LESSON #1: CHN Introduction ➢ recognition of the impact of different factors on

health
COMMUNITY HEALTH NURSING
➢ Nurses’ greater awareness of their clients’ lives
American Nurses Association wrote that:
and situations
➢ Community Health Nursing practice promotes
and preserves the health of population by
integrating the skills and knowledge relevant to Basic knowledge and skills in community health
both nursing and public health. nursing are anchored on nursing theories and
important concepts from the science of public
➢ The practice is comprehensive and general, and
health
is not limited to a particular age or diagnostic
group; it is continual, and is not limited to a 1. Emphasis on the importance of the “greatest
episodic care. good for the greatest number”

➢ While community health nursing practice 2. Assessing health needs, planning, implementing,
includes nursing directed to individuals, families and evaluating the impact of health services on
and groups, the dominant responsibility is to the population groups
population as a whole.
3. Priority of health-promotive and disease
preventive strategies over curative interventions

The Definition of community health nursing 4. Tools for measuring and analyzing community
highlights the following important points: health problems

1. The goal of professional practice is the promotion 5. Application of principles of management and
and preservation of the health populations. organization in the delivery of health services to
the community.
2. The nature of practice is comprehensive, general,
continual and not episodic

3. The knowledge base comes from nursing and Practice of community health nursing is enhanced
public health by the bodies of knowledge of other academic
disciplines such as the social science
4. The different levels of clientele – individuals,
families and groups. This are the concepts from:

5. The practitioner’s recognition of the primacy of ➢ SOCIOLOGY

the population as a whole
➢ PSYCHOLOGY

➢ ANTHROPOLOGY
Addition to the major points according to clark
➢ ECONOMICS
(1999:52)
➢ POLITICAL SCIENCE
Identified other characteristics or distinguishing
“attributes” of community health nursing: ❖ This will help nurses understand the health
care delivery system and their clients, and thus
➢ Greater control for both the nurse and the client
perform their roles and functions better.
in making decisions related to health care

➢ Collaboration between nurse and client as

equals

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 Two most commonly identified subspecialties of Characteristics of the family
community health nursing
➢ Every family is a social system
➢ OCCUPATIONAL NURSING – The specialty in
➢ Every family has a it’s own cultural values and
practice that provides for and delivers healthcare
rules
services to workers and worker populations.
➢ It is the first social group to which the individual
➢ SCHOOL HEALTH NURSING – Promoting the
is exposed
health of school children/learners and preventing
health problems that would hinder their learning ➢ Every family has a structure
and performance of their developmental tasks.
➢ Every family have certain basic function

➢ Every family moves through stages in its life cycle

Types of family structure

• Nuclear family

• Extended family

• Commune family
NURSING ASSESSMENT IN FAMILY NURSING
PRACTICE • Family of origin

Introduction • Family of procreation

Working in a community setting generally involves • Blended family

working with families. CHN must there for
• Single parent family
understand the interactions and dynamics of
families so that they can provide appropriate • Legally married or traditionally married. It’s the
family assessment , planning, intervention and only form accepted culturally in our regions
evaluation

• Thus an understanding of family dynamics and

the context of the community assists the nurse in Nuclear Family
planning care. A family consisting of two parents and their
children. This family is expected to live together in
• When family is the client, the nurse determines
one household. It is sometimes referred to as an
the health status of the family and its individual
immediate family or an elementary family.
members, the level of family functioning, family
interaction family strengths and weakness.

