COMMUNITY HEALTH NURSING

- MR. GERARDO DYERI P. ANDAMO R.N.

COMMUNITY HEALTH NURSING: AN OVERVIEW
Defining Community Health Nursing (CHN)

What is a community?

a group of people with common characteristics or interests living together within a territory or
geographical boundary
COMMUNITY AS CLIENT / PATIENT IN CHN
World Views on Community:
1. The community is an integral part of society and is composed of families
2. Contradictions/conflicts are inherent in a community
3. The community is always in state of continuous movement and change
COMMUNITY AS SETTING IN CHN PRACTICE

What is health?
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2.

3.

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6.

7.

place where people under usual or normal conditions are found

(homes, schools and places of work)
outside of purely curative institutions

Health-illness continuum model

Health is a dynamic state at any point between optimal wellness and death; a balance
between internal and external environments
Holistic as it reflects physical, emotional, intellectual, developmental, social and spiritual
dimensions
High-level wellness model
model recognizes health as an ongoing process toward a persons highest potential of
functioning
Agent-host-environment (Epidemiologic) model
The agent, host and environment interact in ways that create risk factors, and understanding
these is important for the promotion and maintenance of health
Health belief model
People take preventive actions if the three conditions exist:

Seriousness of the disease

Susceptibility to the disease

Cost effectiveness of the preventive action

Evolutionary-based model
Illness and death sometimes serve an evolutionary purpose
Health promotion model
refers to the policies, activities and codes of practice aimed at positively enhancing wellbeing
WHO definition
Not merely the absence of disease
The state of complete physical, mental and social well-being
A social phenomenon
An outcome of the interplay of biological, physical, ecological, political, economic, and sociocultural factors

What is community health?

-

part of paramedical and medical intervention/approach which is concerned on the health of the
whole population
aims:
1. promotion of health
2. prevention of diseases
3. management of factors affecting health
Individual
Anatomy
Demography
Physiology
Sociology
Pathology
Epidemiology

APPLIED STUDY

Community

Structure
Function
Malfunction

Public Health (definitions)

Winslow
- science and art of preventing disease, prolonging life, promoting health and efficiency through organized
community effort to ensure everyone a standard of living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen to realize his birthright of health and longevity

Hanlon
- dedicated to the common attainment of the highest level of physical, mental and social well-being and
longevity consistent with available knowledge and resources at a given time and place towards most
effective total development life of the individual and society
Purdom
- prioritizes survival of human species and recognizes that each phase in human development is of equal
importance with the other phases

What is nursing?
assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
(Henderson)
self-care (Orem)
placing the individual in an environment that will maximize his capacity for self-repair

What is Community Health Nursing?

The utilization of the nursing process in the different levels of clientele-individuals,
families, population groups and communities, concerned with the promotion of health, prevention
of disease and disability and rehabilitation.
- Maglaya, et al
Goal: To raise the level of citizenry by helping communities and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential for high-level
wellness
- Nisce, et al

Community Health Nursing (definitions):

WHO Expert Committee on Health
specialized field of nursing that combines the skills of nursing, public health and some phases of
human assistance and functions
Jacobson
promotion of clients optimum level of functioning through teaching and delivery of care
Freeman
developing and enhancing health capabilities of people

1.
2.
3.
4.
5.
6.

Basic Concepts of CHN

Primary focus is health promotion and disease prevention.
Practice extends from individual to family, population group and community.
CHNurses are generalists
Contact with client continues through time and all types of health care
Nature of practice require application of concepts of various sciences
implicit in CHN is the nursing process.

Basic Principles of CHN

1. The community is the patient in CHN, the family is the unit of care and there are four levels of
clientele: individual, family, population group (those who share common characteristics,
developmental stages and common exposure to health problems e.g. children, elderly), and the
community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in society, in
general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.
Key Principles of CHN
1.
2.
3.
4.
5.
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7.
8.
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Needs of clients provide basis for CHN practice

Objectives and policies facilitate goal achievement
Family is the unit of service
Respect values, customs and beliefs of clients
Health education and counseling are vital parts of CHN
Collaborative working relationship with the health team facilitates goal achievement
Periodic and continuing evaluation is necessary
Continuing staff education programs ensure quality care and upgrade nursing practice
Indigenous and existing community resour5ces must be utilized
People must actively participate in decision-making
Nursing supervision provides guidance and directions to work
Accurate recording and reporting serve as bases for evaluation and guide for future actions.

Responsibilities of CHN
be a part in developing an overall health plan, its implementation and evaluation for communities

provide quality nursing services to clientele based on standards set for CHN practice
maintain coordination/linkages with other health team members, NGO/government agencies in the
provision of public health services
conduct researches relevant to CHN services to improve provision of health care
provide opportunities for professional growth and continuing education through staff development
OBJECTIVES, STRATEGIES AND METHODOLOGIES IN CHN
Strategies and Health Status Targets to Achieve Objectives

Strategies to promote equity in health

priority for the vulnerable and marginalized
primary Health Care as the Key Approach
HEALTH PROMOTION
- Consists of activities directed towards increasing the level of well-being and actualizing the
health potential of individuals, families, communities and societies.
Methods:

Health education

Nutrition

Personality development

Adequate housing, recreation, agreeable working condition

Genetic counseling

Periodic selective examination

DISEASE PREVENTION
PRIMARY LEVEL OF DISEASE PREVENTION
- consists of activities directed towards decreasing probability of specific illnesses or dysfunctions in
individuals, families and communities

Through people
immunization
chemoprophylaxis
nutrition
personality development
personal hygiene
child spacing
protection against carcinogens and allergens

