Community Health Nursing

Community Health Nursing

1. Goal: __________________________________________________________________
2. Nature of practice: _______________________________________________________
3. Knowledge base: _________________________________________________________
4. The different levels of clientele - ___________________ ____________________
____________________
5. Recognize: ______________________________________________________________

Important Concepts
 Emphasis: “____________________________________________________________”
 Nursing Process:
 Priority of health: _______________________________________________________________

 CHN and PHN - ________________________________

 Public Health Nurses - _____________________________________
 Community Health Nurses - _____________________________________

Other Definitions
1. __________________________________ - a state of complete, physical, mental, and social well-being, not
merely the absence of disease or infirmity
2. ___________________________________ - the science and art of preventing disease, prolonging life,
promoting health through organized community effort, as to enable every citizen to realize his birthright and
longevity.
3. ________________________________________________________ - special field of nursing that combines
the skills of Nursing, public health and some phases of social assistance
4. _______________________________________ - service rendered by a professional nurse with communities,
families, individuals for the promotion of health, prevention of illness and rehabilitation
5. ______________________________ - Community Nursing is certainly not confined to public health nursing
agencies
6. ___________________________________ - a service that is available to all people
7. _________________________________ - HIGH LEVEL WELLNESS – an integrated method of functioning which
is oriented toward maximizing the potential of the individual/people
8. __________________________________ - “Man is of worth and dignity”

Subspecialties of Community Health Nursing

1. ___________________________________________ - specialty practice that provides for and delivers health
care services to workers and worker population
 Focus: _________________________________________________
 AUTONOMOUS - __________________________________________________
 Emphasis : __________________________________________________________
 ____________________ – assisting workers to cope with actual and potential stresses in relation to work
 OHNAP - _________________________________________________________________________
2. ____________________________________________ - aims at promoting the health of school children and
preventing health problems that would hinder their learning and performance of their developmental tasks
 __________________________________________________

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 Clients of the Community Health Nurse
1. ________________________________
2. ________________________________
3. ________________________________
4. ________________________________

Philippine health care delivery system (PHCDS)

Sectors:
1. ______________________________
2. ______________________________

 NATIONAL LEVEL - __________________________

 LOCAL HEALTH SERVICE - ______________________________________
 ____________________ - Local Government Code
 Aims to transform local government units into SELF RELIANT COMMUNITIES

Department of Health
 Exercises regulatory powers over health facilities and products
 Takes the lead in the formulation of policies and standards related to health
 __________________ - ROLES of the DOH
1. _______________________________________________
2. _______________________________________________
3. _______________________________________________
 VISION: _________________________________________________________
 MISSION: ________________________________________________________________________
 GOAL: _________________________________________________________

 _____________________________________________ - framework for the implementation of HSRA

1. __________________________________
2. __________________________________
3. __________________________________
4. __________________________________

Millennium Developmental Goals (MDGs)

1. Eradicate extreme poverty and hunger
2. Achieve Universal Primary Education
3. Promote gender equality and empower women
4. Reduce Child Mortality
5. Improve Maternal Health
6. Combat HIV/AIDS, Malaria and other diseases
7. Ensure Environmental Sustainability
8. Develop a Global Partnership for Development

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Roles and Functions of the Public Health Nurse
Section 28 of RA 9173
1. Utilize the nursing process
2. Establish linkages with community resources and coordination with the health team
3. Provide health education to individuals, families and communities
4. Teach, guide and supervise in nursing education in various settings
5. Undertake nursing and health human resource development, training and research

Department of Health
1. Management
a. Plan and organizes the nursing services of the health unit
b. Participates in the preparation of the municipal health plan
c. Participation in the implementation of the municipal health plan
d. Implements the nursing service plan
e. Monitors and evaluates the implementation of the nursing service plan
f. Initiates changes for the improvement of services
g. Manages the RHU in the absence of the Rural Health Physician
2. Training
 Participates in meeting the training needs of ___________________________________________________
3. Supervision - ________________________________________________
4. Provision of health and nursing care - _____________________________________________________
5. Health education - __________________________________________________________
6. Coordination

Qualifications for Nursing Practice

Nurse Education Experience

Community Health Nursing Process

1. ASSESSMENT
 Categories of Health Problems
a. Health Deficit - _______________________________________________________________________
b. Health Threat - _______________________________________________________________________
c. Foreseeable Crisis - ___________________________________________________________________

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  Health need - ________________________________________
 Health problem -_________________________________________

