COMMUNITY HEALTH NURSING

RLE / WEEK 1

ROLES AND RESPONSIBILITIES OF PUBLIC individuals in terms of caring for themselves

HEALTH NURSE  Teaching skills and imparting knowledge on how to
maintain their health
 Preventing further onset of disease by giving proper
OUTLINE medications, wound care, etc
I Roles and Responsibilities of Public Health Nurse  Beyond healh teaching and health information
II Family Nursing Care Process  Changing undesirable knowledge, skills, and
III Bag Technique
attitudes
IV Concept of Health and Illness
 Advocate for healthier actions
 Imminizations
 Influence SB to creae policies banning smoking
I. ROLES AND RESPONSIBILITIES OF PUBLIC
 Health education is part of basic health service
HEALTH NURSE
TRAINING FUNCTIONS
MANAGEMENT FUNCTION
 Empower colleagues
 Administrative role
 Formulate and conducts staff development training
 On hold and provide directions to new staffs about their
programs for healthcare workers in the team
roles in the team
 Training needs assessment, training plan, collaborate
 Work and financial plan with other resource person, evaluation of training
 Supervisory nurses and chief nurses outcomes
 Planning  Participate in training undergraduate nurses or
 Budgeting, mission, vision midwives
 Organizing
 Organizes activities
RESEARCH FUNCTION
 Staffing
 Duties and responsibilities  Conduct research and utilizes research findings in
 Scheduling of staff practice
 Directing  Outcome provides recommendations on how to
 Members of health team improve services or public health practice
 What particular task should and should not be  Example: disease surveillance
done that directs the members of the health care
team II. FAMILY NURSING CARE PROCESS
 Controlling
 Ensuring that all resources are available NURSING PROCESS
 Scientific and systematized approach to healthcare for
SUPERVISORY FUNCTION individuals, families, and communities
 Means by which nurses address the health needs and
 Direct supervisor of people who works under you
problems of their clients and illness prevention
 Supervisor of midwives and other auxiliary health
workers in the catchment area
PURPOSE OF NURSING PROCESS
 Formulates supervisory plan
 Identify client’s health status, actual or potential health
 Conducts supervisory visits
problems or need
 Evaluating performance if duties and
 Establish plans to meet identified needs and to deliver
responsibilities are met
specific interventions to meet those needs
 Evaluate If they are having difficulty in
performing task  To provide a framework in which to practice nursing
 Capacity building  Blueprint of nursing care

NURSING CARE FUNCTION ASSESSMENT

 Inherent function of a nurse (screening and  Process of collecting, validating, and recording data
about a client’s health status
assessment)
 Done continuously throughout the nursing process
 Uses nursing skills and knowledge and the nursing
process
DIAGNOSIS
COLLABORATION AND COORDINATING  Nurse sort, cluster, and analyzes data
FUNCTION  Clinical judgment about individual, family or community
responses to actual and potential health problems/life
 Care coordinators for community and members working processes
together with indivisuals, damily, and community to  Can be actual, potential, or wellness diagnosis
improve and maintain healthy practice
 Link with oher health professionals, government, PLANNNING
agencies, private sectors, NGOs, etc.
 Developing a specific nursing intervention for each
diagnosis
HEALTH PROMOTION AND EDUCATION  Includes formulation of objectives, setting priorities,
FUNCTIONS formulating nursing care plan
 Teach community for them to be independent

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TRANS: COMMUNITY HEALTH NURSING LAB

IMPLEMENTATION
 Actions taken to improve or help situation
 Any treatment based upon clinical judgment and
knowledge that a nurse perform to enhance patient or
client outcome
 Productivity of interview depends
EVALUATION upon the use of effective
Interview
 Assessing client’s response to nursing interventions communication techniques to
and comparing the response to the goals or outcome elicit needed response
criteria in the planning phase
 Through review of an individual’s
FAMILY HEALTH NURSING PROCESS records (medical records, injury
 Focused on the family as a patient to help them reach Records
mechanism, past medical and
and maintain maximum health in a given situation surgical history, prior diagnostic
Review
study results, and type of
PRINCIPLES OF FAMILY NURSING PROCESS treatment the individual has
 Establishing of good professional relationship with the received)
family
 Proper education and guidance should be provided  Through review of an individual’s
 Gather all relevant information about the family to Laboratory records
identify problem and set priorities  Rapid tests
 Provide need-based support and services to the family
to improve their health status
 Health care services should be provided to the family GORDON’S FUNCTIONAL HEALTH PATTERN
irrespective their age, sex, income, religion, etc.  A guide for establishing a comprehensive nursing data
 Proper health message to be communicated to family base of pertinent client assessment information
every contact  Enables the nurse to determine the following aspects of
health and human function in order to plan required
STEPS OF FAMILY NURSING PROCESS nursing care for their clients

