COMMUNITY

HEALTH NURSING
ROMULO D. LOPEZ JR, RN LPT
THEORIES/APPROACHES
HEALTH BELIEF MODEL (HBM)
Health Belief Model

● based on the premise that behavioral change to succeed,

individuals must have the incentive to change.

PURPOSE:

● to explain and predict preventive health behavior.

CONCEPT
PERCEIVED SUSCEPTIBILITY

● one’s belief regarding the chance of getting a given condition.

PERCEIVED SEVERITY

● one’s belief in the seriousness of a given condition

PERCEIVED BENEFITS

● one‘s belief in the ability of an advised action to reduce the health risk
or seriousness of a given condition.
CONCEPT
PERCEIVED BARRIERS

● One’s belief regarding tangible and psychological costs of an advised

action

CUES TO ACTION

● Strategies or conditions in one’s environment that activate readiness to

take action.

SELF-EFFICACY

● One’s confidence in one’s ability to take action to reduce health risks.

MODEL‘S CONCEPT
● all concepts relate to client perceptions.
● For Example: the cue to action in the prevention of dengue fever
maybe provided through an information campaign. this makes
people in barangay aware of the disease and everyone is
susceptible to the possibly fatal disease.
● the HBM would be used by the nurse to help clients in making
behavior modifications to avoid dengue.
MILLIO’s FRAMEWORK FOR PREVENTION
● Nancy Milio developed a framework for prevention that includes concepts of
community – oriented, population- focused care.
● stated that behavioral patterns of the populations-and individuals who make
up populations – are a result of habitual selection from limited choices.
● She challenged the common notion that a main determinant for unhealthful
behavioral choice is lack of knowledge.
● Milio’s framework described a sometimes neglected role of community health
nursing to examine the determinants of a community’s health and attempt to
influence those determinants through public policy.
LEVEL OF PREVENTION MODEL
● advocated by leavell and clark in 1975.
● suggests that the natural history af any disease exists on a
continuum, with health at one end and advanced disease at the
other.
● delineates three levels of the application of preventive measures
that can be used to promote health and arrest the disease process
at different points along the continuum.
● GOAL: maintain a healthy state and to prevent disease or injury
FOUR LEVELS OF PREVENTION MODEL
PRIMORDIAL PREVENTION:

● prevention of the emergence or development of risk factors in population

or countries in which they have not yet appeared
● efforts directly towards discouraging children from adopting harmful
lifestyles.

PRIMARY PREVENTION:

● an action taken prior to the onset of disease

● includes the concept of positive health that encourages the chievement
and maintenance of an “acceptable level of health“
SECONDARY PREVENTION

● an action which halts the progress of a disease at its incipient stage and
prevents complications.
● domain of CLINICAL MEDICINE.
● an imperfect tool in th transmission of disease.
● more expensive than primary prevention

TERIARY PREVENTION:

● all measures available to reduce or limit impairment and disabilities.

