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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?
COMMUNITY AS CLIENT / PATIENT IN CHN
a group of people with common characteristics or interests living together within a territory or
geographical boundary
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?
WHO definition (1978)
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
 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?

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. implicit in CHN is the nursing process.
 Key Principles of CHN
1. Needs of clients provide basis for CHN practice
2. Objectives and policies facilitate goal achievement
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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.
 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
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
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Characteristics of an ideal screening test:

High sensitivity
High specificity
TERTIARY LEVEL OF DISEASE PREVENTION
- 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
 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.
Pillars (major elements):
A. Multi-sectoral approach
Intersectoral linkages
Intrasectoral linkages
B. 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

C. Active Community Participation

Community Organizing in Health
• Social Investigation
Preliminary
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Baseline information from Secondary data sources

Deepening
Continuous appraisal of community situation through Primary data sources
• Entry
Low profile or low key approach
Upon ENTRY, start the ff:
1. DSI
2. Social Preparation
3. Community Integration
• Social Preparation
Tempering the grounds for setting up health program
Target: community leaders
Establish rapport, develop trust, clarify intentions and expectations
Methods: courtesy calls and attendance to meetings
• Community Integration
Imbibing community way of life
Target: community
Deepen rapport, develop mutual trust, draw objectives
Methods: house-to-house, going to places and events where people are, direct participation
in production process
Spot map
Clusters of 8-15 households
• Small-group formation
• Election of CHWs
• Launching
• Community Diagnosis
• Training and Services
Advanced CHWS
• Core-group formation
• Phase out

CO Process:
Pre Entry Phase
1. Site selection
2. PSI
Entry Phase
1. Social preparation
2. Community integration
3. DSI
Organizational formation Phase
1. Small group formation
2. Election of CHWs
3. Organizational meetings
Training Phase
1. Training needs Assessment
2. Curriculum development
3. Actual training
4. Training evaluation
Services Phase
1. Community clinics
2. Other services
Leadership formation Phase
1. Core-group formation
2. Advanced training
Consolidation Phase
1. Evaluation sessions
2. Staff development
Sustenance and Maintenance Phase
1. Endorsement to sectoral organizing
2. Formation of regional coordinating bodies
Phase out
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Levels of Clientele in CHN

 Individual

Basic approaches in looking at the individual:

 Holistic

 Atomistic
 Family

Structural-Functional Model
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
• Wellness condition
transition from a specific level of wellness or capability to a higher level
 POTENTIAL for enhanced capability
wellness state/condition based on client’s performance, current competencies, or clinical
data but NO explicit expression of client’s desire
 READINESS for enhanced capability
With explicit expression of desire to achieve a higher level of state of function in a
specific area of health promotion and maintenance
 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:
FAMILY TASKS:
 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
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The Family Data Base

The Family Nursing Care Plan
The Family Service and Progress Record
The Family Case Study

 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
Focus:
Occupational Health Nursing
The application of nursing principles and procedures in conserving the health of workers
in all occupations
Aims:
School Health Nursing
The application of nursing theories and principles in the care of the school population
Components:
1. School health services
2. School health instruction
3. Healthful school living
4. School community linkage

 Community
 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 Diagnosis Problem-Oriented Community Diagnosis
- aims to obtain general information about the - type of assessment responds to a particular
community 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. prioritization of health problems
7. development of a health plan
8. validation and feedback
 Evaluation Phase
1. Process evaluation
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2. Product evaluation