1. ASSESSMENT 1. Health Perception/Management

 Client’s perceived pattern of health and how health
 Involves set of actions by which measures the status of is managed
the family as a client  Compliance with medication regimen
 Not only involves physical assessment  Health promoting activities
 Includes data collection that will be analyzed to create 2. Nutritional – Metabolic
appropriate nursing diagnosis
 Pattern of food and fluid consumption relative to
 First level assessment metabolic need
 Data on the current health status of the individual
 Eating pattern
member of the family as a system and its
 Condition of skin, teeth, hair, nails, mucous
environment
membranes, height, and weight
 Family structure, socioeconomic and cultural
characteristics, home and environment, values 3. Elimination
and practices on health care, etc.  Patterns of excretory function (bowel, bladder, skin)
 Second level assessment  Frequency of bowel movements
 Perceptions about the attitudes related to the  Voiding pattern
assumption, performance of family health task  Pain on urination
 In-depth interviews about realities and perceptions  Appearance of urine or stool
 Observing family dynamics 4. Activity – Exercise
 Patterns of exercise, activity leisure, and recreation
Data Collection  Exercise
 Ensure effective and efficient data collection  Hobbies
 Identify the types or kinds of data needed  Mobility
 Specify the methods of data gathering and  Activities of everyday living
necessary tools for gathering data 5. Cognitive – Perceptual
 Sensory-perceptual and cognitive patterns
METHODS DESCRIPTION  Vision, hearing, smell, taste, touch
 Done through use of sensory  Pain
capacities  Language
Observation  Data gathered have advantage of  Memory and decision-making
being subjected to validation and 6. Sleep – Rest
reliability testing by other  Client’s perceived pattern of health and how health
observers is managed
 Compliance with medication regimen
 Health assessment of every  Health promoting activities
member of the family as well as 7. Self-perception/Concept
Physical significant data about health  Client’s self-concept pattern and perceptions of self
Examination status of individual members can  Body comfort
be obtained through physical
 Body image
examination
 Perceptions of abilities
 May indicate presence of health
8. Role – relationship
deficits
 Patterns of role engagement and relationships
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 Current major roles and responsibilities Scoring:

 Satisfaction with family and social 1 – Family failing entirely to provide required personal care to
relationships one or more of its family members
9. Sexuality – Reproductive
 Patterns of satisfaction and dissatisfaction with 3 – Family providing partially for needs of its members or
sexuality providing care for some members but not for others
 Reproductive patterns
 Satisfaction with sexual relationship 5 – All family members, whether or not there is infirmity or
disability in one or more of its members, are provided with
 Pregnancy history and childbirth
required care
10.Coping/Stress Tolerance
 General coping pattern for stress
2. Therapeutic Competence
 Usual manner of handling stress
 Includes all of the procedures or treatment prescribed
 Support system
for the care of illness, such as giving medications, using
11.Value – Belief appliances, dressing, exercises, etc.
 Values, beliefs, and goals that guide client’s
decision Scoring:
 Religious affiliation 1 – Family either not carrying out procedure prescribes or
 What is important in life doing it unsafely
 Special religious practices
3 – Family carrying out some but not all of the treatments
GENOGRAM
 Graphically display information about family members 5 – Family members demonstrate that the members can
and their relationships over at least three generations carry out prescribed procedures safely and efficiently with
the understanding of principles involved and with a confident
and willing attitude

3. Knowledge of Health Condition

 Concerned with the particular health condition that is
the occasion for care

Scoring:
1 – Totally uninformed or misinformed about the condition

3 – Has some general knowledge of the disease, but has not

grasped the underlying principles or is only partially informed

5 – Knows salient facts about the disease well enough to

make necessary action at the proper time, understands the
rationale of care, able to observe and report significant
symptoms

4. Application of Principles of General

 Concerned with family action in relation to maintaining
nutrition, securing adequate rest and relaxation for
FAMILY COPING INDEX
family members and preventive measure
 Tool used to assess the coping ability of the family for
certain health situation with its purpose of providing a Scoring
basis for estimating the nursing needs of a particular 1 – Family diet grossly inadequate or unbalanced, necessary
family immunization not secured for children

3 – Failing to apply some general principles of hygiene

DIRECTIONS FOR SCALING
5 – Household runs smoothly, family meals well selected,
Scaling
habits of sleep and rest adequate to needs
 Enables to place the family in relation to their
ability to cope with nine areas of the family nursing
5. Health Attitudes
2 Parts  Concerned with the way family feels about health care
Point of Scale in general including preventive service, care of illness
 Rate from 1 (totally unable to manage the aspect and public health measures
of family care) to 5 (able to handle the aspect of
care without help from community sources) Scoring
Justification 1 – Family resents and resists all healthcare
 Brief statement or phrases that explain why you
have rated the family as you have 3 – Accepts health care in some degree but with reservations

