COMMUNITY HEALTH NURSING 1

INDIVIDUAL &
FAMILY AS CLIENT
 OVERVIEW OF
COMMUNITY HEALTH
NURSING
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.

derived from a Latin word “comunicas” which

means a group of people.
 Allender et al., 2009, p. 6
“a collection of people who interact with one another and
whose the basis for a sense of unity or belonging”

Lundy and Janes, 2009 p. 16

“a group of people who share something in common and interact
with each other, who may exhibit a commitment with one another and may
share a geographic boundary”
‘
Clark, 2008, p.27
“ a group of people who share common interests, who interact with each other,
and who function collectively within a defined social structure to address
common concerns”
Shuster and Goeppinger, 2008, p.344
“a locality-based entity, composed of systems of formal
organizations reflecting society’s institutions, informal groups, and
aggregates”

Maurer and Smith (2009)

further addressed the concept of community and identified four
defining attributes:
1. People
2. Place
3. Interaction
4. Common characteristics, interests, or goals.
2 Main Types of Communities

1. Geopolitical Communities/Territorial Communities

most traditionally recognized
are defined or formed by both natural and man-made
boundaries and include:
Barangays
Municipalities
Cities
Provinces
Regions
Nations
Congressional districts
Neighborhoods
2. Phenomenological Communities
described as functional communities
refer to relational, interactive groups, in which the
place or setting is more abstract, and people share a group
perspective or identity-based on culture, values, history, interests,
and goals.

Ex. Schools, Colleges, and universities; churches and mosques;

and various groups or organizations
Gawad Kalinga
whose members aim to alleviate poverty by community
development, and a group of indigenous people who lobby against
environmental degradation of their ancestral land are examples.
These groups or social units work together to realize a
level of potential “health and to address identified actual and potential
health threats and health needs.
Population
is typically used to denote a group of people having
common personal or environmental characteristics.
refer to all of the people in a defined community
(Maurer and Smith, 2009.)
Aggregates
are subgroups or subpopulations that have some
common characteristics or concerns (Clark, 2008)
Ex. Are age groups or groups undergoing similar physiologic
processes like pregnancy and menopause.
Community Health
Part of paramedical( person who assists physicians
and nurses or is trained physicians and nurses in their activities.) and
medical intervention/approach which is concerned with the
health of the whole population

Aims:
Health promotion
Disease prevention
Management of factors affecting health
 Nursing
Both profession & vocation.
Assisting sick individuals to become healthy and
healthy individuals achieve optimum wellness.
 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.”
( Maglaya, et al)
Goal: “To raise the level of the 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)

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 the conditions in
the social and physical environment, rehabilitation of illness and
disability ( WHO Expert Committee of Nursing)
 A learned practice discipline with the ultimate goal of
contributing as individuals and in collaboration with others to the
promotion of the client’s optimum level of functioning thru’ teaching and
delivery of care (Jacobson)

A service rendered by a professional nurse to

population groups in health centers, clinics, schools, workplaces for the
promotion of health, prevention of illness, care of the sick at home, and
rehabilitation (DR. Ruth B. Freeman)
 IMPORTANT CONCEPT FROM SCIENCE
OF PUBLIC
HEALTH
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.
4. Tools for measuring and analyzing community health nursing.
5. Application of principles of management and organization in
the delivery of health services to the community.
OTHER IMPORTANT
CONCEPTS
1. Health

as a state of physical, mental and

social well being not merely the absence of disease
or infirmity.

