LECTURE NOTES For Nursing Students Community Health Nursing Daniel Mengistu Equlinet Misganaw University of Gondar In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education 2006 Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. ©2006 by Daniel Mengistu and Equlinet Misganaw All rights reserved. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. PREFACE Community health Nursing is the synthesis of nursing and public health practice applied to promote and protect the health of population. It combines all the basic elements of professional, clinical nursing with public health and community practice. Community health nursing is essential particularly at this point in time because it maximizes the health status of individuals, families, groups and the community through direct approach with them. Today community participation and involvement is getting a due attention before the occurrence of illnesses as life-style changes to continue to play a significant role in morbidity and mortality. Chronis illnesses, tobacco smoking, road traffic accident (RTA) …etc, and environmental changes that affect health are steadily becoming the major concerns influencing human health in our country. As nurses of 21st century we have duties and responsibilities to keep a dynamic balance with the ever changing needs of the health of our society. To maintain abreast with this societal needs we professional nurses must understand concepts and models of the community health nursing, the importance of health promotion and disease prevention and health care planning, i implementation and evaluation of health care efforts for the advantage of the community. The purpose for preparing this lecture note is to upgrade the previously prepared lecture note and to present the subject in a relatively simplified and organized way. The teaching material is based on the existing curriculum of community health nursing and consists of 14 units. Each unit has its own objectives, body and reviewing question at the end. Finally a lot of effort has gone in preparing this material within short period of time, valuable and constructive comments have welcome for the improving of this lecture note. ii ACKNOWLEDGEMENT We would like to acknowledge The Carter Center initiative for supporting the preparation of these lecture notes. We are very grateful to the Nursing and Community Health Department staffs for their valuable comments and ideas in revising the first draft. We also owe special gratitude to Mr. Mesfin Negussie, and S/r Hanna Alebachew who have produced the first ever lecture note on Public Health Nursing in this country. We would also like to extend our special regards to Mr. Akililu Mulugeta, Technical Manager, TCC for his support during the entire preparation of this lecture note. Finally, we wish to extend our thanks to W/ro Serkalem Teshome for writing the draft of these lecture notes. iii TABLE OF CONTENTS Preface...............................................................................I Acknowledgment..............................................................III Table of content................................................................IV List of figures.....................................................................X List of tables ....................................................................XI Abbreviations ..................................................................XII Unit one: Introduction to concepts of Community Health Nursing................................................................1 1.1. Introduction .....................................................1 1.2. Health ......................................................3 1.3. Health and wellness.........................................5 1.4. Health and illness ..........................................13 1.5. Health- illness continuum...............................14 1.6. Communing health practice...........................17 1.7. Community health nursing.............................18 1.8. Public health nursing......................................22 Review Questions......................................23 Unit two: Historical Development of Community Health Nursing .............................................................24 2.1. Introduction.................................................24 iv 2.2. Factor influencing the growth of community health nursing .............................................32 2.3. Role of Community Health Nursing ............34 2.4. Setting of Community Nursing Practice..... 39 Review questions .......................................40 Unit three: Health care Delivery System and Primary Health Care............................................................41 3.1. Introduction.................................................41 3.2. Factors affecting health care delivery system.46 3.3. Health care delivery system in Ethiopia .....48 3.4. Primary Health Care...................................62 3.5. Organization of health care delivery system in Ethiopia ...................................................84 Review questions........................................89 Unit Four: Nursing Process in the Community..............90 4.1 Introduction....................................................90 4.2 Phases of nursing process in the community 96 Review questions..............................................108 Unit Five: Maternal and Child Health (MCH) ...............109 5.1 Introduction................................................109 5.2 Historical development of MCH service.......111 5.3 Reason for priority given to MCH service....115 v 5.4 Major target of MCH service.......................117 5.5 Major component of MCH service...............117 5.6 Child Health................................................118 5.7 Common indicator of MCH Service..............119 Review questions.........................................123 Unit Six: Adolescent Reproductive Health (ARH) .......124 6.1 Introduction...............................................124 6.2 Rationale why concern to ARH ................126 6.3 Components of ARH.................................126 6.4 Problem of Adolescent Fertility................ 127 6.5 Strategies of ARH.................................... 129 Review questions......................................134 Unit Seven: Street “On” and “Off” Children ..................135 7.1. Introduction...............................................135 7.2. Reason (factors contributing) for being street.........................................................136 7.3. Problem of Street Children........................136 7.4. Strategies..................................................138 Review questions......................................139 Unit Eight: School Health Service (SHS).....................140 8.1 Introduction ..............................................140 8.2 Goal ..........................................................140 vi 8.3 Components of SHS.................................142 8.4 SHS Program............................................143 8.5 Common health problems among school children.....................................................144 8.6 Role of community health nurse in SH......144 Review questions......................................145 Unit Nine: Prison Health Service (PHS) .....................146 9.1 Introduction...............................................146 9.2 Purpose of PHS........................................146 9.3 Common Health Problem in the prison.... 147 9.4 Responsibilities of Public Health Nursing during PHS................................................149 Review questions.........................................150 Unit Ten: Substance Abuse .........................................151 10.1 Introduction...............................................151 10.2 Factors associated with substance abuse1153 10.3 Diagnostic criteria for substance abuse....156 10.4 Problem associated with substance abuse.158 10.5 Management and control of substance Abuse....................................................... 160 Review questions ..................................... 163 vii Unit Eleven: Addressing the Needs of the Family .......164 11.1. Introduction...............................................164 11.2. Universal characteristics of every family...165 11.3. Characteristics of healthy family...............168 11.4. Application of Nursing Process on promoting family health ..........................................169 Review questions...............................................172 Unit Twelve: Promoting and Protecting the Health of Older Population..............................................173 12.1. Introduction............................................173 12.2. Health problem of elderly people...........175 12.3. Health maintenance program for older people....................................................176 Review questions...................................177 Unit Thirteen: HIV/AIDS ..............................................178 13.1. Introduction............................................178 13.2. Opportunistic infections .........................182 13.3. ARV therapy...........................................184 13.4. Adherence .............................................187 13.5. Nutrition and HIV/AIDS..........................191 13.6. Other social services..............................195 13.7. Action by national nurses associations and other.......................................................197 viii