community and public health nursing
TRANSCRIPT
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Community and Public Health Nursing
Conceptual Literature
Community-based nursing deals with working outside hospital. Community
health nurses provide care to individuals and families, rather than populations. Public
nursing renders population based assessment, planning, and evaluation. However,
implementation of health programs are catered to individuals, families, groups, and
communities. Community and public health nurses are dedicated for the development of
healthy communities. They give unique contributions to fulfill their commitments by
providing equal distributions of health care; forming an environment that is safe to
promote health and protect the clients; educating preventive measures for clients to
avoid themselves to any disease or dysfunction; giving treatment to patients without
bias related to age, gender, socioeconomic status, religion, and cultural predispositions;
encouraging clients to commit themselves to strive for well being (Maurer & Smith,
2008).
Family Health
Every human being has the right to have good health. The national development
requires healthful people. The Department of Health uses the life span approach to
conduct programs and help in the delivery of health services to a narrow range of age
groups. It views health care of individuals within the context of the family. The term
‘family’ is defined as the basic unit of the community. All the family members are given
the right to maintain and improve their health status. They must be free from any
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disorders and infections with no disabilities. In public health perspective, the health of
the family is considered as a while, not by individual.
The Family Health Office has the duty to conduct health programs equipped towards the
health of the family. It is concerned with the health of the mother and a child that is not
yet born, the newborn, the infant, the child, the youth and adolescent, the adult men and
women and seniors.
Specific aims of Family Health Office are to lengthen the lifespan, survival and
the well being of mothers and the unborn through health services for the pre-pregnancy,
prenatal, natal, and post natal stages; reduce the death rate for children 0-9 years old;
reduce mortality from preventable causes among adolescents and young people; lower
the rate of death among Filipino adults and improve their state of living; lengthen the life
span of senior citizens and improve the quality of life. Public Health Nurses have
important roles in making sure that the health of the family in not at risk. Every effort has
to be made to provide holistic approaches of health services to the family for a better
state of living (Cuevas, 2007).
Role of the Nurses as Educator
Health education deals with giving knowledge that guides to positive health
behavior. Community health nurses give information and insights that guide them
regarding on making decisions for their health concerns. They often set health facts to
individuals, families, and groups; and they usually involved to the improvement
population-based health education programs (Clark, 2008).
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Organizations ruling and influencing nurses in practice have identified teaching
as a responsibility of all of them in caring ill and well patients. For nurses to fulfill the
duty of an educator whether the audience is patients, family, nursing students or staff,
or other personnel, they have the right to have a strong foundation in teaching and
learning. The prerequisites for patient education consist of a collaborative effort among
healthcare team members, all of whom play more or less significant roles in teaching.
However, physicians are first and foremost prepared “to treat, not to teach”. Nurses,
apparently, are ready to provide a clarifying approach to care delivery. The teaching
duty is part of our professional structure, because, customers entrust their lives to the
nurses with respect. That makes the nurses to be in an ideal position to provide holistic
information and make something out of nothing. Amidst a fragmented healthcare
delivery system involving many providers, the nurse has the role of a coordinator of
care. By making sure of the consistency of the information, nurses can support clients in
their efforts to achieve their goal of optimal health. They also can assist their peers and
workmates in gaining knowledge and skills needed for the delivery of professional
nursing care (Bastable, 2008).
Research Literature
Community health needs assessment with precede-proceed model: a mixed
methods study
Health services in community gives people with a more convenient and faster
medical service and lessen the pressure on large hospitals. In the Chinese health sector
reform, the government has prioritized developing community health services
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encourage citizens to use it instead of private hospital services. The main question of
health promotion planning is to realize what does the community want, what is actually
needed, and, what can actually be done. The three areas intersected represent what
can be done. However, resources, time and other restrictions do not permit everything
to be referred and so areas must be prioritized. In the PRECEDE-PROCEED model,
thorough needs assessment implicated five phases should be made before planning a
health promotion intervention. Currently, needs assessments are inadequately
conducted prior to community based health promotion activities in China, resulting in
short impact and hapless use of resources. Most health centers have limited funds and
qualified health staff. Health needs assessment can help community participation in
health programs, prevent wasting limited resources and supply baseline for program
analysis. Take to consider that the resources available for health care are limited, health
needs assessment is one of the ways for successful community based health promotion
in China. However, little is known about the health needs of community members and
what community health stations can provide.
By using Green and Kreuter's PRECEDE-PROCEED model, this study looks at
to identify the main health problems having a negative impact on the wellbeing of
community members, identify the key risk factors associated to a disease or health
problem prioritized by the community, and analyze the resources for health promotion in
communities.
In agreement with the PRECEDE-PROCEED model, the needs assessment
includes the identification of health problems (Phase 1 and Phase 2), behavioural and
environmental risk factors (Phase 3), factors affecting behaviour (Phase 4) and
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resources in terms of policy and organizations (Phase 5) . In this study the researchers
accomplised the five phases of the assessment to identify community health problems,
risk factors and existing resources.
