COMMUNITY HEALTH

NURSING
PUBLIC HEALTH
Science and art of preventing disease,
prolonging life,
promoting health and efficiency through
organized community effort
for the sanitation of the environment,
control of communicable diseases,
education of individuals in personal
hygiene,
organization of medical and nursing
services
for the early diagnosis and
preventive treatment of disease,
and development of social machinery 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 TO HEALTH AND
LONGEVITY
Dr. C.E. Winslow (1920)

WHO
The ART OF APPLYING SCIENCE in the
CONTEXT OF POLITICS so as to
REDUCE INEQUALITIES IN HEALTH
while ensuring the best health for the
greatest number
PUBLIC HEALTH NURSING
The practice of nursing in national and
local government health departments
(which include health centers and local
health units), and public schools.
A community health nursing practiced
in the public sector
Standard of Public Health Nursing in the
Philippines, 2005
PUBLIC HEALTH NURSING
Special field of nursing that combines
the skills of nursing, public health, and
some phases of social assistance and
functions as part of the total public
health program
For the promotion of health, the
improvement of conditions in the social
and physical environment, rehabilitation,
and the prevention of illness and disability.
WHO Expert Committee on Nursing
COMMUNITY HEALTH NURSING
Service rendered by a professional nurse
to communities, groups, families, and
individuals at home, in health centers, in
clinics, in schools, and in places of work
For the promotion of health, prevention of
illness, care of the sick at home, and
rehabilitation.
Ruth B. Freeman
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.
Dr. Araceli Maglaya, et al.
GOAL - CHN
To raise the level of health of the citizenry
by helping communities and families cope
with the discontinuities in and threats to
health in such a way as to maximize the
potential for high-level wellness
Nisce, Reyala, et al.
CHN?
WHO?
WHERE?
FOR/ goal?
Philiosophy?
greatest good for the greatest
number
- CHN believes in the worth & dignity
of man

CHN
A service rendered by a professional
nurse.
WHO community, groups, family,
individual at home
WHERE in health centers, clinics,
schools and places of work.
FOR the promotion of health, prevention
of illness and rehabilitation of the sick.
i. The hallmark of community health nursing
is that it is population- or aggregate-focused.
ii. CHN is a synthesis of nursing and public
health practice
1. emphasis on the importance of the
greatest good for the greatest number
2. assessing health needs planning,
implementing and evaluating the impact of health
services on population groups
3. priority of health - promotive and disease
preventive strategies over curative interventions

PRINCIPLES OF CHN
EMPOWERMENT
E Education as a primary tool
M Made available to ALL
P Peoples initiative
O Organizing for health
W Works with family as a unit
E existing organizations of service
R Recording and Reporting
M Monitoring and Evaluation
E Existing indigenous resources
N Needs recognized by community
T Team Effort



POLITICAL
Safety
Oppression
People Empowerment
OLOF
Individuals
Family
groups
Communities
Populations


ENVIRONMENT
Air
Food
Water Waste
Urban/ Rural
Noise
Radiation
Pollution
SOCIO
ECONOMIC
Employment
HEREDITY
Generic
Endowment
-Defects
- strengths
-Risks
-Familial
- Ethnic
- racial


HEALTH CARE
DELIVERY SYSTEM
Promotive
Preventive
Curative
Rehabilitative

BEHAVIOR
Culture
Habits
Mores
Ethnic
Customs
ECO-SYSTEM INFLUENCES ON
OPTIMUM LEVEL OF FUNCTIONING (OLOF)
Modified from (Blum 1974:3) further
modified by the community Health Nursing
Committee, NLPGN, 2000

Determinants of Health
Multidimensional nature of health

ROLES OF THE PUBLIC HEALTH NURSE

1. CLINICIAN or health care provider
2. HEALTH EDUCATOR
3. COORDINATOR AND
COLLABORATOR
4. SUPERVISOR
5. LEADER AND CHANGE AGENT
6. MANAGER
7. RESEARCHER

LEVELS OF CLIENTELE
PATIENT comes from Greek word
pathein which means to suffer
Commonly referred to as the person who
is waiting for or is undergoing medical
treatment and care.
Implies that the person is ill or has a
disease
Person passively accepts the decision
and care of health professionals.
CLIENT
A person who may or may not be sick but
who engages the advice or services of a
health professional.
Presents the client as a collaborator in his/
her care and not as a passive receiver of
health services.
Assumes an active role in health care

CLIENTS OF CHN
1. INDIVIDUAL
Sick or well on a daily basis
2. FAMILY
VERY important social institution that
performs two major functions
reproduction and socialization.
It is generally considered as the basic unit
of care in community health nursing for
many reasons.

3. COMMUNITY
Group of people sharing common
geographic boundaries and/ or common
values and interests.
It functions w/in a particular sociocultural
context, which means that no two
communities are alike.


4. POPULATION GROUP
- or aggregate (clark, 1999:5) is a group
of people who share common
characteristics, developmental stage or
common who exposure to particular
environmental factors, and consequently
common health problems.
FAMILY
I. The Family and Family Health
1. Concepts/ Definition of family
2. Family structure and functions
3. Universal characteristics of families
4. Characteristics of a healthy family
5. Family stages and tasks
6. Levels of Prevention in Family Health

FAMILY
A small social system and primary
reference group made up of two or more
persons living together who are related
by blood, marriage or adoption or who are
living together by arrangement over a
period of time
Murray and Zentner (1997)
Types of families
BASED ON COMPOSITION
1. NUCLEAR FAMILY
2. EXTENDED FAMILY
3. BEANPOLE FAMILY
4. SINGLE-PARENT FAMILY
5. STEP FAMILY/ BLENDED FAMILY/
RECONSTITUTED FAMILY
6. SINGLE STATE
. SAME-SEX OR HOMOSEXUAL FAMILY
8. COHABITING OR COMMUNAL FAMILY