2. PLANNING – based on actual and potential problems that were IDENTIFIED and ______________________
 Prioritizing Health Problems
1. Nature of the Problem - _________________________________________________________________
2. Magnitude of the Problem - ______________________________________________________________
3. Preventive Potential - ___________________________________________________________________
4. Salience - _____________________________________________________________________________
STEPS IN PLANNING
a. Goal setting
b. Constructing a plan of action
c. Developing an operational plan

3. IMPLEMENTATION OF PLANNED CARE

 ___________________________________________________________________
 Maintain ______________________________________ of the client
 Monitor health services provided, make proper referrals as necessary
 Important: __________________________________________________

4. EVALUATION – interwoven in every nursing activity and every step

Nursing Procedures in the Community

1. Clinic Visit - ______________________________________________________________
 _______________________________________ - a pre-clinic lecture is usually conducted prior to the
admission of patients, which is one of providing health education

 STANDARD PROCEDURES
1. Registration and admission - ___________________________________________________________
2. Waiting time- _______________________________________________________________________
3. Triaging - ___________________________________________________________________________
4. Clinical evaluation - ___________________________________________________________________
5. Laboratory and other diagnostic exams - __________________________________________________
6. Referral system - _____________________________________________________________________
7. Prescription / Dispensing - _____________________________________________________________
8. Health education - ___________________________________________________________________

2. Home Visit - ________________________________________________________________

 __________________________________________________________

 Principles
1. A home visit must have a _______________________________________________
2. Make use of all available information - _______________________________________
3. Give priority to essential needs
4. Planning and delivery of care should INVOLVE the individual and family
5. The plan should be __________________________________

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  Guidelines to consider regarding FREQUENCY of home visits
1. ___________________________________________________________
2. ___________________________________________________________
3. Needs of the individual and the family
4. Policy of agency towards health programs
5. Number of health personnel already involved in the care
6. Past services given to the family

 Steps
1. ___________________________________________________________________________
2. ___________________________________________________________________________
3. Observe the patient and determine health needs
4. Put the bag in a convenient place then proceed to perform the bag technique
5. Perform the nursing care needed and give health teachings
6. Record all important data, observation and care rendered
7. Make appointment for return visit

HEALTH EDUCATION
 Process – knowledge, attitude, practice of people are changed
 Aim: improved health
 Basic service and shared by heath team
 Steps:
a. ____________________________
b. ____________________________
c. ____________________________

________________________________________ - a tool by which the nurse, during her visit will enable her to
perform a nursing procedure with ease and deftness, to save time and effort, with the end view of rendering
effective nursing care to clients
________________________________________ - an essential and indispensable equipment of a public health nurse
which she has to carry along during her home visits.
 Principles of the BAG TECHNIQUE
1. ________________________________________________________
2. Saves time and effort
3. Shows effectiveness of total care
4. Can be performed in a variety of ways

 Important POINTS to consider in the use of the bag

1. Should contain all the necessary articles to answer emergency needs
2. Contents should be cleaned often, supplies replaced, and ready for use anytime
3. Contents should be well protected
4. Arrangement should be most convenient to the user

COPAR_____________________________________________________________
is a continuous and a sustained process of:
1. _______________________________
2. _______________________________
3. _______________________________
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it is both a:
__________________________
__________________________

Emphasis of COPAR: ______________________________________________

Importance of COPAR: ____________________________________________

PHASES OF COMMUNITY ORGANIZING

1. _____________________________ - is the initial phase of the organizing process where the community
organizer looks for communities to serve and help.
ACTIVITIES
1. Preparation of the institution
2. Site Selection
 Initial networking with ______________________________
 Conduct __________________________________________ - gathering initial data
 Make long/short list of potential communities.
 Do ocular survey of listed communities.
3. Criteria for Initial Site Selection
 M______________________________________________________________________________
 E______________________________________________________________________________
 N______________________________________________________________________________
 N______________________________________________________________________________
 N________________________________________________________ ______________________
4. Identifying Potential Municipalities
5. Identifying Potential Barangay
6. Choosing Final Barangay
7. Identifying Host Family
 ______________________________________________________________________________
 ______________________________________________________________________________
 ______________________________________________________________________________
 ______________________________________________________________________________
 ______________________________________________________________________________

2. ______________________________________
- Sometimes called the _________________________________________
o Is crucial in determining which strategies for organizing would suit the chosen community.
Guidelines for Entry
 Recognize the role of local authorities by paying them visits to inform their presence and activities.
 Appearance, speech, behavior and lifestyle should be in keeping with those of the community residents
without disregard of their being role model.
 Avoid raising the consciousness of the community residents; adopt a low-key profile.

