Community Health Nursing 1 (Individual - The community is the patient in CHN, the

and Family) family is the unit of care and there are four
Community Health Nursing: An Overview levels of clientele:
 What is a community?  individual,
- a group of people with common  family,
characteristics or interests living together  population group (those who share
within a territory or geographical boundary common characteristics, developmental
- place where people under usual stages and common exposure to health
conditions are found problems – e.g., children, elderly), and
 What is Health? the community.
- Health-illness continuum - In CHN, the client is considered as an
- High-level wellness ACTIVE partner NOT PASSIVE recipient
- Agent-host-environment of care
- Health belief - CHN practice is affected by developments
- Evolutionary-based in health technology, in particular,
- Health promotion changes in society, in general
- WHO definition - The goal of CHN is achieved through
 Health multi-sectoral efforts
- A state of complete physical, mental, and - CHN is a part of health care system and
social well-being and not merely the the larger human services system.
absence of disease or infirmity.  Goals of CHN
 What is community health? - To increase the families, groups and
- part of paramedical and medical communities to cope to cope with health
intervention/ approach which is concerned and illness problems.
on the health of the whole population - To Support and supplement the effort of
- Aims: other professional restoration and
 health promotion preservation of health
 disease prevention - To control or counteract as much as
 management of factors affecting health possible physical and social
 What is nursing? environmental conditions that threaten
- assisting sick individuals to become health and enjoyment of life
healthy and healthy individuals achieve - To contribute to the reinforcement and
optimum wellness empowerment of nursing practice and
 Public Health Nursing public health practice and services
- the term used before for Community  Objectives of CHN
Health Nursing 1. To increase the capability of
- According to Dr. C.E. Winslow, Public community to deal with their own
Health is a science & art of 3 P’s health problems.
 Prevention of Disease - Provision of adequate information to
 Prolonging life their health promotion, health issues
 Promotion of health and efficiency - Can increase the community’s
through organized community effort capability to deal with the health
 Community Health Nursing problems in an effective manner
- The utilization of the nursing process in - People can be taught “how to care for
the different levels of clientele-individuals, themselves” though education,
families, population groups and guidance and supervision
communities, concerned with the - E.g., Helping young mothers to give
promotion of health, prevention of disease care to the children in meeting other
and disability and rehabilitation.” Maglaya, physiological
et al - Safety, love and security needs so as
 Basic Concept of CHN to have normal growth and
development of children
 - Continuous need-based health - Before understanding the concept of
education not only improves health community health nursing, it is
knowledge and skills but also helps in necessary to understand the community
developing positive attitude which health
brings change in health behavior. - The term community is composed of
2. To strengthen community resources three major concepts:
- Community resources include  Community: Client
manpower, money, material their  Health: Goal
development, distribution their  Nursing: The means
utilization - The Two Major Fields;
- Resources need to be strengthened,  The Hospital Nursing
distributed, and utilized properly.  The Community Nursing
- For this purpose, an intersectoral  Characteristics of Community
approach is regarded, wherein, there is - Group of people
need for a strong political, legal and - Common place
administrative support. - Interacting among members
3. To control and counteract environment - Common culture
- It includes environment protection - Common language
measures and changing reaction to - Same feeling
environment - Common Attitude
- When some protection measures are - More or less same type of lifestyle
not feasible - Common values and interest
- Protection measures are as follows:  Other Characteristics of Community
 Safe drinking water A. Distinctiveness
 Clean air and soil - Each community has defined a
 Safe disposal of refuse and excreta geographical boundary having its
 Good social reactions beginning and end. These boundaries
- Changing reactions are more remarkable in smaller
 Mass Immunization communities than in larger communities.
 Mass Screening B. Homogeneity
 Mass prophylactic treatments - There is similarity in psychological
4. To prevent and control communicable characteristics of people living in the
and non-communicable diseases defined boundaries of the community.
- This includes application all the three C. Closeness
levels of preventive measures i.e., - The people in the community have face
 Primary level to face interaction and free
 Secondary level communication.
 Tertiary level D. Sense of Belongingness
5. To provide specialized services - The degree and intensity of this feeling
- It provides specialized services for may vary among members in the
mothers, children, workers, elderly, community.
handicapped and eligible couples, etc. E. Sense of Togetherness
6. To conduct research - There is unity and cohesive among the
- To conduct research to build up members in the community which is
knowledge and contribute to further based on their interactions and sense of
refinement and improvement of belongingness to community.
community health practice F. Self Sufficiency
7. To prepare Health protocol - The community provides all such means
- To prepare health personnel in the and facilities which help in meeting the
community for community health care basic needs of its people i.e., space to
services live, education, protection and security
 Concept of CHN etc.
 Roles of the Public Health Nurses 7. Planner - The community health nurse
1. Clinician - who is a health care provider, while giving comprehensive care to family
taking care of the sick people at home or and community makes a plan on the basis
in the RHU of identified health problems and health
2. Health Educator - who aims towards and nursing needs.
health promotion and illness prevention 8. Care Manager - The community health
through dissemination of correct nurse implements the care which is
information; educating people planned for the family and community.