BASED ON LOCUS OF POWER

9. PATRIFOCAL OR PATRIARCHAL
FAMILY
10. MATRIFOCAL OR MATRIARCHAL
11. EGALITARIAN
12. MATRICENTRIC

BASED ON PLACE OF RESIDENCE

13. PATRILOCAL
14. MATRILOCAL
15. BILOCAL
16. NEOLOCAL
17. AVUNCULOCAL

BASED ON DESCENT
18. PATRILINEAL
19. MATRILINEAL
20. BILATERAL
STAGES OF FAMILY DEVELOPMENT
1. INITIAL OR ESTABLISHEMENT STAGE
courtship and engagement precede the
establishment of the family unit.
Developmental tasks:
Contending w/ partner selection pressure from
parents
Giving over autonomy while retaining some
independence
Preparing for marriage
Becoming free of parental domination.
2. EXPECTANT STAGE
Pregnancy
Couple is expected to learn to assume
new roles father/ mother
Couple expected to think as a family
and not just as a pair.

PARENTHOOD OR EXPANSION
STAGE
Characterized by birth or adoption of a
child
DISENGAGEMENT OR CONTRACTION
STAGE
Occurs when the children leave and the
couple must rework their separateness
Retirement planning
Preparation for the spouses death
Eventual bereavement - loneliness
Health care delivery system
The PHCDS defined as the totality of all
policies, facilities, equipment, products,
human resources and services which
address the health needs, problems, and
concerns of the people.
NATIONAL health situation
Different conditions prevailing in the
communities health picture of each
varies
Ex: goiter prevalent in Cordillera
Schistosomiasis endemic in Leyte
Major players
1. PUBLIC SECTOR
Largely financed through a tax-based
budgeting system at both the national and
local levels
Where health care is generally given for
free at the point of service
National and local government agencies
DOH national level mandated as the
lead agency in health.
2. PRIVATE SECTOR
Largely market-oriented and where health
care is paid for through user fees at the
point of service.
Devolution of health services
October 10, 1991
RA 7160 LOCAL GOVERNMENT CODE
Provided for the decentralization of the
entire government
The local health system is now run by
LGUs.
AIM - to build the capabilities of local
governments for self-governance and to
develop them as fully self-reliant
communities.

devolution
Refers to the act by which the
national government
confers power and authority upon
the various local government units
to perform specific functions and
responsibilities,
including the provision and
delivery of basic health services.
Provincial and district hospitals
under the provincial
government
City/ municipal government
manages the health centers/
rural units and barangay health
stations in every province, city
or municipality
Primary health care
As a strategy
PHC
THE NATIONAL HEALTH SITUATION
GIVES us an idea of the health situation in
the communities where nurses work.
Different conditions the health picture
expected to be varied
Ex goiter highly prevalent in the
Cordillera
Schistosomiasis endemic in Leyte
Demographic profile
Philippines is one of the most populous
country in the world.
2000 population was 75.3 million
Projected to increase to 82,636,689 in
2004
1999 LIFE EXPECTANCY
68.6 71.28 for females
66.03 for males
Up from 61.6 years in 1980

Countrys population very young
39% - of the total population in 1994 was
estimated to be in the 0 - 14 age group.
Only 5% were 60 years old and above.
Dependency ratio 79
(0 - 14 years & 60 y/o and above)
dependent
15 - 59 y/o productive age group
About 249 people for every square
kilometer of Philippine territory.
Metro Manila has the highest population
density (16,051)
CAR has the lowest (75)
High density population density
facilitates the transmission of infectious
and communicable diseases.
The greater need for social services:
decent housing, transportation,
communication, education and health
services
High level of stress in highly congested
areas leads to the disintegration of moral
values and social institutions
Contributes to the incidence of a number
of health problems, including mental
health problems.
Causes of morbidity & mortality
1997 causes of mortality among Filipinos
1. diseases of the heart
2. diseases of the vascular system
3. pneumonias
4. malignant neoplasm
5. TB, all forms
6. accidents
7. chronic obstructive & pulmonary diseases
8. other diseases of the respiratory system
9. diabetes mellitus
10. diarrheal diseases
Leading causes of morbidity
1. diarrheas
2. pneumonias
3. bronchiolitis
4. influenza
5. TB
6. malaria
7. chickenpox
8. diseases of the heart
9. measles
10. dengue H-fever
Infant mortality
1. respiratory conditions of the fetus & NB
2. pneumonias
3. congenital anomalies
4. birth injury and difficult labor
5. diarrheal diseases
6. septicemia
7. measles
8. meningitis
9. other diseases of the respiratory system
10. avitaminosis & other nutritional deficiency
CONCEPTUAL FRAMEWORK

FOCUS OF PHC APPROACH
PHC GOAL
LEGAL BASIS OF PHC
5 As OF HEALTH CARE
II. The Family Health Nursing Process
1. Definition of family health nursing &
family nursing process
2. Principles of family nursing process
3. Steps of the family health nursing
process
4. Initial Assessment/data base for Family
Nursing Practice
5. Family
structure/characteristics/dynamics
6. Social, economic & cultural factors

7. Health status of each family member
8. Values & practices on health promotion

III. Methods of Data Gathering
1. Health assessment of each family
member
2. Observation
3. Interview
4. Review of records/reports & laboratory
results
5. Assessment of home & environment
6. Tools used in family assessment:
genogram, ecomap, initial
database, family assessment guide

LEVELS OF PREVENTION:
1
ST
LEVEL
2
ND
LEVEL
3
RD
LEVEL