COMMUNITY HEALTH NURSING

FOCUS: Promotion and Preservation of the health of populations

NATURE OF PRACTICE: comprehensive, general, continual and not episodic
KNOWLEDGE BASE: from nursing and public health
LEVELS OF CLIENTELE: individuals, family, population groups and community as a whole
COMMUNITY - A group of people sharing common geographic boundaries and common values
and interests.
HEALTH- state of complete physical, mental and social well-being, not merely the absence of
disease or infirmity
WORLD HEALTH ORGANIZATION - Optimum level of individuals, families and communities
MODERN CONCEPT OF HEALTH - This factor pertains to the power and authority to regulate
the environment

FACTORS AFFECTING LEVEL OF FUNCTIONING

POLITICAL - This factor pertains to the  Substance abuse

power and authority to regulate the  Lack of exercise
environment
Examples: SOCIOECONOMIC INFLUENCES
 Safety Components
 Oppression  Employment
 People empowerment  Education
 Housing
HEALTH CARE DELIVERY SYSTEM - One
component of this factor is the primary ENVIRONMENTAL INFLUENCES
health care which is a partnership approach Components
Goal: Effective provision of health services  Air
that are community-based and accessible  Food
Components:  Water waste
 Promotive  Urban/rural noise
 Preventive  Radiation
 Curative  Pollution
 Rehabilitative
HEREDITY
BEHAVIORAL Components
Components  Genetic endowment
 Culture  Defects
 Habits  Strengths
 Ethnic customs  Risks:
Examples  Familial
 Smoking  Ethnic
 Intake of alcoholic drinks  Racial
 PUBLIC HEALTH NURSING
Public health as the science and art of preventing disease, prolonging life and efficiency to
enable every citizen to realize his birthright of health and longevity ( Winslow)

Public health is dedicated to the common attainment of the highest level of physical, mental
and social well-being and longevity
GOAL: contribute to the most effective total development and life of the individual and his
society. (Hanlon)

Community health nursing is a learned practice discipline

Ultimate Goal : contribute to the promotion of client’s optimum level of functioning
Through teaching and delivery of care. (Jacobson)

Community health nursing is a service rendered by a professional nurse with the community,
groups, families and individuals
GOAL: promotion of health, prevention of illness, care of the sick at home and rehabilitation
(Freeman)

Philosophy of community health nursing is based on the worth and dignity of man. (Shetland)

CONCEPTS OF COMMUNITY HEALTH NURSING

 HEALTH PROMOTION – primary focus of community health nursing practice
 Practice is extended to benefit not only the individual but the whole family and
community
 Community health nurses are GENERALISTS

PRINCIPLES OF COMMUNITY HEALTH NURSING

 Community health nursing is based on recognized needs of communities, families,
groups and individuals
 The community health nurse must understand fully the objectives and policies of the
agency she represents
 FAMILY – unit of service
 Community health nursing must be available to all
 HEALTH TEACHING – primary responsibility of the community health nurse
 The community health nurse works as a member of the health team
 There must be periodic evaluation
 Opportunities for continuing staff education program must be provided
 PRINCIPLES OF COMMUNITY HEALTH NURSING
 Make use of available community health resources
 Utilize existing active groups in the community
 Educative supervision
 Accurate recording and reporting
ULTIMATE GOAL: Raise the level of health of the citizenry

ROLES OF THE NURSE IN COMMUNITY HEALTH NURSING

Clinician – focus on the health of the individuals on the larger context of the community
Advocate – promote self-care and self-determination
Collaborator – brings together strengths and weaknesses of people involved toward a common
goal
Researcher – utilizes data to predict future phenomenon and modify interventions
Counselor – key tasks include listening and providing feedback and information
 Case Manager – oversees all aspects of care to facilitate delivery of cost-efficient care; to
individualize and coordinate care
Educator – provide knowledge, skills and attitudes that people need to make appropriate
choices or decision
Hospice Care – providing care skills in a home and other settings and balancing client’s needs

