COMMUNITY

HEALTH NURSING

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 Community Health Nursing:
The 3 Broad Concepts
1. What is a community?
– a group of people with
common characteristics or
interests living together within
a territory or geographical
boundary

– place where people under

usual conditions are found

– The community is the object

or focus of care in CHN, with
the family as the unit of
service.
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 FACTS of CHN
Focus : promotion and preservation of health
Area of Content: skills and knowledge
relevant to both nursing and
public health
Clients : general populations (individuals,
families, communities)
Time : continual, not limited to episodic care
Scope : comprehensive and general, not
limited to a particular age or group
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 Concepts on Community Health
Nursing:
 CLIENTS of Community
Health Nurse
 Composed of different
levels of clientele: Individual,
family, population group,
and community

• Community as a SETTING
for CHN PRACTICE
 School Health
Nursing- School
 Occupational
Health Nursing-
Workplace
 Public Health Nursing-
Home
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2. What Is Health?

A state of complete
physical, mental,
and social well-
being and not
merely the absence
of disease and
infirmity (WHO,
1995).
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 What is Health?
It carries the mandate that health is a
basic human right.

It is seen as a spectrum or a continuum

•The modern concept of health refers to

Optimum Level of Functioning (OLOF) of
individuals, families, and communities, which is
influenced by the ecosystem through a myriad
of factors. 7
What is health?
Health-illness continuum
High-level wellness
Agent-host-environment
Health belief
Evolutionary-based
Health promotion
WHOdefinition
 What influences OLOF?
• Behavioral (culture, habits, mores, ethnic customs)

• Socio-economic (employment, education, housing)

• Political (safety, oppression, people, empowerment)

• Hereditary (genetic endowment, familial, racial)

• Health Care Delivery System (promotive, preventive,

curative, rehabilitative)

• Environment (air, food, water, wastes, noise, radiation,

pollution, congestion)
3. What is Nursing?

 T h e diagnosis and treatment

of human responses to actual
or potential health problems
(ANA, 1980).

 Nursing, together with public

health, is one of the helping
professions in the health care
system which operates at
three levels of clientele –
individuals, families or groups,
and communities

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 I t operates within the realm of health
careboth independently and
interdependently.
 T h e objective of nursing is to assist
clients to achieve, maintain, or recover a
high level of functioning.
 Assisting sick individuals to become
healthy and healthy individuals achieve
optimum wellness (Henderson)
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The PHILOSOPHY of CHN

• is based on the
worth and
dignity of man
(Shetland)
• Concepts and
Principles pertaining
to CHN
 Knowledge-base of CHN
• Biological and social sciences

• Ecology

• Clinical Nursing

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•Utilizes COMMUNITY
HEALTH ORGANIZATIONS
 it is population-focused – “the greatest
good for the greatest number”
> Community diagnosis
> Vital statistics
> Priority setting

 it is a promotive-preventive service
–adheres to Primary Health Care
> Health education
> Preventive treatment

• It is a generalist practice – deals with all

cases
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The ULTIMATE GOAL of CHN
• By:
 help communities and
RAISE the families cope with
discontinuities in health and
level of health threats
 Maximize their potential for
high level wellness
of  Promote reciprocally
supportive relationship
citizenry… between people and their
physical and social
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environment 16
The PRIMARY FOCUS of CHN

health promotion wherein health

teaching is the primary
responsibility of the community
health nurse, who is a generalist
in terms of practice

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 Principles of CHN
E – ducation as primary tool and responsibility
M – ade available to all regardless of race, creed and socio-economic status
P – olicies and objectives of the agency is fully understood by the nurse
O – rganizing for health, with the family as the unit of service
W – orks as a member of the health team (PHN)
E – xisting active organizations are utilized
R – ecording and reporting are accurate
M – onitoring and evaluation of services is periodically done
E – xisting indigenous resources of the community is used
N – eeds of clienteles is recognized and serves as basis for CHN
T – raining and development as opportunities for continuing staff education
programs

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 REMEMBER that in CHN:
1. The patient in CHN is the Community which is composed of
different population groups and several families (the basic unit of
care), and In turn compose of individuals.

