Unit 1 COMMUNITY HEALTH NURSING: AN OVERVIEW

Defining Community Health Nursing

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
What is health?
1. Health-illness continuum
2.
3.
4.
5.
6.
7.

High-level wellness
Age nt - hos t - e nvi r on me nt
Health belief
Evolutionar y-based
Health promotion
WHO definition

What is community health?

- part of paramedical and medical intervention/approach which is concerned on the health
of the whole population
Aims:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health
What is nursing?
- Assisting sick individuals to become healthy and healthy individuals achieve
optimum wellness
What is Community Health Nursing?
T h e u t i l i z a t i o n o f t h e n u r s i n g p r o c e s s i n t h e d i f f e r e n t l e v e l s o f clienteleindividuals, families, population groups and communities, concerned w i t h t h e p r o m o t i o n
o f h e a l t h , p r e v e n t i o n o f d i s e a s e a n d d i s a b i l i t y a n d 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

What is Public Health?

Public Health is directed towards assisting every citizen to realize his birth rights and longevity.
The science and art of preventing disease, prolonging life and
efficiency through organized community effort for:
a. t h e s a n i t a t i o n o f t h e e n v i r o n m e n t
b. t h e c o n t r o l o f c o m m u n i c a b l e i n f e c t i o n s
c. the education of the individual in personal hygiene
d. t h e o r g a n i z a t i o n o f m e d i c a l a n d n u r s i n g s e r v i c e s f o r t h e early
diagnosis and preventive treatment of disease
e. The development of a social machinery to ensure everyone a standard of living,
adequate for maintenance of health to enable every citizen to realize his birth right of
health and longevity-Winslow>
Philosophy of CHN
The p h i l o s o p h y o f C H N i s b a s e d o n t h e w o r t h a n d d i g n i t y o n t h e worth and
dignity of man.- Dr. M. Shetland
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.

Roles of the PUBLIC HEALTH NURSE

1. Clinician, who is a health care provider, taking care of the sick people at home or in the RHU

2. Health Educator, who aims towards health promotion and illness prevention through
dissemination of correct information; educating people
3. Facilitator, who establishes multi-sectoral linkages by referral system
4. Supervisor, who monitors and supervises the performance of midwives I n t h e e v e n t t h a t
the Municipal Health Officer (MHO) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of the
MHOs responsibilities. Other Specific Responsibilities of a Nurse, spelled by the
implementing rules and Regulations of RA 7164 (Philippine Nursing Act of 1991) includes:
Supervision and care of women during pregnancy, labor and puerperium
Performance of internal examination and delivery of babies
Suturing lacerations in the absence of a physician
Provision of first aid measures and emergency care
Recommending herbal and symptomatic medsetc. In the care of the families:
Provision of primary health care services
Developmental/Utilization of family nursing care plan in the provision of care
In the care of the communities:
Community organizing mobilization, community development and people
empowerment
Case finding and epidemiological investigation
Program planning, implementation and evaluation
Influencing executive and legislative individuals or bodies concerning health and development

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
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 staff development

TYPOLOGY OF NURSING PROBLEMS

A. First Level Assessment: to determine problems of family Sources of Problems using IDB
Family: use of Initial Data Base (IDB)

Nature: Health Deficit (HD), Health Threat (HT), Foreseeable Crisis (FC)
USE OF INITIAL DATA BASE (IDB):
1. Family Chart Structure: Nuclear -Father, mother, children
2. Extended (3rd generation)-Relatives staying with the family Multi-generational
extended-apo sa tuhod or apo sa talampakanDyad -Husband & wife only (childless
couple)
3. Blended -widow married another widow & have children
4. Gay -Same sex living together
5. Matriarchal -Mother is the decision maker
6. Patriarchal -Father is the decision maker
7. Communal -different families forming a community

Socio-economic: poverty level, educational attainment & nature of occupation of

members of the family (sources of income)
1. Socio-cultural: different nature of religion
2.
Home environment: assessment according to ES, treatment of garbage,
preparation of food, availability of toilet, water & food sanitation, sources of
diseases
Medical history: history of certain disease, family member with disease

Resources available in community for use by the family:

1. 5 Generalized Ms in resources available in community:
Man/Manpower
Money
Machine
Materials Methods

