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Ns. TAENA, S.Kep

Community Health Nursing

Standards of Practice

(CHN Standards)

Thomas Aquino Erjinyuare Amigo



Ns. TAENA, S.Kep

Standar Praktik Kep

Masyarakat mempunyai kebutuhan dan harapan

untuk hidup lebih sehat dan umur panjang

Menyarankan & mendukung pasien untuk

menentukan pilihan yg positif tentang status

kesehatan terutama dalam hal manajemen diri

Memampukan masyarakat utk melakukan

perawatan di dalam keluarga secara terpadu &

manajemen diri terhadap penyakit jangka

panjang



Ns. TAENA, S.Kep

Standar Perawatan

Cara lain yang digunakan oleh profesi

keperawatan dalam memastikan bahwa

praktisi keperawatan kompeten & amanutk berpraktik adalah melalui penetapan

standar prakti k (Blois, Hayes, Kozies, & Erb,

2006)

Standar digunakan utk m¶evaluasi kualitas

perawatan yg dibrikan oleh perawat



Ns. TAENA, S.Kep

Standards of Practice is«

a published set of behavioral and

professional expectations of certificate

holders (Mildon, Betker, & Underwood,

2011)

K omitment profesi keperawatan dlm

melindungi masyarakat terhadap

praktek yg dilakukan oleh profesi

(DPP.PPNI,1999)



Ns. TAENA, S.Kep

Standard Praktik Keperawatan Klinis(ANA, 1998)

M¶cerminkan nilai & prioritas profesi

keperawatan

M¶brikan arahan utk praktik keperawatan

profesional M¶brikan kerangka kerja utk evaluasi praktik

keperawatan

M¶definisikan tanggung gugat profesi thdpmasyarakat & hasil akhir yg mjd tanggung

jawab perawat

(Blois, Hayes, Kozies, & Erb, 2006)



Ns. TAENA, S.Kep

Laverack (2004), identifies four characteristics of community

(Sines, Saunders, Forbes-Burford, 2009,p.50):

Dimensi spasial, yaitu tempat atau lokasi

Kepentingan, masalah, identitas yang

menghubungkan kelompok-kelompok lain yangheterogen

Berbagi kebutuhan dan kekhawatiran yang dapat

dicapai melalui kegiatan kelompok

Interaksi sosial dan hubungan yang mengikat orang

bersama-sama



Ns. TAENA, S.Kep

Skills Required For Community Development(Sines, Saunders, Forbes-Burford, 2009,p.58)

Building relationships with key partners

Appropriate organisational and leadership styles

Communication with people at different levels

Humility (rendah hati) Maintaining confidentiality

Flexibility negotiating skills

Awareness of equal opportunities

Accountability Advocacy/lobbying

Evaluation skills Research awareness Team working

Interpersonal skills Health promoter



Ns. TAENA, S.Kep

Family roles include, but are notlimited to, the following:(DeLaune & Ladner, 2011,p. 299):

Nurturance (mengasuh) and support

Allocation of resources Development of life skills

Division of labor (pembagian kerja)

Socialization of members (Antai-Otong,2007)



Ns. TAENA, S.Kep

Beberapa Sifat Kesehatan Keluarga(DeLaune & Ladner, 2011,p. 299)

Supporting members (mendukung anggotakeluarga)

Teaching respect for others (mengajarkanuntuk m·hormati org lain)

Helping with problem solving (m·bantu dlm

pemecahan masalah)

Communicating (berkomunikasi)



Ns. TAENA, S.Kep

Setting Praktik Perawatan kesehatanMasyarakat (Perkesmas):

(DeLaune & Ladner, 2011,p. 303)

Schools Workplaces (tempat kerja)

Public health units

Family



Ns. TAENA, S.Kep

Dalam rangka mempromosikan kesehatanmasyarakat, perkesmas melakukan fungsi:

(DeLaune & Ladner, 2011,p. 304)

Prevention of epidemics and spread of disease(Pencegahan epidemi dan penyebaran penyakit)

Protection against environmental hazards(Perlindungan terhadap bahaya lingkungan)

Prevention of injuries (Pencegahan cedera)

Promotion of health behaviors (Promosi

perilaku kesehatan) Response to disasters (Respon terhadap

bencana)



Ns. TAENA, S.Kep

Why are CHN Standards

important?