Note: check “no problem” if the particular category is 5 – Understands and recognizes need for medical in illness
not relevant to the situation and for the usual preventive services

1. Physical Competence
 Concerned with ability to move about, get out of bed, 6. Emotional Competence
take care of daily grooming, walking  Has to go with maturity and integrity with which the
members of the family are to meet the usual stresses

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TRANS: COMMUNITY HEALTH NURSING LAB

and problems of life, and to plan for happy and fruitful  Family profile implies brief description of family
living structure and characteristics, family cycle, and culture,
and other factors
Scoring:  Family health diagnosis is the written statement of
1 – Family does not face realities family health problems which are assessed from
analysis of data collected
3 – Failing members usually do fairly well, but one or more
members evidence lack of security and maturity TYPOLOGY OF NURSING PROBLEMS IN FAMILY
NURSING PRACTICE
5 – All members of the family able to maintain degree of
emotional calm, face up to illness realistically and hopefully
First Level Assessment
7. Family Living 1. PRESENCE OF WELLNESS CONDITION
 Concerned with interpersonal or group aspects of
 Potential or readiness - a clinical or nursing judgment
family life
about a client in transition from a specific level of
wellness or capability to a higher level
Scoring:
1 – Family consists of a group of individuals indifferent or
Potential Enhanced Capability for: / Readiness for Enhanced
hostile to one another, so strongly dominated and controlled
Capability for:
by a single family member
 Healthy life style
3 – Family gets along but has habits or customs that  Healthy maintenance
 Parenting
interfered with the unity of the family
 Breastfeeding
5 – Family does things together, each members act for the  Spiritual well-being-process of client’s
developing/unfolding of mystery through
good of the family as a whole
harmonious interconnectedness that comes from
inner strength/sacred source/God
8. Physical Environment
 Concerned with the home, community and the work 2. PRESENCE OF HEALTH THREATS
environment as is affects family health  Conditions that are conductive to disease and accident,
or may result to failure to maintain wellness or realize
Scoring: health potential
1 – House in poor condition – unsafe, unscreened, poorly  Presence of risk factors for specific diseases
ventilated, neighbourhood detoriated  Threat of cross infection fron communicable
diseases
3 – House needs some repair or painting but fundamentally  Family size beyond what family resources can
sound, neighbourhood with some undesirable social adequately provide
elements  Accident hazards
 Faulty/unhealthy nutritional/eating habits
5 – House in good repair, provides for privacy and free of  Stress provoking factors
accident, pests, hazards, neighbourhood respectable and  Poor home, environmental condition, sanitation
provided with recreational facilities  Unsanitary food handling and preparation
 Unhealthy lifestyle and personal habits/practices
9. Use of Community Facilities  Inherent personal characteristics
 Concerned with the degree of the family use and  Health history (which may participate induce
awareness of the available facilities for health occurrence of health deficit)
education and welfare  Inappropriate role assumption
 Lack of immunization/inadequate immunization
Scoring: status
1 – Family has obvious and serious social needs, but has not  Family disunity
sought or found any help
3. PRESENCE OF HEALTH DEFICITS
3 – Failing is aware of and uses some, but not all of the  Failure in health maintenance
available community resources they need  Illness states, regardless of whether diagnosed or
undiagnosed by medical practitioner
5 – Uses the facilities they need appropriately and promptly,  Failure to thrive or develop according to normal rate
knows when and whom to call for help  Disability – whether congenital or arising from
illness, transient or permanent
DATA ANALYSIS
 Sorting out the data 4. PRESENCE OF STRESS POINTS / FORESEEABLE
 Cluster related cues to determine relationships among CRISIS SITUATION
data  Anticipated periods of unusual demand on the
 Distinguishing relevant data from irrelevant data individual or family in terms of adjustment or family
 Identifying patterns (function, behavior, lifestyle) resources
 Relating family data to relevant clinical research  Marriage
findings  Pregnancy
 Interpreting results  Labor
 Childbirth
 Making inference or drawing conclusion about the
 Parenthood
reasons for existence of health condition problem
 Additional member of the family (newborn, lodger)
 Abortion
2. FAMILY PROFILE / DIAGNOSIS  Entrance at school
 Adolescence
 Divorce or separation

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TRANS: COMMUNITY HEALTH NURSING LAB

 Hospitalization of a family member  Member’s preoccupation with concerns or interests