● minimize suffering caused by exiting departures from good health.
● to promote the patients adjustment to irremediable conditions.
NOLA PENDER‘S HEALTH PROMOTION
● it has been used for nursing research, education and practice.
● HPM designed to be a “complementary counterpart to models of
health protection”
● HEALTH as a positive dynamic state not merely the absence of
disease.
● directed at increasing a clients level of well-being.
● focuses on three areas:
○ Individual characteristics and experience
○ Behavior - specific cognitions and affect
○ Behavioral outcomes.
MAJOR CONCEPTS of HPM
● INDIVIDUAL CHARACTERISTICS
○ prior related behavior and personal factors.
● BEHAVIOR SPECIFIC COGNITIONS
○ perceived benefits of action, perceived
barriers to action, perceived self efficacy,
activity related affect, interpersonal
influences and situational influences
● BEHAVIORAL OUTCOMES
○ commitment to plan of action, immediate
competing demands and preferences and health
promoting behavior.
 SUBCONCEPTS of HPM
● PERSONAL FACTORS
○ these factors are predictive of a given behavior and shape by
nature of the target behavior being considered
■ PERSONAL BIOLOGICAL FACTORS
● include variables such as age, gender, BMI, pubertal
status, aerobic capacity, strength, agility or balance
■ PERSONAL PSYCHOLOGICAL FACTORS
● include variables such as self-esteem, self-motivation,
personal competence, perceived health status and
definition of health
PERSONAL FACTORS
● PERSONAL SOCIO-CULTURAL FACTORS
○ include variables such as race, ethnicity, acculturation,
educatiobn and socio economic status.
 SUBCONCEPTS OF HPM
● PERCEIVED BENEFITS OF ACTION
○ Anticipated positive outcomes that will occur from health behavior
● PERCEIVED BARRIERS TO ACTION
○ anticipated, imagined or real blocks and personal costs of
understatnding a given behavior.
● PERCEIVED SELF-EFFICACY
○ judgement of personal capability to organize and execute a health
promoting behavior.
● ACTIVITY- RELATED AFFECT
○ subjective possitive or negative feeling that occurs before, during
and following behavior based on the stimulus
 SUBCONCEPTS OF HPM
● INTERPERSONAL INFLUENCES
○ cognition concerning behaviors, beliefs, or attitudes of
others.
○ NORMS, SOCIAL SUPPORT, MODELING
○ Primary sources: FAMILIES, PEERS and HEALTH CARE
PROVIDERS
 SUBCONCEPTS OF HPM
Situational Influences

● Personal perceptions and cognitions of any given situation or context that can
facilitate or impede behavior.
● Include perceptions of options available, demand characteristics and
aesthetic features of the environment in which given health promoting is
proposed to take place.
● Situational influences may have direct or indirect influences on health
behavior.
 SUBCONCEPTS OF HPM
Commitment to Plan of Action

● The concept of intention and identification of a planned strategy leads to the

implementation of health behavior

Immediate Competing Demands and Preferences

● Competing demands are those alternative behaviors over which individuals have low
control because there are environmental contingencies such as work or family care
responsibilities. Competing preferences are alternative behaviors over which
individuals exert relatively high control, such as choice of ice cream or apple for a
snack
 SUBCONCEPTS OF HPM
Health-Promoting Behavior

● A health-promoting behavior is an endpoint or action outcome that is directed toward

attaining positive health outcomes such as optimal wellbeing, personal fulfillment, and
productive living
Lawrence Green’s PRECEDE-PROCEED – MODEL
● PRECEDE model was put forward by Lawrence W. Green and
colleagues in year 1970s. Further in year 1991, PROCEED was
added to the model encompassing policy, regulatory and
recognizing environmental factor as an important determinant
of health and behavior of individuals
● PRECEDE/PROCEED model is a widely used model in public
health for bringing change in behavior.
 PRECEDE-PROCEED – MODEL

PRECEDE stands for: PROCEED Stands

for:
P – Predisposing,
P – Policy,
R- Reinforcing,
R – Regulatory,
E – Enabling,
O – Organizational,
C – Construct in,
C – Construct in,
E- Educational,
E – Educational and
D – Diagnosis
E – Environmental,
and
D – Development
E – Evaluation.
 PRECEDE-PROCEED – MODEL
● It emphasized on improving health of people by bringing
change in health related behavior.
● This model is used for implementing programs and for carrying
out behavior change interventions.
● PRECEDE/PROCEED model is used in planning, implementing
and evaluating behavior change program in order to promote
and protect health.
 PRECEDE-PROCEED – MODEL
Purpose of PRECEDE/PROCEED model:
● it provides structural framework for developing behavior change
intervention.
● This model is also used for monitoring and evaluating the
intervention program.
● It is participatory model and involves community participation.
Content, methods/media for a particular program is selected
according to need
 Phases of PRECEDE/PROCEED Framework
PHASE 1: Social diagnosis
● In this phase, social problem that can affect the quality of life of target
population are identified and evaluated.
● programmer try to figure out the connection between social problem
and quality of life affected resources availability, needs of given
population, readiness of community people towards the change and
determine desired outcome.
● Information regarding social problem is gained by using various
methods such as interview, focus group discussion, surveys,
community forums etc.
 Phases of PRECEDE/PROCEED Framework

