Community Health Nursing

Joy Colindres,RN,MAN
Overview of Community
Health Nursing

Community Health Nursing as a

Field of Nursing Practice
 Historical Perspective
 Nursing has
been directed for
a need to reduce
pain with comfort
measures
Influence of Ancient Cultures
on Public Health

Egyptians, Hebrew, Greeks,

Roman
 Egyptians Civilizations
 Built irrigations and granaries for proper
storage of foods
 Practice of prophylaxis by the medicine
man and high priest
 Emphasize on personal hygiene
 Sanitation measures (removal of refuse
and fumigation esp. during epidemic)
 Hebrews
 Founders of public hygiene
 Moses – Father of Sanitation
 Mosaic Health Code – focus on individual,
family and community hygiene
 Principle
of personal hygiene
 Environmental sanitation
Personal Hygiene (rest, hours of
work, cleanliness)
Environmental Hygiene
 Inspection of food
 Methods of disposal of excreta
 Detecting and reporting of disease
 Practice of isolation, quarantine,
fumigations and disinfections
 Handwashing
 Greeks
 Hippocrates – Father of Medicine
 Science of preventive medicines
 Introduce principles of
interrelationship physicians and
mental health
“ A healthy mind dwells in a
healthy body.”
 Romans
 Contributed to the field of sanitations
 Appointing public health medicine
officer
 Establish hospitals which emphasize
on preventive and curative aspects of
care
Development of Public Health
Nursing as a World Movement

Early Christian Period (1st

Century)
Middle Ages
Renaissance
Early 19th Century
 Early Christian Period
(1st Century)
 Order of Deaconesses
Visiting nurse
Forerunners of community health
nurses
Endeavored to practice the corporal
works of Mercy
(feeding the hungry, caring for the sick,
burying the dead)
 Middle Ages
 Beguines of Flanders
 worked as nursing sister in the
hospital
 gives care to the sick in their homes
 staying with the dying and consoles
the family
 Renaissance
 St. Vincent the Paul – introduce modern
principles of visiting nursing and social
services
 Taught that discrimination is harmful
 Emphasized the concept of helping people
help themselves
 Organized Daughters of Charity
 Family is the basic unit of service
 Recognized the importance of supervision of
those who render services of the sick
 Early 19 Century
th

 Pastor Theodor Fliedner – a German

pastor, went on tour to raise fund for a
program on social work.
 Frederika Munster Fliedner – organized
Women’s Society for visiting and nursing
the sick poor in their homes
Development of Modern
Public Health Nursing
Period of Empirical Environmental
Sanitation (1840-1890)
 Emphasized
measures to control
communicable diseases:
Removal of refuse waste
Clean-up campaigns of prisons and
asylum
Improvement of working conditions of
women and children
 Florence Nightingale – “Mother of
Nursing” - (1873) developed a
model for independent nursing
schools to teach critical thinking,
attention to patients individual
needs and respect for patient’s
rights.
William Rathborne – Father of
modern district nursing –
organized training school for
nurses, hospital, private duty,
and district nurse
 Period of Scientific control of
communicable diseases (1890-1910)

Application of
bacteriology
and
immunology
Period of Health Education (1910 to
present)

Emphasized on
education for
prevention of
diseases with
active cooperation
of individual in
health action
 Public Health Nursing in the
Philippines
 Pre-Spanish Era – no records
 Spanish Regime (1591-1898)
 Bro. Juan Clemente (1577) – started public
health services
 Introduction of water sanitation
 Introduction of small pox vaccine
 Creation of position of district, provincial and
national health officers
 American Regime (1898-1946)
 1898 – creation of Board of Health for
physicians
 1899 – appointment of the 1st
commissioner of health
 1901 – Act No. 157 created Board of
Health for the City of Manila; Act No. 309
created Provincial and Municipal Boards of
Health
 1905 – Act No. 1407 (reorganization act)
abolish Board of Health and was taken
over by the Bureau of Health under the
Department of Interior
 1906 – creation of Bureau of Health
 1912 – Fajardo Act (Act No. 2156) created
Sanitary Division. In the same year public
health nursing in the Philippines started.
 1915 – Bureau of Health was renamed
Philippine Health Service; Reorganization Act
No. 2462 – created the office of General
Inspection, headed by nurse-physician Dr.
Rosario Pastor.
 1916 to 1918 – Ms. Perlita Clark took charge of
the public health nursing
 1917 – 4 nursing graduates from Manila were
employed to worked in the city school
 1919
 Public health nursing was inaugurated in Tondo,
Manila when visiting nurse Ms. Balbina Basa was
assigned to make a house to house visit, hold clinic
and dispensary work with special emphasis on
maternal and child care.
 Philippine National Red Cross introduced the
operation of puericulture.
 The program was later extended to the province
incorporation with Bureau of Public Welfare
 Ms. Carmen del Rosario was appointed as
the first Filipino nurse under the Bureau of
Health
 1923 – established 2 government schools
of nursing: Zamboanga General Hospital
School of Nursing and Baguio General
Hospital in Northern Luzon. In later year 4
more school were establish
 1928 – Fist convention of nurses were
held
 1933 – Reorganization Act No. 4007, the
Division of Maternal and Child Health of
the Public Welfare Commission was
transferred to the Bureau of Health
 1940 – The Department of Health and
Welfare was created
 Japanese Regime (1942-1945) – Public health
nursing were interrupted
 1946 – after world war, the Bureau of Health
increased the number of public health nurse.
Mrs. Genara de Guzman, technical assistant in
nursing of the Ministry of Health and concurrent
president of Filipino Nurses Association
recommended the creation of a nursing office in
the Ministry of Health.
 Era of Republic of the Philippines (1949 to
present)
 1947 – Reorganization of government
offices under EO No. 94: Bureau of Public
Welfare to the office of the president and
renamed as Department of Health
 1953 – the office of Health Education and
Personnel Training was created
 May 18, 1954 – Republic Act 1082 was
passed creating Rural Health Units
 June 1957 – Republic Act 1891 – an act
that strengthen health and dental services
in the rural health area
 1975 – Formulation of National Health
Plan and the restructured Health Care
Delivery System
 1982 – Executive Order No. 851, the health
education and manpower development service
was created, and Bureau of Food and Drug
 1986 – The Ministry of Health became
Department of Health again
 1991 – RA 7160 (Local Government Code).
Devolution – transfer of power from the national
to local government which aimed to built their
capabilities for self-government and developed a
self-reliant communities.
 1993 to 1998 – National League of
Philippine Government Nurses was
organized
 1996 – Primary Health Care as a
strategies to attain Health for all by the
year 2000
 1999 – Creation of National Health
Planning Committee and Inter-Local
Health Zones through EO 205
 May 24,1994 – EO 102 signed by Pres. Estrada,
redirecting the function and operations of the
DOH, nursing positions were devolved
 1999 to 2004 – Health Sector Reform Agenda of
the Philippines was launched
 2005 – Fourmula One for Health to ensure
speed, precision and effective coordination
towards improving the efficiency, effectiveness
and equity of health care delivery
 Definitions and Focus: PHN/CHN
 Both term are often interchange but
synonymous
 PHN is a synthesis of public and
nursing practice. (Freeman)
 PHN is a field of professional practice
in nursing and in public health in
which technical nursing,
interpersonal, analytical and
organizational skills are applied to
problems of health as they affect
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 mobilization of the public
for health action.
 Public Health
 According to Dr. C.E. WINSLOW
 PUBLIC HEALTH – is the science and art
of preventing disease, prolonging life,
promoting health and efficiency through
organized community effort for the
sanitations of the environment, control of
communicable diseases, education of
individuals in personal hygiene….
… the organization of medical and nursing
services for early diagnosis and preventive
treatment of disease, and the development
of the social machinery to ensure
everyone a standard of leaving adequate
for the maintenance of health, so
organizing these benefits as to enable
every citizen to realize his birthright of
health and longevity.
 According to WHO
 PUBLIC HEALTH – is the art of applying
science in the context of politics so as to
reduce inequalities in health while
ensuring the best health for the greater
number.
 Therefore, the core element of
governments’ attempts to improve and
promote the health and welfare of their
citizens.
 Core business of PUBLIC HEALTH
 Disease control
 Injury prevention
 Health promotion
 Healthy public policy, in relation to
environmental hazards
 Promotion of health and equitable health gain
 Essential Public Health Functions
 Health situation monitoring and analysis
 Epidemiological surveillance/disease
prevention and control
 Development of policies and planning in
public health
 Strategic management of health systems
and services for population health gain
 Regulation and enforcement to protect
public health
 Human resources development and
planning in public health
 Health promotion, social participation and
empowerment
 Ensuring the quality of personal and
population based health services
 Research, development and
implementation of innovative public health
solutions
 Public Health Nursing
 Made great contributions to the
improvement of the health of the people
 Leaders in providing quality health care
services to communities.
 First level of health workers to be
knowledgeable about new public health
technologies and methodologies.
 Usually the first to be trained to implement
new programs and apply new technology.
 NURSING UNDER W.H.O
 Demarcates the line of nursing action
 To serve both well and ill in the community
 Right to medical care and right to nursing care
are implied in the fundamental human rights
 A changing trend in community care gave
birth to COMMUNITY HEALTH NURSING
 Community Health Nursing
 Maglaya, Jacobson, Freeman
 Utilization of nursing process for clientele
 Concerned with the promotion of health
(optimal level of functioning), prevention
disease and disability and rehabilitation
 Achieved through teaching and delivery of
health care
 GOAL: raise the level of health of the
citizenry
 Philosophy (Dr. Margaret
Shetland)
 Baseon the worth and dignity of
human