1. Define scope & depth of CHN (community health

nurse) practice / Menentukan lingkup &

kedalaman praktek CHN (perawat kesehatan

masyarakat)2. Establish criteria and expectations for acceptable

practice and safe ethical care / Menetapkan

kriteria dan harapan untuk praktek danperawatan yang dapat diterima dan aman

3. Provide criteria for measuring performance /

Menyediakan kriteria untuk mengukur kinerja



Ns. TAENA, S.Kep

Why are CHN Standards

important?

4. Support the ongoing development of CHN

(Mendukung pengembangan berkelanjutan

terhadap CHN)

5. Promote CHN as a specialty (Promosikan CHNsecara khusus)

6. Inspire excellence in & commitment to CHN

practice (Mempunyai keunggulan & komitmendlm praktek CHN)

7. Set a benchmark for new community health

nurses (Menetapkan patokan bagi CHN baru)



Ns. TAENA, S.Kep

COMMUNITY HEALTH NURSINGIncludes: Nurses promoting health of individuals, groups &

communities and an environment that supports health

Home Health (HHN)1. Focus on prevention,

health restoration,maintenance & palliation

2. Focus on clients &families3. Practice in homes,

schools or workplace andintegrates health

promotion, teaching &counseling with provisionof care

4. Educational preparation:gelar sarjana

Public Health (PHN)

1. Focus on health promotion,illness prevention &population health

2. Link individual & familyhealth experiences into thepopulation health frameworkand links population healthto families and individuals

3. Practice in diverse settingsex. Community healthcenters, schools, streets,nursing stations

4. Educational preparation:gelar sarjana



Ns. TAENA, S.Kep

Unique Characteristics of Community Health

Nursing

View health as aresource & focus

on capacities

CHNs promote,protect & preserve

the health of individuals,

families, groups,communities & populations«

«wherever people live,work, learn, worship &

play«.

«in a continuous versusepisodic process

Have a uniqueunderstanding of the influence of

the environmentalcontext of health

Work at ahigh level of autonomy

Buildpartnerships

based onprimary healthcare principles,

caring & empowerment

Combinespecialized

nursing, socialand public

health sciencewith

experientialknowledge

Marshal resourcesto support healthby coordinatingcare & plan Nsg

services, programs& policies



Ns. TAENA, S.Kep

Components of Professional

Practice Model

Individuals, families, groups,

communities, populations,

systems

Code of Ethics

Community Health Nurse Community Health Nursing

Standards

Delivery Structure and Process

Determinants of Health

Discipline specific

competencies: Public Health,

Home Health

Government support

Management practices Professional relationships and

partnerships

Professional Regulatory

Standards

Theoretical Foundation Values and principles



Ns. TAENA, S.Kep

The Community Health Nursing Process(Anderson & McFarlane, 2004)

1. Assessment2. Diagnosis & Planning

3. Intervention (action)

4. Evaluation



Ns. TAENA, S.Kep

1. Promoting Health

a. Health Promotion

b. Prevention and Health Protection

c. Health Maintenance, Restoration and

Palliation

2. Professional Relationships

3. Capacity Building

4. Access and Equity (keadilan)

5. Professional Responsibility and Accountability

CCHN Standards of Practice



Ns. TAENA, S.Kep

Parts of each Standard: Description & Indicators

Description of Standard is provided in initial paragraph

Indicators: begin with the heading ³The community

health nurse...´ and define the specific activities that

CHNs are expected to perform to achieve the Standard.

The indicators begin with assessment type activities,

move to planning, action and end with evaluation

activities.