PHASE 2: EPIDEMIOLOGICAL DIAGNOSIS

● Health problems associated with quality of life is determined in

epidemiological diagnosis.
● Primary or secondary source data are used for acquiring required
information.
● It seeks to identify the specific health problems and non-health factors
associated with poor quality of life.
● Health problems are described on the basis of time, place and person.
● Priorities are set within health problem and with target population.
● Epidemiological data includes vital statistics, disability, incidence,
prevalence etc.
 Phases of PRECEDE/PROCEED Framework

PHASE 3: Behavioral and environmental assessment

● Behaviors, practices, lifestyle, environmental factors are determined affecting health problem
identified in phase 2.
● This assessment facilitate planner to prioritize behavior which will be targeted in intervention
program.
○ Behavioral diagnosis analyzes behaviors that influence the problem identified in phase 1 and
2.
○ Environmental diagnosis analyzes physical and social environment that would affect the
behavior of the individual.
● Non behavioral factors include factors such as climate, workplace, availability and adequacy of
health institutions.
 Phases of PRECEDE/PROCEED Framework

PHASE 4: Educational diagnosis

● In this phase, predisposing, reinforcing and enabling factor that may support or
form barrier to changing environment.
● Predisposing factor
○ It includes any characteristics of individual or population that affects
personal motivation to bring change in their behavior. It includes:
§ Knowledge
§ Beliefs
§ Values
§ Attitudes
§ Norms etc.
PHASE 4: Educational diagnosis

Reinforcing factors
● Reinforcing factors are feedbacks from others which may be positive or negative; continued
reward, incentive can motivate repetition of certain behavior. It includes:

§ Reward/Punishment
§ Peer influence
§ Teacher
§ Family etc.

E.g. peer pressure for smoking.

PHASE 4: Educational diagnosis

Enabling factors
★ They are social and environmental factors that enable motivation attain
specific behavior.

§ Availability
§ Access
§ Health related laws
§ Resources
§ Skills
 Phases of PRECEDE/PROCEED Framework

PHASE 5: Administrative and policy diagnosis

★ It identifies administrative and policy factors which should be
focused before program implementation.
★ Policy diagnosis: it analyzes if goals/ objective of program is
compatible with that of organization.
★ Administrative diagnosis: it analyses policies, resources in
organizational situation that facilitate or hinder development of
program.
 Phases of PRECEDE/PROCEED Framework

PHASE 6: Implementation of program

★ In this phase, planned program is put into action in targeted

population.

PHASE 7: Process evaluation

★ In process evaluation, implementation process is evaluated; it helps
to determine if the program is being conducted as planned and helps
to bring modification if necessary to improve the program.
 Phases of PRECEDE/PROCEED Framework

PHASE 8: Impact evaluation

★ This evaluation is carried out immediately after implementation of program.

★ It helps to determine effectiveness and efficiency of the program as well as
change in predisposing, reinforcing and enabling factors.

PHASE 9: Outcome evaluation

★ It evaluates if the program implemented produce effect favorable to outcomes

identified in phase 1.
★ It measures achievement of overall objective of program and change in
quality of life.
★ It determines effect of program in health and quality of life of the community.
SCHOOL HEALTH NURSING

★ School Nursing is a type of public health nursing that focuses on the

promotion of health and wellness of pupils/students, teaching and
non-teaching personnel of the school.
★ Assist young people in making choices for a healthy lifestyle, reduce
risk taking behavior and focus on issues such as prevention of drugs
and substance abuse, teenage pregnancy, sexually transmitted
infection, malnutrition, communicable and non-communicable disease
SCHOOL HEALTH NURSING
Objectives:

General: To promote and maintain the health of the school and populace by providing
comprehensive quality nursing care.

