COMMUNITY HEALTH NURSING

- MS. ADEL MORONG R.N., M.S.N.

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. High-level wellness
3. Agent-host-environment
4. Health belief
5. Evolutionary-based
6. Health promotion
7. 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?

“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
• 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. the sanitation of the environment
b. the control of communicable infections
c. the education of the individual in personal hygiene
d. the organization of medical and nursing services for the
early diagnosis and preventive treatment of disease
 e. The development of a social machinery to ensure every one
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 philosophy of CHN is based on the worth and dignity on the
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

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

• Health Educator, who aims towards health promotion and illness prevention
through dissemination of correct information; educating people

• Facilitator, who establishes multi-sectoral linkages by referral system

• Supervisor, who monitors and supervises the performance of midwives

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

• 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 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

Unit 2
LEVELS OF CLIENTELE IN CHN

 Individual

Basic approaches in looking at the individual:

1. Atomistic

2. Holistic

Perspectives in understanding the individual:

1. Biological

a. unified whole

b. holon

c. dimorphism

2. Anthropological

a. essentialism

b. social constructionism

c. culture

3. Psychological

a. psychosexual

b. psychosocial

c. behaviorism

d. social learning

4. Sociological

a. family and kinship

b. social groups

 Family

Models:
1. Developmental

Stages of Family Development

Stage 1 – The Beginning Family

Stage 2 – The Early Child-bearing Family

Stage 3 – The Family with Preschool Children

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

2. 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

First Level Assessment

• Health threats:
conditions that are conducive to disease, accident or failure to realize
one’s 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

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

Problem Prioritization:

• Nature of the problem

Health deficit
Health threat
Foreseeable Crisis

• Preventive potential
High
Moderate
Low

• Modifiability
 Easily modifiable
Partially modifiable
Not modifiable

• Salience
High
Moderate
Low

Family Service and Progress Record

 Population Group

Vulnerable Groups:

• Infants and Young Children

• School age
• Adolescents
• Mothers
• Males
• Old People

Specialized Fields:

• Community Mental Health Nursing

A unique clinical process which includes an integration of concepts
from nursing, mental health, social psychology, psychology,
community networks, and the basic sciences

• Occupational Health Nursing

The application of nursing principles and procedures in conserving the
health of workers in all occupations

• School Health Nursing

The application of nursing theories and principles in the care of the
school population

Unit 3
ASSESSMENT OF COMMUNITY HEALTH NEEDS

 Community Diagnosis

- A process by which the nurse collects data about the community in order to
identify factors which may influence the deaths and illnesses of the
population, to formulate a community health nursing diagnosis and develop
and implement community health nursing interventions and strategies

2 Types of Community Diagnosis

Comprehensive Community Problem-Oriented Community

Diagnosis Diagnosis

- aims to obtain general information - type of assessment responds to a

about the community particular need

STEPS:

• Preparatory Phase

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

• Implementation Phase
 1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. priority zation of health problems
7. development of a health plan
8. validation and feedback

• Evaluation Phase
 Biostatistics

A. Demography

-study of population size, composition and spatial distribution as affected by

births, deaths and migration.

* Sources:
Census – complete enumeration of the population

2 Ways of Assigning People

De jure De facto
People were assigned to the place where People were assigned to the place they
usually live regardless of where they where they are physically present at are at the
time of census. the time of census, regardless, of
their usual place of residence.

COMPONENTS:
Population size

Population composition
* Age Distribution
* Sex Ratio
* Population Pyramid
* Median age
age below which 50% of the population fall and above which 50% of the
population fall. The lower the median age, the younger the population (high
fertility, high death rates).
* Age – Dependency Ratio
used as an index of age-induced economic drain on human resources
* Other characteristics:
- occupational groups
- economic groups
- educational attainment
- ethnic groups

Population Distribution

* Urban-Rural
shows the proportion of people living in urban compared to the rural areas
* Crowding Index
indicates the ease by which a communicable disease can be transmitted from
1 host to another susceptible host.
* Population Density
determines congestion of the place

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

• Mortality Rates
Crude Death Rate
Specific Mortality Rate
Infant Mortality Rate
Neonatal Mortality Rate
Post-neonatal Mortality Rate
Maternal Mortality Rate
Proportionate Mortality Rate
Swaroop’s Index
Case Fatality Rate
Cause-of- Death Rate

• Morbidity Rates

Prevalence Rate
Incidence Rate

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

Basic Concepts:
1. Epidemiologic Triad
2. transmission
3. incubation period
4. herd immunity

Factors affecting distribution:

1. PERSON
- intrinsic characteristics
2. PLACE
- extrinsic factors
3. TIME
- temporal patterns

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 susceptibles 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 socio-economic
changes
Endemic
- habitual presence of a disease in a given geographic location
accounting for the low number of both immunes and susceptibles
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

Types of Epidemiological Study Designs

Descriptive VS Analytical

Provides information on patterns of

disease in terms of person, place and Test hypothesis about
causes characteristics of disease

Intervention
* Correlational * Case Reports Observational (Experimental)
 studies
*Case Series * Case control * Trials
* Ecologic *Cross-sectional * Cohort
surveys

Experimental VS. Non-Experimental

With manipulation Mere observation of study conditions

* Clinical Trials * Cohort

* Field Trials * Case Control
* Community Intervention Trials * Proportional-Mortality Studies
* Cross-sectional
* Ecologic

Common Epidemiologic Studies:

Retrospective Cross-sectional Prospective Cohort

Steps in EPIDEMIOLOGICAL IVESTIGATION:

1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained