COMMUNITY HEALTH NURSING ALL TOPIC

The Universal Declaration of Human Rights “Everyone has the right to a standard
living adequate for the health and well-being of himself and his family, including
food, clothing, housing, and medical care.”
Universal Declaration of Human Rights, 1948

Historical Development of Term

Public Health: Developed as a discipline in the mid-19th century in
UK, Europe, and the US and concerned more with national issues.
Data and evidence to support action, focus on populations, social
justice, and equity, emphasis on prevention or cure.

Global Health: More recent in its origin and signifies a greater

scope of health problems and solutions, that *transcend national
boundaries
*Requiring a greater inter-disciplinary approach.

Definition
What is global health?
These are Health problems, issues, and concerns that transcend
national boundaries, which may be influenced by circumstances
or experiences in other countries, and which are best addressed
by cooperative actions and solutions
(Institute Of Medicine, USA- 1997)
Definition
International Health: Developed during past decades, it came
to be more concerned with
the diseases (e.g. tropical diseases) and conditions (war, natural
disasters) of middle and low-income countries.
Tended to denote a one-way flow of ‘good ideas’.

Examples

 Examples include infectious diseases

 (COVIT-19), SARS, TB, avian influenza, malaria,)
 Noninfectious diseases
 (diabetes mellitus, tobacco-related diseases)

 Other health risks

 (global warming, conflict, nuclear power) etc.

Global Health Issues: Refers to any health issue that concerns

many countries or is affected by transnational determinants such
as:
Climate change
 Urbanization
 Malnutrition – under or overnutrition

Or solutions such as:

 Polio eradication
 Containment of avian influenza
 Approaches to tobacco control.

*Key Concepts in Relation to Global Health

1. The determinants of health
2. The measurement of health status
3. The importance of culture to health
4. The global burden of disease
5. The key risk factors for various health problems
6. The organization and function of health systems

Determinants of Health
1. Genetic makeup
2. Age
3.  Gender
4.  Lifestyle choices
5.  Community influences
6.  Income status
7. Geographical location
8. Culture
9. Environmental factors
10. Work conditions
11. Education
12 .Access to health
Source: Dahlgren G. and Whitehead M. 1991
services

Determinants of Health
PLUS MORE GENERAL
FACTORS SUCH AS:
 Political stability
 Civil rights
 Environmental
degradation
 Population
growth/pressure
 Urbanization
 Development of
country of residence

2. The Measurement of Health Status I

 Cause of death: Obtained from death certification but limited
because of incomplete coverage.
Life expectancy at birth: The average number of years a
newborn baby could expect to live if current trends in mortality
were to continue for the rest of the newborn's life.
 Maternal mortality rate: The number of women who die
because of childbirth and pregnancy-related complications per
100,000 live births in a given year.

2. The Measurement of Health Status I

Infant mortality rate

 The number of deaths in infants under 1 year per 1,000 live
births for a given year

 Neonatal mortality rate

 The number of deaths among infants under 28 days in a given
year per 1,000 live births in that year

 Child mortality rate

 The probability that a new-born will die before reaching the
age of five years, expressed as a number per 1,000 live births
This improvement in life expectancy has been achieved due to
improved prevention, information sharing, and global health.
2. The Measurement of Health Status I
High
Fertility/High
Mortality

What are some educational information we can give to this

group(developing country in this graph)
1. 1. Family planning methods and contraception options
2. 2. Maternal and child health, including prenatal care and
immunizations
3. 3. Nutrition and healthy eating habits
4. 4. Hygiene practices and sanitation
5. 5. Sexual and reproductive health education
6. 6. Prevention and management of common diseases, like
malaria or diarrhea
7. 7. First aid and basic emergency care
8. 8. Mental health awareness and stress management
9. 9. Health promotion and disease prevention strategies
10. Access to healthcare services and resources
These topics can help improve health outcomes and empower
individuals and communities to make informed decisions about
their well-being and to increase their population.
Declining
Mortality/High fertilty

What are some educational information we can give to this group

(underdeveloped country in this graph)
1. Family planning methods and contraception options
2. Maternal and child health, including prenatal care and
immunizations
3. Nutrition and healthy eating habits for mothers and children
4. Hygiene practices and sanitation to prevent diseases
5. Sexual and reproductive health education for both men and
women
6. Access to quality healthcare services, including antenatal and
postnatal care
7. Importance of spacing pregnancies for the health of both
mother and child
8. Child mortality prevention strategies, such as vaccination
campaigns and proper nutrition
9. Promoting gender equality and empowering women to make
informed decisions about their reproductive health
10. Collaboration with local communities to raise awareness and
implement effective public health policies.
Reduced
Fertility/Reduced
Mortality

developed countries, education still plays a crucial role in

promoting health and well-being. Here are some educational
topics that are relevant for addressing health issues in developed
countries:

1. Mental health awareness and destigmatization: Educating the

public about mental health conditions, promoting self-care
strategies, and encouraging help-seeking behaviors.