ACTIVITIES
1. ___________________________________- establishing rapport with the people in continuing effort to
imbibe community life.
 living with the community
 seek out to converse with people where they usually congregate
 lend a hand in household chores
 avoid gambling and drinking

2. ______________________________________

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 - verification and enrichment of data collected from initial survey
3. Core Group Formation
 Leader spotting through _______________________________________
__________________________ - approached by most people
__________________________ - approach by key person
__________________________- never or hardly consulted

3. _________________________________________________________
- Entails the formation of MORE FORMAL STRUCTURE and the inclusion of MORE FORMAL PROCEDURE
of planning, implementing, and evaluating community-wise activities

ACTIVITIES
 _____________________________________
 preparation of legal requirements
 guidelines in the organization of the CHO by the core group
 election of officers
 Research Team Committee
 Planning Committee
 Health Committee Organization
 Formation of by-laws by the CHO

4. ___________________________________________________________
- Occurs when the community organization has already been established and the community members are
already actively participating in community-wide undertakings

ACTIVITIES
 Training of CHO for monitoring and implementing of community health program.
 Identification of secondary leaders.
 Linkaging and networking.
 Conduct of mobilization on health and development concerns.
 Implementation of livelihood projects.

5. __________________________________________ - WHEN THE COMMUNITY IS ABLE TO STAND ON THEIR

OWN FEET AND UTILIZE THEIR OWN RESOURCES

Primary Health Care

- Essential health care made universally acceptable to individuals and families in the community (WHO)
• 1st International Conference on PHC (Alma Ata, USSR on Sept, 1978) by WHO
• ______________ – October 19, 1979 by Ferdinand Marcos

Goal: ___________________________________________________________________
Underlying theme: __________________________________________________________________
Concept: _____________________________________________________________________
4 A’s:
a. ________________________________________
b. ________________________________________
c. ________________________________________
d. ________________________________________

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4 Cornerstones:
1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
4. _______________________________________________________________________________

TWO LEVELS OF PRIMARY HEALTH CARE WORKERS

1. ___________________________________________________ - trained community health workers or health
auxiliary volunteer or a traditional birth attendant or healer.
2. ___________________________________________________ - general medical practitioner or their
assistants. Public Health Nurse, Rural Sanitary Inspectors and Midwives compose these groups.

Appropriate Technology
- provision of socially and environmentally acceptance level of service at a least economic cost
Criteria
 Feasible
 Acceptance
 Simple
 Effective and safe
 Inclusive of technology

Example:
ORS – _____________________________
ORS - _____________________________
DOSAGE:
• Infant – _________________
• Child – __________________
• Adult – __________________
Others:
 Moxibustion
 Ventusa
 Aroma therapy
 Massage

__________________________________- a method of maintaining health, treating diseases and alleviating pain by

applying pressure or massaging certain points on the body surfaces.
_____________- life energy
_____________- negative feminine energy
_____________- positive masculine force
There should be _________________ between YIN and YANG to achieve good health.
_______________________- painful spots or nodes which appear when a person has an illness
_____________________________- using patient’s own hands or fingers as a basis for measurement:
______Tsun- thumb
______ tsun-two fingers
______- 3 fingers
______- 4 fingers

Herbal Medicines:
R.A. ____________ – Alternatives for high cost medicines.
__________________________________- asthma, cough, fever

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__________________________________- pain, rheumatism, arthritis, cough and colds, swollen gums, toothache,
menstrual and gas pain, nausea and fainting, insect bites, pruritus.
__________________________________- anti-edema, diuretic, anti-urolithiasis
__________________________________- diarrhea, stomachache
__________________________________- anti-helminthic
__________________________________- washing of wounds, diarrhea, toothache
__________________________________- antifungal
__________________________________- uric acid
__________________________________- lowers cholesterol, toothache
__________________________________- diabetes mellitus- mild non-insulin dependent

Epidemiology
 __________________________________________________________
 EPIDEMIOLOGY is the _________________________________ of the prevention of illness

Levels of Prevention of Health Problems

1. Primary prevention –
________________________________________________________________________
2. Secondary Prevention –
______________________________________________________________________
3. Tertiary prevention –
________________________________________________________________________

Epidemiologic Triangle

Agent

Envir
onm Host
ent

Patterns of OCCURRENCE and DISTRIBUTION

1. Sporadic - ___________________________________________________________
2. Endemic - ___________________________________________________________
3. Epidemic - __________________________________________________________
4. Pandemic - __________________________________________________________

