidemiological approaches
QEmpowering people to care themselves
QProblem solving approaches

4. NURSING PROCESS
Introduction

Nursing process is critical few step process that is used by a nurse for
giving appropriate and care to patient. It helps a nurse to provide
evidence-based care in order to improve health. It is a blue print made
by a nurse for caring a patient. It also helps a nurse to understand the
problems of patient in a deep away.

Vision

5. IT

Five Steps of Nursing Process
Y” Nursing assessment
Y” Nursing diagnosis
v Nursing planning
Y” Nursing implementation
Y” Nursing evaluation

6. Vision

Nursing Assessment

Assessment is the way through which systematically collection of
information about a patient’s current and past health and function status
assessment of patient is done systematically.

Nursing diagnosis
Definition

A diagnosis is a clinical judgment that is formed on the basis of
information and analysis from assessment.

Diagnosis are made in two ways:
¥ Priority diagnose: These diagnosis should be treated first.

y Collaborative diagnosis: Diagnosis formed which are solved by
collaborating action of team.

7. Vision

Formation of Nursing Diagnosis

Nursing diagnosis are formed by the analysis of information gathered
during assessment. A diagnostic label is formed approved by NANDA-
i

Nursing diagnosis have three component:
¥ Problem: Ineffective breathing pattern.
¥ Etiology: Pulmonary hypoplasia

YRisk factor/evidence: Intermittent subcostal and__ intercostal.
Retractions tachypnea abdominal breathing and need of ongoing
oxygen support.

8. Goals and Expected Outcomes
+ With planning setting of goals and expected outcomes are also set.

*Goals are the desired changes that we want as a result of our
intervention.

* Expected outcomes are the changes in patient’s behavior, physical
state and perception that can be measured.

Nursing Planning

Identifying patient diagnosis and collaboration problem. The next step is
prioritizing the diagnosis, collaborative goals and expected outcome.
Choose interventions for each diagnosis. Planning problem solving
requires critical thinking. Nurse take a collaborative action with other
health team to prioritize the things and provide care.

Vision

9. Nursing Implementation

On the basis of nursing planning, nursing interventions are formed.
Nursing intervention is the treatment based on nursing or clinical
judgment and knowledge that over the patient to get desirable outcomes.

y During intervention two types of care is given: Direct care: Direct
care is the intervention that is given to patient directly, e.g., providing
back care for bedsore, infection meditation, hot, cold therapy for acute
risk pain.

vIndirect care: Indirect care is the intervention not given to patient
directly. For example, providing safe and calm environment, to the
patient that indirectly enhance the health.

Vision

10. Nursing Evaluation

+ This is the last step of nursing process. In this step nurse evaluates all
the four steps of nursing process done on the patient to check the
contribution and improvement of patient’s health.

» In this step goals and completed outcomes are evaluated that are
achieved. The expected outcomes are the measures as to know as
which extent it has achieved and how much more efforts to be taken to
achieve the complete goals for the patients.

Vision

11. EPIDEMIOLOGICAL APPROACH

Epidemiology is the study of the distribution and determinants of
health-related states, conditions, or events in specified populations and
the application of the results of this study to the control of health
problems.

Application of Epidemiology
y Studying the health of population.
v Application of gained knowledge for community-based practices.

v Diagnosing the health of a community is the major component of
epidemiology.

y Acceptable public health instructions to control and prevention of
diseases.

Vision

12. Epidemiological
Approaches

Déscriptive Epidemiology

This approach involves the
collection and analysis of data
to describe the distribution of
diseases or health events within
a population. It focuses on
understanding the “who, what,
where, and when” of health
issues. Descriptive
epidemiology can help identify
trends, patterns, and potential

Vision

13. Analytical Epidemiology

Analytical epidemiology aims to determine the
causes of diseases and the factors that contribute
to their occurrence. It involves comparing groups
with and without the disease to identify
associations between exposures (such as risk
factors) and outcomes (such as diseases).
Analytical studies can be observational (e.g.,
cohort, case-control, cross-sectional) or
experimental (e.g., randomized controlled trials).