 Death of a family member  Prolonged disease or disabilities, which exhaust
supportive capacity of family members
Second Level Assessment  Altered role performance
 Role denials or ambivalence
1. INABILITY TO RECOGNIZE THE PRESENCE OF THE  Role strain
CONDITION OR PROBLEM DUE TO:  Role dissatisfaction
 Lack of or inadequate knowledge  Role conflict
 Denial about its existence or severity as a result of fear  Role confusion
of consequences of diagnosis of problem, specifically:  Role overload
 Social stigma, loss of respect of peer or significant
others 4. INABILITY TO PROVIDE A HOME ENVIRONMENT
 Economic or cost implications CONDUCIVE TO HEALTH MAINTAINANCE AND
 Physical consequences PERSONAL DEVELOPMENT DUE TO:
 Emotional or psychological issues or concerns  Inadequate family resources
 Attitude or philosophy in life, which hinders recognition  Financial constraints or limited financial resources
or acceptance of a problem  Limited physical resources (lack of space to
construct facility)
2. INABILITY TO MAKE DECISIONS WITH RESPECT TO  Failure to see benefits of investment in home
TAKING APPROPRIATE HEALTH ACTION DUE TO: environment improvement
 Failure to comprehend the nature or magnitude of the  Lack of knowledge of importance of hygiene and
problem sanitation
 Low salience of the problem or condition  Lack of knowledge of preventive measures
 Feeling of confusion, helplessness and resignation  Lack of skill in carrying out measures to improve home
brought about by perceive magnitude or severity of the environment
situation or problem
 Lack of knowledge or insight as to alternative courses 5. FAILURE TO UTILIZE COMMUNITY RESOURCES
of action open to them FOR HEALTH DUE TO:
 Inability to decide which action to take from among a  Lack of knowledge of community resourced for health
list of alternatives care
 Conflicting opinions among family members or  Failure to perceive he benefits of health care or
significant others regarding action to take services
 Lack of knowledge of community resources for care  Lack of confidence or trust in the agency or personnel
 Fear consequences of action  Previous unpleasant experience with healthy worker
 Social consequences  Fear of consequences of action (preventive, diagnostic,
 Economic consequences therapeutic, rehabilitative)
 Physical consequences  Physical or psychological consequences
 Emotional/psychological consequences  Financial consequences
 Negative attitude towards the health condition or  Social consequences
problem – by negative attitude is meant one that  Unavailability of required care or services
interferes with rational decision-making  Inaccessibility of required services due to:
 Inaccessibility of appropriate resources for care  Cost constraints
 Physical inaccessibility  Physical inaccessibility
 Cost constrains or economic/financial inaccessibility  Lack of family resources
 Lack of trust or confidence in health personnel or  Manpower resources
agency  Financial resources, cost of medicines prescribed
 Misconceptions or erroneous information about  Feeling of alienation to or lack of support from the
proposed courses of action community (stigma due o mental illness)
 Negative attitude or philosophy in life which hinders
3. INABILITY TO PROVIDE ADEQUATE NURSING CARE effective or maximum utilization of community
TO THE SICK, DISABLED, DEPENDENT, OR resources for health
VULNERABLE/AT RISK MEMBER OF THE FAMILY DUE
TO: 3. PLANNING
 Lack of knowledge about the disease or health
condition (nature, severity, complications, prognosis,  Family nursing care plan formulation
and management)  Based on the analysis of diagnosed health problems
 Lack of knowledge about child development and care and assessment of family’s ability to resolve problems,
establish priorities, formulating family health nursing
 Lack of knowledge of the nature or extent of nursing
care plan
care needed
 Lack of necessary facilities, equipment, and supplies of
care
CRITERIA OF PRIORITIZATION OF HEALTH
 Lack of knowledge of skill in carrying out the necessary PROBLEMS
intervention or treatment of care (complex therapeutic
regimen or healthy lifestyle program) 1. Nature of the Problem
 Inadequate family resources of care
 Absence of responsible member CATEGORY SCORE
 Financial constraints Health Deficit 3
 Limitation of luck or lack of physical resources
Health Threat 2
 Significant persons unexpressed feeling (hostility,
anger, guilt, dear, despair, rejection) which his Foreseeable Crisis 1
capacities to provide care
 Philosophy in life which negates or hinder caring for the 2. Modifiability of the Problem
sick, disabled, dependent, or vulnerable member

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TRANS: COMMUNITY HEALTH NURSING LAB

 Probability of success in minimizing, alleviating or Short-term/immediate objectives

totally eradicating the problem through intervention Immediate attention is needed; results: can be observed in a
period of short time
CATEGORY SCORE Medium-term/intermediate objectives
Easily Modifiable 2 Require to attain long term objectives

Partially Modifiable 1 Long-term/ultimate objectives

Several nurse-family encounter + more resources
Not Modifiable 0
Takes time to see the results

