Introduction to community

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1. COMMUNITY HEALTH NURSING I UNIT I : INTRODUCTION TO COMMUNITY 1 MD DANISH RIZVI DEPT. COMMUNITY

2. 2 INTRODUCTION Human beings are social creatures. All of us, with rare exception, live out our lives in the company of other people. An Eskimo lives in a small, tightly knit community of close relatives; a rural Mexican may live in a small village with hardly more than 200 members. In contrast, someone from New York City might be a member of many overlapping communities, such as professional societies, a political party, a religious group, a cultural society, a neighbourhood, and the city itself. Even those who try to escape community membership always begin their lives in some type of group, and usually they continue to depend on groups for material and emotional support. Communities are an essential and permanent feature of the human experience.

3. 3 OBJECTIVES: In the end of this presentation the students will be able to: Define community, community health, community health nursing, urban & rural communities Discuss the concepts of health, wellness, illness and disease. Discuss the historical background of Community Health Nursing from Public Health Nursing. Enlist the essential functions of community health nursing. Discuss the roles of the Community Health Nurse in community settings.

4. 4 COMMUNITY a group of people living in the same place or having a particular characteristic in common. community refers to a collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging.

5. 5 Co n t… It can be a society of people holding common rights and privileges (e.g., citizens of a town), sharing common interests (e.g., a community of farmers), or living under the same laws and regulations (e.g., a prison community). The function of any community includes its members’ collective sense of belonging and their shared identity, values, norms, communication, and common interests and concerns (Anderson & McFarlane, 2004). Although most communities of people share many aspects of their experience, it is useful to identify three types of communities that have relevance to community health practice: geographic, common interest, and health problem or solution.

6. 6 COMMIUNITY HEALTH Com m unity He a l th i s a discipl i ne co n cer n ed with the study and improvement of the health di f fe r e n t c o mm u nitie s . t ends t o f ocus on c h aracte r istics Community geographical of health areas, and includes primary, secondary and tertiary healthcare.

7. 7 PUBLIC HEALTH P u blic health refers to all organized measures (whether public or private) to prevent disease, promote health , and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases. Public Health includes community health. Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals”.

8. 8 Co n t… It is concerned with threats to health based on population health analysis. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health services, environmental health, community health, behavioural health, health economics, public policy, insurance medicine and occupational health (respectively occupational medicine) are other important subfields. A CH service might be responsible for delivery of a range of interventions in a local community, while the PH Service might be involved at a policy level looking at quality of water, traffic calming, or budgets for drugs.

9. 9 COMMUNITY HEALTH NURSING Community health nursing is to “assist the Individual, family and community in attaining their highest level of holistic health. To provide and promote healthy life style choices through education, public awareness and community activities.”

10. 10 URBAN & RURAL COMMUNITIES Rural community is a society that is in a rural area ( country side ). An urban community is a society that is in an urban area ( town or city )

11. URBAN COMMUNITY An Urban Community is a big city or town. It is considered an Urban Community if there are more than 2,500 people living in the community. Urban communities are often busy and crowded. Normally, the city is the most central location in a region. It is also referred to as downtown. In an Urban Community there are many buildings, houses, and people. People often live close together. 11

12. RURAL COMMUNITY an area outside of cities and towns; According to the US Census Bureau, a rural community is one that does not qualify as an urban community. Specifically, if a territory has more than 2,500 people per square mile, it is defined as urban. Areas with less than 2,500 would then be considered rural. 12

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14. 14 H E A L TH “ a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” “World Health Organization” ILLNESS: A highly personal state in which the person feels unhealthy, may or may not related to disease.

15. 15 WELLNESS An integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable. OR progresses towards maximum a n acti v e pr o cess b y which a n i n d i vidual potential possible, regardless of current state of health

16. 16 Historical Development of Community Health Nursing The modern concept of community health and welfare is one which has taken many centuries to evolve. All ancient civilization particularly Egypt, India and China developed their own specific team of medicine.

17. 17 Historical Development of Community Health Nursing Egypt appeared to have been the first and the best in the field that had a fully developed medical system by 3000BC. China appeared around 450 BC. Indian system of medicine around 200BC

18. 18 In modern p e ri o d changes i n dev e l opment of medicine and public health under different stages. Empirical health era Basic science era Clinical science era Public health science era Political science era (1800-1850) (1850-1900) (1900-1950) (1950-1975) (1975-2000)

19. 19 Public Health Science Era (1950-1975) In this period preventive oriented approach started. Now it is being called an era of the community centered approach.

20. 20 Political Health Science Era (1975-2000) In this period the involvement of the community leaders and the members of the health program was practiced stage by stage.

21. 21 Early Home Care Stage (before mid 1800s) Focus: Sick poor Nursing orientation: individuals Service: curative Agencies: Lay & religious orders (St. Phoebe)

22. 22 District Nursing (mid 1800-1900s) Focus: Sick poor Nursing orientation: Individuals Service: Curative/preventative Agencies: Voluntary & some government (Willium Rathbone)

23. 23 Public Health Nursing (1900-1970) Focus: needy public Nursing orientation: families Service: Curative/preventative. Iv. Agencies: Voluntary & some voluntary (Lilliam Wald )

24. 24 Community Health Nursing (1970 to present) Focus: total community Nursing orientation: population Service: health promotion, illness prevention Agencies: many kinds, some independent practice (Ruth Freedman)

25. 25 Development of public health in indo-Pakistan 1802- Vaccination started 1827- Vaccinators appointed 1875- Superintendent- general of vaccination Punjab 1880- Small pox vaccination Vs small pox inoculation (injection)

26. 26 Development of public health in indo-Pakistan 1859- Royal commission focus curative care but formation of local bodies 1888 looks after senators 1896- Plague 1904- Plague commission-strengthen PH services 1919- Reforms (improvement) government of India health transferred to provinces

27. 27 Development of public health in indo-Pakistan 1946- Bhore committee-health survey → Health as basic human right → Preventive importance → Health care accessible → Community participation → Development of primary and secondary unit

28. 28 Development of public health in Pakistan Starting with Bhore report- poor condition 1947-1951 1958 -start with five years plans, opening of medical and nursing school, laboratory of medications. -revolutionary (new) government of Pakistan focused as preventive health was linked with Socio- economical care. - Many vertical programs existed.