2. Healthy lifestyle choices: Providing information on nutrition,

exercise, and stress management to promote overall well-being
and prevent chronic diseases.

3. Sexual education and reproductive health: Offering

comprehensive sex education to empower individuals to make
informed decisions about their sexual health and relationships.

4. Substance abuse prevention: Educating about the risks of

substance abuse, promoting responsible alcohol consumption,
and providing resources for addiction treatment.
5. Health literacy: Enhancing individuals' understanding of
medical information, enabling them to make informed decisions
about their health and healthcare.

6. Environmental sustainability: Educating about the importance

of sustainable practices, such as recycling, reducing waste, and
conserving energy, to protect the environment and combat
climate change.

7. Health equity and social determinants of health: Raising

awareness about the impact of social factors, such as income,
education, and access to healthcare, on health outcomes, and
advocating for equitable healthcare systems.

Remember, education is a lifelong process, and there are always

opportunities to learn and improve our health and well-being. Let
me know if you'd like more information on any specific to

HEALTH PATTERNS IN
RESOURCE-POOR COUNTRIES
Infectious/communicable diseases prevalent:
 Vaccine-preventable diseases, e.g. Measles
 Acute respiratory infections (ARI)  Diarrheal diseases
(cholera)
 Malaria
 Tb
 Hepatitis  HIV/aids

PLUS:
 Malnutrition-related conditions: - Micro-nutrient deficiencies
 Trauma/accidents
 Many of these diseases are treatable.

HEALTH PATTERNS IN RESOURCE RICH COUNTRIES

 Lifestyle factors affecting physical and mental
health:
 Smoking – one third of cancer deaths related
to smoking
 Drinking
 Healthy eating/nutrition
 Physical activity
 Substance abuse
HEALTH PATTERNS IN RESOURCE-RICH
COUNTRIES

 NON-COMMUNICABLE DISEASES PREVALENT:

 Causes of death (all ages):
 40% Circulatory diseases, e.g. heart disease, strokes, etc.
 25% Cancers
 16% of Respiratory diseases
 5% Injuries and Poisonings
 0.6% Infectious diseases

 Premature mortality (<65):

 25% Circulatory diseases
 33% Cancers
 16% Injuries (RTAs/Suicides) and Poisonings
 1% Infectious diseases

Key Risk Factors for Various Health

Conditions
 Tobacco use –
 related to the top ten causes of mortality worldwide.
 Poor sanitation and access to clean water-
 related to high levels of diarrhea/waterborne diseases.
 Low condom use –
 HIV/AIDS, sexually transmitted infections
Malnutrition –
 Undernutrition (increased susceptibility to infectious diseases)
and over-nutrition are responsible for cardiovascular diseases,
cancers, obesity, etc.

What are some of the most important problems in global

health today?
“The Global Burden of Disease”, presented data from 1990 with
data projections out to 2020 for three broad cause groups of
health problems that, collectively, constitute the world's total
disease burden.
These are:
Group 1, communicable, maternal, perinatal and nutritional
conditions;
Group 2, noncommunicable diseases; and
Group 3, injuries.

In addition to different diseases, we will argue that one of the

biggest challenges to global health.
access to information
Problem: Information sharing: An important challenge to
global health in the 21st century
Potential Solution: WWW

Smallpox vaccination: the case of global health efforts in disease

eradication
The history of the rise and fall of smallpox is a success story for
"modern“ clinicians and public health alike.
 Millions of people died in Europe and Mexico as a result of
widespread smallpox epidemics.
 The fall of smallpox began with the realization that survivors of
the disease were immune for the rest of their lives.
 This led to the practice of variolation - a process of exposing a
healthy person to infected material from a person with Smallpox
in the hopes of producing a mild disease that provided immunity
from further infection.