14. Cohort Studies

These studies follow a group of people (cohorts)
over time to compare the incidence of a disease in
those exposed to a certain risk factor and those not
exposed. They can be prospective (starting with
the exposure and following over time) or
retrospective (looking back at historical data).

15. Experimental Studies

Experimental studies involve intentionally
manipulating exposures in a controlled setting to
investigate causal relationships between
interventions (such as treatments) and outcomes.
Randomized controlled trials (RCTs) are a
common type of experimental study that randomly
assigns participants to intervention and control
groups to assess the effects of interventions.

16. Social Epidemiology

Social epidemiology examines how social factors,
such as socioeconomic status, education, and
access to healthcare, influence health outcomes
within populations. It aims to understand the
social determinants of health disparities.

17. MEASUREMENT TOOLS USED IN EPIDEMIOLOGY

v Rate

v Ratio

¥ Proportion

y Surveys and Questionnaires
y Clinical Examinations

¥ Laboratory Tests

Y Medical Records and Health Databases
y Biometric Measurements

y Disease Registries

y Vital Statistics

v Environmental Monitoring

Yision

18. Vision

Utilization of Epidemiological Approaches

y Disease Surveillance and Outbreak Investigation
y Public Health Policy and Planning

y Disease Prevention and Health Promotion

y Clinical Medicine

y Environmental Health

y Occupational Health

y Chronic Disease Management

y Health Disparities and Equity

y Global Health

19. Problem Solving
Processes

Problem-solving processes
involve systematic
approaches to identify,
analyze, and resolve
challenges or issues.

In problem solving process
one should try to understand
the problem and find for
possible solution.

Define problem
Gather information:
Problem analysis
Generation possible solutions
Analysing the solutions
Selecting the best solution
Implementing the solution
Evaluation and revision
Reflect and learn

Iterate and improve

Vision

20. EVIDENCE-BASED PRACTICE APPROACH

Evidence-based practice approach is used to take complicated decision,
such as decision in public health. Health is a broad area: so, it’s very
important to take good and evidence-based decision for a large
community. Generally, the evidence-based derived after the conduction
of cross-sectional studies or quasi experimental study.

DEFINITION

Evidence-based Practice (EBP) is an approach that combines clinical
expertise, patient preferences, and the best available evidence to inform
clinical decision-making and healthcare practices. It emphasizes using
high-quality research evidence to guide medical decisions, with the
ultimate goal of providing the best possible care to patients.

Vision

21. Vision

Steps of EBP

The EBP approach involves several key steps:

+ Ask: Formulate a well-defined clinical question using the PICO(T) format. This helps focus
the search for relevant research evidence.

+ Acquire: Conduct a comprehensive search for the best available evidence related to the
clinical question. This involves searching databases, medical literature, systematic reviews,
and other credible sources.

.

Appraise: Critically evaluate the quality and relevance of the evidence you've gathered.
Consider factors such as study design, sample size, methodology, and potential biases.

+ Apply: Integrate the evidence with clinical expertise and patient values and preferences to
make informed decisions about patient care. This step involves considering the patient’s
individual characteristics, values, and circumstances.

+ Assess: Continuously monitor and evaluate the outcomes of the chosen intervention or
treatment. This helps determine whether the chosen approach is effective and appropriate for
the patient’s specific situation.

22. EMPOWERING
PEOPLE TO
CARE FOR
THEMSELVES

Empowering individuals
to care for themselves is
a fundamental aspect of
promoting health and
well-being. When
people have the
knowledge, skills, and
confidence to take an
active role in managing
their own health, they
can make informed
decisions and adopt
healthier lifestyles.