Extended Family
Definition A family that includes in one household near
relatives (such as grandparents, aunts, or uncles)
• Family: is two or more persons related by birth,
in addition to a nuclear family. Given space, there
marriage, or adoption who reside together in a
household. are ways in which even larger populations than
the extended family can be accommodated
• Family is a structural unit composed of a man under one roof.
and women who are married and have children

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 Communal Family 6. Control

A small group of persons living together, sharing 7. A sense of belonging and of history and place
possessions, work, income, etc., and often
8. Family rituals for rejoicing and grieving
pursuing unconventional lifestyles.
9. Systems for earning money , supporting partners
and children
Family of Origin
10. Sharing of labor, chores required to keep the
The term "family of origin" refers to the unit that family running
cared for you as a child, these are the people that
you had family experiences with growing up. For
example, you might have been raised by Characteristics of healthy family
grandparents, an aunt or uncle, a family friend,
your parents. 1) Facilitative interaction among members

2) Enhancement of individual development

Family of Procreation 3) Effective structuring of relationship

It refers to the family that we create by getting 4) Active coping effort

married and having or adopting children. Through 5) Healthy environment and lifestyle
the family of procreation, parents can influence
the values, behaviors, learning, and development 6) Regular link with the border community
of their children.

Health tasks of the family

Blended Family 1. Recognizing interruptions of health or
Also known as a stepfamily, is a family formed development.
when two people come together and bring a child 2. Seeking health care
or children from previous relationships.
3. Managing Health and non- health crises

4. Providing nursing care to the sick, disabled and

Single Parent Family dependent member of the family.
A single parent is someone who is unmarried, 5. Maintaining a home environment conducive to
widowed, or divorced and not remarried. The good health and personal development.
single-parent household can be headed by a
mother, a father, a grandparent, an uncle, or aunt. 6. Maintaining a reciprocal relationship with the
community and health and institutions

Function of the family

1. Affection, love, care, an emotional support

2. Security

3. Identity

4. Affiliation

5. Socialization

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 Family health assessment ➢ Work

Assessing family health in a systematic fashion ➢ Religion places

require three tools
➢ Health care system
• Conceptual framework upon which to
database the assessment
The developmental framework
• A clearly defined set of assessment
categories for data collection Studies family from lifecycle perspective by examine
members changes roles and tasks in each
• A method for measuring a family’s level of
progressive life cycle
functioning

Family Developmental Tasks

Conceptual frameworks
1. Beginning family
A conceptual framework is a set of concepts
integrated into meaningful explanation that helps one • Establishing a mutually satisfying marriage
interpret human behavior or situations.
• Planning to have or not have children
Three conceptual frameworks are particularly
useful in community health nursing: 2. Childbearing family

◦ 1. Interactional framework • Having and adjusting to infant

◦ 2. The structual-functional framework • Support needs of all three members

• Renegotiating marital relationship

◦ 3. The developmental framework
3. Family with pre- school children

• Adjusting to cost of family life

Interactional framework
• Adapting to needs of pre-school children to
Describes the family as:
stimulate growth and development
❑ unit of interacting,
• Coping and parental loss of energy and
❑ personalities, Privacy
❑ emphasize communication, 4. Family with school age children
❑ role, • Adjusting to the activity of growing children
❑ coping patterns and • Promoting joint decision making between
children and parents.
❑ decision-making process ( focus on internal
relationship) • Encouraging and supporting children’s
educational achievements

5. Family with teenagers and young adults

The structual-functional framework
• Maintaining open communication among
Describes the family as a social system relating
members.
to other social systems in the external
environment, such as: • Supporting ethical and moral values within
the family.
➢ School
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 • Balancing freedom with responsibility of 5. Family functions refers to a a family’s ability to
teenagers. carry out appropriate developmental tasks and
provide for it’s members needs
• Releasing rituals and assistance
6. Family values and beliefs influence all
• Strengthening marital relationship.
aspects of family life, E.g making and spending
• Maintaining supportive home base young money, education, work and religion
adults with appropriate
7. Family communication pattern include the
6. Post- parental family frequency and quality of communication with a
family and between the family and its
• Preparing for retirement environment
• Maintaining ties with younger and older 8. Family decision-making pattern
generations.
9. Family problem solving
7. Aging family
10. Family coping patterns , family support
• Adjusting to retirement
system, responses to stressors
• Adjusting to loss of spouse
11. Family health behavior
• Closing family house
12. Family social and culture pattern