Specific:

➔ Provide quality nursing service to the school population

➔ Create awareness among school children, personnel and administration on the
importance of the promotive and preventive aspects of health through health education.
➔ Encourage the provision of standard functional facilities.
➔ Provide nursing personnel with opportunities for continuing education and training
➔ Conduct and participate in researches related to nursing, and
➔ Establish/ strengthen linkages with government and non- government
organization/agencies for school community health work.
SCHOOL HEALTH NURSING
Duties and Responsibilities:

1. Health Advocacy
2. Health and nutrition assessment including other screening procedures such as
vision and hearing
3. Supervision of the health and safety of the school plant.
4. Treatment of common ailments and attending to emergency cases.
5. Referrals and follow-up of pupils and personnel
6. Home visits
7. Community outreach like attending community assemblies and organizing school
community health councils.
8. Recording and reporting accomplishments.
9. Monitoring and evaluation of programs and projects.
SCHOOL HEALTH NURSING
Functions:

➔ School Health and Nutrition Survey

◆ This shall done initially to provide data for evaluation and for planning purposes.
◆ Survey shall include among others the current health and nutritional status of
school children, situation on health facilities as well as actual status of health
education activities undertaken by the teachers and health personnel
➔ Putting up a Functional School Clinic
◆ R.A 124 mandates that all the schools are to provide school clinics for the
treatment of minor ailments and attendance of emergency cases.
➔ Health Assessment
◆ Aims to discover the signs of illness and physical defects in order to correct them,
check on the health habits of pupils and prevent the progress of those which
cannot be corrected.
★ Standard Vision Testing for School children SCHOOL HEALTH NURSING
★ Ear examination
★ Height and Weight Measurement and Nutritional Status Determination
★ Medical Referrals
★ Attendance to Emergency cases
★ Student Health Counselling
★ Health and Nutrition Education Activities
★ Organization of School Community Health and Nutrition Councils.
★ Communicable Disease Control
★ Establishment of Data Bank on school health and Nutrition Activities.
★ School Plant Inspection for Healthy Environment
★ Rapid classroom inspection.
★ Home Visitation
 SCHOOL HEALTH NURSING
School health program were defined as :

1. School health services

2. School health education

3. A healthy school environment to include both physical and psychosocial aspects

of environment( WHO, 1997)

★ RA 124 in 1947- an act to provide for Medical Inspection of Children Enrolled in

Private Schools, Colleges and Universities in the Philippines. This law stated that
it was the duty of the school heads of private schools with a total enrolment of 300
or more to provide for a part-or full time physician for the annual medical
examination of pupils and students.
★ The physicians were to render of their school health activities at the end of every
quarter of each school year to the Director of Health.
 SCHOOL HEALTH SERVICES
★ Health Education- these are culture sensitive and based on the identified
educational needs of the target population.

Areas of concern for health education:

1. Oral Hygiene- the oral health care program involves the 7

o‘clock tooth brushing habit activity.

2. Injury prevention and developing safety conscious behavior in

the use of the school playground, while engaging in sports, and the
like. MAPEH period is a good time for the school nurse or teacher to
talk with and counsel students about risk of developing health
problems related too physical activity.
3. Tobacco Use- Smoking is a major problem in this country.

● Prevention should be emphasized in young people.

4. Substance Abuse- The use of alcohol and other drugs is associated with problems in
schools, injuries and violence, and motor vehicle deaths.

● National Drug Education Program- designed to promote collaboration of other

sectors with the school system by establishing linkages among government,
private and socio-civic organizations.
● Random drug testing is also carried as part of this program.

5. HIV, AIDS- School-base HIV and AIDS Education and prevention program is an
information dissemination campaign to educate the general Population on the risks of HIV
and AIDS.
 SCHOOL HEALTH SERVICES
★ Physical Education - Sedentary lifestyle is associated with obesity, hypertension,
heart disease and diabetes

- Regular Physical activity helps build and maintain healthy bones and
muscles.