3. Preventive Potential Selection of Appropriate Nursing Interventions

 Nature and magnitude of future problems that can be
minimized or totally prevented if intervention is done on Nurse must choose among set of alternatives
the problem under consideration
Nurse must specify the most effective, efficient and
CATEGORY SCORE appropriate method of nurse-family contact
High 3
• Home visits
Moderate 2 • Clinic conference
Low 1 • Visit in the work, place, and school
• Telephone call
• Group approach- gather families together
4. Salience • Mail
 Family’s perception and evaluation of the problem in
terms of seriousness and urgency of attention needed Nurse must specify the most effective or efficient resources
• Teaching kits- visual aids, handouts, and charts
CATEGORY SCORE • Human- other team members and community leaders
A serious problem,
immediate attention 2
needed Barriers to the Goal-Setting
A problem, but not Failure of the family to perceive the existence of the problem
needing immediate 1 (May feel satisfied with the existing situation)
attention
Not a felt need/problem 0 Family is too busy with other concerns or preoccupations at
the moment

The higher the score, the higher the priority Family does not see the existence of a problem as serious
enough to necessitate attention
Formulation of Goals and Objectives of Nursing Care
Family may perceive the problem and the need to take
Goals action, but they face to do something about the situation
General statement of the condition or state to be brought (Both the nurse and family sees the solution, but solution of
about by specific courses of action the family differs from the solution of the nurse)
Client outcomes
Goals tell where the family is going Reasons for not doing any Action
*Must be formulated with the family Fear of consequence of doing action (Social stigma/financial
reasons)
Objectives Respect for tradition
More specific statements of desired results or outcomes of Failure to perceive the benefits of actions proposed (Based
care on previous experiences)
Specify the criteria by which the degree of effectiveness of Failure to relate the proposed action to the family’s goals
care are to be measured (Family has different perception or interventions for the
Must be specific in in order to facilitate its attainment problem)
Milestones to reach destination Failure between the nurse and the family to establish a
working relationship (Trust and confidence should be
Should be based on nursing diagnosis from the assessment established, Without rapport there will be a lot of barriers for
data base interventions)

Should be SMART (Specific, Measurable, Achievable, How do you summarize the activities involved in making a
Relevant, Time-based) Family Nursing Care Plan?

Take into consideration the factors that affect modifiability Prioritize the health conditions based on:
• Nature of Condition
Must be set together with the family • Modifiability
• Preventive Potential
Family must be able to recognize and accept the presence of • Salience
existing health needs and problems
Define Goals and Objectives of Care:
Nurse must ascertain the family’s knowledge and
acceptance of the problems and the desire to make actions • Formulate expected outcomes
to resolve them • Formulate specific measurable client statements/
competencies (Specific, Measurable, Achievable, Relevant,
Time Span of Objectives Time-bound)

Develop the Evaluation Plan

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TRANS: COMMUNITY HEALTH NURSING LAB

• Specify criteria/outcome based on objectives of care etc., as long as principles of avoiding transfer of
• Methods/tools infection is carried out.

Develop the Intervention Plan

• Decide on measure to help family eliminate problems SCPECIAL CONSIDERATIONS
• Determine methods of nurse- family contact  The bag should contain all necessary articles, supplies
• Specify resources needed and equipment which may be used to answer
emergency need
4. IMPLEMENTATION  The bag and its contents should be cleaned as often as
 The doing phase of the nursing process that is putting possible, supplies replaced and ready for use at any
into action planned care to be rendered to solve the time
problem  The bag and its contents should be well protected from
 Utilize community resources contact with any article in the home of the patients.
 Provide health education and training Consider the bag and its contents clean and /or sterile
while any article belonging to the patient as dirty and
 Document responses to nursing action
contaminated
Categories of Intervention  The arrangement of the contents of the bag should be
• Promotive the one most convenient to the user to facilitate the
• Preventive efficiency and avoid confusion
• Curative  Hand washing is done as frequently as the situation
• Rehabilitative calls for, helps in minimizing or avoiding contamination
of the bag and its contents
 The bag when used for a communicable case should
be thoroughly cleaned and disinfected before keeping
5. EVALUATION and re-using
 Nursing audit Care outcomes
 Performance appraisal STEPS/PROCEDURES
 Assessment of problems 1. Upon arriving at the client’s home, place the bag on the
 Identify needed alterations table or any flat surface lined with paper lining, clean side out
 Revise plans as necessary (folded part touching the table). Put the bag’s handles or
strap beneath the bag.
III. BAG TECHNIQUE
2. Ask for a basin of water and a glass of water if faucet is
TERMS DESCRIPTION not available. Place these outside the work area.
 The vehicle for carrying the tools
needed during a home visit. 3. Open the bag, take the linen/plastic lining and spread over
 The carrier containing the tools , work field or area. The paper lining, clean side out (folded
equipment and materials needed part out)
during the nurse’s visit to home for
performing nursing interventions 4. Take out hand towel, soap dish and apron and the place
Community them at one corner of the work area (within the confines of
which include various
Health Bag the linen/plastic lining).
paraphernalia for demonstration of
care and patient care activities
 Should be dark in color washable 5. Do hand washing. Wipe, dry with towel. Leave the plastic
and durable, should be stable and wrappers of the towel in a soap dish in the bag.
should not be collapsed when
placed over a surface 6. Put on apron right side out and wrong side with crease
touching the body, sliding the head into the neck strap.
 A tool making use of public health
Neatly tie the straps at the back.
bag through which the nurse,
during his/her home visit, can
7. Put out things most needed for the specific case (e.g.)
perform nursing procedures with
thermometer, kidney basin, cotton ball, waste paper bag)
ease and deftness, saving time
and place at one corner of the work area.
and effort with the end in view of
Bag Technique
rendering effective nursing care
8. Place waste paper bag outside of work area.
Rationale:
To render effective nursing care to
9. Close the bag.
clients and /or members of the family
during home visit.
10. Proceed to the specific nursing care or treatment.

11. After completing nursing care or treatment, clean and

PRINCIPLES OF BAG TECHNIQUE alcoholize the things used.
 The use of the bag technique should minimize if not
totally prevent the spread of infection from individuals to 12. Do hand washing again.
families, hence, to the community
 Bag technique should save time and effort on the part 13. Open the bag and put back all articles in their proper
of the nurse in the performance of nursing procedures places.
 Bag technique should not overshadow concern for the
patient rather should show the effectiveness of total 14. Remove apron folding away from the body, with soiled
care given to an individual or family side folded inwards, and the clean side out. Place it in the
 Bag technique can be performed in a variety of ways bag.
depending upon agency policies, actual home situation,

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TRANS: COMMUNITY HEALTH NURSING LAB

15. Fold the linen/plastic lining, clean; place it in the bag and Broad term that encompasses many
close the bag. different physical and mental
alterations in health
16. Make post-visit conference on matters relevant to health
care, taking anecdotal notes preparatory to final reporting. It is a permanent change

17. Make appointment for the next visit (either home or Irreversible alteration to anatomy or
clinic), taking note of the date, time and purpose. function

Requires special patient education

AFTER CARE Chronic Illness for rehabilitation and to learn to live
1. Before keeping all articles in the bag, clean and with condition long term care and
alcoholize them. support
2. Get the bag from the table, fold the paper lining
(and insert), and place in between the flaps and
cover the bag. Requires long term of care and
3. It should be replenished with drugs, dressing and support
other supplies according to their consumption.
Slow onset, remission and
EVALUATION AND DOCUMENTATION exacerbation more common as
population ages.
Record all relevant findings about the client and members of It is the ability of an individual to meet
the family the minimum physical, psychological
Take note of environmental factors which affect the Wellness
and social requirements of
clients/family health appropriate functioning.
Include quality of nurse-patient relationship
Assess effectiveness of nursing care provided Collection of beliefs, about oneself
that includes elements such as
III. CONCEPT OF HEALTH AND ILLNESS Self-concept
academic performance, gender roles
and sexuality, and racial identity.
TERMS DESCRIPTION
Are not static conditions
Broad term, individualized to each
person, affected by many factors,
Subject to continuous evaluation and
has various definitions Health and change health & illness
Illness
Health According to the world health
Health is a multidimensional concept
Organization, is "a state of complete that includes different interdependent
physical, mental and social well-
and interrelated aspects (WHO)
being and not merely the absence of
disease and infirmity"
Objective pathological process
EVALUATION AND DOCUMENTATION
Pathologic change in the structure or  Considers the individual as a holistic system
Disease
function of the mind and body  Looks at the internal and external factors
 Acknowledges the individual's role in life and his value
Signs
Response of person to disease which  Considers health as a dynamic status, which can be
is based on person's perception changed from time to time.
Illness
 Acknowledges the relationship between internal and
Symptoms external environment and health status.
 Recognizes the importance of adaptation to maintain
Rapid onset of symptoms and lasts state of health and well- being.
Acute Illness
only a short period of time
STAGES OF ILLNESS BEHAVIOR
Experiencing symptoms
Assuming the sick role
Assuming a dependent role
Achieving recovery and Rehabilitation

MODELS OF HEALTH AND WELLNESS

HEALTH AND ILLNESS CONTINUUM

 Measures a person’s level of health
 Views health as a constantly changing state with high-
level wellness and death on
 Opposite sides of a continuum illustrates the dynamic
(ever-changing) state of health
 Health and illness are seen as relative concepts and
not as separate absolute
 Health and illness as a graduated scale has two ends

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 Health is a dynamic state that fluctuates as a person  Perceived seriousness

adapts to changes in the internal and external  Perceived benefit out of action
environments to maintain a state of well- being

