COMMUNITY HEALTH NURSING 2 NCM 114-5.pptx

A Nursing Care Plan (NCP) in the community setting is a structured, systematic approach that guides nurses in providing holistic care to individuals, families, and groups within their natural environment. Unlike hospital-based care, community nursing focuses on health promotion, disease prevention, early detection, and rehabilitation. The primary goal is to improve the overall health status of the population and reduce morbidity and mortality through targeted interventions tailored to the community’s unique needs.

Community nursing care planning begins with comprehensive assessment. This includes a community health assessment, which gathers data on the population’s demographics, socioeconomic status, prevalent health issues, environmental conditions, cultural practices, and available healthcare resources. Tools such as surveys, interviews, observation, and public health records are utilized to identify the most pressing health problems in the community. For example, high rates of hypertension, diabetes, infectious diseases, or malnutrition can be identified, forming the basis for prioritizing nursing interventions.

Once data is collected, nursing diagnoses are formulated to clearly define the community’s health problems. Unlike individual nursing diagnoses, community nursing diagnoses focus on collective health risks and potential for improvement. These diagnoses guide the selection of goals, expected outcomes, and interventions that address both immediate health needs and long-term preventive strategies.

Planning in community nursing involves collaboration with stakeholders, including local health officers, barangay health workers, non-governmental organizations (NGOs), schools, and community leaders. Goals are often SMART (Specific, Measurable, Achievable, Relevant, Time-bound) and may target knowledge acquisition, behavior change, risk reduction, or improved access to healthcare services. For example, a goal may be: “Increase the percentage of adults in Barangay X who practice regular blood pressure monitoring from 30% to 60% within six months.”

Implementation of the NCP involves direct and indirect nursing interventions. Direct interventions include health education sessions, vaccination campaigns, screening programs, home visits, and counseling. Indirect interventions may involve advocacy, coordination with health authorities, resource mobilization, and policy development. Nurses also engage in community empowerment, encouraging residents to actively participate in improving their own health through initiatives like clean water programs, sanitation drives, nutritional workshops, and exercise groups. Emphasis is placed on culturally appropriate care, respecting local beliefs and practices while promoting scientifically validated health behaviors.

Evaluation in community nursing assesses the effectiveness of interventions and progress toward goals. Nurses monitor changes in health indicators, behaviors, and disease prevalence, adjusting t

1. ETHICAL CONSIDERATION IN LEADERSHIP AND MANAGEMENT: a. ) MORAL DECISION MAKING PROCESS PRINCIPLE OF MORAL DEVELOPMENT PRINCIPLE OF WELL BEING STRATEGIES OF MORAL DECISION – MAKING PROCESS

2. What is Ethical Leadership and Why is it Important? Ethical leadership involves leaders and managers  making decisions  based on the right thing to do for the common good, not just based on what is best for themselves or for the bottom line.

3. Nursing administration and management is a branch of science that deals with manning skills for the nursing profession, which has its own scientific knowledge and background, to perform the management process in any nursing institution or hospital. The image of a nurse has gradually changed from that of the physician’s handmaid in the olden days to the current one as the nurse manager, leader and administrator. This growth is a crown to the nursing profession. Today’s nurses are working as independent nurse administrators, entrepreneurs, and owners oftheir firms. There are issues still affecting the function of a nurse manager. This topic deals with these issues and the ways to resolve the legal and ethical issues that affect the management process and the functioning of a nurse manager or leader. Nurse managers encounter a wide range of ethical problems related to patients, staff, the organisation and themselves.

4. However, little is known about the methods they use to try to solve these problems. Our goal is to fill this knowledge gap by investigating the ethical problems encountered by nurse managers, the frequency of use and usefulness of different methods to solve these problems, and the background factors associated with the use of the methods. When solving ethical problems, nurse managers use most frequently the same methods as a few decades ago. A more diverse range of methods would be helpful in ethical problem-solving. The use of outside experts, ethics literature and codes of ethics should be combined with ethical reasoning and decision-making to get new dimensions and outside knowledge

5. Nursing Management Nursing management is defined as the role of a nurse manager to control, coordinate, supervise, and lead the nurses under him/her to provide quality nursing care. Nursing Administration Nursing administration is a specialty in nursing that integrates nursing science, business, principles, organizational behaviour and resource management to prepare nurses to participate as full partners in managing and leading health care organization