The next step towards the eradication of smallpox occurred.

with the observation by English physician, Edward Jenner, that
milkmaids who developed cowpox, a less serious disease, did
not develop the deadly smallpox.

 In 1796, Jenner took the fluid from a cowpox pustule on a

dairymaid's hand and inoculated an 8-year-old boy.

 Six weeks later, he exposed the boy to smallpox, and the boy
did not develop any symptoms. Jenner coined the term
"vaccine" from the word "vaca" which means "cow" in Latin.
Cholera 1800s

Cholera: the Disease

 Entry: oral
 Colonization: small
intestine
 Symptoms: nausea,
diarrhea, muscle cramps,
shock

 Infants with cholera

John Snow and the Pump Handle

John Snow is credited by many with developing the modern
field of
epidemiology

John Snow and cholera in 1854 London

John Snow’s Observations

People with cholera develop immediate digestive problems:
cramps, vomiting, diarrhea
Face, feet, hands shriveled and turned blue; died in less than a
day
Probably spread by vomiting and diarrhea
Comparison of pump location with cholera deaths, first 3 days of
epidemic in 1854

London in the 1850’s

Germ theory of disease not widely accepted.
 People lived in very crowded conditions with water and privies in
yard
 (NY 1864: 900 people in 2 buildings pump a block away, privy in
yard)

Snow Index Case


The index case is the first person to become ill 40 Broad Street –
husband and infant child became ill Wife-soaked diapers in pail
and emptied pail into cistern next to pump

New outbreak
Vibrio cholerae
NEW TOPIC: Working
with Families: Applying the
Nursing Process
What is Family?
- A family refers to a group of individuals whose behaviors,
actions, health conditions, and interrelationships impact the
health of the group and the individuals.
What is community?
-A community relates to a set of people in families that
share a common purpose
with a sense of belonging and place (ANA, 2013).
What is the population?
-A population encompasses the total number of persons in
families within communities at a specific geographic
location (ANA, 2013).

Relationship between Family, Community and

Health.
  ● Family is the basic element of a community
and a population.
 ● With this premise in mind, it is important for
families to have equal access to optimal health
care, social services, and community resources in
a supportive and healthy environment.
 ● Maintaining the health of the family is a way to
influence the health and wellness of the
population.
 WORKING WITH FAMILIES IN THE COMMUNITY. ommunity Settings
1. Family visits can take place in various non-home settings such as schools,
workplaces, daycares, senior centers, group homes, or recreational settings.

2. The nurse should ensure that the family feels comfortable with the visit
and understands its purpose in strengthening community resources.

3. Respect and comply with the family member's preferences when

scheduling visits in public places like schools or workplaces.

4. Maintain confidentiality during visits, finding a private location where

others cannot overhear conversations, especially in public settings such as
workplaces or schools.

Advantages of Family visits that can occur in non-home settings.

1. Visiting a family member outside or in a community setting can help

assess their ability to function in public places.
 2. It can help strengthen nurse and client relationship.
3. It can help assess the client ability to manage, participate, and
interact in a frequently visited public place.
4. It can give insight into health problems and emotional issues.

Home Visit;

A home refers to a place that is either a permanent or

temporary residence where an individual eats meal,
interacts with others, rests her or his body, and engages in
recreational activities.

Visiting families in their homes or private spaces and

collaborating with their neighbors within the community is a
privilege, and the cornerstone of this privilege is trust. For
family members to welcome a stranger, particularly a
representative of a governmental agency, into their home, a
level of trust must be established.

Skills Used During Home Visits

Acute Observational Skills;

This refer to the ability to take note of every detail (physical and
nonphysical) Acute observational skills is used to assess both the family
and the environment, which are equally important for a detailed assessment

Observation of Home Environmental Conditions Skill; This skill can

asses the conditions in the neighborhood and home environments reveal
important information that can guide diagnosing, planning, and intervention
with families.

Observation of Body Language and Other Nonverbal Cues skill;

 ● Be observant of family’s nonverbal cues such as body language and

demeanor because they can provide information that must not be
overlooked.
 ● Opening statements such as,
o ○ “You seem anxious today,” or
o ○ “Did I come at a bad time?
o ○ You seem distracted,” will encourage family members to
express what is on their minds.
Components of the Family Health Visit

Previsit Preparation;Here the nurses prepare visitation plans and what

they will do

Making the Visit; Here Aim is to Engage the family in a manner to

build a supportive and trusting relationship.