➔ Health services
1. Health Screening- one of the objective of the school health nursing program in
the Philippines is to detect early signs and symptoms of illness, disabilities and
deviations from normal.

a. Annual Individual health assessment- examination of the eyes, ears, nose,

throat, neck, mouth, skin, extremities, posture, nutritional status, heart and
lungs.
B. Visual acuity tests done with the use of Snellen’s chart, E-chart or
symbol chart.
C. Ball pen click test (auditory screening) - test for hearing acuity.
D. Height and weight measurement- done at the beginning and at the end
of the school year.
E. Rapid Classroom Inspection- inspection of the pupils in the classroom
or while they are in line formation outside the classroom.
F. Done to detect illness, particularly when there is outbreak in the
community
Emergency Care- emergencies can include natural events
such as typhoons, floods, and earthquake and man-made
disasters, such as hazardous material spills, fires and civil
disobedience.
➔ Basic first aid equipment should be available in all
schools.
➔ The school nurse and school health guardians must be
knowledgeable about standard first aid.
➔ EMS activation and Referral system should be in place.
Nutrition- a variety of foods must be ingested to meet their daily
requirement.
➔ Diets should include a proper balance of carbohydrates, proteins, and
fats with sufficient intake of vitamins and minerals.
➔ Skipping meals, especially breakfast and eating unhealthy snacks
contribute to poor childhood nutrition.
➔ Food preparation is expected to be undertaken by the home
economics, feeding teachers, homeroom Parent-Teachers
Association on a rotation basis or both
Obesity – not considered as an eating disorder must be of
concern to the school nurse
3 most common eating disorder:
★ Anorexia- severely restricted intake of food based
on an extreme fear of weight gain.
★ Bulimia- chaotic eating pattern with recurrent
episodes of binge eating.
★ Binge eating-out of control eating of large amounts
of food whether hungry or not.
Counseling, Psychological and social services- children and
teens struggle with depression, substance abuse, conduct
disorders, self-esteem, suicide ideation, eating disorders and under
or overachievement.
➔ One of the most important roles of the nurse with various vague
complaints, such as recurrent stomach aches, headaches, or
sexually promiscuous behavior.
➔ Early detection and treatment may prevent untoward
consequences.
➔ It is important for the nurse to be cognizant of the warning signs
associated with suicide and to recognize and refer at-risk
adolescents to appropriate mental health professionals.
★ Healthy School Environment- the healthy school
environment should consist of (WHO, 1997)
○ 1. A Physical, psychological and social environment
○ 2. A healthy organizational culture within the school
○ 3. Productive interaction between the school and
community.
★ Health Promotion for school staff- staff that participate in
health promotion increase their health knowledge and
positively change their attitudes and behaviors relative to
smoking practices, nutrition, physical activity, stress and
emotional health
STANDARD OF SCHOOL NURSING PRACTICE
Standard 1. Assessment

➔ Nurse collects comprehensive data pertinent to the clients health or the

situation

Standard 2. Diagnosis

➔ Nurse analyzes the assessment data to determine the diagnoses or

issues

Standard 3. Outcomes identification

➔ Nurse identifies expected outcome for a plan individualized to the client

or the situation
Standard 4. Planning
➔ School nurse develops a plan that prescribes strategies and
alternatives to attain expected outcome.
Standard 5 A. Coordination of care
➔ Nurse provides health education and employs strategies to promote
health and a safe environment.
Standard 5 B. health teaching and health promotion
➔ Nurse provides health education and employs strategies to promote
health and a safe environment.
Standard 6. Evaluation

★ School nurse evaluates the client’s progress towards attainment of outcomes.

Standards of professional performance

Standard 7. Quality of practice

➔ School nurse systematically enhances the quality and effectiveness of nursing

practice

Standard 8. Education

➔ School nurse attains knowledge and competency that reflects current school
nursing practice.

Standard 9. Profession practice evaluation

➔ Nurse evaluates ones own nursing practice

Standard 10. Collegiality

➔ Nurse interacts with to the professional development of peers and

school personnel as colleagues.

Standard 11. Collaboration

➔ School collaborates with the client, family, school, staff

Standard 12. Ethics

➔ School nurse integrates ethical provision in all areas of practice.