23. EMPOWERING PEOPLE TO CARE FOR
THEMSELVES

y Health education and awareness
v Self-management skills

y Goal setting

V Shared decision-making

y Behavioral change support

y Digital health tools

y Cultivating self-efficacy

y Peer support

y Cultural sensitivity

¥ Promoting resilience and coping

24. RESIDENT HEALTH SYSTEM

A strong health system have goals, good staff members,
financial support to carry out various activities and good
leader to run the organization. For promoting health among
country or any community there is need to strengthening
the health system. There are many strategies to improve the
health system of the country.

Some of significant health care concepts are as follow:

y Comprehensive Health Care
y Basic Health Services

25. Comprehensive Health Care

In 1946 the concept of comprehensive health care given by the Bhore
Committee. The aim of this to provide integrated, preventive, and
promotional health to all the people belong to defined geographic area
curative.

Features

Y The comprehensive care is the way of provision of preventive,
curative and promotive health services.

y Beneficiaries should have easy access of all services.

Y There should be good cooperation between the beneficiary and
provider.

y The services should be close to the beneficiaries.

Y More focus on vulnerable and weaker sections.

Vision

26. HOME VISITS

Concept

The home visit is an important and essential step for providing health
services to the persons of community. In community, people are living
in home with their family. While doing home visit one can interact with
family and can assess overall health of family. For doing home visit, the
community health nurse (CHN)/other health workers should have
technique skills and knowledge of preventive and therapeutics
measures, having good communication skills, teaching ability judgment
and having full understanding related to human relation

Vision

27. Principles of Home Visiting

Before doing any home visiting one should aware about the principles of home
visiting.
= CHN should collect prior information about the geographical area.
= CHN should collect prior information about the family.

= CHN should make plan before doing any home visiting.

= CHN should not made any personal relationship with the family.

= Professionalism should be maintain at any cost
= CHN should not be the part of any activity which can do any harm to the family.

= CHN should not use any personal information of the family for personal benefit.
Maintain confidentiality of family.

= CHN should not receive any gift items from family members.

= The home visit carry out according to plan but it should be flexible change
according to the family of patient.

Vision

28. Process/Phases of Home Visits

“Introductory Phase

< Pre-visit Planning
“Activity Phase

“Post Visiting

y Recording and Reporting

29. Techniques of Home Visiting
Techniques commonly utilized in home visiting:

>Needs assessment: Conducting initial assessments to identify the specific needs and
challenges of the individuals or families being visited. This helps the home visitor tailor
their approach and support to address those needs.

> Building rapport: Establishing trust and a positive relationship with the individuals or
families being visited. Home visitors often engage in active listening, empathy, and
open Communication to create a safe and supportive environment.

> Goal setting: Collaboratively setting goals with the individuals or families to work
towards during the home visiting sessions. These goals can be related to health,
parenting, education, or any other areas of focus.

> Advocacy: Acting as an advocate for the individuals or families visited, helping them
navigate systems, access services and connect with community resources.

Service coordinate: Assisting individuals and families in accessing and coordinating
various services and resources, both within and outside of the home visiting program.

Vision

30. Vision

BAG TECHNIQUE

The Bag Technique is a procedure/technique in which a nurse knows about the effective
utilization of community bag for performing the procedure with care during home visiting.

Objectives

OTo provide effective health services to family during home visiting.

OTo prevent cross-infection.

QTo develop skills about the effective utilization of bag during the procedure.
Principles of Bag Technique

v Bag technique performing with decrease chances of cross-infection.

v Bag technique performing saves time and efforts.

y Bag technique performance makes it easy to provide procedure during home visit.
v Bag technique should show the effectiveness of health facilities provided to family.

31. Vision

Points to Remember While Using Bag

“Bag should contain all the necessary items for giving and assessing the
needs of health services.

Bag items should be replaced according to utilization.

The inside pockets are always considered to be clean area. Unnecessary
opening and touching should be avoided.

«The bag and its items should not come in contact to the items of home.
The bag items should be maintained such as it is convenient to use.