Historical background (refer to pp 8-

16)
 Basic Concept of CHN
 Primary focus on health promotion and
disease prevention
 Extend the benefits not only to individual
but the whole family and community and
special population
 CH nurse are generalist in terms of their
practice from womb to tomb
 Contact with clients is a long term at all levels of
health care
 PHC (community)
 SHC (regional/provincial/district municipal/local hosp.)
 THC (sophisticated medical centers)
 CHN practice requires knowledge from
biological, social and other related sciences
 Continuous nursing process is applied
 Basic Principles of CHN
 Recognized needs of communities, families,
groups and individuals
 CHN nurses has full knowledge of the
objective and policies of the agency she
represent (facilities goal achievements)
 Set priorities
 Goal setting
 Objective should be client centered and SMART
 Action
 Evaluation
 Focus care on the family
 Available to all race, creed and socio-
economic status and respect values,
customs and beliefs of client
 Health education and counseling are vital
role of CHN
 Collaborative work relationship-
coordinator of health service
 Monitoring or periodic evaluation of health
services (accurate recording and reporting
for evaluation purposes)
 Opportunities of continuous education
program to upgrade nursing practice
 Make use of available community health
resources or the indigenous and existing
community resource appropriate
technology
 CH nurse has active participation in the
community
 Role of Public Health Nurse
 The roles are varied and dynamic.
 It is influenced by the nature of health
needs of the population, specific
goals of the health care system and
the attitudes and practices of the
nurse in providing care.
 Clinician
(health care provider) –
takes care of sick people at home or
in the RHU.
 Home visit
 PHN Bag
 Home visit
 PURPOSE
 Give nursing care to sick, mothers, and
children
 Assess living condition
 Provide health education
 Promote health and use of referral for
utilization of community health
 PRINCIPLE
 State purpose and objective
 Use records and reports
 Give priority to essential needs
 Planning and delivery of care involves clients
 Plan should be flexible
 PHN Bag
 Essential and indispensable equipment
which contains basic medication and
articles necessary for giving care.
 Should observe proper bag technique
principle
 Prevent spread of microorganism
 Save time and efforts for nursing procedure
 Should show effectiveness of total care given to
clients
 Case Manager
 Assistclients to make decisions
about appropriate health care
services and to achieve service
delivery integration and
coordination
 Advocate
 Seek to promote an understanding of
health problems, lobby for beneficial
public policy and stimulate supportive
community action for health
 Teacher/Health Educator
 Application of teaching – learning
principles to facilitate behavioral
changes among clients
 Partner/ Collaborator
 To get people together in order to
address problems or concerns
 Works with people’s and health
organizations educational institutions,
socio-civic organizations and sectoral
groups
 Health Planner/Programmer
 Identifies needs, priority and problems of
individual, families and communities
 Formulates nursing component of health
plans
 Interprets and implements nursing plans,
program policies, memoranda and circulars
for the concerned staff/personnel and provide
technical assistance
 Community Organizer/Leader
 Responsible for motivating and
enhancing community participations in
terms of planning, organizing,
implementing and evaluating health
programs and services
 Case Finder/Epidemiologist
 Looksfor actual or risk problems or
concerns and followed periodically as
they develop
 Recorder and Reporter
 Prepares and submit required records
and report
 Review, validates, consolidates,
analyzes and interprets all records and
reports
 Maintains adequate, accurate and
complete recording and reporting
 Responsibility of CHN
 Be a part in developing and overall health
plan, its implementation and evaluation for
communities.
 Provide quality nursing service to all level
of clientele
 Maintain coordination/ linkages with other
health team members in the provision of
public health service
 Conduct researches relevant to CHN
services to improve provision of HC
 Provide opportunities for professional
growth and continuing education for staff
development
 COMMUNITY HEALTH AND
DEVELOPMENT CONCEPTS,
PRINCIPLES AND STRATEGIES
 CONCEPTS AND DEFINITIONS

 Health is a state of complete

physical, mental and social well-
being and not merely the absence
of disease or infirmity
(WHO,1946)
 A fundamental human right (Ottawa
Charter – 1986).
 All people should have access to basic
resources for health:
 Peace, adequate resources, food and shelter,
and a stable ecosystem and sustainable
resources use.
MODELS OF HEALTH
 Medical Model
 Health is the state of being free of signs or
symptoms of disease and illness.
 The absence of one or more of the “five D’s”
Death
Discomfort
Disease
Disability
Dissatisfaction

 * If you are not sick or dying, you are considered

to be in the best attainable state of health.
 Health Belief Model
 Health and illness is affected by
genetic characteristics and the
cultural values and beliefs learned
and practice by the families and
communities.

Beliefs – Feeling – Behavior

Agent – Host – Environment Model
 The agent- host-
environment model of
health and illness for
community health
(Leavell and Clark –
1965)., is useful for
examining the cause of
disease in an individual.
“health is an ever changing state.”
ENVIRONMENT
(factors external to the host)

AGENT HOST
(microorganism or (living organism capable
chemical substance) of being infected by the agent)
 Health- Illness Continuum
 Health is a constantly changing state, with
high level wellness and death being on
opposite ends of a graduated scale, or
continuum.
 High Level Wellness
 High level wellness
refers to
functioning to one’s
maximum potential
while maintaining
balance of
purposeful
direction in the
environment(1977,
Rodale).
Needs Fulfillment Model
 Health is a state in
which needs are
being sufficiently
met to allow an
individual to
function
successfully in life
with the ability to
achieve the highest
possible potential
 Role Performance Model
 Health is the ability
to perform all those
roles for which on
has been
socialized.
PRIMARY HEALTH
CARE
 30 years ago, the Declaration of Alma-Ata
articulated primary health care as a set of
guiding values for health development, a
set of principles for the organization of
health services, and a range of
approaches for addressing priority health
needs and the fundamental determinants
of health.
 The Declaration of Alma-Ata was
adopted at the International Conference
on Primary Health Care, Almaty (formerly
Alma-Ata), presently in Kazakhstan,
September 6-12, 1978.
 It expressed the need for urgent action by
all governments, all health and
development workers, and the world
community to protect and promote the
health of all the people of the world.
 It was the first international declaration
underlining the importance of primary
health care. The primary health care
approach has since then been accepted
by member countries of WHO as the key
to achieving the goal of "Health for All".
 Primary health care, often
abbreviated as PHC, is
 "essential health care based on practical,
scientifically sound and socially acceptable
methods and technology made universally
accessible to individuals and families in the
community through their full participation
and at a cost that the community and the
country can afford to maintain at every
stage of their development in the spirit of
self-determination"
 In the Philippines, primary health care was
implemented under Letter Of Instruction
949 , which was signed by former
President Marcos on October 19, 1979.
 MISSION
 To strengthen the health care system by
increasing opportunities and supporting
the conditions wherein people will manage
their own health care
 GOAL
 Health for All
 SELF-RELIANCE
 ability to stand on their own self-sufficiency
 In
accordance with the goal of the Department of
Health which is,
 Framework
 People’s empowerment and partnership is the
key strategy to achieve the goal “Health for all
Filipinos and Health in the hands of the
people by the year 2020”.
 GENERAL PRINCIPLES AND
STRATEGIES
 HEALTH AND DEVELOPMENT ARE
INTERRELATED
 ESSENTIAL HEALTH SERVICES MUST
BE ACCESSIBLE, AVAILABLE,
ACCEPTABLE AND AFFORDABLE.
 GENUINE PEOPLE’S PARTICIPATION
IS ESSENTIAL – Community
Participation
 SELF-RELIANCE
 SOCIAL MOBILIZATION
 DECENTRALIZATION
 PROVISION OF QUALITY, BASIC AND
ESSENTIAL HEALTH SERVICES
HEALTH AND DEVELOPMENT
ARE INTERRELATED
 Convergence (meeting) of health, food,
nutrition, water, sanitation, and
population services.
 Integration of PHC into national,
regional, provincial, municipal and
barangay development plans.
 Coordination of activities with economic
planning, education, agriculture,
industry, housing, public works,
communication and social services.
 Establishment of effective health referral
system
 ESSENTIAL HEALTH SERVICES
MUST BE ACCESSIBLE, AVAILABLE
 Health services delivered where the people
are
 Use of indigenous volunteer health worker
as a health provider with a ratio of one
community health worker per 10-20
households
 Use of traditional medicines with essential
drugs
 GENUINE PEOPLE’S
PARTICIPATION IS ESSENTIAL
 Awareness building and consciousness
rising on health- related issues.
 Planning, implementations, monitoring and
evaluation done through small group
meeting (10-20 household cluster)
 Selection of community health workers by the
community.
 Formation of health committees.
 Establishment of community health
organization at the parish or municipal level.
 Mass health campaigns and mobilization to
combat health problems
 SELF-RELIANCE
 Use of local resources
 Training of community in leadership
and management skills
 Incorporation of income generating
projects, cooperatives and small scale
industries.
 SOCIAL MOBILIZATION
 Establishment of an effective health referral
system
 Multi-sectoral and interdisciplinary linkage
 Information, education, communication
support using multi-media
 Collaboration between government and non-
government organizations
 DECENTRALIZATION
 Devolution (RA 7160)
 Transfer of power from the national
government to local government unit
 Reallocation of budgetary resources
 Reorientation of health professionals on
Primary Health Care
 Advocacy for political will and support from
the national leadership down to the
barangay level.
 PROVISION OF QUALITY, BASIC
AND ESSENTIAL HEALTH SERVICES
 Training design and curriculum based on
community needs and priorities
 Attitude, knowledge and skills developed are
on promotive, preventive, curative and
rehabilitative health care
 Regular monitoring and periodic evaluation
of community health worker performance by
the community and health staff.
 MAJOR ELEMENTS
1. Use of Appropriate Technology
 This emphasizes equity and justice, that
health is a basic right of every individual and
not just to those who can afford to pay their
own health care
 Criteria in determining use of appropriate
technology
 Effectiveness and safety
 Complexity – simple and easy to apply
 Cost
 Scope of technology – effective, appropriate
 Acceptability
 Feasibility – compatible with the local setting
2. Multi-Sectoral Approach to Health

Other health related systems

(private/government)

Ways of the Community HeathHealth Care

People System
(knowledge and values)

Environmental (social,
economic, physical conditions)
 Intersectional Linkages
 Primary Health Care forms an integral part
of the health system and the over all social
and economic development of the
community. As such, it is necessary to
unify health efforts within the health
organization it self and with other sectors
concerned. It implies the integration of
health plans with the plan for the total
community development.
 Sectorsmost closely related to health
includes those concerned with:
 Agricultural
 Education
 Public works
 Local government
 Social welfare
 Population control
 Private sectors
 Intrasectoral Linkage
 In the health sector, the acceptance or primary
health care necessitates the restructuring of the
health system to broaden health coverage and
make health service available to all. There is
now widely accepted pyramidal organization that
provides level of services starting with primary
health and progressing to specialty care.
Primary care is the hub of the health system.
 National & Regional
Health Services, Medical
Centers, Teaching & Training
Hospitals

Provincial/City Health services and

Hospitals
Emergency and District Hospitals

Rural Health Units, Community Hosp./Health Centers

Private Practitioners, Barangay Health Station
 HEALTH CARE FACILITIES
 1. Primary Level of Health Care Facilities
 This are the rural health units, their sub-centers, chest
clinics, malaria eradication units operated by the DOH
 Private clinics operated by Philippine medical
Association; large industrial firms for their employees
 Community hospitals and health centers operated by
Philippine Medical care Commission and other health
facilities operated by voluntary religious and civic
groups
 Health services offered: caters to individuals in fair
health and to patients with disease in the early
symptomatic stages.
 HEALTH CARE FACILITIES
 2.
Secondary Level of Health Care
Facilities
 These are smaller, non-departmentalized
hospitals including emergency and
regional hospitals.
 Health services offered: care for patients
with symptomatic stage of disease with
requires moderately specialized knowledge
and technical resources for adequate
treatment.
 3. Tertiary Level of health Care Facilities
 These are highly technological and
sophisticated services offered by medical
centers and large hospitals. These are
specialized national hospital.
 Health services offered: for clients afflicted
with diseases which seriously threaten their
health and which requires highly technical and
specialized knowledge, facilities and personnel
to treat effectively.
Two way referral system
2 3

H H
E E
Barangay Health Public Health Nurse A A
Worker L L
TH T
F H
A F
C A
Barangay Health Rural Health Unit Physician I C
Stations Midwifes L I
I L
T I
I T
E I
S E
Barangay Health Sanitary Inspector S
Midwifes
 PRIMARY HEALTH WORKER
 Village/Grassroots
 Train community health workers, health
auxiliary volunteers, TBA
 1st contact of the community (initial link)
 Work in liaison with local health service
worker
 Provide elementary, curative preventive
health care measures
 Intermediate level
 General Medical Practitioners, PHN,
Midwifes
 1st source of professional health care
 Attend to health problems beyond the
competencies of the village workers
 Provides support to the front line health
workers in term of supervision, training,
referral services and supplies through
linkages with other sectors
 Health Personnel of first line hospitals
 Physicians with specialty area, nurses and
dentists
 Establish close contact with the village and
intermediate level health workers to promote
the continuity of care from hospital to
community to home.
 Provide back-up health services for cases
requiring hospital or diagnostic facilities not
available in health care
3. Community participation
 Defining their health and health related needs
and problems
 Identifying realistic solution
 Organizing community health action
 Mobilizing local resources
 Providing essential health services
 Evaluating the results of health actions
 ELEMENTS OF PRIMARY
HEALTH CARE

H – Hospital as a Center of Wellness

O – Oral and Dental Health
M – Mental Health
E – Elderly Care
 E – Education for Health
 L – Locally Endemic Disease Control
 E – Expanded program on Immunization
 M – Maternal and Child Health
 E – Essential Drugs
 N – Nutrition
 T – Treatment of Communicable Diseases
 S – Safe water and Sanitation
 HEALTH PROMOTION
 Health promotion is a process of enabling
people to increase control over the
determinants of health and thereby
improve their health. WHO (1986) Ottawa
Charter
 Participation is essential to sustain health
promotion action
 STRATEGIES FOR HEALTH
PROMOTION
 Advocacy for health to create the
essential conditions for health,
 Enabling all people to achieve their full
health potentials, and
 Mediating between the different interests
in society in the pursuit of health
 Health Promotion Model
(Nola Pender,1996)
 Individual characteristics and experiences
can be useful in predicting if an individual
will incorporate and use health related
behaviors.
 “ If a behavior has been used before and
becomes a habit, it is more likely to used
again.”
 Behavior- specific knowledge, beliefs and
relationships – major motivators for
engaging in health behaviors.

 A health related behavior is initiated by

committing to a plan of action,
accompanied by developing associated
strategies to perform the value behavior.
 HEALTH PROMOTION MODEL (HPM) –
NOLA PENDER
 Conceptualized that motivation to
participate in health promoting behavior is
influenced by cognitive-perceptual factors
and modifying factors
 COGNITIVE-PERCEPTUAL
FACTORS INCLUDES:
 Importance of health
 Perceived control of health
 Self efficacy
 Definition of health
 Perceived health status
 Perceived benefits of health promoting
behaviors
 Perceived barriers to health promoting behaviors
HEALTH PROMOTION
THEORY
 Self-efficacy
 It is a belief that one has the capabilities to
execute the courses of actions required to
manage prospective situations.
 Example:
 A person with high self-efficacy may engage
in a more health related activity when an
illness occurs, whereas a person with low
self-efficacy would harbor feelings of
hopelessness.
 Therefore:

Self efficacy is
the ability or the
power to
produce an
effect/ change.
 Psychologist Albert Bandura has defined
self-efficacy as one's belief in one's ability
to succeed in specific situations.
 One's sense of self-efficacy can play a
major role in how one approaches goals,
tasks, and challenges.
 According to Bandura's theory, people
with high self-efficacy:
 are those who believe they can perform well
 are more likely to view difficult tasks as
something to be mastered rather than
something to be avoided.
How self-efficacy affects human
function
 Choices regarding behavior
 People will be more inclined to take on a task
if they believe they can succeed. People
generally avoid tasks where their self-efficacy
is low, but will engage in tasks where their
self-efficacy is high.
 Motivation
 People with high self-efficacy in a task are
more likely to make more of an effort, and
persist longer, than those with low efficacy.
 Thought patterns & responses
 Low self-efficacy can lead people to believe
tasks are harder than they actually are.
 People with high self-efficacy often take a
wider overview of a task in order to take the
best route of action.
 People with high self-efficacy are shown to be
encouraged by obstacles to make a greater
effort.
 Self-efficacy also affects how people respond
to failure.
 A person with a high self-efficacy will attribute
the failure to external factors, where a person
with low self-efficacy will attribute failure to
low ability.
 Health Behaviors
 Health behaviors such as non-smoking,
physical exercise, dieting, condom use, dental
hygiene, seat belt use, or breast self-
examination are, among others, dependent on
one’s level of perceived self-efficacy (Conner
& Norman, 2005).
 Self-efficacy beliefs are cognitions that
determine whether health behavior change
will be initiated, how much effort will be
expended, and how long it will be sustained in
the face of obstacles and failures.
 Self-efficacy influences the effort one puts
forth to change risk behavior and the
persistence to continue striving despite
barriers and setbacks that may undermine
motivation.
 Self-efficacy is directly related to health behavior, but
it also affects health behaviors indirectly through its
impact on goals.
 Self-efficacy influences the challenges that people
take on as well as how high they set their goals (e.g.,
"I intend to reduce my smoking," or "I intend to quit
smoking altogether"). A number of studies on the
adoption of health practices have measured self-
efficacy to assess its potential influences in initiating
behavior change (Luszczynska, & Schwarzer, 2005).
 TYPES OF HEALTH
PROMOTIONAL ACTIVITIES
 HEALTH EDUCATION (information
dissemination)
 Use of variety of media to offer information to
the public about the particular lifestyle choices
and personal behavior, the benefits of
changing that behavior and the improvement
of quality of life
 FIVE PRIORITY ACTIONS AREA
 Build healthy public policy;
 Create supportive environments for health;
 Strengthen community action for health;
 Developed personal skills;
 Re-orient health services
Jakarta Declaration on Leading
Health Promotion into the 21st
Century (1997)
 Strategies and action areas are
relevant for all countries
 Comprehensive approaches to health
development are most effective.
 Setting for health offer practical
opportunities for the implementation of
comprehensive strategies.
 Participation is essential to sustain efforts.
 Health literacy fosters participations.
 Five Priorities
 Promote social responsibility for health;
 Increase investments for health
development;
 Expand partnerships for health
promotion;
 Increase community capacity and
empower the individuals;
 Secure an infrastructures for health
promotion
 ACTIVITIES FOR HEALTH
PROMOTION
 HEALTH APPRAISAL WELLNESS
ASSESSMENT PROGRAM
 Appraise individuals of their risk factors that
are inherited in their lives/family in order to
motivate them to reduce specific risk and
develop positive health habits
 Wellness assessment programs are focused
on more positive methods of enhancement
 LIFE-STYLE AND BEHAVIOR CHANGE
PROGRAM
 Basis for changing behavior
 Geared towards enhancing the quality of life
and extending the life span
 WORKSITE
WELLNESS
PROGRAM
 Includes programs that
serve the needs of the
persons in their work
places
 ENVIRONMENTAL
CONTROL
PROGRAM
 Developed to address
the growing problem of
environment pollution
such as air, land,
water etc.
 DISEASE PREVENTION
 Disease prevention covers measures not
only to prevent the occurrence of
diseases, such as risk factor reduction, but
also to arrest it progress and reduce its
consequences once established. WHO
(1984)
 Disease prevention is sometimes used as
a complementary term alongside health
promotion.
 Although there is frequent overlap
between the content and strategies,
disease prevention is defined saparetly.
 Disease prevention is considered to be
actions which usually emanates from
health sector, dealing with individuals and
populations identified as exhibiting
identifiable risk factors, often associated
with different risk behaviors.
 LEVELS OF DISEASE
PREVENTION
 PRIMARY LEVEL
 Directed towards preventing the initial
occurrence of disease.
 Decreases the risk or exposure of
individual and community to disease.
 Example:
 Health education about accident and poisoning
 Health education about standards of nutrition and
growth and development, exercise requirements,
stress management, protection against
occupational hazard.
 Immunization
 Risk assessments for specific disease
 Family planning services and family counseling
 Environmental sanitation and provision of
adequate housing, recreation and work conditions
 SECONDARY LEVEL
 Focus on early identification of health
problem and prompt intervention to
alleviate health problems.
 Includes prevention of complications and
disabilities.
 Example
 Screening surveys
 Encouraging regular medical and dental
examination
 Teaching self-examination for breast and testicular
cancer
 Assessing growth and development of children
 Maintaining skin integrity, turning, positioning,
exercising client, ensuring adequate rest and
sleep, food and fluid intake, elimination,
administering medical therapies such as
medications
 TERTIARY LEVEL
 Begins after illness, when defect or
disability is fixed or determined to be
irreversible
 Focus to help rehabilitate individuals and
restore hem to an optimal level of
functioning within the constraints of the
disability
 Example:
 Referring client to a support group
 Teaching diabetic client to prevent complications
 Referring client to rehabilitation center
 BAHAVIOR ASSOCIATED WITH
LEVELS OF PREVENTION
 PRIMARY
 Quit smoking and avoid alcohol intake
 Regular exercise and eat well balance diet
 Reduce fat and increase fiber intake
 Take adequate fluid intake
 Maintain ideal body weight
 Complete immunization program
 Avoid over exposure to sunlight and wear
protective gear at work place
 SECONDARY
 Have annual health examination
 Regular pap’s test for women
 Monthly BSE for women (20 and up)
 Sputum examination for tuberculosis
 Anal stool guaiac test and rectal examination
for client 50 y.o. and above
 TERTIARY
 Self monitoring of blood glucose among
diabetic client
 Physical therapy after CVA
 Participate in cardiac rehabilitation after MI
COMMUNITY ORGANIZING
TOWARDS COMMUNITY
PARTICIPATION IN HEALTH
 COMMUNITY
 Comunitas – latin word for group of
individuals
 A community is a group of people sharing
common geographical boundaries and/or
common values and interest/ its functions
within a particular socio-cultural context.
(Maglaya, 2004)
 A community is a collection of people who
interact with each other and whose
common interest or characteristics give
them a sense of unity and belonging.
(Spradley & Allender, 1996)
 Dimensions of a Community
 LOCATION
 POPULATION
 SOCIAL SYSTEM
 LOCATION
1. boundary of the community
2. placement of health services
3. geographical features
4. climate
5. plants and animal (ecosystem)
6. human-made environment
 POPULATION
1. size
2. density
3. composition\rate of growth and decline
4. cultural characteristics
5. social class
6. mobility
 SOCIAL SYSTEM
 health  welfare
 family  political
 economic  recreational
 education  legal
 region  communication
Classifications of a community
 URBAN
 RURAL
 SUB - URBAN
 URBAN
 city
 high density area
 socially heterogeneous population
 complex structure
 complex interpersonal social relations
 non-agricultural occupation
 RURAL
 town - province
 low density area
 having simple life
 close family ties
 people usually spend time in farming and
fishing for foods
 SUB - URBAN
 suburbs
 a combination of an urban and rural
community
 thick population
 heterogeneous with mixed family ties
 Difference between Rural and
Urban Community
Criteria Rural Urban