Ns. TAENA, S.Kep

Standard 1- Health Promotion

Melibatkan penduduk secara keseluruhan dalam konteks

kehidupan sehari-hari mereka daripada berfokus hanya

pada orang beresiko

Apakah proses menangani ketidaksetaraan kesehatan dan

memungkinkan orang untuk meningkatkan kontrol atas &untuk meningkatkan kesehatan mereka.

Membawa bersama-sama orang yang menyadari bahwa

sumber daya dasar & kondisi untuk kesehatan (misalnya

faktor sosial dan lingkungan dari kesehatan) sangat penting. Bekerja terbaik ketika semua tingkat-individu, kelompok,

komunitas, masyarakat (pemerintah, media) dan beberapa

pendekatan yang digunakan



Ns. TAENA, S.Kep

EXAM PLES from practice - Health Promotion

PHNs work with a community toadvocate for a smoke-free town or municipality

PHNs promote physical activity andhealthy eating through programs suchas the In-Motion, Supermarket Safariand the Schools Awards Program.

HHNs encourage families dealing witha chronic illness to participate inregular physical and social activities



Ns. TAENA, S.Kep

Standard 2- Prevention & Health

Protection

Para CHN menerapkan kegiatan untuk

meminimalkan terjadinya penyakit atau

cedera dan akibatnya.

Strategi perlindungan kesehatan sesuai

dengan program dan kebijakan



Ns. TAENA, S.Kep

EXAMPLES f rom practice

Prevention & Health Protection

PHN track immunization schedules for each childso that when a child is overdue for vaccine theycan be contacted. (CHNAC)

A CHN observes high rates of smoking within aparticular client group. The concern is raised withthe practice team and a plan is developed to findways to address the issue.

PHN work with a parent¶s organization and thepolice to promote proper installation of car seatsthrough the media and conduct several clinics toprovide one-on-one assessment and teaching.



Ns. TAENA, S.Kep

Utk masalah kesehatan yg akut, kronik, paliatif

(HHNs) health teaching & counseling for health

maintenance or dealing with acute, chronic or terminal illness (HHNs and PHNs).

Links people to community resources &

facilitates/coordinates care needs & supports

(koordinasi dengan berbagai pihak)

Standard 3-

Health Maintenance, Restoration & Palliation



Ns. TAENA, S.Kep

E xamples from practice-

Health Maintenance, Restoration & Palliation

HHNs care for disabled studentsin the classroom: Communicationis required with the child¶s

guardian, teacher and/classroomassistant

CHNs provides ongoing nursingcare to families with seniors whoare experiencing difficulties. The

care may be provided directly or through unregulated workers.This may include telephonefollow-up, home visits or community referrals.



Ns. TAENA, S.Kep

G roup w ork

Introductions: Your name, where you live, where you

work, focus of your practice (change for student

groups)

Each person in turn (no discussion) describes their experience

Recorder takes down main points of each experience

Discuss and determine which of the first three

Standards is most relevant for each experience.

Decide which example from your group could be used

in the reporting session at the end.



Ns. TAENA, S.Kep

Standard 4. Professional Relationships

Built on the principles of connecting & caring

Relationships may be with clients and/or with

organizations/stakeholders

Relationships built on mutual respect and on an

understanding of the power inherent to the CHN

position.

Unique to CHN is building a network of relationships & partnerships ± occurs within a

complex environment for both PHNs and HHNs.



Ns. TAENA, S.Kep

Examples from practiceProfessional Relationships

A HHN working in palliative care listens to the

concerns of stressed and exhausted

caregivers and supports them in making

decisions about respite and hospice care.

A group of PHN working with families

experiencing child care difficulties identify

that post natal visits based on issues or tasksmoves them around too much to be able to

develop a continuing relationship with

families. They bring their concern to the

attention of management.