 Construct action and operation plan

 Devise evaluation parameters
 Revise plan as needed

IMPLEMENTATION - translation of
care plan into action
STEPS:
 Put nursing plan to action
THE NURSING PROCESS  Coordinate care / services
ASSESSMENT - Process of collecting and  Utilize community resources
processing data/information about the  Delegate and supervise
client  Monitor health services provided
STEPS:  Provide health education and
 Initiate contact training
 Demonstrate caring attitudes  Document responses to nursing
 Develop mutual trust and action
confidence
 Collect data from all possible EVALUATION - process of making
sources judgments as to the extent the objectives
 Identify problems are met
 Analyze and interpret data STEPS:
 Care outcomes
 Performance appraisal
PL PLANNING - formulation of steps to be  Estimate cost benefit ratio
undertaken to achieve desired end  Assessment problems
STEPS:  Identify needed alterations
 Prioritize needs  Revise plans as necessary
 Establish goals based on needs and
capabilities

CATEGORIES OF HEALTH PROBLEMS

HEALTH DEFICIT
 A gap between actual and achievable health status
 Instances of failure in health maintenance
 Possible precursors of health deficit:
 History of repeated infections or miscarriages
 No regular health check-up
Examples:
 ILLNESS states, diagnosed or undiagnosed
 Failure to thrive/develop
 Disability
Transient (aphasia or temporary paralysis after a CVA)
Permanent (leg amputation secondary to diabetes, blindness from
measles, lameness from polio)

HEALTH THREAT - conditions that are conducive to disease, accident or failure to realize one’s
potential
 Examples:
 Family history of hereditary disease
 Threat of cross infection
 Accident hazards
 Faulty eating habits
 Poor environmental sanitation
 Unhealthy lifestyle/personal habits

FORESEEABLE CRISIS - anticipated periods of unusual demand on the individual or family in

terms of adjustment/family resources
Examples:
 Marriage
 Pregnancy
 Parenthood
 Divorce or separation
 Loss of job
 Menopause
 Death

PRIORITIZING HEALTH PROBLEMS

NATURE OF THE PROBLEM – categorized into health deficit, health threat and foreseeable crisis
Health deficit 3
Health threat 2
Foreseeable crisis 1

MODIFIABILITY OF THE PROBLEM – refers to the probability of success in minimizing,

alleviating or totally eradicating the problem through intervention
Easily modifiable 2
Partially modifiable 1
Not modifiable 0

PREVENTIVE POTENTIAL –refers to the nature and magnitude of future problems that can be
minimized or totally prevented if intervention is done on the problem under consideration
High 3
Moderate 2
Low 1

SALIENCE – refers to the family’s perception and evaluation of the problem in terms of
seriousness and urgency of attention needed
A serious problem, immediate attention needed 2
A problem, but not needing immediate attention 1
Not a felt need / problem 0

EVALUATION OF CARE AND SERVICES PROVIDED

STRUCTURAL ELEMENTS - include the physical settings, instrumentalities and conditions

through which nursing care is given
Components:
 Philosophy
 Objectives
 Building
 Organizational structure
 Financial resources (budget, equipment, staff)
PROCESS ELEMENTS - steps of the nursing process ( assessment, planning, implementing and
evaluating)
Components:
 Taking the family health database
 Performing physical examination
 Making a nursing diagnosis
 Determining nursing goals
 Writing a nursing care plan
 Performing nursing interventions
 Coordination of services
 Measuring success of nursing actions

OUTCOME ELEMENTS - changes in the client’s health status that result from nursing
interventions
COMPONENTS
 modification of signs and symptoms
 Knowledge
 Attitude
 Satisfaction
 Skill level of client
 Compliance with treatment regimen

NURSING PROCEDURES
PRE-CONSULTATION CONFERENCE
1. Greet and make client at ease
2. Take clinical history
3. Take temperature, blood pressure, height and weight
4. Perform physical assessment
5. Do laboratory examinations
6. Write findings on client records