Concluding and Documenting the Visit; This shows respect for the
family's time, ability to be efficient, and professionalism. It is also
safer to expose the contents of the car at the end of the visit, as it
gives clues about what is stored in the trunk. Documentation or
charting of each home visit used to be completed as soon as the
nurse returned to the agency, but now it is encouraged at the end.

Focus of Family Health Visits 2/2

 - Family Promotion and Illness Prevention;

 - Teaching people how to prevent illness and how to remain healthy is
basic to public

health nursing.

 - Public health nursing is basically essential for teaching people how

to prevent illness and how to remain healthy.
 - Health promotion activities include screening for hypertension and
elevated cholesterol, performing a physical assessment, and teaching
about nutrition and safety.
 - Immunizations are recommended for all populations, regardless of
age, income, culture, or nation of origin.
 - Public health nurses' role and commitment to health promotion is
informed by the broader context of the community and/or the
population.
 - Health promotion and/or illness prevention activities can occur
during a family


HEALTH VISIT OR AT A FAMILY MEMBER'S HOME

AWAY FROM HOME.

1. Before making home visits, home

healthcare workers should secure all
 purses and wallets at the Agency. If you
must take a purse or wallet, lock it in the
trunk of the car before entering the
patient’s home.
2. Always have detailed directions to get to
the patient’s home. Always know exactly
where you are going.
3. Alert the patient/family of the time of
your arrival so that they are watching
and waiting for you.
4. If making an evening or night visit, park
in a well-lit, easily accessible, and safe
area. 4/4
5. For the hours you are going to be staying, You can share
your location to a college nearby.
6. Always make sure your phone is nearby
7. You must carry a hand-held alarm regardless of the
patient or neighborhood
safety rating.
8. Do not attempt to break up domestic arguments. 9.
ALWAYS TRUST YOUR INSTINCTS.
Threats to personal safety can happen anytime, anywhere -
even if the neighborhood or person’s home does not fit the
profile of an unsafe environment.
Guidelines for Family Health Assessment 2/2

1. Focus on the family as a total unit.

2. Ask goal-directed questions.
3. Collect data over time.
4. Combine quantitative and qualitative data. 5. Exercise professional
judgment.

Using the Nursing Process 2/2

On subsequent visits, the nurse and the family work collectively on

actions and activities to reach the goals.
To determine the family’s health by using the nursing process in a
systematic way, three tools are needed:

(1) a conceptual framework on which to base the process, (2) a clearly

defined set of data collection categories, and (3) a method of measuring a
family’s functional level.

six signs of a healthy family 1/2

1. A facilitative process of interaction exists among family members.

2. Individual member development is enhanced.

3. Role relationships are structured effectively.

six signs of a healthy family 2/2

5. Active attempts are made to cope with problems.

5. There is a healthy home environment and lifestyle.
6. Regular links with the broader community are established.
 FIVE PRINCIPLE GUIDE TO ENHANCE PUBLIC HEALTH NURSING

PRACTICE.: alth nursing practice: 1/2

1. Work with the family collectively.
2. Start at the family’s present level of functioning.

3. Adapt nursing interventions to the family’s stage of development.

4. Recognize the validity of family structural variations.

5. Emphasize family strengths.

SUMMARY n Summary

 ● The family unit is the focus of public health

nursing, and family health affects community
health.
 ● It is important for the public health nurse to
understand healthy family characteristics and use
a variety of tools to assess the health of families.
 ● The six characteristics of a healthy family
provide one assessment framework that public
health nurses can use.
 ● Assessment tools include the eco-map and
genogram.
Cont.
– Public health nurses should focus on the family as a
total unit, ask goal- directed questions, collect data
over time, combine quantitative with qualitative data,
and exercise professional judgment.

 ● Making family health visits is a unique role for

nurses and is one of the activities common to
most public health nurses.
 ● They must use acute observational skills, good
verbal and nonverbal communication, assessment
skills, and their intuition to guide them safely in
the community and with the families they visit.
 ● Previsit preparation, conduct of the visit, and
postvisit documentation are the main
components of a family health visit.
 ● Safety is important for all people, and use of a
personal or agency car, public transportation, or
walking to visit families is important.
 ● If family members are arguing or under the
influence of drugs or alcohol, it is best to
terminate the visit.