2. Client is ACTIVE and NOT PASSIVE recipient of care

3. CHN practice is affected by any changes in society and environment

4. Multi-sectoral effort is the key to goal achievement

5. CHN is a part of health care system and the larger human services
system.

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 Quick Review
Exercises

(QRX)

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 QRX
In terms of CHN practice, the nurse in
the community is trained as
a. Certified in public health
b. Specialist in CHN
c. 4-year BSN graduate
d. Generalist in nursing

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Ans: d. Generalist in
nursing
 QRX
The thrusts of CHN must be embodied in the
hearts of health care providers. Which one
strengthens the health care system?

a. Supporting conditions for healthy habits

b. Increasing opportunities to be healthy
c. Letting the people manage their own
health
d. Financing health care program

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Ans:
c.Letting the people
manage their own
health
 QRX
As a Public Health Nurse, what is your
primary function or responsibility?

a. Reporting of cases
b. Health Promotion
c. Community Diagnosis
d. Health Teaching

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• Ans:

d. Health
Teaching
 QRX
The philosophy of CHN practice is based on
the belief that the family is the smallest unit
in a democratic society. Which age group
should be the priority of the nurses in the
community?
a. Older persons and terminally ill
b. Adolescents and adults
c. Infants and children
d. All ages regardless of status
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Ans:
d. All ages
regardless
of status
 HIGHLIGHTS in CHN Concepts

 CHN is based on the recognized needs of

communities, families, groups, ands
individuals.

•CHN is a unique blend of nursing and

public health practice, and is oftentimes
used interchangeably with the term
“Public Health Nursing”.
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 Philosophy of Public Health
Health and longevity as birthrights

Longevity – average lifespan or life

expectancy
• 50 years – Swaroop’s Index
• Untimely death – person died without reaching the
average lifespan

Combined (M/F) – 69.6 y/o Male –

66.74 y/o
Female – 72.61 y/o

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 Objectives of Public Health

3 P’s:
Promote health
Prevent Disease
Prolong Life

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 Basic Public Health Services
• Environmental Sanitation
• Health Education
• Prevention of Communicable Diseases
• Medical Services
• Nursing Services
• Vital Statistics
• Public Health Laboratories
• Maternal and Child Health Services
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 Basic Competencies Needed by the
Public Health Nurse
• Teaching
• Management
• Critical Thinking
• Physical Caregiving
• Application of the Nursing Process
• Application of the Epidemiological
Process
• Documentation
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 Functions of the PHN
 Manager
> Planner, Programmer, Supervisor, Coordinator of services
 Health Care Provider
> Direct nursing care
 Researcher
> Epidemiologist, Health Monitor, Recorder, Statistician
 Community Organizer
> Change Agent
 Trainer
> Health Educator, Counselor
 R o l e Model
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In the care of the families:

 Provision of primary health care services

 Developmental/Utilization of family
nursing care plan in the provision of care

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In the care of the communities:

• Community organizing mobilization, community development

and people empowerment

• Case finding and epidemiologicalinvestigation

• Program planning, implementation and evaluation

• Influencing executive and legislative individuals or bodies

concerning health and development

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 Responsibilities of CHN:
– be a part in developing an overall health plan, its implementation
and evaluation for communities
– provide quality nursing services to the three levels of clientele,
the standards ser 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 for personal growth thru staff development