1. Density of population Less dense Thick dense

2. Social relationship Strong and have close ties and interaction with Face to face contact but usually very casual
the community

3. Social mobility Lesser Greater

4. Social structure No significant difference of wealth, more or There is very wide range of income
less there is even distribution of wealth distribution; few are rich and majority of the
people belong to a lower income

5. Social institution Not very specialized; less in membership; Highly specialized; wide scale institution;
small scale institution more membership

6. Activities Bayanihan is common Paid services

7. Cultural activities Many Few

8. Nature of occupation Agricultural/ non professional White color jobs, professionals

9. Domestic animals Many Few

10. Size Usually small Generally big

11. Choice Based on personal attachment Based on educational attainment, credentials,

achievements, popularity
 HEALTHY COMMUNITY
 A community which is able to:
 collaborate effectively to identify the
needs, concerns and problems of the
community,
 achieve a working consensus on the
agreed-on goals,
 collaborate effectively in the required
actions
 CHARACTERISTIC OF A
HEALTHY COMMUNITY
 prompts its members to a degree of
awareness
 uses its natural resources eg. air to breath,
cooperation, values
 openly recognize the existence of
subgroups and welcome their participation
 prepared to meet crises
 able to solve problems
 has an open channel of communication
 seek to make its system of community
 resources are available for all
 encourage maximum participation in
decision making
 promotes high level of wellness
 Components of a Community
 Core
 Sub system
 CORE
 represents the people that make up the
community
 Social class
 Ethnicity
 Culture
 Beliefs
 Traditions
 SUB - SYSTEM
 HOUSING  HEALTH
 EDUCATION  COMMUNICATION
 FIRE AND SAFETY  ECONOMICS
 POLITICS AND  RECREATION
GOVERNANCE
 HOUSING
 What type of housing facilities are there in
the community?
 Structure, materials, arrangement
 Are there enough housing facilities
available?
 Are there housing laws/regulations
governing the people?
 EDUCATION
 These include laws, regulations, facilities,
and activities affecting educations.
 Ratio of health educators to learners,
distribution of educational facilities
 FIRE AND SAFETY
 Fire protection facilities and fire prevention
activities, and the distribution of these in
the community.
 Peace and order
POLITICS AND GOVERNANCE
 Political structure presents in the
community, decision making process/
patterns leadership style observed etc.
 HEALTH
 Health facilities and activities present,
distribution, utilization, ratio of providers to
clientele served, and priorities in health
programs.
 COMMUNICATION
 Systems, types of communication,
existing, forms of communication be it
formal or informal etc.
 ECONOMICS
 Occupation, types of economic activities,
and income, etc.
 RECREATION
 Recreational activities and facilities
 Type of consumers.
 Elements of a Healthy
Community
 People are partners in health care.
 People work together to attain goals.
 Physical environments promote health,
safety, order and cleanliness.
 Safe water and nutritious food
 Families provide members with basic
needs
 Available, affordable, accessible,
acceptable health care services
 Community Health
 According to Dever :
 fundamental to community health are peace,
shelter, education, food, income, a stable
ecosystem, sustainable resources, social
justice and equity.
 According to Flynn:
 responsibility for health is widely shared in
the community with collaborative decision-
making about health issue. Informed political
action and healthy pubic policies are essential
to healthy community.
 According to Geoppinger:
 community health have 3 dimensions that
are currently assessed by multiple
measures:
 1. STATUS DIMENSION - morbidity,
mortality, life expectancy, risk factors,
consumer satisfaction, mental health,
crime rates, functional levels, and infant
mortality.
 2. STRUCTURAL DIMENSION -
community resources measured by
utilization patterns, treatment data and
providers, population rates, social
indicators measured by dependency
ratios, socio-economic and racial
contribution and education.
 3. PROCESS DIMENSION - effective
community functioning that results in
community competence as evidence by:
commitment, self-awareness and ability
of situational definitions, articulateness,
effective communication, conflict, and
accommodation, participation and
management of relations with large
society.
FACTORS THAT AFFECT
COMMUNITY HEALTH
 POLITICAL
Safety
Oppression
People
SOCIO Empowerment BEHAVIOR
ECONOMIC Culture
Employment Habits
Education, Norms
OLOF
Housing Ethnic Customs
Individuals
Family
ENVIRONMENT Community HEREDITY
Air Genetic
Food, water -defects
Noise HEALTH CARE -risks familial
Radiation DELIVERY ethnic racial
SYSTEM
Promotive, Preventive
Curative, Rehabilitative

