1、Ching-Min Chen,RN,DNSProfessor,College of NursingTaipei Medical UniversityTraining Needs of Public Health Nurses Working in Primary Health Care SettingsDevelopment of Public Health Nursing in TaiwannHealth status of Taiwanese citizens have greatly improvedqLife expectancy:196162.3&66.8 200775.9&81.9
2、qLeading causes of death:from acute and communicable diseases to chronic diseasesnHealth Centers/clinics have been the basic unit for public health and diseases control since 194525373497Manpower of Public Health NursingnLargest segment of the public health workforce(almost 60%),public health nurses
3、 are critical to the functioning of the overall public health systemnThere are 2,573 PHNs worked in health centers(DoH,2005)as center directors,head nurses,professional registered nurses and registered nurses,public health nurse specialists&midwives.Area TypeSuggested standard of nurses allocationCu
4、rrent ratioRemote areas5 personnel per district，For populations over 3000,every additional 1000 needs 1 more nurse.1,476Towns/countiesFor population under 30,000,the basic 5 personnel;More than 30 to 100 thousand people,an additional personnel for every 10 thousand;More than 100 to 200 thousand peop
5、le,an additional one personnel for every 20,000 people;More than 200 thousand,an additional one personnel for every 30,000 people.7,407Urban Same as towns and counties14,273Tasks of PHNs working in Health CentersServiceDetailsCommunicable disease controlepidemic prevention:dengue fever,enterovirus i
6、nfections,tuberculosis,hepatitis b,AIDS prevention,and other epidemicsvaccinations:vaccinations for infants,vaccinations needed in schools,womens rubella vaccination,influenza vaccination and othersCancer preventionexamination and tracking of positive cases of cervical cancer,breast cancer,oral canc
7、er,and rectal cancerDisease prevention in adults and the elderly blood pressure and blood sugar examinations in coordination with community activitiescase records and management of patients with high blood pressure,diabetes,or debilitated eldersFamily planning and superior birth health teenage sex e
8、ducation promotion100%tracking of the mental disabled and psychiatric patients,counseling single cases to execute birth controlPregnancy managementvisitation of foreign bridesInfant health management case tracking of highly dangerous groups or anomaliesDay-care,kindergarten health management health
9、examinationsPsychiatric case management recording cases after discharge and support in forcefully treating cases in communitiesLong-term care visitation of nursing homes in jurisdiction visitation and transfer of casesElderly health examination tracking of abnormal cases promoting health examination
10、s in the elderlyDistrict of health clinic blood pressure,blood sugar exam general examination cervical examination obtainable condoms,orally ingested drugsCommunity health construction participation in the operations of community health construction centersMany Changes and Challenges Public Health N
11、urses are FacingnKey forces affect health and contribute to challenges in service planning and delivery:poverty,increased globalization,climate change,political unrest.nThese challenges shape the environments include:qThe rising costs of health careqIncreasing consumer expectations and demandsqChang
12、ing demographics and ageing populationsqNursing and other health worker shortagesqLegislation and/or political will to fully utilize nursings potentialqSocial conflict and unrest which destabilize services and constrain resourcesqNatural and manmade disastersqEndemic and pandemic disease,as well as
13、new and reemerging onesqThe surge in chronic diseasesqMaking the shift to community-based care.(ICN,2008)International Nurses Day 2008 Delivering Quality,Serving Communities Nurses Leading Primary Health Care護理深耕社區：引領健康照護 We hope they will help you see where you are leading and where and how you mig
14、ht further lead in strengthening PHC and serving your community whether it is a community of the public or a practice,education,research or management community within the profession.It is only by serving our communities that we can deliver quality health outcomes for the individuals,familiesand com
15、munities we care for.Hiroko Minami,President of ICNJudith A.Oulton,Chief Executive Officer“If the millions of nurses in a thousand different places articulate thesame ideas and convictions about primary health care,and cometogether as one force,then they could act as a powerhouse for change”Halfdan
16、Mahler,Director General,World Health Organization,1985.Nurses Contributions in PHCnImproved access to carenImproved prevention of chronic diseasesnImproved cost-effectivenessnImproved outcomesnImproved surveillance.nImproved disaster recoverynImproved patient compliance with carenLeveraging technolo
17、gy for primary health careCore Principles of PHC1.Equal and universally accessible health services.Everyone should have reasonable access to essential health services with no financial or geographical barriers.2.Community participation in defining and implementing health agendas.The public should be
18、 encouraged and empowered to participate in planning and making decisions about their own health care.3.Intersectoral approaches to health.Professionals from various sectors,including the health sector,work interdependently with community members to promote the health of the community.4.Appropriate
19、technology.Technology and modes of care should be based on health needs,and appropriately adapted to the communitys social,economic and cultural development.Nurses Role in PHC PracticenTo maintain links between individuals,families,communities and the rest of the health care systemnTo work both auto
20、nomously and collaboratively to prevent disease and to promote healthnTo provide first-point-of-contact care and disease management across the lifespanTraining Needs for PHNsn2009 project:Working Environment Improvement Project for Public Health Nurses in Health Centers.nMarch-DecembernProject Purpo
21、sesqTo explore public health nursing service needs from citizens viewpointsqTo describe working environments of PHNs in Health CentersqTo recommend the improvement strategiesqTo develop continue education programs for PHNsMethodsnThorough research searchqISI Web of Science:public health nursing*&pri
22、mary health care*,health center*qGovernment Research Bulletin,GRBnFocus group interview for those who are frequent users of public health nursing servicesnTelephone interviewqStrata sampling for 1,600 community citizens Step 1:Thorough research searchnISI Web of Science:public health nursing*&primar
23、y health care*,health center*nGovernment Research Bulletin,GRBannotated bibliographydevelop interview guide and questionnaireStep 2:Focus group interviewnParticipantsqFrequent users of public health nursing servicesq8-15 participants per section(Polit&Hungler,2000)q2 Public health nurses will also b
24、e invitednInstrumentsqOpen-end Semi-structure interview guide qList of tasks of public health nursesnData saturationStep 3:Telephone interviewnCross-sectional research designnSelf-developed Instrument based on literature and results of focus interviewnStrata sampling based on city/county populationqBoth users and non users needs for public health nursing services will be includedqWeighted sampling on those non-users nAt least 1600 valid questionnaire will be collected(Anderson,2006)Thank you for your attention.