Standard 13. Research

➔ School nurse integrates research findings into practice.

Standard 14. Resource utilization
➔ School nurse considers factors related to safety,
effectiveness, cost and impact.
Standard 15. Leadership
➔ School nurse provides leadership in the professional practice
setting and the profession
Standard 16. Program Management
➔ Manages school health services.
 OCCUPATIONAL HEALTH NURSING
★ Occupational Health Nursing is defined as a specialty
practice that focuses on the promotion, prevention, and
restoration of health within the context of a safe and
healthy environment. It includes the prevention of adverse
health effects from occupational and environmental
hazards.
 OCCUPATIONAL HEALTH NURSING
★ Department of Labor and Employment – the lead agency on
Occupational Safety and Health

➔ They are given RULE MAKING and RULE

ENFORCEMENT powers to implement stipulations of the
Philippine Constitution and the Philippine Labor Code.
 OCCUPATIONAL HEALTH NURSING
EVOLUTION OF OCCUPATIONAL HEALTH NURSING IN THE PHILIPPINES

➔ MS. MAGDALENA VALENZUELA – she instituted the INDUSTRIAL NURSING UNIT of the
Philippine Nurses Association on November 11, 1950.

➔ MS. PERLA GORRES – from the Philippine Manufacturing Company (PMC) served as the
first chairperson of the said unit.

➔ MS. ANITA SANTOS – was elected as first president on August 19, 1964. She paved way to
the modification in the name of the organization to Occupational Health Nurses Association
of the Philippines, Inc. on November 12, 1966.

➔ June 5 – 6, 1970 – first annual convention was held.

➔ September 25, 1979 – the organization was registered with the Securities and Exchange
Commission.
 OCCUPATIONAL HEALTH NURSING
ASSESSMENT AND CONTROL OF HAZARDS IN THE WORKPLACE

★ HEALTH HAZARDS – are the elements in the work

environment that can cause work-related disease.

★ SAFETY HAZARDS – are the unsafe conditions or unsafe

acts that significantly increase the risk of a worker to be
injured.
 OCCUPATIONAL HEALTH NURSING
TYPES OF HAZARDS:
1. Biological-infectious hazards – infectious agents such
as bacteria, viruses, fungi.
2. Chemical hazards – various forms of chemical agents.
3. Enviro Mechanical hazards – factors that cause
accident, injuries, strains or discomfort (eg. Poor
equipments)
4. Physical hazards – radiation, electricity, temperature,
and noise
5. Psychosocial hazards – anything that causes emotional
stress and strain or interpersonal problem.
 OCCUPATIONAL HEALTH NURSING
CONTROL MEASURES FOR OCCUPATIONAL HAZARDS:
1. Administrative Control – refers to the development and
implementation of policies, standards, trainings, job design
and the like.
2. Engineering – refers to the adoption of physical, chemical
or technological improvements to limit exposure to hazards.
3. Materials Provision – refers to providing the workers with
supplies or supplements that can decrease their exposure
to hazards.
 OCCUPATIONAL HEALTH NURSING
DUTIES OF OCCUPATIONAL HEALTH NURSE as stated in Rule
1965.04 of the amended OSHS by DOLE:
“The duties and functions of the Occupational Health Nurse
are

1. In the absence of a physician, to organize and administer

a health service program integrating occupational safety,
otherwise, these activities of the nurse shall be in
accordance with the physician;
2. Provide nursing care to injured or ill workers;
3. Participate in health maintenance examination. If a physician is
not available, to perform work activities which are within the scope
allowed by the nursing profession, and if more extensive
examinations are needed, to refer the same to a physician;
4. Participate in the maintenance of occupational health and
safety by giving suggestions in the improvement of working
environment affecting the health and well-being of the workers;
and
5. Maintain a reporting and records system, and, if a physician is
not available, prepare and submit an annual medical report, using
form DOLE/BWC/HSD/OH-47, to the employer, as required by this
Standards.
 PHILIPPINE LABOR CODE (PD 442)

Aims to protect every citizen desiring to work locally or

overseas by securing the best possible terms and conditions
of employment.
Under Article 6, all rights and benefits granted to workers
under this Code shall, except as may otherwise be provided
herein, apply alike to all workers, whether agricultural or non-
agricultural
 COMMUNITY MENTAL HEALTH NURSING
★ Is the application of specialized knowledge to populations and communities to
promote and maintain mental health, and to rehabilitate populations at risk
that continue to have residual effects of mental illness
 COMMUNITY MENTAL HEALTH NURSING
Why develop Nursing Resources for Mental Health?