A health program cannot be based upon what the professionals decide on what
the public should know or not know about a specific issue. Planning, the solution to any
successful health promotion project must include a radical needs assessment using
literature reviews and investigations. Health project planning should target diseases and
their risk factors. Strategies for health promotion should take these factors into
consideration. Policy, organization and manpower need further fortification. (Ying Li et
al, 2009).
Health promotion services for lifestyle development within a UK hospital – Patients' experiences and views
UK public health policy demand hospitals to have impose health promotion
services which let patients to improve their health by means of adopting healthy
behaviours in help of health education. Key to the idea of health promotion is
"empowerment" of individuals, social groups and communities; a process wherein
people obtain greater control over decisions and actions related to their health. Health
promotion interventions within healthcare can encourage people through "self-
reproduction": supporting patients be responsible for self-care physically, mentally and
socially; through "co-production": involvement of the patient in their therapy;
empowering health promotion services for disease management (usually part of
integrated care and beyond the hospital boundaries); and empowering health promotion
services for lifestyle improvement: people are reinforced on a healthy lifestyle by
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preventing risk (e.g. not smoking or excessive alcohol intake) or uplifting lifestyles (e.g.
becoming more physically active).
The outcome of study indicate that hospital patients look at hospitals as an ideal
place for the giving of health education for all risk factors. While there was clear
reinforcement for screening all adult hospital patients for risk factors, reported screening
was not appropriate for any of the risk factors, especially for diet and physical activity.
There was also considerable demand for health education, but poor provision. Patients'
memory may be dissembled by the emotional state they were in when information was
supplied, potentially results to attentional narrowing or state-dependent learning.
Memory may also be tingled by the perceived importance of information (diagnosis is
viewed as very important and treatment less so), and age-related cognitive disorders.
The communication style of healthcare professionals delivering health promotion
services also affects recall, with patients more likely to remember medical information if
healthcare professionals give simple to follow, specific written guidelines (rather than
general/verbal instructions). Medical information is least likely to be remembered, and
therefore acted upon, if it is spoken verbally compared to written/pictorial presentation
or a combination of written and verbal presentation, yet the most usual form health
education took was verbal advice.
The timing of health education has importance to patients. While the many of
them felt that the time around discharge was the most ideal period for health education,
those receiving health education reported that it was frequently delivered on admission.
This may be because admission is the common time for screening of risk factors.
However, it is likely that this is not necessarily the best time for health education as
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patients may be in an unreceptive state due to their condition and their primary concern
may be the immediate development in health.
As the purpose of health promotion is to enable people to change a behavior, it is
significant to assess whether the different potential forms of health education have
accomplished this. This was evaluated by asking patients how "helpful" the health
education services they received were. While more patients look at the services as
"helpful" than "unhelpful", given that so few patients received any form of health
education, it is impossible to draw definitive conclusions concerning the "helpfulness" of
the different services. It is recommended that this question remains as it could give
valuable information about health education services when they are delivered to a larger
number of patients. (Haynes, 2008).
Compliance and Non-compliance
Conceptual Literature
Compliance, in medicine describes the degree to which a patient correctly
follows medical advice. Most commonly, it refers to medication or drug compliance, but
may also mean use of medical appliances such as compression stockings, chronic
wound care, self-directed physiotherapy exercises, or attending counseling or other
courses of therapy. Both the patient and the health-care provider affect compliance, and
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a positive physician-patient relationship is the most important factor in improving
compliance(WHO)
Additional problems may arise when patients do not comply with their prescribed
treatment regimens, these people may not get over their sickness or injury. They may
get even sicker or increase the severity of their present condition(Trisha Torrey,2008).
Experts agree on seven main reasons for non-compliance: Denial of the problem;
Treatment costs; the Regimens difficulty; the Unpleasant outcomes of treatment; Lack
of trust; Apathy; and Previous experience.
Denial of the problem. Asymptomatic diseases and conditions are easy to
ignore, even when they have been diagnosed. Pride may also be a cause of non-
compliance.
The cost of the treatment. The more money\resources a patient has to
consume the more the level of compliance decreases.
The difficulty of the regimen. This is a barrier simply because patients
sometimes do not know how to do the treatment, patients have difficulty in following
certain procedures.
The unpleasant outcomes or side-effects of the treatment. All, if not most
apparent negative side effects or factors such as an unpleasant taste of a medicine, or
the pain of physical therapy may keep the patient from complying to treatment.
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Lack of trust. When patients don't believe in the potential of success, they are
less likely to follow through. In this case, they don't trust that compliance will really
recover their health.
Apathy. The importance of the treatment is very vital. Patients with little or no
knowledge about the treatment and\or their illness, this is a ground for non-compliance
Previous experience. Cases of chronic or repetitive conditions explain this
factor, patients will sometimes decide that a treatment didn't work in the past, so they
are either reluctant or unwilling to try it again.
There are additional reasons patients do not comply; regardless, when a
treatment decision has been reached collaboratively, then patients need to follow
through with those decisions. In such cases of non adherence to treatment, patients are
advised to talk to their physicians or doctors and discuss the reasons for non-
compliance.