29. 29 Development of public health Pakistan 1978- HFA-2000 basic health science, PHC, RHC, - Increase horizontal program -School health, training, and other activities took birth, health care workers

30. 30 Communities: Essential Functions Production, distribution or consumption of items Socialization Transmission of culture Provision of norms/social controls Provision of mutual respect

31. Communities: Four Critical Attributes Group orientation Bond among individuals Human interaction Collective action 31

32. Role of community Health nurses 32

33. 33 General roles Co n t… Clinician/Care provider (Functional role) In community health practice, providing nursing care is different than in hospitals. This is because the target of service expands beyond the individual to include families, groups, and communities.

34. 34 Functional role: Case finding and referral of needed cases. Complete history taken about each individual. Assist in any examination done. Know the first aid measures to implement it in emergency. Know the health services available in the community and use the system of referral when needed.

35. 35 Co n t.. Community health nurse provides care in following forms: Provide Geriatric care Provide antenatal and post natal care Provide Neonatal care Conduct the deliveries in the communities

36. 36 Ge n e r al r ol e C o n t… Provide formal exercises to the bed ridden individuals having paralysis Provides the first aid Provide nursing procedures like cold sponging if fever is observed in any member of family in community Wound dressing Treats minor illnesses

37. 37 Educator: Health teaching is part of good nursing care and one of the major functions of the community health nurse, mainly concerned with health promotion.

38. 38 E du c a t o r r ol e Co n t… As educator, community health nurse focus on the following teaching: Educates individuals, family and community for the principles and techniques of proper prevention of communicable diseases

39. 39 Healt h edu c a t o r Co n t… She teaches about the proper diet in quantity and quality Teaches the personal, family and community hygiene Teaches the handling of first aid techniques for emergencies like snake bite Trains the traditional birth Attendants for normal delivery and delivery in communities.

40. 40 Manager role Co n t… Organizes and manages various programs of health and assume leadership of nursing team for supervision of nursing and other staff. To manage resources for health programs and implement them effectively in the community. FIN A NC I NG STAFFING

41. 41 Role conti…. Leader Community health work in the community Guide them towards better health as leader. Researcher The researcher's role is an integral part of the community health nursing practice. The researcher's role at all levels helps to determine needs, evaluate effectiveness of care and develop theoretical basis for community health nursing.

42. 42 Role in research and evaluation: Help in evaluating the health program. Must have knowledge about how to keep records related to the people who utilize the clinic. She must complete the questionnaire for purpose of accurate study. Analysis and evaluation of nursing practices to fulfill the statistical survey.

43. 43 THE ROLE OF THE COMMUNITY HEALTH NURSE IN THE CLINIC: Administrative role: Participate in the organization of health program in the institution. Delegation of work. Plan of work hours. Cooperation with other health members. Systematic gathering of information for evaluation.

44. 44 Supervisory role: Understanding the policy of her agent. Supervise the function of her staff. Give in-service education program to the other health team. Guides group discussion with staff. Guides her staff to overcome their difficulties in work.

45. 45 Advocate: To speak in the community. She participates the district Govt meeting and talks to administration for the favor of talks for solution of health care, social and financial problems available in her constituency .

46. 46 APPLYING THE ROLE OF COMMUNITY HEALTH NURSE ACCORDING TO NURSING PROCESS ( role in home visit ) 1 . Assessment: Identifying the needs of the family before making the visit. By analyzing data available in the family records, know all family members; whether there are any children, if so, what are their ages; what the health problems of this family are; the environment of the house. Then actual visit.

47. 47 2. Planning: Planning can be short term or long term, and interventions can be implemented immediately over a long period of time. Short term plans are those which can be met in a few weeks time whereas long term plans are accomplished over many weeks or perhaps months or years.

48. 48 In planning, the following are done : Setting the goal / objectives for the visit. Identifying the needs and health problems of the family. Specifying the actions to be carried out by the nurse during the home visit e.g. health teaching about nutrition, Select proper place and time for carrying the visit. Prepare necessary equipment, instruments and material which the nurse will need during the home visit i.e. cotton, eye drops, etc.

49. 49 3. Implementation: During the home visit, the nurse should: Identify the traditions & customs and healthful practices of the family. Use effective therapeutic communication. Use audiovisual materials in teaching, also available home utensils and materials. Emphasize to the family that this visit was made for them.

50. 50 Cont…. Tie the family with the center. Explain services offered. An s wer qu e stions r o se f r om f amily members clearly. Do not record any wo r d said b y f a mily members in front of them. 4. Evaluation: Evaluate whether the objectives were fulfilled or not. If not, should know the reasons and correct it.

51. 51 References Sarah Coulter Danner.community helth.4 th Ed. Department of Nursing Oglala Lakota College Japee tapa.Community health nursing.3 rd Ed.1998 New Dehli,india.

52. 52 QU E S TIONS ? ? THANK YOU