FACTOR AFFECTING HEALTH

 POLITICAL
 Politics greatly influence the social climate in
which people live. Political jurisdictions have the
power and authority to regulate the environment.
Examples are safety, oppression and people
empowerment. Increase in crimes and the lack
of safety in streets and even in homes are major
concerns of society. Oppression especially of
the poor, differential treatment in various classes
of society affects health.
 SOCIO-ECONOMIC
 Families from the lower income groups are the
ones mostly served in public health services and
by the community health workers. This is
because, people from the lower income groups
tent to have proportionately greater number of
illnesses and health problems than those in the
higher income groups. However, the middle and
upper income group have also very pressing
health problems such as drug abuse and life-
style diseases.
 HEREDITARY
 Understanding of genetically influenced
diseases is increased through knowledge
about the nature of the genetic materials
and about the process by which genetic
traits are transmitted. Early knowledge of
the genetic risk makes it possible to
anticipate and counteract genetic
outcomes thus enabling the medical team
to prepare for necessary therapeutic
intervention.
 ENVIRONMENT
 The menace of pollution has been growing
over the years and has greatly affected the
health of the people. The diseases today
are largely man made.
 BEHAVIORS/
ATTITUDE/LIFE-STYLE
 A person’s level of functioning is affected
by certain habits that he has. These may
be in form of smoking, intake of alcoholic
drinks, substance abuse and lack of
exercise. The people’s lifestyle, health
care and child rearing practices are
shaped, to a large extent, by their culture
and ethic heritage.
 HEALTH CARE DELIVERY
SYSTEM
 HEALTH CARE DELIVERY SYSTEM. In the
Philippines, primary health care is a partnership
approach to the effective provision of essential
health services that are community based,
accessible, acceptable, sustainable and
affordable. Although promotive and preventive
health measures are emphasized in community
health the availability and accessibility of
curative and rehabilitative services also affect
people’s health.
 COMMUNITY HEALTH
DEVELOPMENT PROCESS
 COMMUNITY, HEALTH,
DEVELOPMENT
 WHO defined community as “ A social
group determined by geographical
boundaries and/or common values and
interests.”
 WHO defined health as “A complete state
of mental, physical, and social well-being
and not merely the absence of disease or
infirmity.”
 Development is defined as:
 a change, a process of unfolding from an un-
manifested condition to more advance or
effective condition. In these process the
qualities reveals possibilities, capabilities
emerge, and potentials are realized.
 A multi-dimensional process involving major
changes in social structures, population,
attitudes and national institutions, as well as
the acceleration of economic growth,
reduction of inequality and eradication of
absolute poverty.
 The goal of development is to have a better
life. (Teodoro, 1978)
 According to NEDA: Development
includes consumption of basic goods and
services such as health and education and
the generation of more productive
employment and reduction of inequalities
in income and access.
 Community Development
 is a process designed to create a condition of
economic and social progress for the whole
community with its active participation and
fullest possible reliance on the community
initiatives.
 This is achieved through:
 Democratic procedures
 Voluntary cooperation
 Self-help
 Development of indigenous leadership
 Education
 How can we say that the community is
developed?
 the people are working together
 have the vision
 know how
 capabilities and experience to confront and
solve problems of under development
 Community development principle is committed
to the services of the people to become self-
reliance.
 Therefore, the health of the community depends
on its ability to work toward common health
goals and upon adequate distribution of health
resources to all members.
 Furthermore, Organized community effort
to prevent disease and promote health is
valuable and effective.
 Approaches to community
development
1. WELFARE APPROACH
2. MODERNIZATION APPROACH
3. TRANSFORMATORY/
PARTICIPATORY APPROACH
 WELFARE APPROACH
 This is an immediate and/or spontaneous
response to ameliorate the manifestation of
poverty, especially on the personal level.
 Assumes that poverty is caused by bad luck,
natural disasters and certain circumstances,
which are beyond the control of the people.
 MODERNIZATION
APPROACH
 This is also referred to as the project
development approach.
 Introduces whatever resources are
lacking in a given community.
 Also considered a national strategy,
which adopts the western mode of
technological development.
 Assumes that development consists of
abandoning the traditional methods of doing
things and must adopt the technology of
industrial countries.
 Believes that poverty is due to lack of
education, lack of resources such as capital
and technology.
 TRANSFORMATORY/
PARTICIPATORY APPROACH
 This is the process of empowering/
transforming the poor and the oppressed
sectors of society so that they can
pursue a more just and humane society.
 Believes that poverty is caused by prevalence
of exploitation, oppression, domination and
other unjust structure.
 COMMUNITY ORGANIZING
PARTICIPATORY ACTION RESEARCH
(COPAR)
 A social development approach that aims
to transform the apathetic, individualistic,
and voiceless poor into a dynamic,
participatory and politically responsive
community.
 A collective, participatory, transformative,
liberated, sustained and systematic process of
building people organizations by mobilizing
and enhancing the capabilities and resources
of the people for the resolution of their issues
and concerns towards affecting change in their
existing oppressive and exploitative conditions.
 A process by which community identifies
its need and objective. Develops
confidence to take action in respect to
them and in doing so extends and
develops cooperative attitudes and
practices in the community.
 A continuous and sustained process of educating the
people to understand and develop their critical
awareness of their existing condition, working with the
people, collectively and efficiently on their immediate
and long term problems, and mobilizing the pursue to
develop their capability and readiness to respond and
take action on their immediate needs toward solving
their long term problems.
 IMPORTANCE OF COPAR
 COPAR – is an important tool for
community development and people
empowerment, as this helps the
community workers to generate
community participation and
developmental activities.
 COPAR – prepares people/clients to
actually takeover the management of
development programs in the future.
 COPAR – maximizes community
participation and involvement; community
resources are mobilized for community
services.
 PRICIPLES OF COPAR
 People especially the most oppressed, exploited
and deprived sectors are open to change, have
the capacity to change, and able to bring about
change.
 COPAR should be based on the interest of the
poorest sectors.
 COPAR should lead to self-reliant community
and society.
PROCESSES AND METHODS
USED
 A PROGRESSIVE CYCLE OF ACTION-
REFLECTION-ACTION (ARA) – which
begins with small, local, and concrete
issues identified by the people and the
evaluation and reflection of actions taken
by them.
 CONSCIOUSNESS RISING – through
experiential learning is centered to the
COPAR process because it places
emphasis on learning that emerges from
concrete action and which enriches
succeeding action.
 PARTICIPATORY AND MASS BASED – it
is primary directed towards and based in
favor of the poor, the powerless and the
oppressed.
 GROUP CENTERED AND NOT LEADER
ORIENTED – leaders are identified,
emerged and are tested through action
rather than appointed or reelected by
some external force or entity.
 PHASES OF COPAR
PROCESS
 PRE-ENTRY PHASE
 ENTRY PHASE
 CORE GROUP FORMATION PHASE
 ORGANIZATION-BUILDING PHASE
 SUSTENANCE AND STRENGTHENING
PHASE
 PRE-ENTRY PHASE
 The initial phase of the organizing
process where the community organizer
looks for communities to serve or help.
 It is considered the simplest phase in
terms of actual outputs, activities and
strategies and time spent for it.
 Activities included:
 Designing a plan for community development,
including all its activities and strategies for care
and development.
 Preparing the health care worker.
 Designing criteria for the selection of site
 Depressed
 Oppressed
 Poor
 Exploited
 Actual selecting the site for community care
 ENTRY PHASE
 Sometimes called the social preparation phase
 This includes the synthesis of the people on
the critical events in their life, motivating them
to share their dreams and ideas on how to
manage their concerns and eventually
mobilizing them to make collective action on
these.
 NOTE:
 Recognize the role of local authorities by
paying them visits to inform them of their
presence and activities.
 Health worker appearance, speech, behavior
and lifestyle should be in kept in low profile
and health workers should always serves as
a role model.
 Avoid raising the consciousness of the
community residents
 Work always with community member to
identify potential leaders.
 This phase signals the actual entry of the
community worker/organizer into the community.
She must be guided by the following:
 Integration with the community
 Conduct of courtesy calls
 Conduct of information campaigns about the community
health development programs
 Conduct of the community study and social investigation
 Provision of health and health related services, and
 Identification of potential leaders
NOTE:
 Recognize the role of local authorities by
paying them visits to inform them of their
presence and activities.
 Health worker appearance, speech,
behavior and lifestyle should be in kept in
low profile and health workers should
always serves as a role model.
 Avoid raising the consciousness of the
community residents
 Work always with community member to
identify potential leaders.
 CORE GROUP FORMATION
PHASE
 Once the community health nurse identifies the
potential leaders, they were formed into a core
group.
 The core group will be given the role of
community organizer.
 Integration with the core group members
 Deepening social investigation
 Training and education
 Mobilizing the core group
 ORGANIZATION-BUILDING
PHASE
 Entails the formation of more formal
structures and the inclusion of more
formal procedures of planning,
implementing, and evaluating
community-wide activities.
 It is at this phase where the organized
leaders or groups are being given trainings
(formal, informal) to develop their ASK
(attitude, knowledge and skills) in
managing their own concerns/programs.
 Other community members are encourage
to join and form a community organization
 Pre-organizationbuilding activities
 Organizing the barrio health committee
 Setting up community organization

 Training and education for the

organization
 SUSTENANCE AND
STRENGTHENING PHASE
 Occur when the community organization
has already been established and the
community-wide undertakings.
 At this point, the different committees set-
up in the organization-building phase are
already expected to be functioning by way
of planning, implementing and evaluating
their own programs, with the overall
guidance from the community-wide-
organization.
 Strategies used:
 Education and training
 Networking and linking
 Conduct of mobilization on health and
development concerns
 Implementation of livelihood projects
 Developing secondary leaders.
 CRITICAL STEPS IN BUILDING
PEOPLE ORGANIZATION
 INTEGRATION
 SOCIAL INVESTIGATION
 TENTATIVE PROGRAM PLANNING
 GROUNDWORK
 MEETING
 ROLE PLAYING
 MOBILIZATION OF ACTIONS
 EVALUATION
 REFLECTION
 ORGANIZATION
 CRITICAL STEPS IN BUILDING
PEOPLE ORGANIZATION
 INTEGRATION – a community organizer
becoming one with the people in order to:
 immerse himself in the poor community
 understand deeply the culture, economy,
leaders, history, rhythms and lifestyle of the
community.
 SOCIAL INVESTIGATION – A
systematic process of collecting,
collating, analyzing data to draw a clear
picture of the community. Also known as
community study
 TENTATIVE PROGRAM PLANNING –
Community organizer to choose one issue
to work on in order to begin organizing the
people.
 GROUNDWORK – Going around and
motivating the people on something or an
issues. A time to spot and develop
potential leader. The entry phase or
sometimes called the social preparation
phase.
 MEETING – Core group formation. People
collectively ratifying what they have
already decided individually. The meeting
gives the people the collective power and
confidence. Problems and issues are
discussed.
 ROLE PLAYING – To act out the meeting
that will take place between the leaders of
the people and the government
representatives.
 MOBILIZATION OF ACTIONS – Actual
experience of the people in confronting the
powerful and the actual exercise power.
 EVALUATION – determines whether the
goal is met or not.

