COMMUNITY

HEALTH NURSING

4/10/15

4/10/15

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 NursingSchool
Occupational Health
Nursing- Workplace
Public Health Nursing-Home

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2. What Is Health?
A state of complete
physical, mental,
and social wellbeing 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
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7
factors.

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?
The 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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It operates within the realm of health care

both independently and interdependently.
The 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
with
all
cases
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deals
15

The ULTIMATE GOAL of CHN

RAISE
the level
of
health
of
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By:
help communities and
families cope with
discontinuities in
health and threats
Maximize their
potential for high level
wellness
Promote reciprocally
supportive relationship
between people and
their physical and
16
social environment

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
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for CHN

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
Ans: c.Letting the people manage their own
health
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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:

All ages
regardless
status
d.

of

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
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Nursing.

Philosophy of Public Health

Health and longevity as birthrights
Longevity average lifespan or life expectancy

50 years Swaroops 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 Ps:
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

Role 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 epidemiological investigation
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
clients 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
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Other factors affecting health

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.
B.
C.
D.

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Wellness State
Health Deficit
Health Threat
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
Value 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 ones
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
52
*Family Service and Progress Record
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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
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54
assessment or situational analysis

 A process by which the people in the

community and the health team assess
the communitys 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.
2.
3.
4.
5.

site selection
preparation of the community
statement of the objectives
determine the data to be collected
identify methods and instruments for data
collection
6. finalize sampling design and methods
7. make a timetable
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Implementation Phase
1.
2.
3.
4.
5.
6.
7.
8.

data collection
data organization/collation
data presentation
data analysis
identification of health problems
prioritization of health problems
development of a health plan
validation and feedback

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

Crude Birth Rate, Crude Death Rate

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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

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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

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Leading causes of mortality, morbidity,

infant
mortality, infant morbidity, maternal
mortality
64

CHN Process
Parts of Community Diagnosis:
G.Health Resources

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manpower-population ratio

manpower distribution

manpower policies

health budget and policies

sources of health funding

categories of health institutions available

categories of health services available

65

CHN Process
Parts of Community Diagnosis:
H.Political and Leadership Patterns

Power structures in the community

Confidence of people to authority

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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

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Health status

Health resources

Health-related

69

CHN Process
Steps in Conducting Community
Diagnosis:
10. Prioritization of CHN Problems
Nature
Magnitude
Modifiability
Preventive potential
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Social concern

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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
4.
5.
6.
7.
8.
9.
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Age Distribution
Median Age
Dependency Ratio
Sex Ratio
Population Pyramid
Others: occupational groups, economic groups,
educational attainment, and ethnic groups
73

Population Distribution
1. Urban-Rural

Shows the proportion of people living in urban

compared to the rural areas

2. Crowding Index

Indicates the ease by which a communicable

disease can be transmitted from 1 host to another
susceptible host

3. Population Density

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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
General Fertility Rate
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Mortality Rates
Crude Death Rate
Specific Mortality Rate
Infant Mortality Rate
Neonatal Mortality Rate
Post-neonatal Mortality Rate
Maternal Mortality Rate
Proportionate Mortality Rate
Swaroops Index
Case 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 socioeconomic 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
Complexity of the Services
Provided

Type

Service

According to the
Type of Service

Type

Example

Primary

Health Promotion,
Preventive Care,
Continuing Care for
common health
problems, attention to
psychological and social
care, referrals

Health
Promotion
and illness
Prevention

Informatio
n
Dissemina
tion

Secondar
y

Surgery, Medical
services by Specialists

Diagnosis
and
Treatment

Screening

Tertiary

Advanced, specialized,
diagnostic, therapeutic
& rehabilitative care

Rehabilitati
on

PT/OT

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The
Healt
h
Secto
r

DOH
LGU

NGO/PS

Self-Reliant, Healthy Filipino

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The Health
Sector
Department of Health
Vision: Leader and staunch
advocate and model in promoting
Health for ALL in the Philippines
Mission: Guarantee equitable,
sustainable, and quality health for all
Filipinos, specially the poor and shall
lead the quest for excellence in
health
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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 Noncommunicable Dse.
A lternative Health Care Practices
(HerbalMeds/Acupressure)
M
aternal and Child Health and IMCI
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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
Health Resource Development Personnel
Relief and Disaster Management
Networking
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PRIMARY LEVEL
Health Promotion and
Illness Prevention

SECONDARY LEVEL
Prevention of
Complications thru Early
Dx and Tx

TERTIARY LEVEL
Prevention of Disability,
etc.

Provided at
Health care/RHU
Brgy. Health Stations
Main Health Center
Community Hospital
and Health Center
Private and Semiprivate agencies

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

When highlyspecialized 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

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Primary Health Care

WHO: PHC was declared in the ALMA ATA
CONFERENCE(USSR) in September 612, 1978, as a strategy to community
health development.
Philippines: Adopted through LOI 949
signed by President Marcos on October
19, 1979 with the themeHealth in The Hands of the People by 2020
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Primary Health Care

CommunityBased

Accessible

Affordable

PHC

Acceptable
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Sustainable
91

Framework
People
Empowerment

Health for All

Filipinos by the
Year 2000 and
Health in the
Hands of the
People by
2020
Partnership

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

P I L L A R S

P
R
O
P
E
R

S
U
P
P
O
R
T

T
E
C
H
N
O
L
O
G
Y

M
E
C
H
A
N
I
S
M

O F

P H 94C

PILLARS
A. Multi-sectoral approach
Intersectoral linkages (population control, private
sectors, social welfare, public service, enrironmental,
etc.)
Intrasectoral linkages (peoples 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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Example:
- ORS
- - Herbal Meds
- -Botica sa Baryo
- -Use of
Indigenous
Materials

96

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
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RA 8423:
utilization of medicinal
plants as alternative for
97 cost medications
high

D. Support mechanism made

available
TYPES OF PRIMARY HEALTH WORKERS
Village/Grassroots
Health Workers

Intermediate Level

Health Personnel of
First-Line Hospitals

Trained Community
Health worker; health
auxiliary volunteer;
Traditional Birth
Attendant

General Medical
Practitioners
Public Health Nurses
Midwives

Physicians with
specialty area
Nurses
Dentists

Initial link, 1st contact of

the community
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1st source of
professional healthcare

Establish close contact

with the village and
98
intermediate
level HW

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 Noncommunicable Dse.
A lternative Health Care Practices (Herbal
Meds/Acupressure)
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M
aternal and Child Health and IMCI

99

Reproductive Health
Exercise of reproductive right &
responsibility
Vision: RH practice as a way of life for every
man and woman throughout life
Goals: 4 Es
> 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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