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ممرضة الصحة العامـــــة
The Public Health Nurse
Public Health Nurses
- Are found in various health settings and occupying various positions in the hierarchy.
- Are assigned in rural health units, city health centers, provincial health offices, regional health offices, and evening the national office of the Department of Health.
- Are also assigned in public schools and in the offices of government agencies providing health care services.
- Occupy a range of positions from Public Health Nurse I to Nurse Program Supervisors to Chief Nurse in public health settings.
- Uses various tools and procedures necessary for her to properly practice her profession and deliver basic health service.
- Uses nursing process in her practice and is adept in documenting and reporting accomplishments through records and reports.
- Technically competent in various nursing procedures conducted in settings where she is assigned
Public health nurse
- must be professionally qualified and licensed to practice in the area of public health nursing.
- Must possess personal qualities and “people skills” that would allow her practice to make a difference in the lives of these people.
- Functions in accordance with the dominant values of public health nurses, within the ethico-legal framework of the nursing profession, and in accordance with the needs of the clients and available resources for health care.
- Functions of PHN are consistent with the Nursing Law 2002 and program policies formulated by the DOH and local government health agencies. They are related to management, supervision, provision of nursing care, collaboration and coordination, health promotion and education training and research.
· Management Function
- the management function of the public health nurse is inherent in her practice.
- The nurse, in whatever setting and role has been trained to lead and manage.
- Objectives set for work being done can only be achieved through the execution of the five management functions of planning, organizing, staffing, directing and controlling.
- This function is performed when she organizes the “nursing service” of the local health agency.
- Managing the nurses and their activities
- Program management. This is a function where the PHN actually excels in.
- A program manager is responsible for the delivery of the package of services provided by the program to the target clientele.
- Reports on program accomplishments is a documentation of her management skills.
· Supervisory Function
- PHN is the supervisor of the midwives and other auxillary health workers in the catchment area.
- Formulates a supervisory plan and conducts supervisory visits to implement plan.
- Conducts supervisory visits using a supervisory checklist
- During the visit the PHN identifies together with the supervisee any issue or problem encountered and addresses them accordingly.
- Enhancement of training for the supervisee
- Report of the encounter is given to the supervisee and kept in her personal file for future reference.
· Nursing Function
- An inherent function of the nurse
- Her practice as a nurse is based on the science and art of caring
- Public health nursing is caring for individuals, families and communities toward health promotion and disease prevention
- PHN are expected to provide nursing care
- PHN uses her knowledge and skill in the nursing process. She does assessment, plans, and implements care, and evaluates outcomes.
- Establishes rapport with her client: individual, family or community
- Home visits
- Referral of patients to appropriate levels of care
· Collaborating and coordinating Function
- Brings activities or group activities systematically into proper relation or harmony with each other.
- Care coordinators for communities and their members
- Actively involved both socially and politically to empower individuals, families and communities as an entity to initiate and maintain health promoting environments.
- Establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector, NGOs, people’s organizations to address health problems.
- Identifies persons, groups, organizations, other agencies and communities whose resources are available within and outside the community and which can be tapped in the implementation of individuals, family and community health care.
· Health Promotion and Education Function
- Activities goes beyond health teachings and health information campaigns.
- Understands that health is determined by various factors such as physical and political environment, socio-economic status, personal coping skills and many other circumstances, and it is inappropriate to blame or credit a person’s health to himself alone because he is unlikely to control many of these factors.
- Understanding the multidimensional nature of health will enable her to plan and implement health promoting interventions for individuals and communities.
- Uses her skills in advocacy for the creating of a supportive environment through policies and reengineering of the physical environment for healthier actions.
- As an educator, the nurse provides clients with information that allows them to make healthier choices and practices.
- Health education is a major component of any public health program.
- PHN are expected to teach on a daily basis as part of their practices.
· Training Function
- Initiates the formulation of staff development and training programs for midwives and other auxillary workers
- Does training needs assessment for these health workers, designs the training program and conducts them in collaboration with other resource persons.
- Also does evaluation of training.
- PHN participates in the training of nursing and midwifery affiliates in coordination with the faculty of colleges of nursing and midwifery.
- Participates in teaching, guidance and supervision of student affiliates for their RLEs in the community setting.
- Health promotion calls for the active participation of the community.
- Mobilize communities for health actions.
- Community organizing is a means of mobilizing people to solve their own problems. Through this, people learn that their problems have social causes and fighting back is a more reasonable, dignified approach than passive acceptance and personal alienation.
· Research Function
- Participates in the conduct of research and utilizes research findings.
- PHN function is disease surveillance. Purposes of disease surveillance:
o To measure the magnitude of the problem
o To measure the effect of the control program
- It is important in monitoring the progress of the disease reduction initiatives: Poliomyelitis, Neonatal Tetanus Elimination, Measles Control, NCD risk factors, etc.
Community Health Nursing Process
Community health purposes and goals are realized through the application of a series that lead to desired results. The nursing process is central to all nursing actions~ it is the very essence of nursing, applicable in any setting, in any frame of reference, and within any philosophy. Its uniqueness will depend on the best application of nursing and public health skills to family and community problems.