Environmental control
safe water supplies
good food hygiene
safe excreta and rubbish disposal
disinfection and sterilization
vector and animal reservoir control
good living nag working conditions

SECONDARY LEVEL OF DISEASE PREVENTION

-emphasizes early diagnosis and prompt intervention to halt pathological process, thereby
shortening its duration and severity and enabling individual regain normal function at the earliest possible
time.
Screening
- the presumptive identification of unrecognized disease or defect by the application of tests,
examinations or other procedures that can be applied rapidly and inexpensively to populations
Screening Methods:
mass screening
case-finding
contact-tracing
multi-phasic screening
surveillance
Characteristics of an ideal screening test:
High sensitivity
High specificity
TERTIARY LEVEL OF DISEASE PREVENTION
- Comes into play when a defect or disability is fixed. Rehabilitation goal is more than halting the
disease process itself it is restoring the individual to an optimum level of functioning within the constraints
of disability.
Methods:
Diagnosis
Treatment
Management
Rehabilitation
3 Levels of Prevention

PRIMARY LEVEL
Health Promotion and
Illness Prevention
Provided at
Health care/RHU
Brgy. Health Stations
Main Health Center
Community Hospital and
Health Center
Private and Semi-private
agencies

SECONDARY LEVEL
Prevention of Complications thru
Early Dx and Tx

When
hospitalization
is
deemed necessary and
referral
is
made
to
emergency (now district),
provincial or regional or
private hospitals

TERTIARY LEVEL
Prevention of Disability, etc.

When
highly-specialized
medical care is necessary
referrals are made to
hospitals
and
medical
center such as PGH, PHC,
POC, National Center for
Mental Health, and other
govt private hospitals at
the municipal level

COMMUNITY ORGANIZING
Continuous and sustained process of raising the level of awareness, organizing and mobilizing
Levels of Awareness:

Political socialization

Political mobilization

Interest aggregation

Interest articulation

Culture of silence/passivity
Basic concepts and principles:
1. objective analysis of objective conditions
2. basic trust on the people
3. from, for, by and with the people
4. people want and can change
5. self-willed changes are more meaningful and permanent than imposed changes
Context of CO: Current situation
Goal of CO: Community development
PRIMARY HEALTH CARE
PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to community health
development. It is a strategy aimed to provide essential health care that is:
Community-based
Accessible
Part and parcel of the total socio-economic development effort of the nation
Acceptable
Sustainable at an affordable cost.
Framework
Peoples Empowerment and Partnership is the
Key Strategy to achieve the goal, Health For all Filipinos by the year 2000
And Health in the Hands of the People by the year 2020
WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS?
It stands for:

Education of prevailing Health Problems

Locally-endemic Disease Prevention and Control
Expanded Program of Immunization
Maternal and Child Health and Family Planning
Environmental Sanitation and Safe Water Supply
Nutrition and Food Supply
Treatment of Communicable & Non-communicable Diseases/ Conditions
Supply and Proper use of Essential Drugs and Herbal Medicine
Dental Health Promotion
Access to and use of hospitals as Centers of Wellness
Mental Health Promotion

Pillars (major elements):

A. Multi-sectoral approach
Intersectoral linkages
Intrasectoral linkages
B. Community Participation
Rungs of Peoples Participation:

Genuine Participation

Token Participation

Non-participation
Phases

of CO in Health:
Social Investigation
Entry to the community
Social preparation
Community integration
Small-group formation
CHW election
Launching of organization
Community diagnosis
Training and Services
Core-group formation
PHASE OUT

C. Appropriate Technology
- method used to provide a socially and environmentally acceptable level of service or quality
product at the least economic cost.
Criteria:
Feasible
Acceptable, Affordable
Complex
Effective
Safe
Scope-wise
10 MEDICINAL PLANTS:
Lagundi
Ulasaming-Bato
Bawang
Bayabas
Yerba-buena

Sambong
Ampalaya
Niyog-niyogan
Tsaang gubat
Akapulko

COMMUNITY ORGANIZING IN HEALTH

Social Investigation
Preliminary
Baseline information from Secondary data sources
-

Deepening

Continuous appraisal of community situation through Primary data sources

Entry
Low profile or low key approach
Upon ENTRY, start the ff:
1. DSI
2. Social Preparation
3. Community Integration

Social Preparation
Tempering the grounds for setting up health program
Target: community leaders
Establish rapport, develop trust, clarify intentions and expectations
Methods: courtesy calls and attendance to meetings

Community Integration
Imbibing community way of life
Target: community
Deepen rapport, develop mutual trust, draw objectives
Methods: house-to-house, going to places and events where people are, direct participation in
production process
Spot map
Clusters of 8-15 households

Small-group formation

Election of CHWs

Launching

Community Diagnosis

Training and Services

Advanced CHWS
Core-group formation
Phase out

COMMUNITY ORGANIZING IN HEALTH

Pre Entry Phase

1. Site selection
2. PSI

Entry Phase
1. Social preparation
2. Community integration
3. DSI

Organizational formation Phase

1. Small group formation
2. Election of CHWs
3. Organizational meetings

Training Phase
1. Training needs
2. Assessment
3. Curriculum development
4. Actual training
5. Training evaluation

Services Phase
1. Community clinics
2. Other services

Leadership formation Phase

1. Core-group formation
2. Advanced training

Consolidation Phase
1. Evaluation sessions
2. Staff development

Sustenance and Maintenance Phase

1. Endorsement to sectoral organizing
2. Formation of regional coordinating bodies

Phase out