COMMUNITY HEALTH

NURSING NCM 104

By :
Professor Karen C.
Aranzado
 What is Community Health Nursing?
Community/public health nursing is the
synthesis of nursing practice and public health
practice applied for promoting and preserving
health of population.
Public health nursing may be defined as a field
of professional practice in nursing and public
health in which technical nursing, interpersonal,
analytical and organizational skills are applied to
problems of health as they affect the
community.
Major Goal of Community/Public Health

• Promoting and preserving the

health of the community and
the surrounding population
SERVICE rendered by a professional NURSE to:
Individual;
Families;
Communities;
Population as a group;
 PURPOSE

Promote health;
Prevent Illness;
Effective Rehabilitation;
WHAT IS NOW THEN THE
ULTIMATE GOAL OF CHN?
TO Attain THE HIGHEST LEVEL OF HOLISTIC
HEALTH

(rather than focusing on a specific illness,

consider person as integral being)
 How to achieved the ultimate goal?
Through a MULTIDISCIPLINARY APPROACH

Reciprocally supportive relationship between

PEOPLE and their PHYSICAL and SOCIAL
ENVIRONMENT
Strengthen, support, and mobilize communities and partnerships to improve health (Essential Public
Health Service)

Multidisciplinary approach is synthesis of nursing

and public health practice
Assure an effective system that enables equitable access to the individual services and care needed to be
healthy (Essential Public Health Service)
 Community Health Nursing

Health care system from disease -oriented to

health- oriented system
Devolution on local government units
Activities- health promotion and disease
prevention
High cost= budgetary allocation is important
Rising prevalence of lifestyle diseases
IMPORTANT CONCEPT AND
PRINCIPLE OF CHN
 FAMILY;
PARTNERSHIP;
CHANGE;
HEALTH CARE DELIVERY SYSTEM;
UTILIZE THE NURSING PROCESS
 FAMILY:

Basic Unit of service of CHN

Promotion of health and prevention of diseases
is always the priority
 PARTNERSHIP
Nurse should ACTIVELY WORK in PARTNERSHIP with:
Individual;
Family;
Population group;
Community;
PARTNERSHIP in ORGANIZING, PLANNING,
IMPLEMENTATION, MANAGEMENT and
EVALUATION of CARE..
 CHANGE

Health is affected by changes of the society

Change affect the health of the community
 HEALTH CARE DELIVERY SYSTEM
CHN services are shares with other member of
the health team and other sector in the
community

The delivery must ON A MULTIDISCIPLINARY

APPROACH: (efficient, effective, equitable,
affordable, accessible services)
 UTILIZE THE NURSING PROCESS

ADPIE
Thus, in measuring and analyzing community
health problem it utilize variety of instrument:
(public health statistics, vital statistics,
community map, interview, schedules, survey
form, questionnaires)
•Recipient of Care by CHN
services
 INDIVIDUAL;
FAMILY;
POPULATION GROUP;
COMMUNITY;
 INDIVIDUAL
Note of the various stages of life
CHnurse know the specific person in various
stages of health or illness
 FAMILY
Structure of the family may also have a
significant relation to the health of the
members.. (decision maker e.g)
Types of Family: (STUDY)
 Population group
Vulnerable groups
Risk to a certain health related risk:
Have a common characteristics;
Common developmental stage;
Resulting to common health problem
 COMMUNITY
People sharing common geographic boundaries
and or common values and interest..
Classification:
Rural;
Urban;
Community and Public Health nurses
• Align themselves with public health programs
that promote and preserve health of
populations
Ex.maternal health services=prenatal check up
• Allows nurses to be positioned to promote
health, welfare and safety of all individuals
• Ex.giving health education
 HEALTH
• A state of complete physical, mental and
social well-being and not merely the absence
of disease or infirmity. ( WHO )
• Social health connotes community vitality
Health ( WHO, 1986 )
• A resource for everyday life ; a positive
concept emphasizing social and personal
resources and physical capacities
• (SAYLOR, 2004 ) dimensions of health
• Physical > general perceptions of
• Social health status
• Role
• Mental
WELLNESS (DUNN)
• FAMILY , COMMUNITY, SOCIETY AND
ENVIRONMENT ARE INTERRELATED AND HAVE
AN IMPACT ON HEALTH.
COMMUNITY
• ( ALLENDER) – Collection of people who
interact with one other and whose common
interest and characteristics form the basis for
a sense of unity and belonging.
• 4 defining attributes:
1. People
2. place
3. Interaction
4. Common characteristics, interests or goals
2 MAIN TYPES OF COMMUNITIES:
1. GEOPOLITICAL ( TERRITORIAL)
> BOTH NATURAL AND MAN MADE
BOUNDARIES
1. PHENOMENOLOGICAL (FUNCTIONAL)
> RELATIONAL and INTERACTIVE GROUPS
DETERMINANTS OF HEALTH AND
DISEASE
FACTORS ASSOCIATED WITH THE HEALTH
STATUS OF THE COMMUNITY
1.Health care access- is health services
accessible in the community?
2. Economic conditions=income, employment
3. Social and environmental issues=air,Water
quality
4. Cultural practices=example: maternal cravings
during pregnancy
 DETERMINANTS:
1. Income and social status- higher income and
social status> better health
2. Education- low education levels lead to poor
health, more stress and lower self-confidence
3. Physical environment- safe water, clean air,
healthy workplaces, safe houses,safe
communities,roads contribute to good
health.
4. Employment and working conditions= people
are healthier for those who have control over
their working conditions; not stressful
5. Social support networks= greater support
from families,friends and communities is linked
to better health
6.Culture=customs and traditions,beliefs of the
family and community affects health
7.Genetics- determines lifespan,
healthiness and likelihood of developing
illness.
8. Personal behavior and coping skills-
balanced eating, keeping active, smoking,
drinking drinking and how we deal with
life’s stresses
9. Health Services- access and use of health
services that prevent and treat disease
10. Gender= men and women suffer from
different types of diseases at different ages
INDIVIDUAL’S BIOLOGY AND BEHAVIORS
INFLUENCE HEALTH.
COMMUNITY HEALTH NURSES MUST WORK
WITH POLICY MAKERS AND COMMUNITY
LEADERS > Identifies patterns of disease and
death; advocate for activities and policies of
health promotion
COMMON HEALTH INDICATORS:

