Post on 06-May-2015
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According to American Nursing
Association,“Community health nursing is a synthesis of nursing practice
and public health practice applied in promoting and preserving the health of populations. the nature of this practice is general
and comprehensive. it is not limited to a particular age or diagnostic group. It is continuous and not episodic. The dominant responsibility is to the population as a whole”
Definition
Therefore Nursing directed to individuals, families or groups contributes to the health of the total population. Health promotion, health maintenance, health education, coordination and continuity of care are utilized in a holistic approach to the management of the individual, family group and community. The nurse’s actions acknowledge the need for comprehensive health planning, recognize the influences of social and ecological issues, give attention to populations at risk and utilize dynamic forces which influence change.
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Philosophy of CHN
Philosophy of individual’s right of being
healthy
Philosophy of working together under a
competent leader for the common good.
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Philosophy of CHN
Philosophy that people in the community
have the potential for continual
development and are capable of dealing
with their own problems if educated and
helped.
Philosophy of Socialism.
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Aims of CHN
Aims:
The aim of community health nursing practice is to promote health and efficiency
To prevent and control diseases and disabilities.
To prolong life by providing need based, well balanced comprehensive health care services to community at large through organized community efforts.
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Objectives
1) To increase the capability of community to deal
with their own health problems.
2) To strengthen community resources
3) To control and counteract environment
4) To prevent and control communicable and non-
communicable diseases
5) To provide specialised services
6) To conduct research
7) To prepare health personnel
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Principles of CHN
1)Recognized needs and functioning within the total health programme.
2)Clearly defined objectives and purposes for it’s services
3)An active organized citizens group of the community group is an integral part of the community health programme.
4)Community health nursing services are available to the entire community
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Principles of CHN
5)Community health nursing recognized the family and community as units of service.
6)Health education and counseling for the individual, family and community are the integral part of community health nursing.
7)Participation in planning relating to goals for the attainment of health.
8)The community health nurse should qualify as a full-fledged nurse.
9)Based on the needs of the patient and there should be proper continuity of services to patients.
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Principles of CHN
10) Periodic and continuous appraisal and evaluation of health situation
11) The community health nurse should function/serve as an important member of the health team.
12)There should be provision for qualified nurse to make supervision for community health services.
13)The community health nurse directs the patient to appropriate community resources for necessary financial and social assistance.
14)Should not accept gifts or bribes from the patients
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Principles of CHN
15)The community health nurse should not belong to one particular section or political group.
16)Community health agency should provide a continuing education programme for nurse
17)The nurses assume responsibilities of their own continuing professional development through acquiring higher and higher education and forming and strengthening the professional associations
18)The community health nursing services should develop proper guidelines, in maintaining records and reports.
19)There should be proper facilities and job conditions.
20)The community health nurse should maintain professional relationship with all leaders in the community and maintain ethics at all times.
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Quality assurance in CHN
Define quality assurance
Quality assurance can be defined as ”the
promise or guarantee that certain standards of
excellence are being met in care delivered.”
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Goals of quality assurance
To ensure the delivery of quality client
care.
To demonstrate the efforts of the health
care provider for the best possible
result.
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Two Approaches of Quality
assurance
General Approach
Specific Approach
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General Approach
Licensure
Accreditation
Certification
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Specific Approaches
1)Staff review committees(Peer review)
2)Utilization review committees
3)Research studies
4)Client satisfaction surveys
5)Malpractice litigation
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Model quality assurance
Programme
Purpose:
The primary purpose of a quality
assurance
programme is to ensure the results of an
organized activity are consistent with
Expectations.
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Steps in Model Quality Assurance
1)identify the sources needed
2)Describe the nature of the personnel
required to handle resources, supplies,
equipments, facilities and finance.
3)Once the resources are identified, then
policies, procedures, job descriptions
should be clearly laid down for use.
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Process
The primary approach used for process
evaluation includes the peer group
committee and the client satisfaction
survey.
Technique used for process evaluation
is direct observation, questionnaire,
interview, written audit and videotape of
client and provider.
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Outcome
For the purpose of evaluation the nurse
uses client’s admission data, acuity of the
problem and discharge data that may point
out changes in the level of dependence
and activity.
Direct physical examination and interview
will help a lot measure the outcome.
This will help one to identify the causes
and problems associated with health care.
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Evaluation, Interpretation and
Action
Interpretation is one of the major components of quality assurance
Evaluation of the process should be carried out at major intervals and periodic reports should be prepared.
Action is the final step in quality assurance model.
The action must be based upon their significance, economic benefits and timeliness.