6. Ethical and Legal Issues in Management Handling Conflicts among the Staff, between Staff and Management, and Vice Versa. The nurse administrator has to solve the issues according to the nursing ethical decision-making model. He/ she should not be favouring anybody and the solution given should be reasonable to both the parties at conflict. For example, there may be a conflict between sweepers and nurses. The sweeper may not clean the floors and toilets properly and may be negligent in work. The nurse may repeatedly warn the sweeper about his/her negligent action. If there is no change, the nurse may complain to the nurse administrator. The sweeper might have been active and good at work at the beginning but might have later on lost interest and hence neglected work. Conflicts can arise from any issue; the nurse administrator should be skillful in tackling the issues exhibiting the qualities of justice, veracity, and beneficence to the affected people in the conflicts.

7. 2. Whistle Blowing Issues : W histle-blowers are those who alert or disclose internal or external danger,malpractice , corruption, bribery, theft, fraud, negligence, resource wastage, misinterpretation, andsafety volition done by an employee or the authorities of management to the public and the Concerned authorities. Anyone can make mistakes, but we have to follow certain ethical principles to regulate the behaviour of the workers. The nursing activities of the nurses, especially the newly appointed ones, are evaluated, controlled and supervised to check their eligibility for being made permanent and for promotions. The employee will not know that he/she is being observed. The attitude, behaviour, approach, and working ability towards patient care will be evaluated by the nursing administrator who will then decide whether to continue with the staff or not. In whistle-blowing process, there will be an officer or administrator to evaluate the concerned staff every day.

8. 3 . Isues on Unethical Behaviour : Issues such as libel, slander, negligence, malpractice, ill-treating patients, theft, fraud work, bribery, wasting the hospital resource by staff, validating safety measures, misinterpretation of patient results are all important legal issues.

9. ETHICAL ISSUES IN PRACTICE The following are the ethical issues in nursing practice that result in conflict: Libel : This refers to the false and harmful written reports given by the nurse with an intention of hurting the colleague’s reputation in nursing practice. Slander : This is the false and harmful oral report about one nurse given by another nurse with an intention to hurt his/her reputation in nursing practice. Malpractice : This refers to the failure in performing professional duties or the lack of skill or practice that causes injury or harm to the client or patient. Negligence : This means failure of the nurse to administer or provide nursing care in the right time to the right patient at the right place; it is also called as carelessness. Bribery and Corruption : This refers to the act of violating the legal and medical laws towards the patient care, such as performing illegal abortion against the Medical Termination of Pregnancy ( MTP ) Act by an untrained nurse and getting some gift or money as bribe from the affected patient.

10. Forgery and Fraud : Getting the signature from the patient in the informed consent form is an important procedure. If the nurse signs instead of the patient or if he/she signs in the register for another nurse, it is called forgery or fraud. Theft or Stealing : It is quite common is hospitals to find that cotton, gauze, solution, unused sanitary pads, etc. disappear from patients’ side lockers; it can be taken by the sweepers, attenders, and even nurses. Misinterpretation : Healthcare providers such as nurses or co-workers should not confirm the diagnosis before the physician confirms and informs the patient, because misinterpretation of report results and diagnosis leads to conflicts in the health care system.

11. MORAL DECISION MAKING IN LEADERSHIP AND MANAGEMENT Decision-making is embedded in the concept of leadership, as those who have the authority and the ability to make informed, well-reasoned, and timely decisions are often viewed as leaders. It is a dynamic mechanism wherein ethical leaders influence ethical behavioral outcomes of group members. A leader that is a moral person must possess a moral identity that is more likely to integrate ethics into their decision-making process which produces ethical outcomes. A moral person is someone that is seen to be trustworthy, honest, and with integrity. Leaders shape organizations through the decisions they make. Therefore, an organization that aims to be ethical needs to have an ethical leader that makes ethical decisions. Moreover, leaders in an organization influence the way others make decisions. A moral person is a precondition to develop a moral manager. Moral managers influence members to behave in ethical ways to bring forth ethical organizational outcomes. Ethical outcomes have been found to enhance the performance of an organization.

12. PRINCIPLE OF MORAL DISCERNMENT Discernment is the ability to discern the moral good, discern a moral right from wrong, and must have the standard with measure or compare the good and bad thing. Moral discernment is defined as the moral convictions that determine one’s behavior and ultimately one’s life. A person having moral integrity can live with consistent convictions orbeliefs of themselves. This is where a person has the ability to discern what is morally right from wrong which requires moral reflectiveness on the meaning of good and bad. In addition, it is the ability to draw conclusions from the discernment to develop convictions.