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 CHN Process
1. Establishing a working relationship with
the client
• Initiating contact
• Communicating interest in the
client’s welfare
• Showing willingness to help with
expressed need of the client
• Maintaining a two-way communication
with the client
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 CHN Process
2. Assessment of needs, taking into consideration
personal, environmental and psycho-socio-
cultural factors influencing health
• Situation and trends revealed in personal, socio-
economic and environmental history
• Physical, emotional, intellectual ability to perform a
function
• Attitudes, knowledge and perceptions of health and
illness
• Health behavior and patterns of health care
• Resources available to meet own needs
• Other factors affecting health
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A. Collection of Data
A. Community
 Demographic data
 Vital statistics
 Community Dynamics
 Disease surveillance
 Economic, cultural , and environmental characteristics
 Health service utilization

B. Family and Individual

- Health status/ education
- Socio-cultural factors
- Occupation
- Family dynamics
- Environment
- Patterns of coping

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B. Categories of Health Problem
A. Wellness State
B. Health Deficit
C. Health Threat
D. Foreseeable Crisis

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 CHN Process

3. Planning of care

• Summarizing problems and needs

• Establishing priorities of care
• Setting objectives of care
• Determining approaches or strategies
to meet identified objectives

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 CHN Process

4. Implementation of care

• Actual delivery of care

• Institution of planned interventions
• Application of coordination,
supervision, social mobilization,
health education, therapeutic
communication
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 CHN Process
5. Evaluation of care

• Monitoring of status
• Systematic documentation of
results
• Analysis of effectiveness of care
provided
(Structural elements, Process
Elements, and Outcome elements)
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 Levels of Clientele
Individual

• Basic approaches in
looking at the
individual:

– Atomistic

– Holistic
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Family
Models:
Developmental

Stages of Family Development

Stage 1 – The Beginning Family

Stage 2 – The Early Child-bearing Family

Stage 3 – The Family with Preschool Children

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Stage 4 – The Family with School Age Children

Stage 5 – The Family with Teen-agers

Stage 6 – The Family as Launching Center

Stage 7 – The Middle-aged Family

Stage 8 – The Aging Family

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 Structural-Functional

Initial Data Base

 Family structure and Characteristics

 Socio-economic and Cultural Factors

 Environmental Factors

 Health Assessment of Each Member

 Va l u e Placed on Prevention of
Disease

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First Level Assessment
Health threats:
 conditions that are conducive to disease, accident or failure to realize
one’s health potential

Health deficits:
 instances of failure in health maintenance (disease, disability,
developmental lag)

Stress points/ Foreseeable crisis situation:

 anticipated periods of unusual demand on the individual or family in
terms of adjustment or family resources

Wellness State/ Potential

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Second Level Assessment:

• Recognition of the problem

• Decision on appropriate health action
• Care to affected family member
• Provision of healthy home environment
• Utilization of community resources for
health care

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 Problem Prioritization:

 Nature of the problem

Wellness State
Health deficit
Health threat
Foreseeable Crisis

 Preventive potential
High
Moderate
Low

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• Modifiability
Easily modifiable
Partially modifiable
Not modifiable

• Salience
High
Moderate
Low

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*Family Service and Progress Record
Population Group

• Vulnerable Groups:

Infants and Young Children

School age
Adolescents
Mothers
Males
Old People
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 CHN Process
Community Diagnosis
•Determining the health status of the
populations in the community as well as the
factors that directly or indirectly affect their
health status
• It is an integral part of the assessment phase
of the CHN Process
•It is also known as community assessment
o12r/05s/12ituatio nal analysis 54
• A process by which the people in the
community and the health team assess
the community’s health problems and
needs as bases for health program
development.
• A learning process for the community to
identify their own health problems and
needs.
• A profile that depicts the health problems
and potentials of the community.
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2 types of Community Diagnosis:

1.Comprehensive- provides general health

profile of the community

2.Specific or Problem-Oriented- yields a

comprehensive profile of a particular
health problem

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STEPS:
Preparatory Phase

1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data
collection
6. finalize sampling design and methods
7. make a timetable
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Implementation Phase

1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. prioritization of health problems
7. development of a health plan
8. validation and feedback

