COMMUNITY HEALTH

NURSING 2:
POPULATION GROUPS AND COMMUNITY
AS CLIENTS
HEALTH-(WHO)-state of complete physical, mental, and social well-being,
not merely the absence of disease or infirmity.

FACTORS/DETERMINANTS OF HEALTH
1. INCOME
2. EDUCATION
3. PHYSICAL ENVIRONEMENT
4. EMPLOYMENT AND WORKING CONDITIONS
5. SOCIAL SUPPORT NETWORKS
6. CULTURE
7. GENETICS
8. PERSONAL BEHAVIOR AND COPING SKILLS
9. HEALTH SERVICES
10.GENDER
 COMMUNITY HEALTH NURSING

COMMUNITY-group of people with common characteristics, interests living

together within a territory or geographical boundary. Place where people
under usual conditions are found.
-part of paramedical and medical intervention approach which is concerned
on the health of the whole population that aims:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health

TARGET POPULATION: IFC (INDIVIDUAL, FAMILY, COMMUNITY)

• NURSING-assisting sick individuals to become healthy and healthy

individuals to achieve optimum wellness.
PUBLIC HEALTH NURSING-aka Community Health nursing

Public health-science and art of 3 P’s (Dr. C. E Winslow)

• P-revention of disease
• P-rolonging life
• P-romotion of health and efficiency through organized community effort.

COMMUNITY HEALTH NURSING

“The utilization of the nursing process in the different levels of clientele-
individuals, families, population groups and communities, concerned with the
promotion of health, prevention of the disease, disability, and rehabilitation.”
-Maglaya, et al
✓Specialized field of nursing practice.
✓Science of Public Health combined with Public Health Nursing Skills and Social
assistance with the goal of raising the level of health of the citizenry to raise
optimum level of functioning of the citizenry (characteristic of CHN).

PRINCIPLES OF COMMUNITY HEALTH NURSING

1. The recognized need of individuals, families and communities provides the basis for CHN
practice. Its primary purpose is to further apply public health measures within the framework
of the total CHN effort.
2. Knowledge and understanding of the objectives and policies of the agency facilitates goal
achievement. The mission statement commits Community Health Nurses to positively
actualize their service to this end.
3. CHN considers the family as the unit of service. Its level of functioning is influenced by the
degree to which it can deal with its own problems. Therefore the family is an effective and
available channel for the most of the CHN efforts.
4. Respect for the values, customs and beliefs of the clients contribute to the
effectiveness of care to the client. CHN services must be available sustainable
and affordable to all regardless of race, creed, color or socio-economic status.
5. CHN integrated health education and counseling as vital parts of
functions. These encourage and support community efforts in the discussion
of issues to improve the people’s health.
6. Collaborative work relationships with the co-workers and members of the
health team facilities accomplishments of goals. Each member is helped to
see how his/her work benefits the whole enterprise.
7. Periodic and continuing evaluation provides the means for assessing the
degree to which CHN goals and objectives are being attained. Clients are
involved in the appraisal of their health program through consultations,
observations and accurate recording.
8. Continuing staff education program quality services to client and are
essential to upgrade and maintain sound nursing practices in their
setting. Professional interest and needs of Community Health Nurses are
considered in planning staff development programs of the agency.
9. Utilization of indigenous and existing community resources maximizing the success of the
efforts of the Community Health Nurses. The use of local available ailments. Linkages with
existing community resources, both public and private, increase the awareness of what care
they need what are entitled.
10. Active participation of the individual, family and community in planning and making
decisions for their health care needs, determine, to a large extent, the success of the CHN
programs. Organized community groups are encouraged to participate in the activities that
will meet community needs and interests.
11. Supervision of nursing services by qualified by CHN personnel provides guidance and
direction to the work to be done. Potentials of employees for effective and efficient work are
developed.
12. Accurate recording and reporting serve as the basis for evaluation of the progress of
planned programs and activities and as a guide for the future actions. Maintenance of
accurate records is a vital responsibility of community as these are utilized in studies and
researches and as legal documents.
 THEORETICAL MODELS/APPROACHES

HEALTH BELIEF MODEL (HBM)

• one of the first theories of health behavior.
• developed in the 1950s by a group of U.S. Public Health Service social psychologists who wanted to
explain why so few people were participating in programs to prevent and detect disease.
• good model for addressing problem behaviors that evoke health concerns (e.g., high-risk sexual
behavior and the possibility of contracting HIV) (Croyle RT, 2005)
• proposes that a person's health-related behavior depends on the person's perception of four critical
areas:
• the severity of a potential illness,
• the person's susceptibility to that illness,
• the benefits of taking a preventive action, and
• the barriers to taking that action.
• popular model applied in nursing, especially in issues focusing on patient compliance and preventive
health care practices.
• postulates that health-seeking behaviour is influenced by a person’s perception of a threat posed by
a health problem and the value associated with actions aimed at reducing the threat.
• addresses the relationship between a person’s beliefs and behaviors. It provides a way to
understanding and predicting how clients will behave in relation to their health and how they will
comply with health care therapies.
 MILIO’S FRAMEWORK FOR PREVENTION
• Nancy Milio developed a framework for prevention that includes concepts of
community – oriented, population- focused care.
She challenged the common notion that a main determinant for
unhealthful behavioural choice is lack of knowledge.
• Milio’s framework described a sometimes neglected role of community health
nursing to examine the determinants of a community’s health and attempt to
influence those determinants through public policy.
 • HEALTH PROMOTION MODEL
• proposed by Nola J Pender (1982; revised, 1996)
• defines health as a positive dynamic state not merely the absence of disease. Health
promotion is directed at increasing a client’s level of well being.
• describes the multi dimensional nature of persons as they interact within their
environment to pursue health.
The health promotion model notes that each person has unique personal
characteristics and experiences that affect subsequent actions. The set of variables for
behavioral specific knowledge and affect have important motivational significance.
These variables can be modified through nursing actions. Health promoting behavior
is the desired behavioral outcome and is the end point in the HPM. Health promoting
behaviors should result in improved health, enhanced functional ability and better
quality of life at all stages of development.
 PRECEDE–PROCEED MODEL
-proposed in 1974 by Lawrence W. Green
-In this framework, health behavior is regarded as being influenced by both individual
and environmental factors, and hence has two distinct parts.
-"educational diagnosis" – PRECEDE, an acronym for Predisposing, Reinforcing
and Enabling Constructs in Educational Diagnosis and Evaluation.
-"ecological diagnosis" – PROCEED, for Policy, Regulatory,
and Organizational Constructs in Educational and Environmental Development.