Data collection categories

Assessment methods

• Ecomap: is diagram of the connection between a

A list of 12 data collection categories family and the other system in its ecological
enviroment or its A picture of the family’s patterns
1. Family demographic ( composition,
socioeconomic)

2. Physical environment Nurses can use an ecomap to identify:

a. housing and the conditions inside, outside and - Family resources that are present
surrounding it
- Family needs
b. Any existing safety or environmental hazards
- Conflicts
c. The amount and quality or services available
- Connections that are present or absent
d. Geography and climate
- The balance or lack of balance between a
3. Psychological and spiritual environment such family's needs and the resources available to the
as: family

Mutual respect, support, promation and

members self-esteam

4. Family structure and roles include:

Family organization

Division of labor and allocation

Use of authority and power

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 1. Ecomap 3. Family Health Tree

a record of diseases that occur in a family

It can be used to track

• Diseases that have genetic bases

• Environmental diseases

• Mental health disorders

2. Genogram

A graphic picture of family history, usually

used over three or more generation.

The genogram maps such information as:

• Relationships among family members

• Important life events

• Place of residence

• Characteristics such as race, culture and

religious affiliations
There are two systems of nursing diagnosis

a. NANDA system

Uses nursing diagnosis labels

b. Omaha system

Develop for community health nurses, consist of:

➢ Problem classification

➢ Intervention

➢ Problem rating scale for outcomes

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 b) Clients have greater control over their health and
lives.

c) The community health nurse gains access to

families to provide health education and other
prevention strategies.

d) The nurse can observe family and environment

factors that influence health.

e) Home visits allow for primary intervention, to

prevent disease or injury from occurring.

f) Home visits facilitate family participation and

Remember: promote family focus.
➢ Planning and intervention for families must be in
partnership with family members, not imposed
from by CHN Disadvantages of home visit

➢ Planning and intervention for families by CHN • The nurses skills, personality, or physical ability
must used the three level of prevention may not be compatible with providing home visit.

➢ Work with the family collectively • Home visits are time consuming; travel time is
required to get to the persons needing care.
➢ Start where the family is
• There is no easy access to emergency equipment
➢ Fit nursing intervention to the family stage of or consultation with other health professionals if
development needed.
➢ Recognize the validity of family structural • Home visits may present issues regarding the
variation nurse personal safety in some community or
family settings.
➢ Emphasize family strength
• The nurse has less control over the care setting
(for example, cleanliness, noise, privacy, or
The goals of primary health nursing are often met distractions)
through providing health care to families in their
home. It can be provided By:
The community health nurse develops objectives for
❑ Visiting nurse association
primary, secondary, and tertiary prevention levels, in
❑ Hospice consultation with the family. To accomplish these
objectives, the nurse needs to: Assess clients ability
❑ Public health departments
or willingness to comply with treatment directions
❑ Home health agencies and/ or change certain behaviors. Anticipate family
needs, such as the timing of visits, the need to
❑ School districts
educate family members, respite care, and so on.

Advantages of home visits:

a) These visits cost less than hospital care, with

better outcomes, especially when chronic health
issues are involved.
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 Community health nurse bag Termination of home visits occurs when both client
and nurse are satisfied that goals have been met or
Requirements include equipment for basic
that appropriate referrals have made.
assessment, medical asepsis, and waste disposal.
Telemedicine: which use phone and computer
These precautions must be followed to avoid
technologies to monitor clients and provide care
contamination from blood, body secretions,
without the nurse making a home visit.
excretions, or contaminated items.

- Wash hands

- Use gloves.

- Wear eye and face protection

- Wear gown

- Handle client care equipment carefully.

- Clean environmental surfaces.

- Use proper sharps disposal container.

The community health nurse doing home visits

usually works as part of a home health care team that
can includes social workers, rehabilitation
specialists, and home health nurses or aides.
Cooperation and communication with other care
providers are essential.

The three most common intervention in home

health care include:

Evaluation is the ongoing process that continually

assesses clients progress toward expected outcome.

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