DEFINE THE PROBLEM

NATURE
1. Health Deficit (HD)- if identified problem is an abnormality, illness or disease, theres a
gap/difference between normal status (ideal, desirable, expected) & actual status (the
outcome/result/problem encountered on that actual day)
2. Health Threat (HT)-any condition or situation which will be conducive to health alteration,
health interference & health disturbance.
3. Foreseeable Crisis (FC)-stress points, anything which is anticipated/ expected to become a
problem
Jobless Father Suffering from TB
Wife is pregnant for the 8 time2 y/o youngest child lacks immunization rd9 y/o eldest
child is 3 degree malnourished
Poor environmental sanitation

III. PLANNING Four (4) Standard Steps:

1. Prioritization -start if there are multiple identified problems
2. Formulation of objectives -planning a procedure will start here if there is only one problem
3. Developing strategies of action
4. Formulation of evaluation tools for the identified strategy developed
CRITERIA IN IDENTIFYING THE PROBLEM
Criteria Score Weight
I.
Nature: assess by PHW Health deficit (HD) 3 1 Health threat (HT) 2 Foreseeable
Crisis (FC)1
II.
Modifiability Easily 2 2 Intermediate (moderate) 1 Not modifiable 0
III.
Preventive Potential Highly 3 1 Moderate 2 Low 1
IV.
Salience of the Problem - Problem needing urgent 2 1 attention Problem not needing
1 urgent attention Not a felt problem 0
Steps:
a. Decide on a score
b. Score x weight ----------------- Highest Score
b. Get the sum total of all the scores
Interpretation: Perfect score=5, if score nearing 5 then prioritize the problem Criteria 1, 2 & 3
has to be assessed objectively by the health worker Criteria 4 has to be assessed by the
perception of the family
Compute for 3rd Degree Malnutrition
IV. INTERVENTION Is the professional phase of nursing process Is the time when the PHN
executes the standard function of an RN
Three (3) Standard Functions of RN:
1. Dependent-giving of medicines
2. Independent-monitor, assess, provide, educate
3. Interdependent-referrals
V. EVALUATION Three (3) Things to be evaluated:
1. Structure of program & activity -what articles, equipments, supplies are utilized
2. Process utilized -steps used
3. Outcome of activity -results can be:
Desirable -to be implemented, advocated, strengthen
Undesirable -to be avoided
Two (2) Aspects to be evaluated in the Outcome
1) Quality -characteristic or kind of outcome; no numerical value, not
measurable
2) Quantity -from the word quantum, with numerical value, measurable

OBJECTIVES OF COPAR Patterns to be followed:

1. Organize people
2. Mobilize people
3. Work with people
4. Educate people
PHASES OF COPAR
1.Preparatory
2.Organizing
3.Mobilizing
4.Educating
5.Collaborating
6.Phase Out
1. PREPARATORY PHASE
A. Area of Selection
It should be DOPE Community: Depressed, Oppressed, Poor & Exploited, a new
criteria for community organization
Old Criteria it must be a virgin community=meaning no agency has gone there.
This is a dangerous situation thats why RA 7305: Magna Carta for Public Workers
was provided-a PHN is to receive a hazard pay of 20-25% of monthly salary
B. Entry: the 1st thing to do upon entering the community is to have a courtesy call with
the Barangay
C. Integration/Immersion
Immersion is imbibing the life situation/ condition of the community by living, eating
& sleeping with the family to be able to understand their situation
It requires 2 Qualities of PHN:
o Empathy
o Sympathy (Integration)
D. Community Study: Diagnosis of Community-COPAR
Makes use of the Nursing Process/Problem Solving Approach
Prioritized which among the problems identified is to be attended 1st like in
nature, magnitude, modifiability, preventive potential, salience
PRIORITIZATION OF COMMUNITY PROBLEMS
I.
NATURE OF THE PROBLEM
1) Health Status (HS)
Categories according to 5 Aspects of Man (PEMSS)
1) Physical, Physiological, Psychological
2) Emotional
3) Mental
4) Social
5) Spiritual
2) Health Resource(s)
5 Ms-Manpower/Man, money, machinery, material & methods (+) available
facilities-Hospital/Clinic, mode of transportation, market, school & movie houses for
recreation

3) Health Related Indicators of Health Status

a)
Condition: Fertility: CBR=community is overpopulated= HS Morbidity:
IR (new cases) & PR (old cases)=HS Mortality: Deaths like children dying of
pneumonia=HS

MAGNITUDE OF THE PROBLEM: % of population affected by the

identified problem
1. MODIFIABILITY Easily 3 Intermediate 2Low 1Not modifiable
2. PREVENTIVE POTENTIAL Highly 3 Moderate 2 Low 1
3. SALIENCE