13. PRINCIPLES UNDER MORAL DISCERNMENT Principle of Formal Cooperation According to St. Alphonsus Liguori (1787), this is defined as the participation of the agent in the activity of another agent to produce a particular effect or share in a joint activity. This occurs when someone intentionally helps another person carry out a sinful act. Explicit formal cooperation - occurs when someone wills the evil action of the principal. An example for this is: A doctor who openly encourages or recommends a direct action. Implicit formal cooperation – happens when a person, for the sake of a good aim, Establishes the structure by which a specifically described immoral action will take place, grants formal approval to an immoral action, or uses the principal agent’s evil action as the means for achieving some other good. An example for implicit formal cooperation is: W hen a doctor believes that a certain surgery is immoral, yet still performs it, he is participating in the action.

14. b . Principle of Material Cooperation In the Principle of Material Cooperation, the cooperator does not share the intention of the evil act but participates in some way. There are 2 types of Material cooperation which includes the Mediate Material Cooperation and Immediate Material Cooperation. Mediate Material Cooperation- Occurs when there is a degree of causal (not physical) separation between the action and the principal agent's moral act. The degree of causal distance may vary along a scale from proximate to remote. Immediate Material Cooperation- When the action is so intimately linked with the principal agent’s immoral act that they are nearly distinguishable. One cannot perform an immoral act without the cooperator .

15. c . Principle of Lesser Evil The principle that when faced with selecting from two immoral options, the one which is least immoral should be chosen. d . Principle of Double Effect It aims to provide specific guidelines for determining when it is morally permissible to perform an action in pursuit of a good end in full knowledge that the action will also bring about bad results. Example : A physician considers the possibility of relieving a terminally ill patient's pain. In order to do so, she would have to administer painkillers that could harm the patient or even shorten the patient's life. Hence, there is a moral dilemma of relieving pain (good) or causing harm ( bad ).

16. 2 . PRINCIPLE OF WELL-FORMED CONSCIENCE Conscience is a practical judgment of reason upon which an individual acts as either good and to be performed or as evil and to be avoided. It is our own understanding of what is good and evil, our judgment about how we should act, and our commitment to do so. It involves our moral principles and must be connected with reality and truth, which should not be based on mere will, desire or blind choices. In addition, conscience is an imperfect thing about human nature as it is based on human intellect thus, being prone to errors and misapprehensions.

17. The Principle of Well-Formed Conscience ● It indicates that people are obligated to inform themselves about ethical norms, incorporate that knowledge into their daily lives, act according to that knowledge, and take responsibility for those actions. ● Conscience judges a concrete act as good or evil in accord with a norm of morality given to it. This norm is NATURAL LAW. Well-Formed Conscience ● To attain the true goals of human life by responsible actions, in every free decision involving ethical questions, people are morally obliged to do the following: 1. Informed self as fully as practically possible about the facts and the ethical norms. 2. Form a morally certain judgment of conscience on the basis of the information. 3. Act according to this well-formed conscience; accept responsibility for his actions

18. Conscience Formation Our conscience is formed first through discerning what is right and wrong then, being able to diligently learn about the laws of moral life. Through this, an individual is able to examine one’s conscience and make moral decisions that demand mature responsibility. In addition, the conscience needed to be achieved should be free, correct, clear and certain. Moreover, we learn about what is a true and certain conscience regarding our own perception, understanding of natural law, traditional wisdom, what is taught at home, school and Church then lastly, would be our very own experience.

19. 3 . STRATEGIES OF MORAL DECISION MAKING PROCESS Moral decision making refers to the process of evaluating and choosing among alternatives in a manner consistent with ethical principles. In making moral decisions, it is necessary to perceive and eliminate unethical options and select the best ethical alternatives. Throughout our careers, clinical and administrative healthcare workers face moral dilemmas. It might be tied to a dilemma over withholding or withdrawing life-sustaining measures, or it could be related to a breach of patient confidentiality. Once the ethical issue has been resolved, when a problem is recognized, the difficulty is determining how healthcare professionals and other personnel engaged in the scenario should respond. Making moral judgments through a systematic method can improve the analysis that leads to a morally defensible response, reducing the likelihood of making hasty conclusions that lack careful deliberation and strong ethical reasoning.