(WHO, 1948)
 Physical health implies a mechanistic functioning of the
body.
Mental health
means the ability to think clearly and
coherently and has to do with your thinking and feeling and
how you deal with your problem.
A mentally healthy person has the capacity to
live with other people, understand their needs, and achieve
mutually satisfying relationships.
Social health refers to the ability to:
Make and maintain relationships with others
Interact well with people and the environment.
Health
designates the ability to adapt to changing
environments to growing up and to aging, to healing when damaged,
to suffering, and to a peaceful expectation of death

(lllich 1975)
MODELS OF HEALTH
1. LEAVELL & CLARK’S AGENT-HOST-ENVIRONMENT MODEL or
ECOLOGICAL MODEL
Three dynamic interactive elements:
1. Agent: any environmental factor or stressor (biological, chemical,
mechanical, physical, and psychological) whose presence or absence
can lead to illness or death
2. Host: person(s) who may or may not be at risk of acquiring a disease
based on family history of the disease, lifestyle habits, and age
3. Environment: all factors external to the host that may or may not
predispose the person to the development of disease
2. HEALTH-ILLNESS CONTINUUM
DUNN’S HIGH-LEVEL WELLNESS
GRID
A health grid in which the health axis and
the environment axis intersect to demonstrate
interaction.

Health axis extends from peak wellness to death

Environmental axis extends from very favorable to very
unfavorable.
The intersection forms four health/wellness quadrants:
1. High-level wellness in a favorable environment:
- an example is a person who implements healthy
lifestyle behaviors and has economic resources to support this
lifestyle and a family or social environment that also practices or
encourages the practice of a healthy lifestyle.
2. Emergent high-level wellness in an unfavorable environmental
- an example is a person who knows the importance of
implementing a healthy lifestyle but could not do so because of
family responsibilities, job demands, or lacks the resources to do so.
3. Protected poor health in a favorable environment
- an example is an ill person confined in a hospital whose needs are
met by the hospital personnel, who can afford appropriate
medication, proper diet, and other treatments needed.

4. Poor health in an unfavorable environment

- an example is a starving young child in a refugee camp
in Mindanao.
3. HEALTH BELIEF MODEL (HBM)
Becker, 1975

describes the relationship between a person’s

beliefs and behavior.

Individual perceptions and modifying

factors may influence health beliefs and preventive health
behavior.
Individual perceptions include the ff:
1. Perceived susceptibility to an illness.
refers to the subjective assessment of the risk of developing a
health problem.
2. Perceived seriousness of an illness.
refers to the subjective assessment of the severity of a health
problem and its potential consequences.
3. Perceived Benefits
Belief about the potential positive aspects of a health action
4. Perceived Barriers
Belief about the potential negative aspects of a
particular health action
Structural variables
knowledge about a given disease
prior contact with the disease
4. Cues to action
This is the stimulus needed to trigger the decision-making
process to accept a recommended health action.
These cues can be internal (e.g., chest pains, wheezing, etc.) or
external (e.g., advice from others, illness of a family member, newspaper
article, etc.).
5. Self-Efficacy
the belief that one can achieve the behavior required to
execute the outcome
TRAVIS’ ILLNESS-WELLNESS CONTINUUM

-The model illustrates that movement to the right of the

neutral point indicates increasing levels of health and well-being for
an individual.
-This is achieved through awareness, education, and
growth.
-In contrast, movement to the left of the neutral point
indicates a progressively decreasing state of health.
TRAVIS’ ILLNESS-WELLNESS CONTINUUM

-The model illustrates that movement to the right of

the neutral point indicates increasing levels of health and well-
being for an individual.
-This is achieved through awareness, education and
growth.
-In contrast, movement to the left of the neutral
point indicates a progressively decreasing state of health.
 Modern concept of health:
Optimum level of individuals, families and communities
Several factors in the eco-system, which affect the level of
functioning:
1. Political
–political jurisdictions have the power and authority to regulate the
environment. E.g. safety, oppression and people empowerment
2. Behavioral
–level of functioning is affected by culture, habits,; mores, ethnic
customs
3. Hereditary
–genetically influenced diseases and genetic risk factors; such as
defects, familiar, ethnic, racial
4. Healthcare delivery
–promotive, preventive, curative, rehabilitative care
5. Environmental influences
–air, food, pollution, radiation, noise, water waste, etc.
6. Socio-economic
–employment, education, housing, etc
2.RIGHT TO AND RESPONSIBILITY FOR HEALTH
-Health is a basic human right.
-The universal declaration of human rights article
25, section 1that: “everyone has the right to a standard living
adequate for the health and wellbeing of himself and his family,
including food, clothing, housing and medical care and necessary
social services, and the right to security in the event of
unemployment, sickness, disability, widowhood, old age, or other
lack of livelihood in circumstances beyond his control.-
WHO (1995)
“The government has the responsibility for the health
of their people which can be fulfilled only by the provision of
adequate health and social measures.”

