COMMUNITY HEALTH NURSING CONCEPTS

Community Health Nursing -

Public Health Nursing -
Community - Collection of The synthesis of nursing
Promoting and protecting the
people who interact with one practice and public health
DEFINITION health of populations using sciences.
another and share common practice applied to promoting
knowledge from nursing,
interests and characteristics. and preserving the health of
social, and public health
populations.
 CHN GOAL

Preserve the health of the community and surrounding populations by

focusing on health promotion and health maintenance of individuals,
families, and groups within the community.
 TWO TYPES OF COMMUNITY

A. Geopolitical Community
 Barangays, cities,
 regions, nations
B. Phenomenological Community
 Interactive groups/shared groups based on culture, values, perspective,
interests, history and goals.
PHILOSOPHY AND PRINCIPLES

 PHILOSOPHY OF:
- Individual’s right of being healthy.
 Working together under a competent leader for the common good.
 The people in the community have the potential for continual development
and are capable of dealing with their own problems if educated and helped.
 Socialism

- Involves epidemiology and information about the community

 Data collection for assessment and management decisions within a community
is ongoing, not episodic
 PRINCIPLES:
1. CHN is based on the recognized needs of communities, families, groups, and
individuals.
2. The CH nurse must fully understand the objectives and policies of the agencies
she represents.
3. In CHN, the family is the unit of service.
4. CHN must be available to all.
5. Health teaching is the PRIMARY responsibility of the CH nurses.
6. The CH nurse works as a member of the health team.
7. There must be provision for periodic evaluation of CHN services
8. Opportunities for continuing staff education programs for nurses must be
provided by the Agency.
9. The CH nurse makes use of available community health resources
10. The CH nurse utilizes the already existing active organization in the
community
11. There should be accurate recording and reporting in CHN
FEATURES OF CHN

 POPULATION-BASED
Involves specific approach: community assessment, community diagnosis,
planning, intervention, and evaluation
 Involves epidemiology and information about the community
 Data collection for assessment and management decisions within a community
is ongoing, not episodic
 DELIVERS CARE FOR DIFFERENT LEVELS OF CLIENTELE
 individual
 family
 group/aggregate
 community as a whole
 COLLABORATES WITH A VARIETY OF OTHER PREOFESSIONS,ORGANIZATIONS,
ENTITIES, AND THE COMMUNITY ITSELF
 identify
 implement
 evaluate
 meet the health needs
 PRIORITIZES ON HEALTH PROMOTION
 AND DISEASE PREVENTION
 ACTIVELY REACHES OUT ALL WHO
 MIGHT BENEFIT OF THE SERVICE
 OPTIMAL USAGE OF RESOURCES AND
 SELECTED STRATEGIES ARE MADE TO
 ENSURE BEST SERVICES FOR THE
 POPULATION
THEORETICAL MODELS/APPROACHES

 A. HEALTH BELIEF MODEL

 It was initially proposed in 1958 by group of social psychologists --
 Irwin M. Rosenstock, Godfrey M. Hochbaum, Stephen Kegeles, and
 Howard Leventhal at the U.S. Public Health.
 This was developed by the group of psychologists to explain why the public
failed to participate in the screening for tuberculosis.(Hochbaum,1958)
 It provides the basis for the practice of HEALTH EDUCATION and HEALTH
PROMOTION
 It is the one of the most widely used conceptual framework in health behavior
to be able to explain behavior change and maintenance of behavior change
and to guide health promotion interventions.
 It includes different key concepts -perceived susceptibility, perceived
severity, perceived benefits, perceived barriers, cues to action, self-efficacy
 KEY CONCEPTS
 Perceived susceptibility - One's belief regarding the chance of getting a
disease
 Perceived severity - One's belief regarding the seriousness of given condition
 Perceived benefits - One's belief in the ability of an advised action to reduce
the health risk orof a given condition
 Perceived barriers - One's belief regarding the tangible and psychological
costs of an advised action
 Cues to action - Strategies or conditions in one's environment that activate
readiness to act
 Self-efficacy - One's confidence in one's ability to act to reduce health risks.
 Kurt Lewin's work lent itself to the model's core dimensions. He proposed that
behavior is based on current dynamics confronting an individual rather than
prior experiences
 The Health Belief Model assumes that the major dominant of preventive
health behavior is disease avoidance.
 Disease avoidance includes:
 perceived susceptibility to disease
 "X"
 perceived seriousness of disease
 "X"
 modifying factors
 cues to action
 perceived benefits minus
 perceived barriers to preventive
 health action
 perceived threat of disease "X"
 likelihood of taking a recommended health action
HOW IS HBM USED LIMITATION OF HBM
BY NURSE?