1. Life expectancy
2. Infant mortality
3. Maternal mortality
4. Age-adjusted death rates
5. Disease incidence rates
Indicators of mortality illustrates the health of the
community
( please read about this health indicators stated
above)
DEFINITION and FOCUS of PUBLIC HEALTH and
COMMUNITY HEALTH NURSING
PUBLIC HEALTH (C. E. Wislow )
> science and art of 3 P’s
= preventing disease
= prolonging life
= promoting health and efficiency
through organized community effort
for;
1. sanitation of the environment
2. control of communicable infections
3. education of an individual for personal
hygiene
4. organization of medical and nursing
services for the early diagnosis and
preventive treatment of disease
5. development of the social machinery 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.
PUBLIC HEALTH connotes:
Organized, legislated, tax-supported efforts
that serve people through government agencies.
PURPOSE :improve the health of the public by
promoting healthy lifestyles, preventing disease
and injury, and protecting the health of the
communities.
THREE PRIMARY FUNCTIONS of PUBLIC
HEALTH
1. Assessment
2. Policy Development
3. Assurance
 ASSESSMENT

Regular collection, analysis, and

information sharing about health
conditions, risks, and resources in
the community.
 POLICY DEVELOPMENT

Use of information gathered

during assessment to develop local
and state health policies and to
direct resources toward those
policies.
 ASSURANCE
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 having the capacity
to respond to critical situations and
emergencies.
PUBLIC HEALTH of NATIONAL and LOCAL LEVELS

NATIONAL : provides support and advisory

services
LOCAL: Its structure provide direct services
through 2 avenues :
1. Environmental Health services = protects
public from hazards
2. Personal services= immunization, FP services
ESSENTIAL PUBLIC HEALTH
FUNCTIONS:
1. Health situation monitoring and analysis
2. Epidemiological surveillance / disease
prevention and control
3. Development of policies and planning in
public health
4. Strategic management of health systems and
services for population health gain.
 5. Regulation and enforcement to protect public
health
6. Human resource development and planning
in public health
7. Health promotion, social participation and
empowerment.
8. Ensuring the quality of personal and
population-based health service
9. Research , development, and
implementation of innovative health
solutions.
 PREVENTIVE APPROACH TO HEALTH

Health Promotion activities enhance

resources directed at improving well-being
Disease Prevention activities protect
people from disease and the effects of
disease. Prevention includes a wide range
of activities — known as “interventions” —
aimed at reducing risks or threats to
health.
 LEVELS OF PREVENTION
1. PRIMARY PREVENTION
> activities directed at preventing a problem
before it occurs by altering susceptibility or reducing
exposure for susceptible individuals.
> This is done by preventing exposures to hazards
that cause disease or injury, altering unhealthy or
unsafe behaviours that can lead to disease or injury,
and increasing resistance to disease or injury should
exposure occur.
 EXAMPLES:
legislation and enforcement to ban or control
the use of hazardous products (e.g. asbestos)
or to mandate safe and healthy practices (e.g.
use of seatbelts and bike helmets)
education about healthy and safe habits (e.g.
eating well, exercising regularly, not smoking)
Immunization
environmental sanitation and removal of
hazards
2. SECONDARY PREVENTION
Early detection and prompt intervention
during the period of early pathogenesis.
Halt or slow the progress of the disease to
prevent reinjury or recurrence
 EXAMPLES
Regular examinations and screening tests to
detect disease in its earliest stages
Diet and exercise programs
Suitably modified work so that injured or ill
workers can return safely to their jobs
organized screening programs for
communities
3. TERTIARY PREVENTION
Targets populations that have experienced
disease or injury and focuses on the limitation
of disability and rehabilitation.
done by helping people manage long-term,
often-complex health problems and injuries
 EXAMPLES
Teaching insulin administration at home
provide nutrition education to mothers of
children with severe malnutrition