Mental health is crucial to the well-being of individuals, societies and

countries:

Mental health is more than the absence of mental disorders. It

involves a state of well-being whereby the individual recognizes their
abilities, is able to cope with the normal stresses of life, works
productively and contributes to the community.
 COMMUNITY MENTAL HEALTH NURSING
★ Mental health problems are common: 450 million people suffer
from a mental or behavioral problem and nearly one million people
commit suicide every year. Depression, alcohol use disorders,
schizophrenia and bipolar disorder are among the ten leading causes
of disability worldwide.

★ Treatment is not available to most people: Despite the existence of

effective treatments, these are not available to the overwhelming
majority of people with a mental disorder. Many of the resources that
are available are wasted on ineffective interventions
 COMMUNITY MENTAL HEALTH NURSING
Nurses are important providers of treatment and care: In most
countries, nurses are the largest group of professionals providing
mental health care in both primary and specialist health services.
However, in many countries the education of nurses is inadequate
and their role is under developed. With education and support,
nurses can contribute to the promotion of mental health and the
prevention and treatment of mental disorders
WHAT ARE THE PRIORITIES?
1. Primary Health Care
➔ WHO recommends that mental health treatment should be part of or
integrated into primary health care, however, many nurses lack the
knowledge and skills to identify and treat mental disorders.
➔ Education is effective in improving the recognition of mental disorders in
primary health care, increasing the referral to more specialized health
providers and enhancing the initiation of supportive therapies.
➔ In addition ongoing supervision and support from specialist mental health
services are needed to assist nurses to care for people with more
complex mental health needs and facilitate referral to specialist services
when required.
2. Nurse Education
★ Mental health should be incorporated into basic nursing and
midwifery education with mental health concepts introduced
early, reinforced and expanded throughout the curricula and
developed through experiential learning opportunities.
★ The areas to include in the education of nurses will depend on the
needs of the country, the role of the nurse, current competencies and
the resources that are available. The following is not intended as a
comprehensive list of areas for education, but as general guidance
when developing education programs:
o Advocacy
o Assessment of mental disorders
o Communication skills
o Community mental health nursing
o Emotional self-care (i.e. Nurses caring for their own
mental health)
o Evaluation and research
➔ Legal and ethical issues, including understanding the
rights of people with mental disorders
➔ Management of emergencies (e.g. suicidal behavior,
violence)
➔ Management of psychotropic medication
➔ Mental health care in humanitarian emergencies
➔ Promotion of mental health
➔ Public health models of mental health
➔ Stigma and discrimination
➔ Substance abuse
➔ Treatment of mental disorders
➔ Working in teams
➔ Working with service users and their families
➔ Working with specific groups (e.g. children and
adolescents, elderly)
3. Involve nurses in the development of mental health policies
★ Mental health policies define a vision for improving mental health
and reducing the burden of mental disorders in a population, and
establish a model for action based on agreed values, principles
and objectives. Nurses are important stakeholders who should be
consulted and actively involved in the development policies and
plans.
★ The development of nursing resources for mental health should
be coordinated through a mental health policy. The WHO Fact
Sheet 'Mental health policies and service development' provides
more information on developing and implementing policies and
plans.
4. Information for decision-making
★ While there is a growing body of research documenting good practice,
many countries have little or no information on the size, composition,
or quality of their nursing workforce for mental health, and no
knowledge of their impact on health outcomes. It is important that
countries gather this information in order to better inform mental
health policy development and the role of nursing within this context.