3. Facilitator - who establishes multi- - She directly provides the care with the
sectoral linkages by referral system active participation of family and
4. Supervisor - who monitors and community members.
supervises the performance of midwives 9. Medical Assistant Role - Community
 Target Population (IFC) are health nurse assists the physician and
- Individual coordinates with the other team members
- Family in the community health care team in
- Community rendering community health services.
 Roles and Function of CHN  Major Areas of Function
1. Care Provider - Provides a continuous - Role
and comprehensive care to the individual,  Educator
family and community. The emphasis is  Advocate
on promotive and preventive care.  Manager
2. Health Educator - Health education  Collaborator
focuses on preventing illness and aspect  Leader
related to care during illness and  Researcher
rehabilitation form disability.  Care Provider
3. Counsellor - The community health nurse  Qualities of Community Health Nurse
helps individual, families and the - Interest in community health nursing
community at large to recognize and - Good interpersonal skills
understand their problems to be solved, - Interested in people
find solutions with-in resources and - Emotional Stability
implement feasible and acceptable - Good communicability
solutions. - Guiding and helping nature
4. Resource Person - The community - Sensitive observation
health nurse explores community - Good listener
resources in terms of money, manpower, - A friendly disposition
material, agencies etc. - Initiative
- She makes use of these resources in - Resourcefulness
helping individual, family groups and - Endurance and patience
community to meet their health and  3 Elements considered in CHN:
nursing needs. - Science of Public Health (core
5. Sensitive Observer - The community foundation in
health nurse makes observations of any CHN),
untoward change in health behavior and - Public Health Nursing Skills and
health status of the community, people, - Social Assistance Functions
their surroundings, unusual occurrence of  Definition of Health
disease and take action accordingly. - Health is a state of complete physical,
6. Advisor - The community health gives mental and social well-being and not
some suggestions on practical situation merely the absence of disease or
which requires immediate actions and infirmity.
where there is little scope of health - Health is a condition of being sound by
education. body, mind or spirit especially free from
physical disease or pain.
 Concept of Health  The Main Determinants of Health
- Health is holistic state of wellbeing, Include:
including the soundness of mind body - Income and social status.
and spirit - Genetic make up
- Wellness health plus the capacity to - Employment and working conditions.
develop one’s potential, leading to a - Education and literacy.
fulfilling productive life. - Childhood experiences.
- Illness is state of being relatively of - Physical environments.
unhealthy - Social supports and coping skills.
 Changing Concept of Health - Healthy behaviors.
1. Biomedical Concept - Stress on Germ - Access to health services.
Theory that disease or illness is caused  Primary Health Care
due to disease causing organism. - Primary Health Care, or PHC refers to
2. Ecological Concept - The ecologist "essential health care" that is based on
viewed health as a harmonious practical, scientifically sound and
equilibrium between man and his socially acceptable method and
environment and disease as a technology made and universally
maladjustment of human organism to accessible to individuals and families in
the environment. the community through their full
3. Psychosocial Concept - It is also participation and at a cost they and the
influenced by various factors like social, country can afford to maintain in the
psychological, cultural, economical and spirit of self-reliance and self-
political. determination.
4. Holistic Concept - Health is a  Two Levels of Primary Health Care
multidimensional process involving the Workers
wellbeing of the whole person in the 1. Barangay Health Workers – trained
context of his environment. community health workers or health
 Signs of Good Health auxiliary volunteers or traditional birth
1. Physical attendants or healers.
- Energetic 2. Intermediate level health workers
- Has a good posture - include the Public Health Nurse, Rural
- Weighs normal for his age and height Sanitary Inspector and midwives.
- Has a body organ functioning normally  Primary Health Care
- Has clear and clean skin - It is broad concept and comprehensive
- Has bright eyes concept approach to health
- Has good texture and shiny hair development.
- Has a good appetite - It forms integral part of both the
- Gets sound sleep country’s health system
2. Mental - It is the first contact of individuals
- Control on emotions - Primary care refers only to the first level
- Sensitive to the needs of others of contact or close-to-client health care
- Confidence in one’s own ability  Elements of Primary Health Care
- Freedom from unnecessary tensions, 1. Education for Health - Is one of the
anxieties and worries potent methodologies for information
- Relaxed and free from any worries dissemination. It promotes the
3. Social partnership of both the family members
- Gets along well with others and health workers in the promotion of
- Has a pleasant manner health as well as prevention of illness.
- Help others 2. Locally Endemic Disease Control -
- Fulfills responsibility towards others The control of endemic disease focuses
- If she or he can move in the society on the prevention of its occurrence to
confidently with others
 reduce morbidity rate. Example Malaria on the prevention, control and treatment
Control and Schistosomiasis Control of these illnesses.
