NCM 113 – COMMUNITY HEALTH emotionally, spiritually, and socially”

(Murray, Zentner, and Yakimo, 2009)

NURSING - “Realization of human potential
through goal-directed behavior,
HEALTH DEFINITION competent self-care, and satisfying
relationships with others” (Pender,
- Health as a concept and as a reality. Murdaugh, and Parsons, 2011)
- “A state of complete physical, mental, - A state of a person that is
and social well-being and not merely characterized by soundness or
the absence of disease or infirmity.” wholeness of developed human
(WHO, 1958) structures and of bodily and mental
- Social means “of relating to living functioning (Orem, 2001).
together in organized groups or similar
close aggregates and refers to units of
people in communities who interact
DETERMINANTS OF HEALTH AND DISEASE
with one another.
- “Social health” connotes community 1. Biology
vitality and is a result of positive 2. Behaviors
interaction among groups within the 3. Social Environment
community with an emphasis on health 4. Physical Environment
promotion and illness prevention. 5. Policies And Interventions
- WHO in 1986 emphasize recognition of
the social implications of health.
- Thus, health is: the extent to which an SOCIAL DETERMINANTS OF HEALTH
individual or group is able, on the other
hand, to realize aspirations and satisfy 1. Economic Stability
needs; and, on the other hand, to 2. Education Access and Quality
change or cope with the environment. 3. Health Care Access and Quality
- Health is, therefore, seen as resource 4. Neighborhood And Built Environment
for everyday life, not the objective of 5. Social And Community Context
living; it is a positive concept
MAJOR GOAL OF CPHN
emphasizing social and personal
resources, and physical capacities. - “to preserve the health of the
(WHO, 1986) community and surrounding
- WHO definition considers several populations by focusing on health
dimensions of health (Saylor, 2004) promotion and health maintenance of
- These includes physical individuals, families and groups within
(structure/function), social, role, the community:
mental (emotional and intellectual), - CPHN is associated with health and the
and general perceptions of health identification of populations at risk
status. rather than with an episodic response
- It also conceptualizes health from a to patient demand.
macro perspective, as a resource to be - Requires identifying the factors which
used rather than a goal in and of itself. make people at risk and what keeps
them well.
NURSING DEFINITIONS OF HEALTH
DETERMINANTS OF HEALTH AND DISEASE
- “`A state of well-being in which in
which the personal is able to use  Biology
purposeful, adaptive responses and - An individual’s genetic makeup, family
processes physically, mentally, history and any physical and mental
 health problems developed in the SOCIAL DETERMINANTS OF HEALTH
course of life
- Heredity, ageing, physical activity, - The conditions in which people are
smoking, stress, alcohol or drug abuse, “born, grow, work, live, and age, and
injury, etc. the wider set of forces and systems”
(economic, social policies, and political
systems) that shape the conditions of
 Behaviors
daily life (WHO, 2019).
- The individual’s responses to internal - These SDH affects a person’s health,
stimuli and external conditions functioning, and quality of life
- Interact with biology – one may outcomes and directly result in health
influence the other inequities which could be avoided if all
individuals are provided with equal
 Social environment access to social and/or economic
- Includes interactions and relationships resources (Kneipp et al., 2018).
with family, friends, coworkers and
others in the community SOCIAL DETERMINANTS OF HEALTH
- Social institutions (law enforcements,
religious communities, schools, 5 DOMAINS
government agencies, housing, safety,
public transport, availability of
resources.

 Physical environment
- What is experienced by the senses
(seen, smelled, touched, heard and
tasted)
- Can affect health positively or
positively
- Presence of poisonous and infectious
agents, sanitation, etc.

 Policies and interventions

- Have a profound effect on the health of
individuals, groups and communities
- Policies on smoking, seatbelt, littering,
health care, etc.
 SOCIAL DETERMINANTS OF HEALTH a) Social cohesion within a community
b) Civic participation
 Economic Stability c) Discrimination
- Refers to the connection between the d) Workplace conditions
financial resources people have e) Incarceration
(income, cost of living, and
socioeconomic status) and their health.
Key issues include:
FOUNDATIONS OF CPHN
a) Poverty
b) Employment A. HIERARCHY OF NURSING SCIENCE
c) Food security - A strong knowledge base is essential to
d) Housing stability competently address the myriad needs
and concerns of the people of the
 Education Access and Quality community.
- Refers to the connection of education - Other fields are focused on individuals
to health and well-being. The key and their specific health issues in a
issues include: hospital setting
a) High school graduation - CPHN focuses on all population groups:
b) Enrollment in higher education
c) General educational attainment
d) Early childhood education and
development