AGENT-HOST ENVIRONMENT MODEL

 This model is used primarily in describing causes of
HEALTH PROMOTION MODEL (PENDER)
illness rather than in promoting wellness
 It helps in identifying risk factors that result from  Illustrates the “multidimensional nature of persons
interaction of agent-host- environment interacting with their environment as they pursue
 When each of the agent-host-environment factors are health”
in balance, health is maintained and when not in  Incorporates individual characteristics and experiences
balance, disease occurs (fluid, electrolytes, vitamins, and behavior- specific knowledge and beliefs, to
etc.) motivate health- promoting behavior
 Personal, biologic, psychological, and sociocultural
factors are predicative of a certain health-related habit
 Health-related behavior is the outcome of the model
and is directed toward attaining positive health
outcomes and experiences throughout the lifespan
 Used to design and provide nursing interventions
 Used to predict how a person is likely to incorporate
health promotion behaviors into their lifestyle. Smoking.
If parents smoke children more likely to smoke.

HIGH-LEVEL WELLNESS AND GRIND MODEL

(DUNN)
 Encourages the nurse to care for the total person
 Involves functioning to one’s maximum potential while
maintaining balance and a purposeful direction
 Regards wellness as an active state, oriented toward
maximizing the potential of the individual, regardless of
his or her state of health
 Incorporates the processes of being, belonging,
becoming, and befitting
 X axis is Health
 Ranges from peak wellness to death
 Y axis is Environment
 Ranges from very favorable to very unfavorable

FACTORS AFFECTING HEALTH BELIEF, HEALH

STATUS, AND PRACTICE
Internal
 Biological Dimension
 Developmental stage
 Heredity, genetics, race, and gender
 Psychological Dimension
 Mind-body interaction
 Self-concept
 Emotional factors
 Cognitive/Intellectual Dimension
 Lifestyle choices
 Spiritual and religious beliefs
HEALTH BELIEF MODEL
External
 This model is concerned with what people perceive
 Family Practices
about themselves in relation to their health
 Socioeconomic Status
 Modifying factors for health include demographic,
sociopsychological, and structural variables  Cultural Background
 There are several factors that influence an individual to  Social Support Networks
be motivated towards a favorable result (Consider
perceptions) HUMAN DIMENSIONS OF HEALTH
 Perceived susceptibility

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EMOTIONAL  Effective interprofessional communication is essential

 How the mind affects the body function and responds to to provide safe transitions and care. Effective
body conditions communication is critical in promoting collaboration and
teamwork in providing patient-centered care
 The nurse’s communication can result in both harm and
SPIRITUAL good
 Spiritual beliefs and values  Nurses with expertise in communication express caring
by:
INTELLECTUAL  Becoming sensitive to self and others
 Cognitive abilities, educational background, and past  Promoting and accepting the expression of positive
experiences and negative feelings
 Developing helping-trust relationships
 Instilling faith and hope
PHYSICAL  Promoting interpersonal teaching and learning
 Genetic inheritance, age, developmental level, race,  Providing a supportive environment
and gender  Assisting with gratification of human needs
 Allowing for spiritual expression
ENVIRONMENTAL
 Housing, sanitation, climate, pollution of air, food ,and DEVELOPING COMMUNICATION SKILLS
water  Critical thinking
 Perseverance and creativity
 Self-confidence
SOCIOCULTURAL
 Fairness and integrity
 Economic level, lifestyle, family, and culture  Humility
LEVEL OF PREVENTIVE CARE BASIC ELEMENTS OF THE COMMUNICATION
PROCESS
PRIMARY PREVENTION
 Promoting health and preventing diseases REFERENT
 Diet, exercise, immunizations
 Motivates one to communicate with another
SECONDARY PREVENTION
SENDER AND RECIEVER
 Focuses on early detection of diseases
 One who encodes and one who decodes the message
 Screenings, mammograms, family counseling

TERTIARY PREVENTION MESSAGE

 Content of the message
 Begins after illness diagnosed to reduce disability and
rehabilitate patients
 Medications, surgical treatment, rehabilitation CHANNELS
 Means of conveying and receiving messages
IV. COMMUNICATION PROCESS
FEEDBACK
COMMUNICATION & NURSING PRACTICE
 Message the receiver returns
 Therapeutic tool and an essential nursing skill that
influences others and achieves positive health
VERBAL ASPECTS OF COMMUNICATION
outcomes
 Vocabulary
 Health care professionals must communicate effectively
to convey care plans and apply nursing skills and  Intonation
knowledge  Pacing
 Builds relationships with patients, families, and  Denotative and connotative meaning
multidisciplinary team members  Clarity and brevity
 Nurses be assertive so they can ask the correct  Timing and relevance
questions and their voices can be heard, especially
when acting as their patient's advocate FORMS OF COMMUNICATION
 Competent communication will help you maintain
effective relationships within the profession and meet NON-VERBAL
legal, ethical, and clinical standards of care  Personal appearance
 Breakdown in communication among the health care  Posture and gait
team is a major cause of errors in the workplace and  Facial expressions
threatens professional credibility  Eye contact
 Gestures
COMMUNICATION & INTERPERSONAL  Sounds
RELATIONSHIPS  Territoriality and personal space
 The ability to relate to others is important for
interpersonal communication
SYMBOLIC
 Developing communication skills requires an
understanding both of the communication process and  The verbal and nonverbal symbolism used by others to
of one’s own communication experience convey meaning art and music are forms of symbolic
 Therapeutic relationship will begin when you first meet communication
your patient. The first eye contact and first interactions
will set the stage for you and your patient and family METACOMMUNICATION
members