MEDICAL EXAMINATION
1. Assist client before, during and after examination by physician
2. Inform physician of relevant findings gathered in pre-conference
3. Work with the physician during the examination
4. Ensure privacy, safety and comfort of patient throughout procedure
5. Observe confidentiality of examination results
Nursing Intervention:
1. Carry out physician’s orders as giving medication or injection
2. Explain and reinforce physician’s orders and advises
3. Teach patient measures to promote and maintain health as proper diet, exercise
and
Personal hygiene.
4. Seek information regarding health status of other family members
5. Counseling

PRE-CONSULTATION CONFERENCE
1. Explain findings and needed care or intervention
2. Refer patient to other health worker/agency
3. Make appointment for next clinic/home visit

DEPARTMENT OF HEALTH
VISION: Health for all Filipinos

MISSION: Ensure accessibility of health care to improve the quality of life of the Filipinos
especially the poor

NATIONAL HEALTH OBJECTIVES

 Improve the general health status of the population
 Reduce morbidity, mortality, disability and complications
 Eliminate the following diseases as public health problems (schistosomiasis, malaria,
filariasis, leprosy, rabies, measles, tetanus, diphtheria, pertussis, vitamin A and iodine
deficiency)
 Eradicate poliomyelitis
 Promote healthy lifestyle
 Promote health and nutrition of families and special populations
 Promote environmental health and sustainable development

BASIC PRINCIPLES TO ACHIEVE IMPROVEMENT IN HEALTH

 Ensure universal access to basic health services
 Epidemiological shift from infectious to degenerative disease must be managed
 Enhance the performance of the health sector
 Ensure the prioritization of the health and nutrition of vulnerable groups

PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS

 Support for frontline health workers and local system development
 Assurance of health care
 Increasing investment for primary health care
 Development of national standards and objectives for health

- Dental health program

- Osteoporosis prevention
- Health education and community organizing

- Primary health care

- Reproductive health
- Older persons health service
- Guidelines for good nutrition
- Respiratory Infection Control
- Alternative health care
- Maternal and child care
- Sentrong Sigla Movement

PRIMARY HEALTH CARE

 Essential health care made universally acceptable to individuals and families in the
community
 By means acceptable to them and through their full participation
 At a cost that the community and country can afford at every stage of development

ESSENTIAL HEALTH CARE SERVICES

GOAL : Health for all Filipinos and Health in the Hands of the People by the year 2020
MISSION : To strengthen the health care system wherein people will manage their own health
care
CONCEPT : partnership and empowerment of the people
LEGAL BASIS:
  Letter of Instruction 949
 President Ferdinand Marcos
 October 19, 1979
 First International Conference on Primary Health care
 Alma Ata, USSR
 September 6-12, 1978
 Sponsored by the World Health Organization and UNICEF

ELEMENTS/COMPONENTS of PHC
- Education for Health
- Locally Endemic Disease Control
- Expanded Program on Immunization
- Maternal and Child Health
- Essential Drugs and Elderly Care
- Nutrition
- Treatment of CD and Non-CD
- Sanitation: Water and Environment

ORGANIZATIONAL STRATEGY
 Framework for meeting the goal of primary health care
 Calls for active and continuing partnership among the communities, private and
government agencies in health development

LEVELS OF HEALTH CARE SERVICES

PRIMARY
 Barangay Health Station
 Private Practitioners
 Community Hospitals
 Rural Health Unit
SECONDARY
 Emergency/District Hospitals
 Provincial/City Hospitals
TERTIARY
 Regional Medical Centers
and Training Hospitals
 National Medical Centers
 Teaching and Training
Hospital
TWO LEVELS OF PHC WORKER
 VILLAGE / BARANGAY HEALTH WORKERS (V/BHWs)
- Trained community health workers
- Health auxiliary volunteer
- Traditional birth attendant or healer

 INTERMEDIATE LEVEL HEALTH WORKERS

- General medical practitioner
- Public health nurse
- Rural sanitary inspector
- Midwives