INTRODUCTION TO

COMMUNITY
HEALTH NURSING
`
Definition of
Community
• Community is seen as a group or
collection of locality-based
individuals, interacting in social units
and sharing common interests,
characteristics, values, and/ or
goals.
Definition of
Community
• a. Allender- “a collection of people who interact with
one another and whose common interests or
characteristics form the basis for a sense of unity or
belonging.”
• b. Lundy and Janes- “a group of people who share
something in common and interact with one another,
who may exhibit a commitment with one another and
may share geographic boundary.”
• c. Clark- “a group of people who share common
interests, who interact with each other, and who
function collectively within a defined social structure to
address common concerns.”
• d. Shuster and Goeppinger- “a locality-based entity,
composed of systems of formal organizations reflecting
society’s institutions, informal groups and aggregates.
TWO MAIN TYPES OF
COMMUNITY
(Maurer and Smith (2009)

A. Geopolotical communities- also

called as territorial communities.
• are most traditionally recognized.
• defined or formed by both natural and
man-made boundaries and include
barangays, municipalities, cities,
provinces, regions and nations.
TWO MAIN TYPES OF
COMMUNITY
(Maurer and Smith (2009)
b. Phenomenological communities-
also called as functional communities.
• refer to relational, interactive groups, in
which the place or setting is more
abstract, and people share a group
perspective or identity based on culture,
values, history, interest and goals.
Definition of Health
• a. WHO- “a state of complete physical,
mental and social well-being and not merely
the absence of disease or infirmity.”

• b. Murray- “a state of well-being in which the

person is able to use purposeful, adaptive
responses and processes physically, mentally,
emotionally, spiritually, and socially.”

• c. Pender- “actualization of inherent and

acquired human potential through goal-
directed behavior, competent self-care, and
satisfying relationship with others.”
d. Modern Concept of Health – refers to
optimum level of functioning of individual, family,
community optimum level of health (OLOF) is
influenced by the EcoSystem
• Ecosystem Factors
• Socio-economic status
• Hereditary factor  genetic
• Health care delivery system
• Activities and Behavior
• Political factors
• Environmental factors
Modified from Blum (2000)
DETERMINANTS OF HEALTH
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support networks
6. Culture
7. Genetics-
8. Personal behavior and coping skills-
9. Health services
10.Gender-
INDICATORS OF HEALTH
AND ILLNESS
• National Epidemiology Center of DOH,
Philippine Statistics Authority (PSA) and local
health centers/ offices/ departments - provide
morbidity, mortality and other health
status related data.
• Local health centers/ offices/ departments
• Nurses should participate in investigative
efforts to determine what is precipitating the
increased disease rate and work to remedy the
identified threats or risks.
Definition & Focus of Community
Health or Public Health
• a. C. E. Winslow- “Public health is the science
and art of 3P’s (1) Preventing disease, (2)
Prolonging life, and (3) Promoting health and
efficiency through organized community effort
for:
• sanitation of the environment,
• control communicable infections,
• education of the individual in personal hygiene,
• organization of medical and nursing services for the
early diagnosis and preventive treatment of
disease, and
Definition & Focus of Community
Health or Public Health

b. Hanlon
• “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.” (Hanlon)

