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COMMUNITY HEALTH NURSING

- MR. GERARDO “DYERI” P. ANDAMO R.N.
MODULE 1: COMMUNITY HEALTH NURSING: AN OVERVIEW

 Defining Community Health Nursing (CHN)

 What is a community?
a group of people with common characteristics or interests living together within a territory or
geographical boundary
COMMUNITY AS CLIENT / PATIENT IN CHN
World Views on Community:
1. The community is an integral part of society and is composed of families
2. Contradictions/conflicts are inherent in a community
3. The community is always in state of continuous movement and change
COMMUNITY AS SETTING IN CHN PRACTICE
- place where people under usual or normal conditions are found
(homes, schools and places of work)
- outside of purely curative institutions
 What is health?
1. Health-illness continuum model
Health is a dynamic state at any point between optimal wellness and death; a balance
between internal and external environments
Holistic as it reflects physical, emotional, intellectual, developmental, social and spiritual
dimensions
2. High-level wellness model
model recognizes health as an ongoing process toward a person’s highest potential of
functioning
3. Agent-host-environment (Epidemiologic) model
The agent, host and environment interact in ways that create risk factors, and understanding
these is important for the promotion and maintenance of health
4. Health belief model
People take preventive actions if the three conditions exist:
 Seriousness of the disease
 Susceptibility to the disease
 Cost effectiveness of the preventive action
5. Evolutionary-based model
Illness and death sometimes serve an evolutionary purpose
6. Health promotion model
refers to the policies, activities and codes of practice aimed that positively enhancing well-
being
7. WHO definition
Not merely the absence of disease
The state of complete physical, mental and social well-being
A social phenomenon
An outcome of the interplay of biological, physical, ecological, political, economic, and socio-
cultural factors
 What is community health?
- part of paramedical and medical intervention/approach which is concerned on the health of the
whole population
- aims:
1. promotion of health
2. prevention of diseases
3. management of factors affecting health
Individual APPLIED STUDY Community
Anatomy Structure Demography
Physiology Function Sociology
Pathology Malfunction Epidemiology
Public Health (definitions)
Winslow
- science and art of preventing disease, prolonging life, promoting health and efficiency through organized
community effort 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 of health and longevity
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Hanlon
- dedicated to the common attainment of the highest level of physical, mental and social well-being and
longevity consistent with available knowledge and resources at a given time and place towards most
effective total development life of the individual and society
Purdom
- prioritizes survival of human species and recognizes that each phase in human development is of equal
importance with the other phases
 What is nursing?
assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
(Henderson)
self-care (Orem)
placing the individual in an environment that will maximize his capacity for self-repair
(Nightingale)
 What is 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 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
Community Health Nursing (definitions):
WHO Expert Committee on Health
specialized field of nursing that combines the skills of nursing, public health and some phases of
human assistance and functions
Jacobson
promotion of client’s optimum level of functioning through teaching and delivery of care
Freeman
developing and enhancing health capabilities of people
 Basic Concepts of CHN
1. Primary focus is health promotion and disease prevention.
2. Practice extends from individual to family, population group and community.
3. CHNurses are generalists
4. Contact with client continues through time and all types of health care
5. Nature of practice require application of concepts of various sciences
6. implicit in CHN is the nursing process.
 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.