The nursing process is a systematic, scientific, dynamic, on-going interpersonal process in which the nurses and the clients are viewed as a system with each affecting the other and both being affected by the factors within the behavior. The process is a series of actions that lead toward a particular result. This process of decision-making results in the optimal health care for the clients to whom the nurse applies the process.
Goal of Care
*Nursing Audit *Care Outcomes *Performance Appraisal *Estimate cost benefit ratio *Assessment of problems *Identify needed alterations *Revise plans as necessary
*Prioritize Needs *Establish goal based on needs & capabilities of staff *Construct action and Operation plan *Develop evaluation parameters *Revise plan as needed
*Initiate Contact *Demonstrate caring attitudes *Mutual trust & confidence *Collect data from all possible sources *Identify health problems *Assess coping ability *Analyze and interpret data
*Put Nursing Plan to action *Coordinate care/Services *Utilize community resources *Delegate *Supervise/monitor health services provided *Provide health education and training *Document responses to Nursing action
- provides an estimate of the degree to which a family, group or community is achieving the level of health possible for them
- identifies specific deficiencies or guidance needed and estimates the possible effects of the nursing interventions.
Assessment process involves the following steps:
a. Collection of Data
- Relevant data are collected on the health status of the family, groups and community: demographic data, vital health statistics, community dynamics including power structure, studies of disease surveillance, economic, cultural and environmental characteristics, utilization of health services by the population: and on individuals and families: health status, education, socio-cultural, religious and occupational background, family dynamics, environment and patterns of coping.
o Various methods to collect data:
§ Community surveys
§ Interview of individuals, family, groups and significant others
§ Observation of health-related behaviors of individuals, family groups and environmental factors
§ Review of statistics, epidemiological and relevant studies
§ Individual and family health records
§ Laboratory and screening tests and physical examinations of individuals.
b. Categories of Health Problems
- Health deficits, health threats and foreseeable crises or stress points are categories of health problems. The public health nurse analyzes the data in accordance with the nurse’s conception of the source of the client’s problems and needs that can be met through nursing intervention. The nursing diagnoses are interpreted and validated with individuals, members of the community and family groups concerned.
Capabilities and limitations to are identified:
a. A health deficit occurs when there is a gap between actual and achievable health status. No regular check-up is example.
b. Health threats are conditions that promote disease or injury and prevent people from realizing their health potential.
c. Foreseeable crises includes stressful occurrences
d. A health need exists when there is a health problem that can be alleviated with medical or social technology
e. A health problem is a situation in which there is a demonstrated health need combined with actual or potential resources to apply remedial measures and a commitment to act on the part of the provider or the client.
2. Planning Nursing Actions/Care
- plan for nursing action or care is based on the actual and potential problems that were identified and prioritized. Planning nursing actions include the following steps:
a. Goal Setting
- A goal is a declaration of purpose that gives essential direction to action.
- Specific objectives of care are made. These objectives are stated in behavioral terms: Specific, Measurable, Attainable, Realistic and Time bounded (SMART).
- The nurse prioritizes these objectives.
b. Constructing a Plan of Action
- Planning phase of community health nursing process is concerned with choosing from among the possible courses of action, selecting the appropriate types of nursing intervention, identifying appropriate and available resources for care and developing an operational plan.
- Course of action may have positive/negative effects.
- Ability of the family to cope or solve its own problems and make decisions on health matters should be considered.
- Improve the capacity of the clients to act in their behalf.
c. Developing an Operational Plan
- PHN must establish priorities, phase and coordinate activities.
- Plans of care are prioritized in order of urgency to determine those that need the earliest action or attention.
- These plans are broken down to manageable units and properly sequenced.
- Development of evaluation parameters is don in the planning stage and based on standards set by the nursing services
3. Implementation of Planned Care
a. PHN carry out nursing procedures which are consistent with the NCP, are adopted to present situations which promote a safe and therapeutics environment.
b. The role of the community health nurse shifts from direct care giver to that of a teacher.
c. Clients need the support of his own knowledge to maintain his optimum level of functioning.
d. Utilization of a support system provides a harmonious, orderly care to enable client to function optimally.
e. Client is offered planned assistance.
f. PHN monitor the health services provided, make proper referrals as necessary.
g. Documentations are legal records to protect the agency and the health care providers or the client himself.
4. Evaluation of Care and Services Provided
a. Evaluation is interwoven in every nursing activity and every step of the public health nurses.
b. Process elements include the steps of the nursing process itself-assessing, planning, implementing and evaluating, making a nursing diagnosis, determining nursing goals, writing an NCP, performing the necessary nursing interventions and coordination of services and measuring success of nursing actions.
c. Quality assurance efforts now recommend that evaluation of structure, process and outcomes criteria be made. This will evaluate the effectiveness of nursing care done, or changes in behavior, condition or compliance.
d. Evaluation based on professional practice
e. Evaluation of structure include cost-benefit ration, qualifications and number of members of the heath team in proportion to the populations served and the material resources in terms of quantity and quality.
f. Evaluation based on information gathered is utilized to improved community health nursing services as part of the total community health services.
I. CLINIC VISIT
جــــ .. الله كل خير ..ــــزاك ..*_*
موضوع مفصل وراقي جدا ..*_*
سلمــــ ..أناملك ..ــــت ..*_*
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