Research Literature
Compliance and Non-compliance
To deliver the topic about therapeutic non-compliance, it is prioritized as the most
significant way to have a clear and meaningful definition of compliance. According to the
Oxford Dictionary, compliance has the denotation as the practice of obeying rules or
request made by the people in authority (Oxford Advanced Learner's Dictionary of
Current English). In healthcare, the most commonly used definition of compliance is a
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connotation known as "patient's behaviors (in terms of taking medication, following
diets, or executing lifestyle changes) coincide with healthcare providers'
recommendations for health and medical advice" (Sackett, 1976). Therefore,
therapeutic non-comliance occurs when a person's health-seeking or maintenance
attitude lacks equality with the recommendation as prescribed by a healthcare provider.
Other terms have been used instead of compliance, and the meaning is more or less
congruent. For example, the word adherence is often used interchangably with
compliance. It is defined as the ability and willingness to abide by a prescribed
therapeutic regimen. Recently, the word "concordance" is also suggested to be used. It
makes the patient the decision maker in the process and defines patients-prescribers
agreement. Although there are differnences between those terms, they are used
interchangably (Jin et al, 2008).
Levels of Compliance
The most common way for dealing with constantly changing levels of
compliance is what is known as a 'as-treated' breakdown of thoughts, which is
comparable to the people who participate with those who didn't. An 'as-treated' analysis
is equipped by biased estimates of the effect of participation because it is concluding
the effect by comparing two cultures of people; those who fully participate with everyone
and those who would have participated had they been in the treatment group, and those
who wouldn't have. Those who fully participate in the program are likely different from
those who do not, in both observed and unobserved ways. As an example, there's this
mother-baby intervention, there are some evidence that women who fully participated
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had higher liftime risk of having a major depressive episode before entry into study.
That concludes that the benifits of random assignment are lost when an as treated
analysis is done, since groups being compared are now indifferent from each other.
Relevant to an as-treated breakdown of thoughts is the approach of inclusive of
the level of participation as a predictor in the model of the outcome, thus "controlling for"
participation. Inopportunely, this method is also equipped by biased estimates of the
effects, since it focuses on just the observed levels of participation and compares
individuals in the treatment and control groups with the same observed participation.
Nevertheless, people in the treatment group with an observed level of participation (e.g.,
non-participation) may not be indifferent from individuals in the control group with that
said participation. Special processes may lead to non-participation in the treatment
group and the control group, and in specific some of the apparent non-participants in
the control group would likely have participated if they had been in the other group. A
conclusion of casual effects need to be a comparison of effects among similar
individuals, which this approach does not do. This issue is broadly known in the
epidemiology literature as post-treatment selection bias.
Instead, the intuitive idea behind CACE analysis is that the investigators need to
have a comparison between the participants in the treatment condition with a similar
group of people from the control subgroup of the study--those who would have
participated had they been given the chance to do so. If there was a direct to the point
approach to identify those individuals, the investigators could simply have a comparison
of outcomes of the participants in both groups. Nonetheless, the investigators cannot
identify those individuals directly--the investigators do not know which control group
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members would have participated had they been in the treatment group. CACE
methods instead use and indirect way to conclude the effect of interest (Stuart,
2008).
References
Ø Francis A. Maurer & Claudia M. Smith, Community/Public Health Nursing:
Health for Families and Pupolations, Forth edition, 2008
Ø Mary Jo Clark, Community Health Nursing: Advocacy for Population
Health, Fifth edition, 2008
Ø Frances Precilla L. Cuevas, Public Health Nursing in the Philippines, Tenth
edition, 2007
Ø Susan B. Bastable, Nurses as Educator: Principle of Teaching and
Learning for Nursing Practice, Third edition, 2008
Online Sources
Ø Elizabeth A. Stuart,Deborah F. Perry, Huynh-Nhu Le, Nicholas S. Ialongo,
Estimating intervention effects of prevention programs: Accounting for
noncompliance, Published October 9 2008, Retrieved January 15 2011,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921838/?tool=pmcentrez
Ø Jing Jin, Grant Edward Sklar, Vernon Min Sen Oh, Shu Chuen Li, Factors
affecting therapeutic compliance: A review from the patient’s perspective,
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Published February 4 2008, Retrieved January 15 2011,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503662/
Ø Jason Van Dyke, 5 Ways to Improve Your Patient's Compliance, Published
April 2 2009, Retrieved January 15 2011, http://ezinearticles.com/?5-Ways-to-
Improve-Your-Patients-Compliance&id=2074912
Ø http://patients.about.com/od/decisionmaking/a/noncompliance.htm
Ø Ying Li,#1 Jia Cao, Hui Lin, Daikun Li, Yang Wang, and Jia He, Community
health needs assessment with precede-proceed model: a mixed methods
study, Published October 9 2009, Retrieved January 17 2011,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770049/?tool=pmcentrez
Ø Charlotte L. Haynes, Health promotion services for lifestyle development within a UK hospital – Patients' experiences and views, Published August 13 2008, Retrieved January 17, 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2527563/?tool=pmcentrez