Community Health Nursing

CHW – group of people with common chrematistics or interest within a territory or

geographical boundary

Community

1. Patient/Client
2. Setting - outside curative institutions
o home – family HNSg
o school – SHSg
o places of work – occupational HNSg

World Views:

1. Community integral part of society compose of families

Eg. – poor community

o under nutrition
o poor food supply
o level of knowledge – poor

2. Conflicts/contradiction – always present in the community

o intrapersonal conflict – choosing what to wear
o intrapersonal family
o intrapersonal community (interfamilial) regionalism – parochial
o intra sociedad (inter societal)

Note: Should be positive in dealing with conflict.

3. Condition in the family is always changing

Health

1. Wellness – Illness continuum

Optimum – internal ------------- death

Wellness - external

External
 Macro system

o political
o economic
o socio cultural – education, customs, beliefs, practices, tradition,

mass media

2. High Level Wellness

o maintain continuum balance and purpose direction with environment
o progress toward a high level of FXU, lice to the fullest potential

3. Agent Host Environmental Model

o Epidemiologic model

Agent (Etiologic Facts)

a. Infections/biological factor
b. Mechanical
c. Physical
d. Carcinogenetics – pringels, tobleron (GMO’s – chemical
e. Poison – eg. MSG
f. Allergies
g. Nutritive elements
h. Psychological

Host – intrinsic factor – age, sex

o exposure
o response – susceptibility

- resistance

environment – extrinsic factor

4. Health Belief Model

o relationship bet a person’s belief and his behavior in health

3 components

1. Susceptibility to illness

2. Seriousness of an illness

3. Benefits taking the action

 AN/AIDS

Common in

1. Commercial Sex Worker – unprotactive penetrated sex

2. Sea farers
3. Religious Nums

Vaginal – male and female 1:000

Oral – male to male also common in male to female 1:200

Felacio – mouth to penis

Oral – cumaningus – mount to vagina

Aningus – mouth to amus

Preventive :

A. abstinence – sex (safe)

B. Be Faithful – Mutual/Monogamy
C. Correct continous consistent use of condom
D. Do no penetrate

5. Evolutionary Based Model

o illness and death sometimes serves an evolutionary function

Elements:

o life events
o life style determinants
o control perception
o viability emotions
o health out comes

6. Health Promotion Model

o client’s won being

7. WHO – Definition 1978 – Alma Ata

o health is not merely the absence of DSE illness of infirmity
o state of complete physical mental, and social wen being

Health
 1. Social phenomenon – Health outcome is interplay of different societal factors

outcome with interplay of different factors and society:

o biological
o physical
o ecologic multiple causation Theory

o political (Holistic)
o economic
o socio-cultural

Community Health

Part of medical paramedical intrapersonal which is concerned and the heath of the
whole population.

Major Concept

1-health promotion & DSE prevention

2- people participation

Individual Applied Community

Client Study As Client

- Anatomy - structure - demography

- Physio - functions - Sociology

- Patho - malfunction - epidemiology

Public Health & Longetirity (CBQ)

WINSLOW – contribution to the most effective total development and life on the

Individual and the society.

HANLON – priority the survival of the species the prevention of condition which

lead to the structure destruction or retardation of human function and

potential in early year of life.

Communication Health Nursing

- special field of nursing that combines the skills of nursing public health, and some
phases of social assistance and FXUS as part of the total health project and promotion of
health.

JACOBSON – is a learned practice discipline with the ultimate goal of contributing as

individual and in collaboration with others, promotions of clients’ optimum level of
fractioning through teaching and delivery care.

Jacobson Major Roles

1. Health Educator

2. Provider of Nursing Care

FREEMAN – aimed developing and enhancing health capability of people,

Individual, families and communities.

Community

People Organization (PO)

Agency

1. Ngo

2. GO – DOH – National – Regional – Province – Municipal – BHW

RA – 7305 – Magna Corta of PHWorker

RA – 7160 – Local Government Code

Devolution of Health Services

CHN CONCEPTS:

1. 10 Focus on CHN is an heath promotion

2. CHN practice is extended to benefit not only individual but whole & family

3. CHN are generalist in terms of their practice throughout life’s continuum – its full
range of Health problems and need.
 4. Contact with client may continue over a long period of time which includes all ages
and types of HC

Levels

Primary HC – community

20 HC – Regimal, Provincial, Municipal & District

Tertiary – sophisticated medical center

Assessment:

Community Dx

o health problems and needs

o sources of solve to problem

Principle of Community Health Nursing

1. Recognize needs of individual

2. Knowledge and understanding of agency and policies facilitates goal achievement

3. The family is the unit of service

Planning

1. Prioritization

2. Goal setting

3. Objectives

4. Actions/Intervention

5. Evaluation out come:

- criteria

- standard

Health Education and Counseling

o common goal – behavior change or modification

Basic Different

Health Education – dive advice

Counseling – provide all option

Implementation:

Community – family focus of /unit of care

4. Respect values, customs and beliefs of clients – as nurse we should not be judgmental

5. Health education and counseling are vital parts of CHN

6. Collaborative working relationship with the health team facilitates goals achievement.

7. Continuing staff education ensures quality client care and upgrade nursing practice.

8. Indigenous and communication resources

appropriate tech – methods and tech both scientifically sound and socially

and acceptable

9. Individual families and communities must actively participate in decision making

10. Supervising of nursing services be qualified personnel provides guidance and

direction to work.