 Health care access and quality

- Refers to the connection between
people’s access to and understanding
of health services and their own health.
The key issues include:
a) Access to healthcare children, adults, elderly, and their
b) Access to primary care families.
c) Health insurance coverage B. Key concepts of CPHN
d) Health literacy 1. Community as a client
- Community: group of people living in a
 Neighborhood and built environment particular area with common beliefs,
- Refers to the connection between values and traditions
where a person lives (housing, - Geographic boundaries and shared
neighborhood, and environment) and belief system or culture
their health and wellbeing. Key issues 2. Health as a goal
include: - Healthcare needs to be holistic, the
a) Quality of housing nurse foster multi-disciplinary efforts
b) Access to transportation to address determinants of health
c) Availability of healthy foods - Healthcare should be universal to
d) Quality of air and water achieve health as a human right
e) Neighborhood crime and violence 3. Nursing as the vehicle
- Nursing is the art and science of caring
 Social and community context - Grounded on the works of nurse
- Refers to the connection between theorist
characteristics of the contexts within - Florence Nightingale, Virginia
which people live, learn, work, and Henderson, etc
play, and their health and wellbeing. C. Definition of CPHN
Key issues include:
 - Specialized field of nursing practice -People in the community are not
that renders care to individuals, merely public consumers or end-users
families, and communities of healthcare service
- Health promotion and disease - They are considered as partners in
prevention through people health
empowerment: the core of CPHN - Active participation at all levels is
practice essential
- Help people reduce their risks from  CPHN uses repayment mechanism
developing disease and maintain their - Not free, funded by taxes of people
optimum functioning - Healthcare is a basic social service
- Health promotion and disease provided to all
prevention through people  CPHN focuses on preventive
empowerment: the core of CPHN - Services are not limited o attending to
practice health needs of the community
- Preventive measures: vaccination and - Reduce risks for vulnerable population
screening  CPHN offers comprehensive care
- Sharing information to help them - From womb to tomb; holistic care
manage their own healthcare needs - Cannot choose patients and cannot
- Empowerment predict cases
- Enabling people to do things on their - Requires the nurse to be skilled and
own: utilization of health education knowledgeable on the broad areas of
nursing

E. Philosophical and Ethical Underpinnings

D. Characteristics and features of CPHN  Worth and dignity of man
 CPHN is developmental  Responsibility for health rests primarily
- The people in the community are on people
primarily responsible for their health  Attainment of independence and self-
- Educate to do self care and maintain reliance in health
optimum level of functioning  Requires active participation of the
- Health education is a primary activity people
 CPHN is multidisciplinary  Adheres to the tenets of social justice –
- Nurse fosters collaboration with promoting good
different professionals and sectors  Observance of universal ethical
from society principles - beneficence,
- Working within and among nonmaleficence, veracity, fidelity,
government agencies or departments autonomy
in a private organization
 CPHN is ecology oriented F. Roles of CPHN
- Care is provided in the natural 1) Healthcare provider
environment of people - Providing care to clients
- Setting includes homes, schools, 2) Health educator
workplaces, even prisons and churches - Communicating information to help
 CPHN promotes social justice clients make informed choices
- All people should enjoy access to regarding health
healthcare 3) Program implementer
- Protect the interest of all by advocating - Execute programs initiated by the DOH
for equitable healthcare at all levels
 CPHN values consumer involvement 4) Community organizer
 - Working with people in the (3) promoting health and efficiency through
community, providing them ownership organized community effort for:
of their healthcare needs and to act a. sanitation of the environment,
collectively on their issues b. control of communicable infections,
5) Manager/Leader c. education of the individual in personal hygiene,
- Employs principles of management to d. organization of medical and nursing services for
maximize resources effectively and the early diagnosis and preventive treatment of
efficiently disease, and
6) Researcher/Epidemiologist e. development of the social machinery to ensure
- Health monitor of the community everyone a standard of living adequate for the
- Keep track with illnesses encountered maintenance of health, so organizing these
in their areas benefits as to enable every citizen to realize his
- Conducts investigation to identify birthright of health and longevity.
etiology
7) Client advocate Core Public Health Functions
- Ensures that the right to health of the
population is realized and protected - Community health nurses work as partners
- Engages stakeholders in clamoring and with other professionals (in public health and
lobbying for policies that impact health other disciplines), nonprofessionals, and
- Initiates formation of coalitions and consumers to improve the health of
linkages populations

G. Levels of Clientele - The various roles and settings for practice

- RA 9173: Philippine Nursing Law of hinge on three primary functions of public
2002 health: assessment, policy development, and
- To individuals, families and assurance (Institute of Medicine, 1988)
communities in any health care setting
- Conception, labor, delivery, infancy, - These functions are foundational to all roles
childhood, toddler, preschool, school assumed by the community health nurse and
age, adolescence, adulthood and old are applied at three levels of service: to
age individuals, to families, and to communities

Clients of a Community Health Nurse - Regardless of the role or setting of choice,

these three essential responsibilities direct
the work of all community health nurses.
 Individual