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Health provider evaluation
It is essential to determine the individual
service provider’s contribution to the quality
assurance programme .
Punctuality and performance are needed to
evaluate the individual based on traditional
trait ratings.
Objective oriented action tools are developed
in consultation with supervisor and the nurse.
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Nursing Audit
Staff review committees are the most
common review committees designed to
assess the clent-specific aspects of
certain levels of care.
The audit is the major tool used to
ascertain the quality of care:
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Process of Nursing Audit
Selection of a topic for study.
Selection of a explicit criteria for quality care.
Review of records whether criteria are met.
Peer review of all the cases that do not meet the criteria.
Specific recommendations to correct the problems.
Follow-up to determine whether problems have been eliminated.
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Types of Nursing Audit
1)Concurrent Audit
2)Retrospective Audit
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Concurrent Audit
Concurrent audit is used by Medicare and
Medicaid to evaluate care being received
by public health/home health clients.
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Advantages
Identification of the problems.
Provision of a mechanism for identifying
and meeting client needs during care.
Implementation of measures to fulfill
professional responsibilities.
Provision of a mechanism for
communicating on behalf of the client.
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Disadvantages
1) Time consuming
2) Less cost efficient than retrospective Audit.
3)It does’t represent the total picture of the
care that the client will ultimately will
receive.
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Retrospective Audit
Retrospective audit or outcome audit
evaluates
the quality of care through appraisal of the
nursing process after the client’s discharge
from
the health care system.
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Advantages
1) Comparison of actual practice to
standard of care
2) Analysis of actual practice findings
3) A total picture of the care given.
4) More accurate date for planning
corrective action.
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Disadvantages
1) Focus of evaluation is directed away from
ongoing care.
2) Client problems are identified after
discharge,
so corrective action can be only used to
improve
the care of the future.
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Community Nursing Theories
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Precede ModelThe model PRECEDE is an acronym for
predisposing, reinforcing and enabling causes in
educational diagnosis and evaluation.
Two basic propositions underscore the outcome
oriented PRECEDE model.1)Health and health behaviours
are caused by
multiple factors.
2)Health education designed to influence the
behavior must be multi-dimensional.
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Health Belief Model
It has 3 major components:
1)Individual Perception
2)Modifying Factors
3)Variables affecting the likelihood of initiating
action.
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Contributory factors in Health Belief Model
Age
Sex
Race
Ethnicity
Personality
Social class
Pressure
Reference group
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Health promotion model
Pender (1987) developed this model to be used
as a complement to health protecting models
like Health Belief Model.
Determinants of health promotion behavior are
organized into:
Cognitive-Perceptual factors
They include factors like:
Importance of health
Perceived self-efficacy
Definition of health
Barriers to health-promoting behavior.
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CONCEPTUAL MODELS
A conceptual framework refers to global ides
about individuals, groups, situations and
events
of interest to a discipline. A conceptual model
provides a reference platform for members of
a
discipline to guide their thinking, observation
and interpretation.
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Models applicable in CHN
1) System model
2)Developmental Model
3)Interaction Model
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System Model
It is postulated by Von Bertalanffy(1952)
It focuses on the organization,
interaction, interdependency and
integration of parts and elements.
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Characteristics-System Model
Wholeness
Organisation
Openness
Boundary
Entropy
Feedback
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Application to Community Health Nursing
The community is a social system made
of interrelated subsystems.
The subsystems include economic,
educational, religious, health care,
political, welfare. law enforcement,
energy and recreational systems
They are interrelated and have a
specific orientation towards each other.
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Developmental Model
It is a way of thinking how changes occur based on theories of development of the human organization.
According to Lewis,the change may be both reactive and structural.
The reactive theory emphasizes the influence of environment in development programmes,and the structural theory emphasizes the genetically determined programme for development
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Application to CHN
It is useful in working with infants and
children,because the major role of a
nurse working with them is to assess the
developmental progress and to promote
overall growth and development.
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Interaction Model
These models are based upon theories that
stem from philosophical writings such as those
of Cooley(1969) and Mead(1934).
The major concepts used in interaction models
are communication, perception, role playing
and self conception.
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Application to CHN
Communication
Self-Conception
Perception
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Bibliography
Lucita M. Public health and community health nursing in the new millennium. 1st
ed. Chennai: B.I Publications Private Limited; 2006. p.88-93,136-43.
Gulani KK.Community health nursing: principles and practices. 1st ed. Delhi: Kumar Publishing House; 2008.p.33-46.
Stanhope M,Lancaste J. Community Health Nursing:promoting health of aggregates,families and individuals. 4th ed. St.Louis:Mosby;1996.p.225-27
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