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Evaluation Phase
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 CHN Process
Parts of Community Diagnosis:
A. Demographic Variables
• Total population and population density
• Age and sex composition, Population Pyramid
• Sex Ratio
• Civil Status
• Population movement/patterns of migration
• Growth Rate, Life Expectancy
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 CHN Process
Parts of Community Diagnosis:
B. Social Indicators
• Literacy Rate
• Educational attainment
• Communication network
• Transportation system
• Housing conditions (types, ownership,
lighting, ventilation, crowding/congestion)
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 CHN Process
Parts of Community Diagnosis:
C. Economic Indicators
• Dependency Ratio
• Occupation
• Income
• Poverty index
• Unemployment Rate
• Underemployment Rate
• Types of industry present in the community
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 CHN Process
Parts of Community Diagnosis:
D. Cultural Factors
• Ethnicity

• Race
• Language
• Religion
• Beliefs (superstitions and traditions)
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 CHN Process
Parts of Community Diagnosis:
E. Environmental Indicators
• Topographical characteristics

• Water supply
• Garbage disposal/collection system
• Excreta disposal
• General sanitary condition
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 CHN Process
Parts of Community Diagnosis:
F. Health Patterns
• Food storage
• Infant feeding practice
• Immunization status
• Health seeking behavior
• Source of health information
• Leading causes of mortality, morbidity, infant
mortality, infant morbidity, maternal mortality
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 CHN Process
Parts of Community Diagnosis:
G. Health Resources
• manpower-population ratio
• manpower distribution
• manpower policies
• health budget and policies
• sources of health funding
• categories of health institutions available
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 CHN Process
Parts of Community Diagnosis:
H. Political and Leadership Patterns
• Power structures in the community
• Confidence of people to authority
• Conditions that cause developmental conflicts
• Prevailing issues
• Practices that are usually utilized in settling
concerns of the community
• Stakeholder Analysis
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 CHN Process
Steps in Conducting Community Diagnosis:
1. Determining the objectives
2. Defining the study population
3. Determining the data to be collected
4. Developing an instrument
• survey questionnaire
• interview schedule
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 CHN Process
Steps in Conducting Community Diagnosis:
5. Data gathering
• Records review
• Observation
• Surveys
• Interviews
6. Data collation
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 CHN Process
Steps in Conducting Community Diagnosis:
7. Data presentation
8. Data analysis
9. Identification of CHN Problems
• Health status
• Health resources
• Health-related
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 CHN Process
Steps in Conducting Community Diagnosis:
10. Prioritization of CHN Problems
• Nature
• Magnitude
• Modifiability
• Preventive potential

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• Social concern 70
 Biostatistics

A. Demography
A study of population size, composition,
and spatial distribution as affected by
births, deaths, and migration

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SOURCES OF DEMOGRAPHIC
DATA:

1. Survey
1. Census- De jure or De facto
2. Sample Survey
2. Continuing Population Registers
3. Other Records and Registration Systems

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COMPONENTS:
Population Size
1. Natural increase
2. Net migration
3. Rate of natural increase
Population Composition
1. Age Distribution
2. Median Age
3. Dependency Ratio
4. Sex Ratio
5. Population Pyramid
6. Others: occupational groups, economic groups,
educational attainment, and ethnic groups
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Population Distribution
1. Urban-Rural
• Shows the proportion of people living in urban
compared to the rural areas
1. Crowding Index
• Indicates the ease by which a communicable
disease can be transmitted from 1 host to another
susceptible host
1. Population Density
• Determines the congestion of the place

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B. VITAL STATISTICS
The application of statistical measures to
vital events (births, deaths and common
illnesses) that is utilized to gauge the
levels of health, illness and health services
of a community.