It assists clients in making necessary It places the Burden or pressure

behavior to action
modifications by making them conscious of exclusively on the client
the
need for such modifications It focuses on giving interventions
designed to modify the client's
It is used by the nurse to determine perceptions
client’s misperceptions
that serve as barriers to appropriate It DOES NOT acknowledge the
health action health's
professional’s responsibility to
alter or
reduce health care barriers
MILIO’S FRAMEWORK FOR PREVENTION

 This was proposed by Nancy Milio, a Public Health Nurse, and leader in public
health policy and education.
 A framework for prevention that includes concepts of community-
oriented, population-focused care.
 Inclusion of economic, political and environmental health determinants.
 This provides a mechanism for directing attention upstream and examining
opportunities for nursing intervention at the population level.
 Made of six propositions that relate an individual's ability to improve healthful
behavior to a society's ability to provide accessible and socially affirming
options for healthy choices.
 She challenged the common notion that a main determinant for unhealthful
behavioral choice is lack of knowledge.
 According to Milio, the range of available health choices is critical in shaping
a society's overall health status & that policy decisions in governmental and
private organizations shape the range of choices available to individuals.
MILIO’S FRAMEWORK FOR PREVENTION

 Most human beings, professional or non-professional, provider or consumer,

make the easiest choices available to them most of the time.
 Health-promoting choices must be done readily available and less costly than
health-damaging options for individuals to gain health and for society to
improve health status.
 Milio believed that national level policy-making was the best to favorably
impact the health of most people rather than concentrating efforts on
imparting information in an effort to change individual patterns of behavior.
 Individual's health and lifestyle choices are influenced by resources,
availability, cost, and convenience more than knowledge obtained in
education.
MILIO’S SIX PROPOSITIONS

 Population health deficits results from deprivation and/or excess of critical

health sustaining resources
 Behaviors of populations result from selection from limited choices that arise
from actual and perceived options available as well as beliefs and
Expectations developed from socialization, education and experience.
 Organizational decisions and policies (both governmental and non
governmental) sets the range of options available to individuals and
populations and influence choices
 Individual choices related to health promotion or health damaging behaviors
are influenced by efforts to maximized valued resources.
 Alteration in patterns of behavior resulting from decision making or a
significant number of people in a population can result in social change.
 Without concurrent availability of alternative health promoting options for
investments of personal resources, health education will be largely
ineffective in changing behavior patterns.
PENDER’S HEALTH PROMOTION MODEL

 NOLA J. PENDER
 Living legend of the American Academy of Nursing
 A nursing theorist who developed the Health Promotion Model.
 An author and a professor emeritus of nursing at the University of Michigan.
 Started studying health-promoting behavior in the mid-1970s and first
published the
 Health Promotion Model in 1982.
THE HEALTH PROMOTION MODEL

 Originally published in 1982 and later improved in 1996 and 2002.