3. Expanded Program on Immunization - 8.  Supply of Essential Drugs - This
This program exists to control the focuses on the information campaign on
occurrence of preventable illnesses the utilization and acquisition of drugs.
especially of children below 6 years old. - In response to this campaign, the
Immunizations on poliomyelitis, GENERIC ACT of the Philippines is
measles, tetanus, diphtheria and other enacted. It includes the following drugs:
preventable disease are given for free Cotrimoxazole, Paracetamol,
by the government and ongoing Amoxycillin, Oresol, Nifedipine,
program of the DOH Rifampicin, INH (isoniazid) and
4. Maternal and Child Health and Family Pyrazinamide,Ethambutol,
Planning - The mother and child are the Streptomycin,Albendazole,Quinine
most delicate members of the  Goal of Primary Health Care
community. So, the protection of the - HEALTH FOR ALL FILIPINOS by the
mother and child to illness and other year 2000 AND HEALTH IN THE
risks would ensure good health for the HANDS OF THE PEOPLE by the year
community. The goal of Family Planning 2020.
includes spacing of children and - An improved state of health and quality
responsible parenthood. of life for all people attained
5. Environmental Sanitation and through SELF RELIANCE.
Promotion of Safe Water Supply -  Key Strategy to Achieve the Goal:
Environmental Sanitation is defined as  Partnership with and Empowerment
the study of all factors in the man’s of the people – permeate as the core
environment, which exercise or may strategy in the effective provision of
exercise deleterious effect on his well- essential health services that are
being and survival. Water is a basic community based, accessible,
need for life and one factor in man’s acceptable, and sustainable, at a cost,
environment. Water is necessary for the which the community and the
maintenance of healthy lifestyle. Safe government can afford.
Water and Sanitation is necessary for  3 Major Aspects of PHC
basic promotion of health. - The World Health Organization, or
6. Nutrition and Promotion of Adequate WHO, elaborates on the goals of PHC
Food Supply - One basic need of the as defined by three major categories,
family is food. And if food is properly 1. "Empowering people and communities,
prepared then one may be assured 2. multisectoral policy and action; and
healthy family. There are many food 3. primary care and essential
resources found in the communities but public health functions as the core of
because of faulty preparation and lack of integrated health services."
knowledge regarding proper food  4 Pillars of Primary Health Care
planning, Malnutrition is one of the 1. Community Participation
problems that we have in the country. 2. Inter-Sectoral Coordination
7. Treatment of Communicable 3. Appropriate Technology
Diseases and Common Illness - The 4. Support Mechanism Made Available
diseases spread through direct contact  Community participation is a social and
pose a great risk to those who can be proven approach to addressing health care
infected. Tuberculosis is one of the needs of the community people.
communicable diseases continuously - It means the involvements of the
occupies the top ten causes of death. community people concerned in
Most communicable diseases are also analysis, decision-making, planning, and
preventable. The Government focuses program implementation, as well as in
all the activities and share their needs
 living in a specific geographic area and  Characteristics of PHC Include:
establish mechanisms to meet these - Patient/family centeredness, self-reliance
needs. and participation
- Resources include – - Community engagement and participation
 Manpower, - Health workers collaborating in inter-
 Money and disciplinary teams
 Material - Proactive Prevention Focus
 Inter-sectoral coordination - Integration and coordination of services
- refers to the collective actions involving - Accessibility
more than one specialized agency, - Better Management of Chronic Conditions
performing different roles for a common - Localized set of choices
purpose. Health cannot be improved by - Sustainability
intervention within just the formal health - Multi-sector alignment and involvement
sector; other sectors are equally  Health Promotion
important in promoting the health and - Health promotion is the process of
self-reliance of communities. Its involve enabling people to increase control over,
agriculture, animal husbandry, food, and to improve their health.”
industry, education, housing, public  Why is Health Promotion Important?
works, communication and other - Improves the health status of individuals,
sectors. families, communities, states, and the
- This cooperation requires: nation.
 Strong political will, - Enhances the quality of life for all people.
 Adapting the administrative system to - Reduces premature deaths.
enable such coordination, - By focusing on prevention, reduces the
 Making suitable legislation to ensure costs (both financial and human) that
this, individuals, employers, families, insurance
 Development planning should be companies, medical facilities,
together, involving all the sectors to communities, the state and the nation
avoid duplication of activities. would spend on medical treatment.
 Appropriate Technology:  Core Values of Health Promotion
- Appropriate healthcare technologies are - A broad and positive health concept;
an important strategy for improving the - Participation and involvement;
availability and accessibility of - Action and action competence;
healthcare services. - A settings perspective and
- This means methods, procedures, - Equity in health.
techniques and equipment that are:  Roles of Practitioners
 Scientifically valid, - Health professionals play a central and
 Adapted to local needs, critical role in improving access and
 Acceptable to users and recipients, quality health care for the population.
 Maintainable with local resources. - They provide
 Support Mechanism Made Available:  essential services that promote health,
 The main target of primary healthcare is  prevent diseases and
available and accessible at least to deliver health care services to
essential health care and to first level individuals, families and communities
referral facilities all over the universe. based on the primary health care
Support Mechanism is vital to health and approach.
quality of life. Support mechanism in  Pre-Requisite of Health Promotion
primary health care is a natural or - Educate
established process by which something - Enable
brought about to enhances quality of life - Mediate
and provides a buffer against adverse
life events.