_____________________________
- Refers to the systematic study of vital events such as births, illnesses, marriages, divorces, separation and
deaths
 Statistics of death - __________________________
 Statistics of illness - __________________________
 ______________________________ - source of statistics
 Births and deaths are registered in the _______________________________________________________
 __________________________- shows relationship between a vital event and those persons exposed to the
occurrence of said event, WITHIN A GIVEN AREA AND DURING A SPECIFIED PERIOD OF TIME.
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  __________________________- used to describe the relationship between 2 numerical quantities or
measures of events WITHOUT TAKING PARTICULAR CONSIDERATION TO TIME AND PLACE.
 __________________________- referred to the total living population.
 __________________________- the relationship is for a specific population class or group.

o ___________________________- natural growth or increase in population.

o ____________________________- a measure of one mortality from all causes which may result in a decrease of
population
o ____________________________- measures the risk of dying during the 1st year of life
o ____________________________- measure the risk of dying from causes related to pregnancy, childbirth, and
puerperium
o ______________________________- measures pregnancy wastage
o ____________________________- measures the risk of dying the 1st month of life
o ____________________________- describes more accurately the risk of exposure of certain classes or groups to
particular diseases
o _____________________________- measures the frequency of occurrence of the phenomenon during a given
period of time
o ______________________________- measures the proportion of the population which exhibits a particular
disease at a particular time
o _____________________________- a more accurate measure of the risk of exposure

o _____________________________ (Death Ratios) - shows the numerical relationship between death from a cause
(or groups of causes), ages (or groups of age) etc. and the total no. of deaths from all causes in all ages taken
together. Not a measure of risk of dying.
o _______________________________- index of the killing power of a disease. It is influenced by incomplete
reporting and poor morbidity data.
o _____________________________ - measures death among people 50 years old and above

Presentation of data:
________________________ - shows peaks, valleys and seasonal trends. Also used to show the trends of birth and
death rates over a period of time
________________________ - expresses a quantity in terms of rates or percentages of a particular observation like
cause of death and illness
________________________ - shows the relative importance of parts to the whole

Functions of the Nurse:

 Collects data
 Tabulates data
 Analyzes and interprets data
 Evaluates data
 Recommends redirection and/or strengthening of specific areas of health programs as needed

Environmental Health and Sanitation

______________________________
- Branch of public health that deals with the study of preventing illnesses by managing the environment and
changing people’s behavior to reduce exposure to biological and non – biological agents of disease and injury
______________________________
- The study of all factors in man’s physical environment, which may exercise a deleterious effect on his health,
well-being and survival
______________________________________
- Responsible for the promotion of healthy environmental conditions and prevention of environmental diseases
through appropriate sanitation strategies

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Sanitation Code of the Philippines: _________________________

Water Supply and Sanitation Program

Approved types of water supply facilities

Level 1 _______________________________________________________
- Protected well or developed spring with an outlet but without a _______________________
- Normally serves around ______________________ households and its outreach must not be more than
____________ meters from the farthest user
Level 2 _______________________________________________________
- A system composed of a source, a reservoir
- Piped distribution network and _______________ faucets
- Designed to deliver to an average of ______________ households with one faucet per 4 to 6 households
- Generally suited for rural areas where houses are _____________
Level 3 _______________________________________________________
- A system with a source, a reservoir, a piped distribution network, and household taps
- Generally suited for densely populated urban areas
- Requires minimum treatment or disinfection

Unapproved types
- Water from doubtful sources
 Require quality standards that meet provisions of the National Standards for drinking water set by
_________________________
 The examination of drinking water shall be performed only in private or government laboratories duly
accredited by _________________________________
 Certificate of potability of an existing water source is issued by _______________________________ or his
duly authorized representative (local health authority)

Proper Excreta and Sewage Disposal

Approved types
Level 1
 _______________________________________ - no water is necessary to wash the waste into the receiving
space. (pit latrines, reed odorless earth closet)
 Toilet facilities requiring small amount of water to wash the waste into the receiving space. (pour flush toilet
and aqua privies)
Level 2
 On site toilet facilities of the water carriage type with water – sealed and flush type with
_______________________ disposal facilities
Level 3
 Water carriage types of toilet facilities connected to ___________________ and to
_________________________

Laws on Sanitation
__________________ - Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990
__________________ - Clean Air Act of 1999
__________________ - Ecological Solid Waste Management Act of 2000
__________________ - Clean Water Act of 2004

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