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 A broad term that refers to all factors that influence  Difficulty with comprehension
communication  Associated difficulty in self-expression or altered
 Send messages that oftentimes present incongruence communication patterns may contribute to other nursing
between the word and body language diagnoses:
 All the nonverbal cues (tone of voice, body language,  Anxiety
gestures, facial expression, etc.) That carry meaning  Social isolation
that either enhance or disallow what we say in words.  Ineffective coping
 Compromised family coping
 Powerlessness
4 PHASES NURSE-PATIENT RELATIONSHIP  Impaired social interaction

PRE-INTERACTION PHASE PLANNING

 Occurs before meeting the patient.  Goals should be smart
 Smart possible outcomes may include:
ORIENTATION PHASE  Patient initiates conversation about diagnosis or
health care problem
 When the nurse and the patient meet and get to know  Patient is able to attend to appropriate stimuli
each other  Patient conveys clear and understandable
messages to health care team
WORKING PHASE  Patient expresses increased satisfaction with the
 When the nurse and the patient work together to solve communication process
problems and accomplish goals  Setting priorities
 Always maintain an open line of communication;
ensure the patient is comfortable and that all
TERMINATION PHASE
physical needs have been met
 Occurs at the end of a relationship  Teamwork
 If patients have problems with communication, you
PROFESSIONAL NURSING RELATIONSHIPS may need to seek the services of a speech therapist
 Nurse-patient helping relationships or an interpreter
 Nurse-family relationships
 Nurse-health team relationships IMPLEMENTATION
 Nurse-community relationships
 Therapeutic communication-specific responses that
 The same principles that guide one-on-one helping
encourage the expression of feelings and ideas and
relationships apply when the patient is a family unit,
convey acceptance and respect
although communication within families requires
additional understanding of the complexities of
 Active listening
family dynamics, needs, and relationships
 Attentive to what a patient is saying both verbally
 Communication within the community occurs
and nonverbally
through many channels
 Use “SOLER”
 Sit facing the patient
ELEMENTS OF PROFESSIONAL COMMUNICATION
 Observe
 Appearance, demeanor, and behavior  An open posture
 Courtesy  Lean toward the patient,
 Use of names  Establish and maintain intermittent eye
 Trustworthiness  Contact
 Autonomy and responsibility  Relax
 Assertiveness  Nontherapeutic communication techniques
 Nontherapeutic communication hinders or damages
NURSING PROCESS professional relationships: asking personal
questions, giving personal opinions, changing the
ASSESSMENT subject, automatic responses, false reassurance,
and sympathy, asking for explanations, approval or
 Gather information, synthesize, and apply critical
disapproval, defensive responses, passive or
thinking
aggressive responses, and arguing.
 When communicating with patients, it will be important
 Communication techniques often must be adapted for
to deal properly with the ff:
patients with special needs. Such patients include
 Physical and emotional factors
aging persons, those who have problems speaking and
 Developmental factors
understanding, the hearing impaired, the visually
 Sociocultural factors
impaired, and those who do not speak English
 Gender
 Patients who cannot speak clearly
 Patients need to be treated respectfully with regard to  Cognitive impairment
age and culture
 Hearing impairment
 Visual impairment
DIAGNOSIS  Unresponsive patients who do not speak English (or
 The primary nursing diagnostic label used to describe a your language)
patient with limited or no ability to communicate verbally  Older adults with sensory, motor, or cognitive
is impaired verbal communication impairments require adaptation of communication
 Many patients experience difficulty with communication: techniques to compensate for their loss of function
 Lacking skills in attending, listening, and special needs
 Responding, or self-expression
 Inability to articulate, EVALUATION
 Inappropriate verbalization  Patient Outcomes
 Difficulty forming words

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 Nurses and patients need to determine whether the

plan of care has been successful.
 Nursing interventions are evaluated to determine which
strategies or interventions were effective.
 If expected outcomes are not met, the plan of care
needs to be modified
 Desired outcomes for patients with impaired verbal
communication include:
 Increased satisfaction with interpersonal
interactions
 The ability to send and receive clear messages, and
attention to and accurate interpretation of verbal
and nonverbal cues

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