 REFLECTION – dealing with deeper, on-

going concerns to look at the positive
values compared to the ideal.
 ORGANIZATION – the result of many
successive and similar actions of the
people. Occurs when the community
organization has already been established
and the community members are already
participating in a community wide
undertaking.
COMMUNITY HEALTH
NURSING PROCESS
 Assessment of
Community Health Needs
 Community Diagnosis
 A process by which the nurse collects
data about the community in order to
identify factors which may influence the
illness and deaths of the population.
 To formulate a community health
nursing diagnosis and develop and
implement community health nursing
interventions and strategies.
 Steps involved:
 Site selection
 Preparation of the community
 Statement of the objectives
 Determine the data to be collected
 Identify methods and instruments for data
collection
 Finalize sampling design and methods
 Make time table
 Population group
 Vulnerable groups
 Infants and young children
 School age
 Adolescents
 Mothers
 Male
 Old people
 Implementation Phase
 Data collection
 Data organization/collation
 Data preparation
 Data analysis
 Identification of health problems
 Prioritization of health problems
 Development of health care plan
 Validation and feedback
 Community health problems are
categorized as:
A. Health status problem – they may be
described in terms of increased or
decreased morbidity, mortality or fertility
B. Health resources problems – they may
be describe in terms of lack or absence
of manpower, money, materials or
institutions necessary to solve health
problem
c. Health related problems – they may be
described in terms of existence of social,
economic, environmental and political
factors that aggravate the illness-
inducing situation in the community
 Priority Setting
 Criteria:
 nature of the problem presented –the problems are
classified by the nurse as health status, health
resources or health related problems
 magnitude of the problem – this refers to the severity
of the problem which can be measured in terms of the
proportion of the population affected by the problem
 modifiability of the problem – this refers to the
probability of reducing, controlling or eradicating the
problem
 preventive potential – this refers to the probability of
controlling or reducing the effects posed by the problem
 social concern – this refers to the perception of the
population or the community as they are affected by the
problem
 Criteria Weight
Nature of the problem 1
Health status 3
Health resources 2
Health related 1
Magnitude of the problem 3
75% - 100% affected 4
50% - 74% affected 3
25% - 49% affected 2
< 25% affected 1
Modifiability of the problem 4
High 3
Moderate 2
Low 1
Not modifiable 0
Preventive potential 1
High 3
Moderate 2
Low 1
Social concern 1
Urgent community concern 2
Recognized as problem but
not needing urgent attention 1
Not a community concern 0
 Individual, Family, Community
Goal of Care
Assessment Planning nursing Implementation of Evaluation of care
action plan of care and services
rendered
Initiate contact Prioritize needs Put nursing plan into Nursing audit
Demonstrate caring Establish goal base action Care outcomes
attitudes on needs and Coordinate Performance
mutual trust and capabilities of staff care/services appraisal
confidence Construct action and Utilize community Estimate cost
Collect data from all operation plan resources benefit ratio
possible sources Develop evaluation Delegate Assessment of
iIentify health problems parameters Supervise/monitor problems
Assess coping ability Revise plan as health services Identify needed
Analyze and interpret necessary provided alterations
Provide health
data Revise plan as
education and necessary
training
Document
responses to nursing
care
TOOLS USED IN COMMUNITY
DIAGNOSIS: DEMOGRAPHY,
VITAL AND HEALTH
STATISTICS
EPIDEMIOLOGY
 Biostatistics
 Demography
Study of population size,
composition and spatial
distribution as affected by births
and deaths and migration.
 Sources
 Census – complete enumeration of the
population
 De jure –people were assigned to place where
they usually live regardless of where they are at
the time of the census
 De facto –people were assigned to place where
they physically present at the time of the census
 Components

 Population Size
 Population Composition
 Age distribution
 Sex ratio
 Population pyramid
 Median age
 Age dependency ratio
 Other characteristics
 Occupationalgroups, Economic group,
Educational attainment, Ethnic group
 Population Distribution
 Urban – Rural
 Crowding Index – indicates the ease by
which a communicable disease can be
transmitted from one host to another
susceptible host
 Population Density – determine the
congestion of the area/place
 Vital statistics
 The application of statistical
measurements to vital events such as
births, deaths and common illness that is
utilized to gauge the levels of health,
illness and health services of a
community.
 Fertility rate
 Crudebirth rate
 General fertility rate
 Mortality rates  Morbidity rates
 CDR  Prevalence rate
 Specific mortality rates  Incidence rate
 Infant mortality rate
 Neonatal mortality rate
 Post-neonatal rate
 Maternal mortality rate
 HEALTH INDICATORS.
A list of information determined the
health of a particular community
particularly the population.
 TYPES OF HEALTH INDICATORS
 CBR – Crude Birth Rate
 CDR – Crude Death Rate
 IMR – Infant Mortality/Morbidity Rate
 MMR – Maternal Mortality/Morbidity Rate
 NDR - Neonate Death Rate
 IMPORTANCE/IMPLICATION OF
HEALTH STATISTICS
 Itis a tool in planning, implementation
and evaluating health programs.
 Serves as indexes of the health
condition obtaining in a community or
population group.
 Provide variables due as to the nature
of health services or action needed.
 Serves as basis for determining the
success or failure of such services or
actions.
 Crude Birth Rate (CBR )
 Refers to the number of live birth/1000
population (fertility rate).

CBR = # of total registered live birth x 1,000

Estimated mid year population
 Crude Death Rate (CDR)
 Refers to the deaths/1000 population. This
also measures the force of mortality in a 1
year calendar.

CDR = # of total deaths x 1,000

Estimated mid year population
 Infant Mortality Rate (IMR)
 Pertains to the number of death under 1
yr/ 1000 live births

IMR = # of deaths under1 yr. X 1,000

# of registered live births
 Maternal Mortality Rate (MMR)
 Refers to the number of deaths related to
pregnancy/ 1000 population.

MMR = # of deaths related to pregnancy x 1,000

# of registered live births
 Neonatal Death Rate (NDR)
 Refers to the total number of deaths
among individual below 28 days old.

NDR = # of deaths under 28 days x 1,000

# of registered live births
Barangay Wakat, Nagcarlan, Laguna has an
estimated mid year population of 550 for
the year 2007. In the same year 250 live
births are registered at the Municipal Hall.
There are 75 deaths from any cause of
disease, which occurs, in the same year.
There are 7 mothers who died resulting
from pregnancy, labor and delivery at the
same year. 15 babies dies during prenatal
and post natal period.

Compute for the following: CBR, CDR, IMR,

MMR
 Given:
population = 550
# of registered live births = 250
# of registered deaths = 75
# of deaths resulting from pregnancy = 7
# of babies deaths = 15
1. CBR = # of total registered live birth x 1,000
Estimated mid year population

= (250/550) x 1,000
= 454 / 1,000 population

Interpretation: There are 454 live births per

1,000 population
2. CDR = # of total deaths x 1,000
Estimated mid year population
= (75/550) x 1000
= 136 / 1,000 population

Interpretation: There are 136 deaths per

1,000 population
3. IMR= # of deaths under1 yr. X 1,000
# of registered live births

= (15/250) x 1,000
= 0.06/ 1,000 population

Interpretation: There are 0.06 infant mortality

rate per 1,000 population
4. MMR= # of deaths related to pregnancy x 1,000
# of registered live births

= (7/250) x 1,000
= 0.028 / 1,000 population

Interpretation: There are 0.028 maternal

mortality rate per 1,000 population
 Incidence Rate
 This measures the frequency of
occurrence of the phenomenon during a
given period of time. Deals only with new
cases.