20. Types of Moral Decision Making Process Strategies Standards-Based Model ● Determining primary dilemma – identify the dilemma by acquiring as much information as possible; describe facts, sorting away innuendos, assumptions, theories, or suspicions. ● Spell out ethical standards for response – autonomy, freedom, objectivity, privacy, beneficence, and loyalty are modern bioethical principles. These are tools for analyzing the character structure of the individual who benefits from the dilemma (Husted, 1995). ● Determine if there is a reason to deviate – consider implementing a standard or evaluation criterion to evaluate circumstances based on prevalent ethical ideas such as utilitarianism , rights , or justice . Determine which norm applies to the unique scenario and which criterion is more important to you in this case. ● Decide on a course of action – make a choice by choosing an action that is supported by all of the ethical theories or other criteria employed in the decision-making process.

21. II . Principles-Based Model Clarify ● Determine the dilemma ● Formulate alternatives ● Determine: What key ethical principles and values are involved. ● Recognize all the potential options for responding to the ethical question. This includes reviewing the ethical justification for each option Evaluate ● Is any ethical principle violated? – examine shared and conflicting values, duties, and interests in order to fully comprehend the complexities of the ethical situation; evaluate the moral principles of autonomy, nonmaleficence , beneficence, justice, and faithfulness. ● Distinguishing facts from beliefs, theories, opinions - information are vital because good ethics begins with excellent facts. Separate innuendos, assumptions, speculations, or suspicions from the facts. You can ask yourself many questions, such as: Is it an ethical, legal, professional, or clinical issue? Is it a combo of many of these? ● Consider the credibility of sources because this determines whether it is reliable or not. ● Weigh the benefits, burdens and risks

22. Decide ● Evaluate alternatives and determine consequences - Consider each alternative and the potential ramifications for all individuals involved, based on the information you have acquired. Consider the consequences of each option for the client, those who will be impacted, and yourself as a professional. Remove the alternatives that plainly do not provide the intended outcomes or have more significant repercussions. Examine the remaining possibilities to evaluate which option or combination of options best suits the scenario and satisfies your priorities. ● Prioritize ethical principles/values. ● Consider the worst case scenario. ● Apply principles

23. Implement ● The decision maker , ust take action after choosing the best alternative to maximize benefits and minimize costs and risks. Monitor and modify ● As new information emerges the decision maker should reflect, debrief and obtain feedback on the ethical decision and action that was taken. ● Consider organizing a follow-up debriefing and continuing session and/or planning changes to related policies and procedures

24. II . Virtues-Based Model According to Scott G.G, using virtue-based ethical reasoning to make decisions would do so based on the kind of person s/he is or how s/he thinks of him or herself. While the decision-maker may wish to consult the organization's rules or code of ethics, or weigh the costs and advantages of a certain action, he or she will also want to make a decision that is consistent with his or her conscience or feeling of behaving with integrity. In doing so, he or she would want to do what appears to be the "correct" thing to do given the circumstances. ● Virtue ethics asks of any action: ➢ What kind of person will I become if I do this? ➢ Is this action consistent with my acting at my best ● Use virtues in considering options o Virtues : ● Autonomy: right to noninterference , self determination ● Beneficence: mercy, kindness, charity to others ● Empathy: experience the experience of others ● Fidelity: faithfulness to duties or obligations (competence) ● Justice: benefits, risks, costs distributed fairly ● Universability : all moral principles/judgements have universal applicability

25. IV . Moral Reasoning-Based Model Moral intensity is a concept that refers to issues based on their perceived moral importance. Individuals' perceptions of moral intensity should influence their awareness of situations that pose moral dilemmas, as well as their ethical judgements and behavioral intentions toward those concerns (Barnett, 2001). ● Recognize the moral issue. ● Make a judgment – Emotions should not be detached while making moral judgments since sympathy, compassion, kindness, and other emotions can play a crucial role in balancing opposing moral principles or adopting our guiding ideals. ● Establish intent. Moral intent is the desire to act ethically when facing a decision and overcome the rationalization to not be ethical. o Individual and situational variables o Factors of opportunity and significant others