Congressional Commission on Health (1993),

“AS A Fundamental Right, Health Deserves to be a
TOP NATIONAL PRIORITY”.
3. PUBLIC HEALTH
-is the science and the art of preventing disease, prolonging
life, and promoting health and efficiency through organized community effort,
for the sanitation of the environment.

The control of communicable infections, the education of the individual in

personal hygiene, the organization of medical and nursing services for the
early diagnosis and preventive treatment of disease, and the development of
the socials machinery to ensure 4 everyone a standard of living for the
maintenance of health, so organizing these benefits as to enable every citizen
this birthright of health longevity,

WINSLOW, (1920)
 Public Health

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.

According to WHO
4. PRIMARY HEALTHCARE

– is “essential health care based on

practical, scientifically sound and socially acceptable methods and
technology made universally accessible to individuals, families in the
community can afford to maintain at every stage of their development in
the spirit of self-reliance and self-determination.”
(WHO/UNICEF 1978, in STANLOPE and LANCASTER)
5. Public health nursing
a special field in nursing that combines skills
of nursing, public health, and some phases of social assistance
and functions as part of the total public health programme for the
promotion of health, the improvement of the conditions in the
social and physical environment, and rehabilitation of illness and
disability.

-World HEALTH Organization Expert Committee

of Nursing
 Mission of CHN
Health Promotion
Health Protection
Health Balance
Disease prevention
Social Justice

Philosophy of CHN
“The philosophy of CHN is based on the worth and dignity
man.”(Dr. M. Shetland)
GOALS OF COMMUNITY HEALTH
1. To decrease morbidity and mortality rate
2. To increase the lifespan for an individual

AIMS OF COMMUNITY HEALTH

1. To improve quality of life
2. To improve standard of living
3. To reduce risk factors
4. To strengthen self -care activities of an individuals
 BASIC PRINCIPLES OF
COMMUNITY HEALTH NURSING

1. The community is the patient in CHN, the family is the unit of

care and there are four levels of clientele.
2. In CHN, the clientele is considered as an active partner not the
passive recipient of care.
3. CHN practice is affected by development in which technology,
in particular, changes in society, in general.
4. The goal of CHN is achieved through multi-sectorial efforts.
5. CHN is a part of the health care system and the larger human
system.
 Nursing Theories and important concepts
from the science of public health such as:
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
4. Tools for measuring and analyzing community health problems
5. Application of principles of management and organization in the
delivery of health services to the community.
 CLIENTS OF THE COMMUNITY HEALTH NURSE
1. INDIVIDUAL
The PHN deals with individuals – sick or well on daily basis,
these are the people:
-who consult at the health center
-receive health services such as:
pre-natal supervision
well-child follow-ups
morbidity services
clients with chronic illnesses such as DM and HPN who go to health
centers for blood sugar and blood pressure monitoring.
The individual client will be considered as the “entry point” in
working with the whole family.
2. FAMILY
– is a very important social institution that performs two
major functions :
Reproduction
Socialization
- the basic unit of care in CHN for many reasons.
-It performs health promoting, health maintaining and
disease-preventing activites.
-is the focus of decision-making on health matters.
-It is the source of the most solid support and the care to its
members, particularly to the young, the elderly, the disabled and the
chronologically ill.
3. POPULATION GROUP/AGGREGATE
is a group of people who share common
characteristics, developmental stages or common exposure to
particular environmental factors, and subsequently common
health problems.
Some of these groups are children,
men, women and elderly.
4. COMMUNITY
-is a group sharing common geographic
boundaries and/or common values and interest?
-It functions within a particular socio-cultural
context, which means that no two communities are alike.
-The physical environment varies, and so
with the people’s way of behaving and coping.
-The people are different from each other,
this, the dynamics in one community differs from the other.
 CHARACTERISTICS OF A HEALTHY COMMUNITY
Rural or Urban
1. Awareness that “we are a community”.
2. Conservation of natural resources.
3. Recognition of, and respect for, the existence of subgroups.
4. Participation of subgroups in community affairs.
5. Preparation to meet a crisis.
6. Ability to problem solve.
7. Communication through open channels.
8. Resources available to all.
9. Setting of disputes through legitimate mechanisms.
10. Participation by citizens in decision-making.
11. Wellness of a high degree among its members.
Remember! CHN means:

Community
the client
Health
the goal
Nursing
the means
 ROLES, FUNCTIONS OF, and
COMPETENCIES REQUIRED BY A
COMMUNITY HEALTH NURSE
Role – refers to a set of behavior patterns that are deemed appropriate
for a person by virtue of his/ her status in society and/or a position he/she
occupies in an organization.

Function - a set of activities and tasks expected of a person to perform

by virtue of his position or role in society.

Competency – the quality of being functionally adequate in performing

the task and assuming the role of a specific position.
 Roles of the PUBLIC HEALTH NURSE
1. Clinician or Health Care Provider
utilizes the nursing process in the care of the client in the
home setting through home visits and in public health care facilities
conducts referral of patients to appropriate levels of care when
necessary
2. Health Educator
utilizes teaching skills to improve the health knowledge, skills and
attitude of the individual, family and the community and conducts health information
campaigns to various groups for the purpose of health promotion and disease prevention
3. Coordinator and Collaborator
establishes linkages and collaborative relationships
with other health professionals, government agencies, the private sector, non-government
organizations and people’s organizations to address health problems
4. Supervisor monitors and supervises
the performance of midwives and other auxiliary
health workers
also initiates the formulation of staff
development and training programs for midwives and other
auxiliary health workers as part of their training function as
supervisors

5. Leader and Change Agent

influences people to participate in the overall
process of community development
6. Manager
organizes the nursing service component of the local
health agency or local government unit (ex.Nursing service plan component of
the overall municipal health plan);
also, as program manager, the PHN is responsible for the
delivery of the package of services provided by the health program to the
target clientele (ex. The PHN is almost always the program manager of the
National Tuberculosis Program)
7. Researcher
participates in the conduct of research and utilizes
research findings in practice (ex. Disease surveillance or the continuous
collection and analysis of data on diseases and causes of death)
*In the event that 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 MHO’s 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( time
from the delivery of the placenta through the first few weeks after the delivery)
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 meds…etc.
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 of 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
Standards in CHN
1. Theory
Applies theoretical concepts as basis for decisions in practice
2. Data Collection
Gathers comprehensive, accurate data systematically
3. Diagnosis
Analyzes collected data to determine the needs/ health problems of IFC
4. Planning
At each level of prevention, develops plans that specify nursing actions unique
to needs of clients
5. Intervention
Guided by the plan, intervenes to promote, maintain or restore health, prevent
illness and institute rehabilitation
6. Evaluation
Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnoses and plan
7. Quality Assurance and Professional Development
Participates in peer review and other means of evaluation to assure quality
of nursing practice
Assumes professional development
Contributes to development of others
8. Interdisciplinary Collaboration
Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and evaluating
programs for community health
9. Research
Indulges in research to contribute to theory and practice in community health
 CORE COMPETENCIES

Safe and quality nursing care

Management of resources and environment
Health education
Legal responsibility
Ethico-moral responsibility
Personal and professional development
Research
Record management
Communication
Collaboration and teamwork