No. of new cases of a particular disease

IR = registered during a specific period of time x 100,000
estimated population as of July of same year
 Prevalence Rate
 This measures the proportion of the
population which exhibits a particular
disease at a particular time. This can only
be determined following a survey of the
population concerned. Deals with the total
number of old and new cases.
 No. of new and old cases of a certain
PR = disease registered at a given time x 100
total number of person examined at
same given time
 Epidemiology
 The study of the distribution of disease or
physiological condition among human
populations and the factors affecting such
distribution.
 The study of the occurrence and
distribution of health conditions such as
disease, death, deformities or disabilities
on human populations.
IMPORTANCE AND USES OF
EPIDEMIOLOGY IN PUBLIC
HEALTH

Serve as backbone of the prevention of

diseases
Uses of Epidemiology: according to
Morris
 To study the history of the health
population and the occurrences of disease
 To diagnose the health of the community
and the condition of people
 To study the working of health services
with a view of improving them
 To estimate the risks of disease,
accidents, defects and the chances of
avoiding them
 Factors affecting distribution
 Person
 Intrinsic characteristics
 Place
 Extrinsic factors
 Time
 Temporal patterns
Patterns of Disease Occurrence
 ENDEMIC – places where diseases are
regularly experience; occurrences of disease are
constant. Example: malaria
 EPIDEMIC – when disease occurs in short
duration of time or season. Example: measles,
chickenpox, dengue.
 PANDEMIC – when disease occurs worldwide.
Example: SARS, AIDS, cholera
 SPORADIC - when disease occurs on and off.
Example: rabies, tetanus
 Steps in EPIDEMIOLOGICAL
INVESTIGATION
 Establish fact of presence of epidemic
 Establish time and space relationship of
the disease
 Relate to characteristics of the group in
the community
 Correlate all data obtained
 Establish fact of presence of
epidemic
 Verify diagnosis
 Reporting
 Is there an unusual prevalence of the
disease
 Establish time and space
relationship of the disease
 Are the cases limited to or concentrated in
a particular area
 Relation of cases by days of onset to
onset of the first known cases (usually
done in weeks)
 Relate to characteristics of the
group in the community
 Relation of cases to age, groups, sex,
color, occupation, school attendance, past
immunization.
 Relation of sanitary facilities
 Relation to milk and food supply
 Relation of cases to other cases and
known carriers if any
 Correlate all data obtained
 Summarize the data
 Draw final conclusion
 Establish source of epidemic and the
manner of the spread
 Make suggestions as to the control and
preventions of future outbreaks
 Outline on the operational
procedure during a disease
outbreak
 Organization team
 Epidemiological investigation
 Collection of laboratory specimens
 Treatment of patients and contacts
 Immunization campaign
 Environmental sanitation
 Health education
 Involvement of other agencies
 Reporting
 Health Care Delivery System
 the network of health facilities and
personnel, which carry out the task of
rendering health care to the people.
 Types Services Types of Examples
health
services
Health promotion, Health promotion Information
Primary preventive care and illness dissemination
Continuing care for prevention
common health
problems, attention
to psychological and
social care, referrals
Surgery, medical Diagnosis and Screening
Secondary services by Treatment
specialist

Advances, Rehabilitation PT/OT

Tertiary specialized,
diagnostic,
therapeutic and
rehabilitative care
 Health Sector
 groups of services or institutions in the
community, which is concern with the
protection of the population.
 National
 Local
 Private
 NGO
 DEPARTMENT OF HEALTH
 VISION
 The DOH is the leader, staunch, advocate
and model in promoting HEALTH FOR
ALL in the Philippines
 MISSION
 Guarantee equitable, sustainable, and
quality health care for all Filipinos,
especially the poor, and lead the quest for
excellence in health.
BASIC PRINCIPLES TO ACHIEVE
IMPROVEMENTS IN HEALTH
 Fostering a strong and healthy nation
 Enhancing the performance of the health
sector
 Ensuring universal access to quality
essential health care
 Improving macro-economic and social
conditions for better health
 FOURmula ONE FOR HEALTH
 OVER-ALL GOALS:
 The implementation of FOURmula One for
Health is directed towards achieving the
following end goals, in consonance with
the health system goals identified by the
WHO, the Millennium Development Goals,
and the Medium Term Philippine
Development Plan:
 Better health outcomes
 More responsive health system
 More equitable healthcare financing
 General Objective:
 FOURmula One for Health is aimed at
achieving critical reforms with speed,
precision and effective coordination
directed at improving the quality,
efficiency, effectiveness and equality of
the Philippine Health System in a manner
that is felt and appreciated by Filipinos,
especially the poor.
 Components
 Health Financing
 Health Regulation
 Health Service Delivery
 Good Governance in Health
 Health Financing
 Objective
 To secure more, better, and sustained
investments in health to provide equity and
improved health outcomes, especially for
the poor.
 Strategies
 Mobilizing resources from extra budgetary
sources
 Adopting a performance based financing
system
 Coordinating local and national health
spending
 Focusing direct subsidies to priority program
 Expanding the national health insurance
program
 Health Regulation
 Objective
 Assuring access to quality and affordable
health products, devices, facilities and
services, especially those commonly used
by the poor.
 Strategies
 Harmonizing licensing, accreditation and
certification
 Issuance of quality seals
 Assuring the availability of low-priced
quality essential medicines commonly
used by the poor
 Health Service Delivery
 Objective
 Improving the accessibility and availability
of basic and essential health care for all,
particularly the poor. This shall cover all
public and private facilities and services.
 Strategies
 Designating providers of specific and
specialized services in localities
 Ensuring availability of providers of basic
and essential health services in localities
 Intensifying public health programs in
targeted localities
 Good Governance in Health
 Objective
 Improve the health system both national and
local levels
 Improve coordination across local health
system
 Enhance effective private-public partnership
 Improve national capabilities to manage
health sector
 Strategies
 Estblishisng inter LGU coordination
mechanisms like interlocal health zones
and other model of appropriate local health
systems in the context of devolution.
 Developing performance assessment
systems that cover local, regional and
central health offices
 Institutionalizing a professional career
track mechanisms for human resources for
health
 Improving management support systems
to enhance the delivery of health goods
and services.
 Local Government Unit – with the
process of devolution (decentralization),
the responsibility for health promotion and
protection has become a shared effort
between the LGU’s and the DOH.
 Private Sector - This consists of both
commercial and business organizations and
non- commercial organizations.
 Their involvement includes:
 Inputs provision which covers supplies and
equipments/treatment and facilities
 Service delivery activities includes case findings/
treatment and follow-ups, counseling, environmental
sanitation and to manufacture goods.
 Support research, personnel training, project
monitoring and evaluation and development of IEC
materials.
 Financing through financial assistance
 Non-Government Organizations – plays
an important role in national and local
development.
 They assumed the role of policy and
legislative advocates, organizers, human
rights advocates, research and
documentation, health resources
development personnel, relief and disaster
management and networking.
 Communities, Families and Individuals
– the person who participates and
benefited the health care delivery systems.
 Health Facilities – infrastructures that
offers health services. This includes
hospitals, health centers, health stations,
clinics and laboratories. The government,
private sectors and NGO’s operates these
health facilities today.
 The National Health Care Plan
 A long term plan for health
 The blueprint defining the country’s health
 Goal
 To enable the Filipino population to
achieve a level of health which will allow
Filipino to lead a socially and
economically-productive life, with no
longer life expectancy, low infant mortality,
low maternal mortality and less disability
through measures that will guarantee
access of everyone to essential care.
 Broad objectives:
 Promote equality in health status among
all segments of society
 Address specific health problems of the
population
 Ports
 Physical environment: clean, spacious and
secure, with public waiting areas, passengers
terminals, safe drinking water, sanitary food
shops and public toilets, conveniently and
economically accessible.
 Hotels/Motels
 Physical Environment: clean, safe, pleasant
place, conforms with set of guidelines and
standards, prove comfort and security.
 Street
 Well maintained roads and public waiting
areas
 Well mark traffic signs and pedestrian
crossing line and visible street names
 Clean and obstruction-free sidewalks
 With minimal traffic problems
 With adequate strict law enforcement
 Vehicles
 Clean, safe, comfortable, smoke free, well ventilated,
in good running condition
 Manned by a reliable and dependable licensed
operators
 With posters on health promotion and illness
prevention
 Movie House
 Provides rest, recreation and wholesome
entertainment
 Has sanitary toilets and adequate communication
facilities
 Strategies and Methodologies in
CHN
 Priority for the vulnerable groups
 Infants (0 – 1 year old)
 Children (1 – 4 y.o.)
 Women of reproductive age (15 – 44 y.o.)
 Adolescent
 Elderly

 Key Approach
 PRIMARY HEALTH CARE
 Levels of Health Care
 Health Promotion  Disease Prevention
 Individual wellness
 Family wellness
 Community wellness
 Environmental
wellness
 Social wellness
 Primary
 Secondary
 Tertiary
 Focus on screening
 Case finding
 Contact tracing
 Multi-phasing screening
 surveillance