“Only required items are taken from the bag. After performing
handwashing. Do not take out the things which are not required during
procedure.

“Putting back all the things after proper decontamination of articles.

32. Vision

QUALITIES OF COMMUNITY HEALTH NURSE
Community health nurse should have the following qualities:

+ Communication: A CHN should be a good communicator for maintaining good relationship with the
family.

Care provider: A CHN should be a good care provider for giving therapeutic services to the family.

Good observer: A CHN should be a good observer for doing a good assessment of the family and giving
services according to their needs.

Teacher: A CHN should be a good teacher for providing health education to the family according to their
needs. Make them understand about the benefits of preventive care.

Advocator: A CHN should be a good advocate to provide advice to people for good health.

Advisor: A CHN should be a good advisor. She should have knowledge of various diseases. So she gives
right advise according to the need of the patient. For example, regarding referrer, concerning higher
health facilities.

Manager: A CHN should be a good manager for managing the various things during home visiting,
performing procedure, doing assessment and while referring the patient.

Planner: A CHN should be good planner. She should plan well all the activities before executing so to
cut down many barriers.

33. PUBLIC HEALTH FUNCTION FOR HEALTH PROMOTION,
PREVENTION AND DISEASE SURVEILLANCE

Public health plays a critical role in promoting the overall well-being of
communities by focusing on health promotion, disease prevention, and
disease surveillance. These functions work together to improve the

health of populations and reduce the burden of illness

34. Vision

Health Promotion

Health promotion involves empowering individuals and communities to take control of their
health and make informed decisions to lead healthier lives. This function aims to prevent health
problems before they occur by promoting healthy behaviors and lifestyles. It includes activities
such as:

OHealth education: Disseminating accurate information about healthy behaviors, nutrition,
exercise, sexual health, and more to raise awareness and enable people to make informed
choices.

OCommunity engagement: Collaborating with communities to identify their health needs,
concerns, and priorities, and working together to design interventions that address those
needs.

OBehavioral interventions: Implementing programs that encourage people to adopt healthier
behaviors, such as smoking cessation, stress management, and regular physical activity.

QPolicy advocacy: Advocating for policies that support health, such as clean air regulations,
workplace wellness initiatives, and access to nutritious foods.

35. Disease Prevention

Disease prevention involves taking proactive measures to reduce the risk of
disease occurrence and transmission. This function focuses on preventing
diseases from taking hold or spreading within populations. It includes
activities such as:

Olmmunization programs: Administering vaccines to protect against
infectious diseases and maintain herd immunity.

OScreening programs: Conducting regular screenings (e.g., mammograms,
Pap smears, blood pressure checks) to detect diseases at an early stage when
treatment is most effective.

QHealth counseling: Providing guidance and counseling on topics such as
safe sex practices, family planning, and substance abuse prevention.

QEnvironmental health: Ensuring safe and clean environments to prevent

exposure to harmful substances and reduce the risk of environmental
diseases.

Vision

36. PRINCIPLES OF COUNSELING

Counseling is a process that involves providing guidance, support, and
assistance to individuals facing personal, emotional, or psychological
challenges. Effective counseling is guided by certain principles that
create a safe, empathetic, and productive environment for clients to
explore their feelings, thoughts, and concerns.

Vision

37. Vision

Principles of counseling

QEmpathy and Respect
UClient-Centered Approach
ONon-Judgmental Attitude
QConfidentiality

QActive Listening
QUnconditional Positive Regard
OEmpowerment
ACollaboration

Ethical Boundaries

OCultural Sensitivity

38. TECHNIQUES OF COUNSELING

y Active Listening

y Reflective Listening

y Open-Ended Questions
y Empathetic Responses

y Summarizing

y Cognitive Restructuring
y Behavioral Interventions
¥ Problem-Solving

y Role-Playing

y Narrative Therapy

v Art and Expressive Therapies

Vision