 Key Principles of CHN

1. Needs of clients provide basis for CHN practice
2. Objectives and policies facilitate goal achievement
3. Family is the unit of service
4. Respect values, customs and beliefs of clients
5. Health education and counseling are vital parts of CHN
6. Collaborative working relationship with the health team facilitates goal achievement
7. Periodic and continuing evaluation is necessary
8. Continuing staff education programs ensure quality care and upgrade nursing practice
9. Indigenous and existing community resour5ces must be utilized
10. People must actively participate in decision-making
11. Nursing supervision provides guidance and directions to work
12. Accurate recording and reporting serve as bases for evaluation and guide for future actions.
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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 clientele based on standards set 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 through staff development
OBJECTIVES, STRATEGIES AND METHODOLOGIES IN CHN
 Strategies and Health Status Targets to Achieve Objectives
Strategies to promote equity in health
► priority for the vulnerable and marginalized
► primary Health Care as the Key Approach
HEALTH PROMOTION
- Consists of activities directed towards increasing the level of well-being and actualizing the
health potential of individuals, families, communities and societies.
Methods:
 Health education
 Nutrition
 Personality development
 Adequate housing, recreation, agreeable working condition
 Genetic counseling
 Periodic selective examination
 DISEASE PREVENTION
PRIMARY LEVEL OF DISEASE PREVENTION
- consists of activities directed towards decreasing probability of specific illnesses or dysfunctions in
individuals, families and communities
Through people
 immunization
 chemoprophylaxis
 nutrition
 personality development
 personal hygiene
 child spacing
 protection against carcinogens and allergens
Environmental control
 safe water supplies
 good food hygiene
 safe excreta and rubbish disposal
 disinfection and sterilization
 vector and animal reservoir control
 good living nag working conditions
SECONDARY LEVEL OF DISEASE PREVENTION
-emphasizes early diagnosis and prompt intervention to halt pathological process, thereby
shortening its duration and severity and enabling individual regain normal function at the earliest possible
time.
Screening - the presumptive identification of unrecognized disease or defect by the application of tests,
examinations or other procedures that can be applied rapidly and inexpensively to populations
Screening Methods:
mass screening
 case-finding
contact-tracing
 multi-phasic screening
 surveillance
Characteristics of an ideal screening test:
High sensitivity
High specificity
TERTIARY LEVEL OF DISEASE PREVENTION
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- Comes into play when a defect or disability is fixed. Rehabilitation goal is more than halting the
disease process itself’ it is restoring the individual to an optimum level of functioning within the
constraints of disability.
Methods of Tertiary Prevention:
o Diagnosis
o Treatment
o Management
o Rehabilitation
3 Levels of Prevention
PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL
Health Promotion and Prevention of Complications Prevention of Disability, etc.
Illness Prevention thru Early Dx and Tx
Provided at – ► When hospitalization is ► When highly-specialized
► Health care/RHU deemed necessary and medical care is necessary
► Brgy. Health Stations referral is made to ► referrals are made to
►Main Health Center emergency (now district), hospitals and medical
►Community Hospital and provincial or regional or center such as PGH, PHC,
Health Center private hospitals POC, National Center for
►Private and Semi-private Mental Health, and other
agencies gov’t private hospitals at
the municipal level
 COMMUNITY ORGANIZING
Continuous and sustained process of raising the level of awareness, organizing and mobilizing
Levels of Awareness:
 Political socialization
 Political mobilization
 Interest aggregation
 Interest articulation
 Culture of silence/passivity
Basic concepts and principles:
1. objective analysis of objective conditions
2. basic trust on the people
3. from, for, by and with the people
4. people want and can change
5. self-willed changes are more meaningful and permanent than imposed changes
Context of CO: Current situation
Goal of CO: Community development
 PRIMARY HEALTH CARE
PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to community health
development. It is a strategy aimed to provide essential health care that is:
Community-based
Accessible
Part and parcel of the total socio-economic development effort of the nation
Acceptable
Sustainable at an affordable cost.
Framework:
People’s Empowerment and Partnership is the Key Strategy to achieve the goal, “Health For all Filipinos by
the year 2000 And Health in the Hands of the People by the year 2020”
WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS?
It stands for: Education of prevailing Health Problems
Locally-endemic Disease Prevention and Control
Expanded Program of Immunization
Maternal and Child Health and Family Planning
Environmental Sanitation and Safe Water Supply
Nutrition and Food Supply
Treatment of Communicable & Non-communicable Diseases/ Conditions
Supply and Proper use of Essential Drugs and Herbal Medicine
Dental Health Promotion
Access to and use of hospitals as Centers of Wellness
Mental Health Promotion
Pillars (major elements):
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A. Multi-sectoral approach
Intersectoral linkages
Intrasectoral linkages
B. Community Participation
Rungs of Peoples Participation:
Genuine people’s participation
Citizen’s control
Delegated power
Partnership/shared leadership
Token participation
Placation
Consultation
Information
Non-participation
Therapy
Manipulation
Phases of CO in Health: (see hand-out on COPAR)
 Social Investigation
 Entry to the community
 Social preparation
 Community integration
 Small-group formation
 CHW election
 Launching of organization
 Community diagnosis
 Training and Services
 Core-group formation
 PHASE OUT
C. Appropriate Technology
- method used to provide a socially and environmentally acceptable level of service or quality
product at the least economic cost.
Criteria: Feasible
Acceptable, Affordable
Complex
Effective
Safe
Scope-wise

10 MEDICINAL PLANTS:
Lagundi Sambong
Ulasaming-Bato Ampalaya
Bawang Niyog-niyogan
Bayabas Tsaang gubat
Yerba-buena Akapulko