• Fertility Rate

– Crude Birth Rate

12/05/–12General Fertility Rate 75
 Mortality Rates
 C r u d e Death Rate
 Specific Mortality Rate
 Infant Mortality Rate
 Neonatal Mortality Rate
 Post-neonatal Mortality
Rate
 Maternal Mortality Rate
 Proportionate Mortality
Rate
 Swaroop’s Index
 C a s e Fatality Rate
 Cause-of- Death Rate
 Morbidity Rate
 Prevalence
 Incidence Rate
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C. EPIDEMIOLOGY

– The study of distribution of disease or

physiologic condition among human
population s and the factors affecting such
distribution

– The study of the occurrence and distribution

of health conditions such as disease, death,
deformities or disabilities on human
populations
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Basic Concepts:

– Epidemiologic Triad
– Transmission
– Incubation period
– Herd immunity

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Factors affecting distribution:

• PERSON
– intrinsic characteristics
• PLACE
– extrinsic factors
• TIME
– temporal patterns

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Patterns of Disease Occurrence:
• Epidemic
– a situation when there is a high incidence of new cases of a
specific disease in excess of the expected.
– when the proportion of the susceptible are high compared to the
proportion of the immunes
• Epidemic potential
– an area becomes vulnerable to a disease upsurge due to causal
factors such as climatic changes, ecologic changes, or socio-
economic changes

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• Endemic
– habitual presence of a disease in a given geographic location
accounting for the low number of both immunes and susceptible
e.g. Malaria is a disease endemic at Palawan.
– the causative factor of the disease is constantly available or
present to the area.
• Sporadic
– disease occurs every now and then affecting only a small
number of people relative to the total population
– intermittent
• Pandemic
– global occurrence of a disease

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 THE NATIONAL HEALTH
SITUATION
 Health Care Delivery System

Health Care Delivery System is

“the totality of all policies, facilities,
equipments, products, human resources
and services which address the health
needs, problems and concerns of the
people. It is large, complex, multi-level and
multi-disciplinary.”
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 According to Increasing According to the Type
Complexity of the Services of Service
Provided
Type Service Type Example
Primary Health Promotion, Health
Information Preventive
Care, Continuing Promotion Disseminati
Care for common health and illness on
problems, attention to Prevention
psychological and social
care, referrals
Secondary Surgery, Medical services by Diagnosis and
Screening Specialists
Treatment
Tertiary Advanced, specialized, Rehabilitation
PT/OT diagnostic,
therapeutic &
rehabilitative care
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 The
Health
Sector

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 The Health
Sector
Department of Health
Vision: Leader and staunch advocate and model
in promoting Health for ALL in thePhilippines

Mission: Guarantee equitable, sustainable, and

quality health for all Filipinos, specially thepoor
and shall lead the quest for excellence inhealth

12/05/12 86
3 Major Functions:
 1 . LEADERSHIP in health
 National policy – formulation, monitoring and evaluation
 Regulatory institution
 Advocates adoption of health policies, plans and programs

 2 . Enabler and Capacity Builder

 Innovate new strategies to improve health programs
 Exercise oversight function
 Ensure highest achievable standards

 3 . Administrator of Specific Services

 Manage selected national health facilities and hospitals
 Administer direct services for emergent health concerns
 Administer health emergency response services
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 DOH Programs
D –ental Health
O –perations for Environmental Sanitation
H –ealth Education and Community Organizing
P –revention and Control of Communicable Diseases
R –eproductive Health
O –lder Persons Health Services
G –uidelines for Nutrition
R – ehabilitation and Management of Non-communicable Dse.
A – lternative Health Care Practices (HerbalMeds/Acupressure)
M –aternal and Child Health and IMCI

S12–/05e/1n2trongSigla Movement 87
Local Government Units (LGU)
RA 7160 Local Government Code

Private Sector
Composed of both commercial and business
organizations, non-business organizations

Non-Government Organizations
Assumes the following roles:
 Policy and Legislative Advocates
 Organizers, Human Rights Advocates
 Research and Documentation
 Healt h Resource Development Personnel
 Relief and Disaster Management
 Networking