1. Assessment
 Family
- gather and analyze information that
will affect the health of the people to be
 Population groups - A group of people served
who share common characteristics,
- the systematic collection, assembly,
development stage or common exposure
analysis, and dissemination of information
to particular environmental factors
about the health of a community
leading to common health problems
- Data gathering: interviewing people
in the community, conducting surveys,
 Community
gathering information from public records
(many of which are available online), and
H. Public Health by Charles Edward Winslow
using research findings
-Public health is the Science and Art of (1)
preventing disease, (2) prolonging life, and 1. Assessment
- Done both formally and informally; Essential Public Health Services
interact with key community leaders, with
1. Monitor health status to identify and
families to evaluate family strengths and
solve community health problems.
areas of concern; the individual level,
people are identified within the family 2. Diagnose and investigate health problems
who are in need of services, evaluate the and health hazards in the community.
functional capacity of these individuals
3. Inform, educate, and empower people
through the use of specific assessment
about health issues.
measures and a variety of tools.
4. Mobilize community partnerships and
- the initial step in the nursing process
action to identify and solve health
problems.
2. Policy Development
5. Develop policies and plans that support
- Uses the scientific information gathered
individual and community health efforts.
during assessment to create
comprehensive public health policies 6. Enforce laws and regulations that protect
health and ensure safety.
- Enhanced by the synthesis and analysis of
information obtained during assessment 7. Link people to needed personal health
services and assure the provision of
- Provides leadership in convening and health care when otherwise unavailable.
facilitating community groups to evaluate
8. Ensure competent public and personal
health concerns and develop a plan to
health care workforces.
address those concerns.
9. Evaluate effectiveness, accessibility, and
- Recommends specific training and quality of personal and population-based
programs to meet identified health needs health services.
of target populations
10. Research for new insights and innovative
- Raising the awareness of key policy solutions to health problems.
makers about factors such as health
regulations and budget decisions that Public Health
negatively affect the health of the Interventions
community 1. Surveillance - describes and monitors
health events through ongoing and
3. Assurance systematic collection, analysis, and
interpretation of health data for the
- The pledge to constituents that services
purpose of planning, implementing, and
necessary to achieve agreed-upon goals
evaluating public health interventions
are provided by encouraging actions of
others (private or public), requiring action
through regulation, or providing service
directly

- Focuses on the availability of necessary

health services throughout the community

- Includes maintaining the ability of both

public health agencies and private
providers to manage day-to-day
operations and the capacity to respond to
critical situations
2. Disease and other health event problem solving with a community
investigation - systematically gathers and system and family or individual
analyzes data regarding threats to the
12. Collaboration - commits two or more
health of populations, ascertains the
source of the threat, identifies cases and
others at risk, and determines control
measures

3. Outreach - locates populations of interest

or populations at risk and provides
information about the nature of the
concern, what can be done about it, and
how services can be obtained

4. Screening - identifies individuals with

unrecognized health risk factors or
asymptomatic disease conditions

5. Case finding - locates individuals and

families with identified risk factors and
connects them with resources
persons or organizations to achieve a
6. Referral and follow-up - assists common goal through enhancing the
individuals, families, groups, capacity of one or more of the members
organizations, and/or communities to to promote and protect health
identify and access necessary resources
13. Coalition building - promotes and
to prevent or resolve problems or
develops alliances among organizations
concerns
or constituencies for a common purpose
7. Case management - optimizes self-care
14. Community organizing - helps
capabilities of individuals and families
community groups to identify common
and the capacity of systems and
problems or goals, mobilize resources,
communities to coordinate and provide
and develop and implement strategies for
services
realizing the goals they collectively have
8. Delegated functions - carries out direct set
care tasks under the authority of a health
15. Advocacy - pleads someone’s cause or
care practitioner as allowed by law
acts on someone’s behalf, with a focus on
9. Health teaching - communicates facts, developing the community, system, and
ideas, and skills that change knowledge, individual or family’s capacity to plead
attitudes, values, beliefs, behaviors, and their own cause or act on their own
practices of individuals, families, systems, behalf
and/or communities
16. Social marketing - utilizes commercial
10. Counseling - establishes an interpersonal marketing principles and technologies for
relationship with a community, a system, programs designed to influence the
and a family or individual, with the knowledge, attitudes, values, beliefs,
intention of increasing or enhancing their behaviors, and practices of the
capacity for self-care and coping population of interest

11. Consultation - seeks information and 17. Policy development and enforcement -
generates optional solutions to perceived places health issues on decision makers’
problems or issues through interactive agendas, acquires a plan of resolution,
and determines needed resources,
 resulting in laws, rules, regulations,
ordinances, and policies. Policy
enforcement compels others to comply
with laws, rules, regulations, ordinances,
and policies

I. Fields of CPHN

 Public Health Nursing

- A field of professional practice in nursing and

in public health in which technical nursing,

interpersonal, analytical, and organizational

skills are applied to problems of health as they

affect the community

 Occupational Health Nursing

- The promotion and maintenance of the
highest degree of physical, mental, and social well-
being of workers in all occupations
- Occupational Safety and Health (OSH) – DOLE
as the lead agency
 School Health Nursing
- Education and health are
interrelatedness
- To learn effectively, children need
good health (WHO, 1950)
 Emerging Fields of CPHN in the Philippines
- Hospice home care/home health care; faith
community nursing, correctional nursing,
entrepreneurship in nursing (EntrepreNurse)
EntrepreNurse – promote nurse entrepreneurship
by introducing home health care industry