c. Jacobson
• achievement of OLOF (Optimum level of
Functioning) through health teaching
• PUBLIC HEALTH - key phrase
definition: “through organized
community effort”
• connotes organized, legislated, and
tax-supported efforts that serve all
people through health departments
or related governmental agencies.
 9 ESSENTIAL PUBLIC
HEALTH FUNCTIONS (WHO)
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 resources 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
public health solution
WHAT IS NURSING?
• assisting sick individuals to become
healthy and healthy individuals
achieve optimum wellness
WHAT IS COMMUNITY
HEALTH NURSING?
• “the synthesis of nursing practice and public
health practice applied to promoting and
preserving health of the populations (ANA,
1980)
• encompasses subspecialties that include
public health nursing, school nursing,
occupational health nursing, and other
developing fields of practice, such as home
health, hospice care, and independent nurse
practice
Public Health Nursing (PHN) –
the term used before for
Community Health Nursing
(broader and includes
independent nursing practice)
Ultimate Goal of CHN
• “To raise the level of health of the
citizenry”
• To enhance the capacity of
individuals, families and
communities to cope with their
health needs
MISSION OF PUBLIC HEALTH
• is social justice that entitles all
people to basic necessities, such as
adequate income and health
protection, and accepts collective
burdens to make possible.
Public Health Nursing
(Freeman)
• the field of professional practice in which technical
nursing, interpersonal, analytical, and
organizational skills are applied to problems of
health as they affect the community.
• These skills are applied in concert with those of
other persons engaged in health care, through
comprehensive nursing care of families and other
groups and through measures for evaluation or
control of threats to health, for health education of
the public and for the mobilization of the public for
health action.
Community Health Nursing
(Maglaya et al)
• The utilization of the nursing process
in the different levels of clientele,
individual, family, community and
population groups concerned with the
• Promotion of health
• Prevention of disease
• and Disability and Rehabilitation
COMMUNITY-BASED
NURSING
• application of the nursing process in
caring for individuals, families and
group where they live, work go to go
school to or they move through the
health care system
• setting-specific such as home
health nursing
COMMUNITY HEALTH NURSING vs.
COMMUNITY-BASED NURSING

• Community Health Nursing

• emphasizes preservation and protection
of heath
• the primary client is the community
•

• Community-based Nursing
• Emphasizes on managing acute and
chronic
• the primary clients are the individual
and the family
POPULATION-FOCUSED
NURSING
• concentrates on specific groups of people and
focuses on health promotion and disease
prevention, regardless of geographical location
• focused practice:
1. focuses on the entire population
2. is based on assessment of the populations’ health
status
3. considers the broad determinants of health
4. emphasizes all levels of prevention
5. intervenes with communities, systems, individuals
and families
CHN PRACTICE REQUIRES THE FF. TYPES OF DATA
FOR SCIENTIFIC APPROACH AND POPULATION:

• the epidemiology or body of

knowledge of a particular problem and
its solution
• information about the community
 Types of Sources
information
Demographic Vital Statistics; census
Groups at high risk Health statistics; disease
statistics
Services/providers City directors, phone books,
available local/regional social
workers, list of low income
providers, CH nurse
3 IMPORTANT ELEMENTS of
CHN
1. It is population-based/focused
• Population-focused nursing care means
providing care based on the greater need
of the majority of the population.
2. It contains 3 levels of clientele
(IFC)
• Individual
• Family (basic unit of care)
• Community (patient)
3. It identifies and defines 12 Public Health
Interventions Surveillance
• Surveillance -monitors health events
• Disease and other health event investigation
• Outreach – locates populations of interests or
populations at risk
• Screening – identifies individuals with unrecognized
health risk factors
• Case finding – identifies risk actors and connects them
with resources
• Referral and follow-up – assist to identify and access
necessary resources
• Case management – optimizes self-care capabilities of
individuals and families
• Delegated functions – direct care tasks that the nurse
carries out
• Health teaching – communicates facts, ideas and skills
that change knowledge, attitudes values, behaviors and
• Counseling – establishes an interpersonal relationship;
with the intention of increasing or enhancing their capacity
for self-care and coping
• Consultation – seeks information and generates optional
solutions to perceived problems
• Collaboration – commits two or more persons or an
organization
• Coalition building – develops alliances among
organizations
• Community organizing – helps community groups to
identify common problems or goals mobilizes resources and
develop and implement strategies
• Advocacy – pleads someone’s cause or acts on someone’s
behalf
• Social marketing – utilizes commercial marketing
principles for programs
• Policy development and enforcement – place issues on
decision makers’ agendas, acquires plan of resolution
TYPES OF FAMILY IN THE
COMMUNITY
a.Nuclear Family – consists of father, mother and
children (either adopted or biological)
b.Extended – consists of father, mother, and children with
other relatives
c. Single-Parent – single with children
d.Binuclear/Blended/Reconsituted – extended family
consisting of 2 or more separate household from
separated or divorced parents with children
e. Step Family –remarriage of a widowed person with
children
TYPES OF FAMILY IN THE
COMMUNITY
f. Compound – one man/woman with several spouses
g.Cohabiting family – lived-in unmarried couple
h.Dyad – husband and wife without children
i. Homosexual family – female-female or male/male,
gay/lesbian with or without children
j. Communal family – e.g. bahay-ampunan, Home for
the aged, Kumbento
k. No-Kin - have no legal or blood tie to each other
BASIC PRINCIPLES OF CHN
• The community is the patient in CHN,
the family is the unit of care and there
are four levels of clientele: individual,
family, population group (those who
share common characteristics,
developmental stages and common
exposure to health problems – e.g.
children, elderly), and the community.
• the client is considered as an ACTIVE
partner NOT PASSIVE recipient of
BASIC PRINCIPLES OF
CHN
• CHN practice is affected by
developments in health technology, in
particular, changes in society, in
general
• The goal of CHN is achieved through
multi-sectoral efforts
ROLES OF THE PUBLIC
HEALTH NURSE
• REMEMBER: Generalist never Specialist
• Clinician, who is a health care provider, taking care of the sick people
at home or in the RHU
• Health Educator, who aims towards health promotion and illness
prevention through dissemination of correct information; educating
people (knowledge, skills, attitude - KSA)
• Facilitator, who establishes multi-sectoral linkages by referral system
• Supervisor, who monitors and supervises the performance of
midwives
• Leader, role model, and Change Agent
• Researcher
OBJECTIVES OF PUBLIC
HEALTH: CODES
• C - ontrol of Communicable Diseases
• O - rganization of Medical and Nursing
Services
• D - evelopment of Social Machineries
• E - ducation of IFC on personal
Hygiene→ Health Education is the
essential task of every health worker
• S - anitation of the environment
PUBLIC HEALTH WORKERS
(PHW)
• Medical Officer (MO)-Physician
• Public Health Nurse (PHN)-Registered Nurse
• Rural Health Midwife (RHM)-Registered Midwife-
• Dentist
• Nutritionist
• Medical Technologist
• Pharmacist
• Rural Sanitary Inspector (RSI)-must be a sanitary
engineer
EMERGING FIELDS OF CHN
IN THE PHILIPPINES
• SCHOOL HEALTH NURSING - the
application of nursing theories and
principles in the care of the school
population
• Focus: Promotion of health and wellness
of students and teachers
• Primary Role of CHN: to ensures that
educational potential is not hampered by
unmet health needs
Functions of the School
Nurse:
1. School Health and Nutrition survey
2. Putting up a functional school clinic
3. Health assessment
4. Standard vision testing
5. Ear examination
6. Height and weight measurement and
nutritional status determination
7. Medical referrals
8. Attendance to emergency cases
9. Student health counselling
Functions of the School
Nurse:
10.Health and nutrition education
activities
11.Organization of school-community
health and nutrition councils
12.Communicable disease control
13.Establishment of data bank on
school health and nutrition activities
EMERGING FIELDS OF CHN
IN THE PHILIPPINES
• OCCUPATIONAL HEALTH NURSING
• the application of nursing principles and
procedures in conserving the health
workers in all occupations
• Mission: To assure that every man and
woman in the country is safe and in
healthful working conditions
• R.A. 1054 is also known as the
Occupational Health Act
• Based on R.A. 1054, an occupational
nurse must be employed when there are
30 to 100 employees and the workplace
is more than 1 km. away from the
nearest health center
• Occupational hazards: Physical, ,
chemical, biological, mechanical,
psychosocial
EMERGING FIELDS OF CHN
IN THE PHILIPPINES
• HOME HEALTH CARE – this practice
involves providing nursing care
nursing care to individuals and
families in their own places of
residence mainly to minimize the
effects of illness and disability.
• HOSPICE HOME CARE – homecare
rendered to the terminally ill.
Palliative care is particularly important
ENTREPRENURSE
• A project initiated by the Department
of Labor and Employment (DOLE), in
collaboration with the Board of
Nursing of the Philippines,
Department of Health, Philippines
Nurses Association and other
stakeholders to promote nurse
entrepreneurship by introducing a
home health care industry in the
Philippines.
AIMS OF
ENTREPRENURSE
1. Reduce the cost of health care for the
country’s indigent population by bringing
primary health care services to poor rural
communities

2. Maximize employment opportunities for the

country’s unemployed nurses

3. Utilize the countries unemployed human

resources for health for the delivery of public
health services