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 PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL
Health Promotion and Prevention of Prevention of
Illness Prevention Complications thru Disability, etc.
Early Dx and Tx

Provided at – ► When hospitalization ► When highly-

► Health care/RHU is deemed specialized medical care
► Brgy. Health Stations necessary and referral is is necessary
►Main Health Center made to emergency ► Referrals are made to
►Community Hospital (now district), provincial hospitals and medical
and Health Center or regional or private center such as PGH,
►Private and Semi- hospitals PHC, POC, National
private agencies Center for Mental Health,
and other gov’t private
hospitals at the municipal
level

12/05/12 90
 Primary Health Care
WHO: PHC was declared in the ALMA ATA
CONFERENCE(USSR) in September 6-
12, 1978, as a strategy to community
health development.
Philippines: Adopted through LOI 949
signed by President Marcos on October
19, 1979 with the theme-
“Health in The Hands of the People by 2020”

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 Primary Health Care

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 Framework

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 How can PHC be possible?
Control of Communicable Diseases
Offers Health Education
Maternal and Child Care
Provision of Medical Care and Emergency Treatment
Offers “Immunization”
Nutrition and Food Supply
Environmental Sanitation
N “Family Planning”
Treatment of Locally Endemic Diseases
Supply and Proper Use of Essential Drugs

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 S P S
C U
E R
O P
C O
M P
T P
M. O
O E
R R R
P T
A
A
L T
R M
E
T E
L C
I C
I H
P H
N N
A A
K O
T N
A L
I I
G O
O S
E G
N M
S Y

12/05/12 95
 PILLARS
A. Multi-sectoral approach
Intersectoral linkages (population control, private
sectors, social welfare, public service, enrironmental,
etc.)

Intrasectoral linkages (people’s empowerment;

within own system)

B. Community Participation
e.g. Community Organizing
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C. Appropriate Technology

- method used to provide a socially and environmentally acceptable

level of service or quality product at the least economic cost.
Criteria:
Safe
Acceptable
Feasible
Effective
Scope-wise
Affordable
Complex

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 10 Medicinal
Plants:
Bawang-anti cholesterol
Ulasimang-Bato-lowers uric acid
Bayabas- antiseptic; diarrhea
Lagundi-cough, asthma, and colds
Yerba Buena- toothache, pain, and arthritis
Sambong- renal calculi
Ampalaya- diabetes mellitus
Niyog-niyogan- anti-helminthic
Tsaang-Gubat- diarrhea
Akapulko- fungal infection RA 8423: utilization
of medicinal plants as
alternative for high cost
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 D. Support mechanism made
available
TYPES OF PRIMARY HEALTH WORKERS
Village/Grassroots Intermediate Level Health Personnel of
Health Workers First-Line Hospitals

Trained Community General Medical Physicians with

Health worker; health Practitioners specialty area
auxiliary volunteer; Public Health Nurses Nurses
Traditional Birth Midwives Dentists
Attendant

Establish close contact

Initial link, 1st contact of 1st source of
with the village and
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intermediate level HW 98
 Strategies and Programs:
D –ental Health
O –perations for Environmental Sanitation
H –ealth Education and Community Organizing
P –revention and Control of Communicable Diseases
R –eproductive Health
O –lder Persons Health Services
G –uidelines for Nutrition
R – ehabilitation and Management of Non-communicable Dse.
A –lternative Health Care Practices (Herbal Meds/Acupressure)
M –aternal and Child Health and IMCI
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S –entrong Sigla Movement
 Reproductive Health
• Exercise of reproductive right & responsibility
• Vision: RH practice as a way of life for every
man and woman throughout life
•Goals: 4 E’s
> Every pregnancy should be intended
> Every birth should be healthy
> Every sex act should be free of coercion
> Every family should achieve its desired size
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