11. Accurate recording and reporting serve as bases for evaluation and guide for future
actions.

12. Periodic and continuing education

board quest

how would you evaluate – objective – if both present answer this

criteria

HEALTH SITUATION

1. Health Indices

A. Basic Indicators Anemia

 1. Nutrition 48% of Filipinos

2. DSE Pattern 58% of pregnant women

- morbidity

- mortality

infant mortality rate according to DOH – 18.7

life expectancy: Female 69.2

Male 63.7

HEALTH PROMOTION

Consist of activities directed towards increasing the fever of well being and actualizing
the health potential of individuals families communication and societies.

Different with prevention

o not desl dysixy or health problem financial

o “approach “ behavior not
o avoidance behavior
o seeks to expand (+) potential for health

Multidimensional Nature of Health Promotion

1. Individual – lifestyle

- personal habits & practices affecting health

-lifestyle

- lifestyle responsibility

2. Family – health behavior and belief

3. Community – norms

4. Environment – harmony and bal bet human and surroundings

5. Society – basic human needs

HEALTH PROMOTION METHODS

• health education
• Good standard nutrition adjusted to development phases of life
• Attention to personality development
• Provision of adequate housing
• Recreation and agreeable working condition
• Genetics counseling
• Periodic selective examination – self breast examination (SBE)

SCREENING METHOD

Presumptive identification of unorganized dse or defect by the application of test,

examination or other procedures that can be applied rapidly and inexpensively
population.

o mass screening
o case finding
o contact tracing
o multi phasic screening eg HIV antibody testing
o surveillance

RA 7305 – Jon reporting of communicable dse

Tertiary Prevention

• methods
• Dx
• Tx
• Mx
• Rehabilitation

Community Organizing

• Awareness raising
• Organizing
• Mobilizing / responsible action

Key Concepts and Principles

1. Objective analysis of objective condition – scientific

2. Basic trust among people

3. By the people from the people, for the people

4. People want and can change

5. Self-willed changes will have move meaning and performance than imposed changes.

Primary Health Care

- Essential care based on scientifically – sound and socially acceptable methods and
technology made universally available to individuals families and communities at the
cost they can afford at any given stage development than their full participation towards
self-reliance and self determination.

8 Primary Health Care

1. Health Education

2. Food Supply and Nutrition

3. Immunization

4. Hw and Basic Sanitation

5. Prevent & control of common dse

6. Tx of endemic dse

7. MCH including FP

Individual

1. Assessment

a. Data collection

2 types data – subject & objective

2 methods – interview & observation

4 Instruments

1. Nursing History (subjective)

2. Physical Examination

3. Laboratory Exam

4. Process Recording
 b. Data Analysis

2. Nsg. Dx

Health Care V/E Etiology

3. Planning

a. Prioritization

b. Goal

c. Objective

d. Nsg. Intervention

e. Evaluation Outcomes - Criteria , standard

4. Implementation

- health educator

- provider of HC

- supervisor Client /Patient Advocate

- researcher

- health organizer

- CH, Monitor

8 Basic Tasks:

1. Physical Maintenance

2. Allocation of Resources

3. Division of Labor

4. Socialization of Family Members

5. Reproduction, recruitment and releases

6. Maintenance of order
 7. Placement of members in larger society – production of good member

8. Maintenance of motivation and morale

Nuclear Family – Mother, Father, son & daughter

Extended – grandparent relation or daughter in law.

First Level Assessment

o Health Threats
o Health Deficits
o Forcible Crisis/Stresspoints

Family Tasks

1. Ability to recognize the presence of the problem

2. Ability to make decisions.

3. Ability to perform nursing care to sick

4. Ability to provide home environment

5. Ability to utilize community resources

Incubation Pd- entry of Pathogen to appearance of 1st SK

IMMUNITY

Passive – quick to come/to go active – slow to come / to go

1. natural – utero, breast feeding 1. Natural – getting the dse

2. Artificial – sevum prob. Antitoxin 2. Artificial – utanus toxoid

Pregnant

TT1 – 4th month

TT2 – 8th month

Pregnancy 2

TT3 – booster 1st

Pregnancy 3

TT4 – booster 2nd

Pregnancy 4

TT5 – booster – lifelong immunization

Community Mental Health Nursing

1. A unique process which includes an integration of concepts from nursing mental

health, social psychology community network.

Occupational Health Nursing

- Application of Nursing principles and procedure conserving health of the healthworkers.

School Health Nursing

Components

1. School Health Services

2. Health Instruction

a. direct – nurse doing the school teaching

b. indirect

3. Health School Living

4. School – Community Linkage

Median age of Filipinos is 20 yrs old

50 % - 20 years old

50% - above 20 years old

Vital Statistics – application of statiscal measure to vital events fertility , mortality,

morbidity

RA 3753 – Civil Registry Law

Requires the registration of births and deaths to local registrars

 RA 3573 – Law on reporting notifiable disease

Family Planning Program

Goal Improve material & child through:

o proper timing of pregnancy

o proper spacing of pregnancy
o number of pregnancies

Pregnancy :

Ideal age: 30-30- yrs.

20 -18 - 30 – 35 with risk

18 – 35 – high risk

Ideal interval – 3 years

2 years – with risk

4 years – high risk

ideal No – 3

4 – with risk

4 – risk

Family Planning Method

1. Spacing – Hormones, (pills injectable), IUD, Condoms, Natural, Standard Base bead

2. Permanent – Tubal ligation, Vascetomy,

25 to 40 ejaculation - to know sterility