Ns. TAENA, S.Kep

Standard 5. Capacity Building

Peningkatan kapasitas kemampuan individu /

masyarakat untuk mendefinisikan, menilai,

menganalisis & bertindak pada masalah kesehatan.

Aktif terlibat dalam mengatasi masalah yang kritis CHN bekerja sama dg orang-orang yang

berpengaruh mengontrol sumber daya & dalam

masalah kesehatan

CHNs menilai tahap kesiapan untuk perubahan &

prioritas tindakan.

CHNs membangun kekuatan yang ada.



Ns. TAENA, S.Kep

E xamples from practice

Capacity Building

A HHN encourages a mother and teens to workout a schedule for ROM exercises for thegrandmother. The family is happy that they wereable to work out the problem together.

A PHN encourages a school to mobilize a schoolhealth committee that includes students, parents,teachers, administration, and community partners.Committee members identify the schoolcommunity¶s strengths and needs, and prioritize,

plan, implement, evaluate and celebrate action for a healthier school. The school community¶scapacity to take its own action for health isenhanced via a sustainable structure (thecommittee). The PHN is a partner in the process.



Ns. TAENA, S.Kep

Standard 6. Access & Equity

CHNs megidentifikasi fasilitas umum sertasumber dan pelayanan yang dapat dijangkau

CHNs memfasilitasi semua tingkatan didalam masyarakat untuk mendapatkanpelayanan yang tepat

CHNs bekerjasama dg pelayanan dan sektor

lain utk pelayanan yang komperehensif padaklien dan memperoleh hasil yang optimal



Ns. TAENA, S.Kep

Ex amples f rom practice

Access & Equity

A PHN identifies that one ethnic group

does not use health care services

(including prenatal classes) outside their

area. The PHN works with a champion

from this group to organize local prenatal

classes delivered by a PHN and translated

by a woman from the community.



Ns. TAENA, S.Kep

Standard 7. Professional Responsibility &

Accountability

CHNs bekerja dengan tingkat otonomi

yang paling tinggi yang mempunyai

tanggung jawab atas kompetensinya CHNs bekerja di lingkungan yang paling

kompleks dengan bertanggungjawab

terhadap berbagai otoritas CHNs menghadapi dilema etika yang

unik



Ns. TAENA, S.Kep

Ex amples f rom practice-

Professional Responsibility and Accountability

HHN diminta oleh keluarga untuk melepaskansemua peralatan yang terpasang pada pasien yangtelah koma 1 minggu. Jika dilepaskan maka pasientersebut akan meninggal. Perawat harus

mendiskusikan dg keluarga apa yang membuatkeluarga membuat keputusan seperti itu

PHN adalah ditugaskan untuk bekerja dalamprogram pertukaran jarum suntik didasarkan pada

pengurangan bahaya. Dia memiliki kesulitanmenerima prinsip-prinsip pengurangan dampakburuk dan menggunakan praktik reflektif pribadi dandengan atasannya untuk memahami dan mengubah

asumsi-asumsi.



Ns. TAENA, S.Kep

REFERENSI

Anderson, E. T., & McFarlane, J. (2004). C ommunity As Partner.

Philadelphia: Lippincott Williams & Wilkins.

Blois, K. K., Hayes, J. S., Kozies, B., & Erb, G. (2006). Praktik

K eperawatan Profesional: K onsep & Perspektif. Jakarta: EGC.

DeLaune, S. C., & Ladner, P. K. (2011). Fundamentals of Nursing:S tandards & Practice. New York: Delmar Cengage Learning.

Mildon, B., Betker, C., & Underwood, J. (2011). S tandards of Practice

in C ommunity Health Nursing: A Literature Review Undertaken to

Inform Revisions to the C anadian C ommunity Health Nursing

S tandards of Practice. Ottawa: Community Health Nurses of Canada.

Sines, D., Saunder, M., & Forbes-Burford, J. (2009). C ommunity

Health C are Nursing. United Kingdom: Wiley-Blackwell.



Ns. TAENA, S.Kep

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