26. ● Moral intensity ( effect of decision on others ): Concentration of effect (individual or group) – when an impact of an act is felt by an individual or a group, it is predicted to affect the perceived ethicality of a situation. Probability of effect (likelihood of harm) – the likelihood of an act will cause harm. The more likely an act is to cause harm, the greater the propensity of an individual to view the act as unethical. Proximity (closeness to the issue) – degree of nearness or closeness that the decision maker has for those affected by the issue or action in question. Social consensus (agreement with the society) – degree of social agreement that a proposed act is evil or good. Temporal immediacy (closeness in time) – length of time between the present and the onset of consequences of the moral act in question. Magnitude of consequence (impact) – the level of pain a certain action is likely to inflict on its targets; the more dire the repercussions of a given action, the higher its moral intensity

27. ● Act – implement the moral decisions established V. Practice-Based Model ● Recognize problems, get facts. ● Assess values, benefits, burdens – examine the shared and competing values, obligations and interest of the many stakeholders in order to fully understand the complexity of the ethical problem. ● Determine legal, social influences – law impacts morality by modifying how a person feels they and others "ought" to behave or think; evaluate applicable laws and professional standards; and weigh stakeholders' experience and judgment. ● Generate solutions, outcomes – recognize the probable responses to the ethical problem; identify all accessible solutions and assess the many options that may be adopted. ● Consult – seek advice from experienced professional colleagues and/or bosses. They may see other issues that are relevant or provide a perspective you have not considered as they review the information gathered. Supervisors may also identify aspects of the dilemma that you are not viewing objectively. Consulting professional associations can provide assistance with the dilemma.. ● Act, review, reflect – make a choice or choose a course of action that is supported by the criteria employed in the decision-making process; assess the chosen course of action to determine if it raises any new ethical concerns; consider if the actions had the expected impact and implications

28. Ethical Decision-making Before making decisions, a nurse has to analyze all the preliminaries, think systematically, and use a standard model developed by Thirona and Hallo Raw called as the MORAL model for ethical decision-making. The steps involved in MORAL decision-making are as follows: M : Identify the Members Involved in Ethical Dilemma. Identify the important members involved in a particular ethical dilemma, explain the issue clearly, sort out all the members and the entire health care team, and find what their role is in the particular dilemma. O : Outline or Delimit the Possible Options Clearly. Examine each and every option. Consider the realistic and less-conflicting options, and sort out the more-conflicting and less-realistic options. Listing out transparently gives an overall picture that helps in finding a good solution later

29. R : Resolve the Existing Dilemma. Since all the issues have been listed, apply the basic ethical principles to each issue listed and decide on the best options that resolve the issues. A : Act or Implement the Chosen Action. This is a difficult stage. Apply or implement the decided options. This involves actually resolving the issue and applying the solution for the issue. L: Look Back or Evaluate/Take up a Feedback. This is the most important step. Check whether the applied decision has achieved its goal or not. Evaluate the success of the decision-making by ensuring that the ethical dilemma is solved with the first option. If not, choose the second option. The process is repeated with all options until the issue is resolved

30. Role of Nurse in Ethical Dilemma Identify the Problem The nurse should make an effort to describe the issue clearly. At this point, turning into one's intuitions is helpful. What is it about the event that causes one to feel nervous? Sensitivity to the moral aspects of nursing is necessary to recognize an ethical issue. Poor planning or communication, for instance, could have unintended consequences but still not be considered an ethical issue.

31. Gather All Possible Information Knowledge of a patient's diagnosis and prognosis, what may have happened that brought on the problem, what information is already known, and what additional information is needed helps the nurse in organizing problem analysis. The questions that should be asked include those about the people involved in the situation and how they relate to one another. List Options The nurse makes a list of plausible options for action given the information she has gathered and describes the intended outcomes of each option. They consider the effects and potential benefits and disadvantages of each decision

32. Identify the Ethical Principles The nurse decides which ethical standards are conducted and the results of the problematic situation. Is a disagreement over principles or points of view at the core of the problem? Does the scenario seem to prioritize a particular professional objective or other aspects? The concepts of respect for person, autonomy, beneficence, normal efficiency, and fairness, as well as fundamental values, include health and personal freedom, including the elements that give a person's life quality and meaning, can all be helpful in situations where the ethical concerns are unclear. Make a Decision One rarely has time to analyze every aspect of an ethical challenge due to the time constraints on the majority of clinical choices. As a result, the nurse eventually decides after considering all the evidence.

33. Act The nurse takes the best course of action for resolving an ethical issue. Evaluate The nurse compares the actual results to the expected outcomes after implementing the decided action. The nurse will carry out the action plan if the objectives are met.