 It explores many biopsychosocial factors that influence individuals to pursue
health promotion activities.
 Does not include threat as a motivator, as threat may not be a motivating
factor for clients in all age groups.
 Was designed to be a “complementary counterpart to models of health
protection.”
 Defines health as “a positive dynamic state not merely the absence of
disease”. It describes the multi-dimensional nature of persons as they
interact within the environment to pursue health.
 Health Promotion - It is an approach to wellness
 Health Protection - Focuses on illness prevention
 The health promotion model focuses in the following areas:
INDIVIDUAL CHARACTERISTIC
AND EXPERIENCES

PRIOR RELATED PERSONAL FACTORS

BEHAVIOR Biological Factors:
Prior behaviors Age, body mass
influence index, strength,
subsequent and agility.
behavior through Psychological
perceived self- Factors: Self-
efficacy, esteem, self-
benefits, barriers, motivation,
and affects and perceived
related to health status.
that activity. Sociocultural
Strong indicator: Factors: Race,
Habit ethnicity,
acculturation,
education, and
Socio economic status.
BEHAVIOR-SPECIFIC COGNITIONS AND
AFFECT

 Perceived benefits of action - Strong motivators of the behavior. These

motivate behavior through intrinsic and extrinsic benefits
 Perceived barriers to action - Perceived unavailability, inconvenience,
expense, difficulty, or time regarding health behaviors.
 Perceived self-efficacy - One’s belief that he or she is capable of carrying out
a health behavior
BEHAVIORAL OUTCOME

 Health-promoting behavior - This is the goal of the Health Promotion

 Model. To attain positive health outcomes.
 Immediate competing demands And preferences Alternate behaviors that one
considers as possible optional behaviors immediately prior to engaging in the
intended, planned behavior.
 Commitment to a plan of action Initiates a behavioral event. This
commitment will compel one into the behavior until completed, unless a
competing demand or preference intervenes
PERCEDE – PROCEED MODEL

 Provides a model for community assessment, health education planning and

evaluation
Behind PRECEDE-PROCEED lie some assumptions about the prevention of
illness and promotion of health, and by extension, about community as well.
These include:
 PRECEDE-PROCEED model should be a participatory process.
 Health is, by its very nature, a community issue.
 Health is an integral part of a larger context, probably most clearly defined as
the quality of life, and it's within that context that must be considered.
 Health is more than physical well-being, or the absence of disease, illness, or
injury.
 PREDISPOSING
 REINFORCING
 ENABLING
 CONSTRUCTS IN
 EDUCATIONAL
 DIAGNOSIS AND
 EVALUATION
 SOCIAL ASSESSMENT Determine the social problems and needs of a given
population and identify desired results.
 EPIDEMIOLOGICAL ASSESSMENT Identify the health determinants of the
identified problems and set priorities and goals.
 ECOLOGICAL ASSESSMENT Analyze behavioral and environmental determinants that
predispose, reinforce, and enable the behaviors and lifestyles to be identified.

IMPLEMENTATION

 POLICY
 REGULATORY AND
 ORGANIZATIONAL
 CONSTRUCTS IN
 EDUCATIONAL AND
 ENVIRONMENTAL
 DEVELOPMENT
 IMPLEMENTATION Design intervention, assess availability of resources, and
implement program.

 PROCESS EVALUATION Determine if program is reaching the targeted

population and achieving desired goals.
 IMPACT EVALUATION
 Evaluate the change in behavior
 OUTCOME EVALUATION
 Identify if there is a decrease in the incidence or prevalence of the identified
negative behavior or an increase in identified positive behavior
 ROLES AND ACTIVITIES OF COMMUNITY HEALTH NURSE

1. EDUCATOR Assess the people and provides health education

2. CLINICIAN Ensures health care services Holism, health promotion, and skill
expansion
3. ADVOCATE preserving human dignity, promoting patient equality, and providing
freedom from suffering.
4. MANEGERIAL
 Administrative direction towards the accomplishment of specified goals
5. COLLABORATOR
 Coordinates with patients and groups for health-related services. Coordinates
nursing program with other health programs.
6. LEADER - Acting as the strategic lead for patient care initiatives (Change
agent) Influencing others through effective communication and interpersonal
skills

7. RESEARCHER - Systematic investigation, collection, and analysis of data to

solve problems and enhance community health nursing practice