PRECEDE phases PROCEED phases

Phase 1 – Social Diagnosis Phase 5 – Implementation

Phase 2 – Epidemiological, Behavioral &

Phase 6 – Process Evaluation
Environmental Diagnosis

Phase 3 – Educational & Ecological Diagnosis Phase 7 – Impact Evaluation

Phase 4 – Administrative & Policy Diagnosis Phase 8 – Outcome Evaluation

• Predisposing factors - characteristics of a person or population that motivate
behavior prior to or during the occurrence of that behavior.
-individual's knowledge, beliefs, values, and attitudes.
• Enabling factors - characteristics of the environment that facilitate action and any
skill or resource required to attain specific behavior.
-programs, services, availability and accessibility of resources, or new skills required
to enable behavior change.
• Reinforcing factors are rewards or punishments following or anticipated as a
consequence of a behavior.
-strengthen the motivation for a behavior
-social support, peer support, etc.
Administrative and Policy Diagnosis
Administrative diagnosis assesses policies, resources, circumstances and prevailing
organizational situations that could hinder or facilitate the development of the health
program.
Policy diagnosis assesses the compatibility of program goals and objectives with
those of the organization and its administration. This evaluates whether program goals
fit into the mission statements, rules and regulations that are needed for the
implementation and sustainability of the program.

Process Evaluation- evaluate the process by which the program is being

implemented
Impact Evaluation- Often this phase is used to evaluate the performance of
educators.
Outcome Evaluation- changes in health and social benefits or quality of life.
- a participatory model for creating successful community health promotion and
other public health interventions.
- based on the premise that behavior change is by and large voluntary, and that
health programs are more likely to be effective if they are planned and evaluated
with the active participation of those who will implement them, and those who
are affected by them.
- it looks at health and other issues within the context of the community.
 DIFFERENT FIELDS OF NURSING

SCHOOL HEALTH NURSING

-focuses on the promotion of health and wellness pf the students, teaching and
non-teaching personnel of the school.
-assists young people in making choices for
-healthy lifestyle
-prevention of drug and substance abuse
-teenage pregnancy
-STD’s
-malnutrition
-communicable nad non-communicable diseases
 OCCUPATIONAL HEALTH NURSING
-assesses the health needs of the working population and design healthful working
interventions.

COMMUNITY MENTAL HEALTH NNURSING

- provides holistic nursing services for people with mental health issues, in a
community setting THROUGH
Treatment Planning
Medication Management
Assessment
Counseling
Family Support
Education
Group Support
Facilitate services with visiting Psychiatrists
 TYPES OF COMMUNITY
1. GEOGRAPHIC- city, town, neighborhood.
2. COMMON INTEREST- church, professional organization, people with
mastectomies
3. COMMUNITY OF SOLUTION- group of people who come together to solve a
problem that affects all of them.

FACTORS AFFECTING HEALTH OF THE COMMUNITY

1. Characteristics of the population
2. Location of the community
3. Social systems of the community
 Characteristics of a healthy community
• The physical environment is clean and safe.
• The environment meets everyone’s basic needs.
• The environment promotes social harmony and actively involves everyone.
• There is an understanding of the local health and environment issues.
• The community participates in identifying local solutions to local problems.
• Community members have access to varied experiences, interaction and
communication.
• The health services are accessible and appropriate.
• The historical and cultural heritage is promoted and celebrated.
• There is a diverse and innovative economy.
• There is a sustainable use of available resources for all.
 ROLE AND ACTIVITES OF COMMUNITY HEALTH NURSE
1. Planner/Programmer
2. Provider of Nursing Care
3. Community Organizer
4. Coordinator of Services
5. Coordinator of Services- environmental sanitation, health education, dental health,
and mental health
6. Trainer/Health Educator- RHMs, Barangay Health Workers (BHW), and hilots.
-resource speaker on health and health related services
-pre-marital counseling
7. Health Monitor- through contacts/visits with them
8. Role Model
9. Change Agent= Motivates changes ( lifestyle in order to promote and maintain
health)
10. Recorder/Reporter/Statistician- reports and records, Reviews, validates,
consolidates, analyzes, and interprets all records and reports
-Prepares statistical data/chart and other data presentation
11. Researcher- conduct of survey studies and researches on nursing and health-
related subjects
-Coordinates with government and non-government organization in the
implementation of studies/research