Professional Documents
Culture Documents
Community Health Nursing
Community Health Nursing
NURSING
Content Outline
Part 1 Definition of Terms
Part 2 Basic Principles of CHN
Part 3 Roles and Functions of the PHN
Part 4 Levels of Care
Part 5 Levels of Clientele
Part 6 Health Care Delivery System
Part 7 Primary Health Care
Part 8 Ten Herbal Plants Recommended by
the DOH
Part 9 Family Nursing Process
Part 10 Community Diagnosis
Part 11 COPAR
Part 12 Selected Public Health Situation
Part 13 Vital Statistics
Part 14 Epidemiology
Part 15 Demography
Part 16 Target Setting
Part 17 Environmental Sanitation
Part 18 DOH National Events
PART 1 DEFINITION OF TERMS
A. Public Health
• Science and Art of Preventing Disease, Prolonging Life,
Promoting Health and efficiency through organized community
effort for the sanitation of the environment, control of
communicable diseases, the education of individuals in personal
hygiene, the organization of medical and nursing services for the
early diagnosis and preventive treatment of disease, and the
development of social machinery to ensure everyone a standard
of living adequate for the maintenance of health, so organizing
these benefits as to Enable Every Citizen to Realize His Birthright
to Health and Longevity
- Dr. C.E. Winslow
• Art of applying Science in the Context of Politics so as to Reduce
Inequalities in Health while ensuring the best health for the
greatest number
- WHO
B. Public Health Nursing
• Special Field of Nursing that combines the skills of nursing, public
health, and some phases of social assistance and functions as
part of the total public health program for the promotion of
health, the improvement of the conditions in the social and
physical environment, rehabilitation of illness and disability.
- WHO
C. Community Health Nursing
• Service rendered by a professional nurse with communities,
groups, families, individuals at home, in health centers, in clinics,
in schools, in places of work for the promotion of health,
prevention of illness, care of the sick at home and rehabilitation.
- Ruth B. Freeman
• Nursing Practice in a wide variety of community services and
consumer advocate areas, and in a variety of roles, at times
including independent practice… community nursing is certainly
not confined to public health nursing agencies.
- Jacobson
• The utilization of the Nursing Process in the Different Levels of
Clientele-Individuals, Families, Population Groups and
Communities, concerned with the Promotion of Health,
Prevention of Disease and Disability and Rehabilitation
- Dr. Araceli Maglaya
B. Philosophy of CHN
• A philosophy is defined as a system of beliefs that provides a
basis for a guides action. A philosophy provides the direction and
describes the whats, the whys, and the hows of activities within a
profession.
• CHN Practice is guided by the following beliefs:
Humanistic values of the nursing profession upheld
Unique and distinct component of health care
Multiple factors of health considered
Active participation of clients encouraged
Nurse considers availability of resources
Interdependence among health team members practiced
Scientific and up-to-date
Tasks of CHN vary with time and place
Independence or self-reliance of the people is the end goal
Connectedness of health and development regarded
Part 3 Roles and Functions of the Public Health Nurse
A. Roles of the CHN
• Clinician or Health Care Provider: utilizes the nursing process in
the care of the client in the home setting through home visits and in
public health care facilities; conducts referral of patients to appropriate
levels of care when necessary
• Health Educator: utilizes teaching skills to improve the health
knowledge, skills and attitude of the individual, family and the
community and conducts health information campaigns to various
groups for the purpose of health promotion and disease prevention
• Coordinator and collaborator: establishes linkages and
collaborative relationships with other health professionals, government
agencies, the private sector, non-government organizations and
people’s organizations to address health problems
• Supervisor: monitors and supervises the performance of midwives
and other auxiliary health workers; also initiates the formulation of
staff development and training programs for midwives and other
auxiliary health workers as part of their training function as supervisors
• Leader and Change Agent: influences people to participate in the
overall process of community development
• Manager: organizes the nursing service component of the local health
agency or local government unit; also, as program manager, the PHN
is responsible for the delivery of the package of services provided by
the health program to target clientele
• Researcher: participates in the conduct of research and utilizes
research findings in practice
B. Responsibilities of the CHN
• Be a part in developing an overall health plan, its implementation and
evaluation for communities.
• Provide quality nursing services to the four levels of clientele
• Maintain coordination/linkages with other health team members, NGO/
government agencies in the provision of public health services
• Conduct researches relevant to CHN services to improve provision of
health care
• Provide opportunities for professional growth and continuing education
for staff development
C. Specialized Fields of CHN
• Community Mental Health Nursing: a unique clinical process which
includes an integration of concepts from nursing, mental health, social
psychology, psychology, community networks, and the basic sciences
• Occupational Health Nursing: the application of nursing principles
and procedures conserving the health of workers in all occupation
• School Health Nursing: the application of nursing theories and
principles in the care of the school population
Part 4 Levels of Care
A. The Three Levels of Health Care Services
• Primary Level of Care: devolved to the cities and
municipalities and is the first contact between the community
people and the different levels of health facility; refers to health
care provided by the health center staff
• Secondary Level of Care: rendered by physicians with basic
health training in district hospitals, provincial hospitals, and city
hospitals; these facilities are capable of basic surgical procedures
and simple laboratory examinations; serves as referral center of
primary health facilities
• Tertiary Level of Care: rendered by specialists in medical
centers, regional hospitals and specialized hospitals like the Lung
Center of the Philippines; serves as the referral center of
secondary health facilities
B. Three levels of Health Care Services and the Two-Way Referral
System
National Health
Services, Medical TERTIAR
Centers, Tertiary
Teaching and Y
Training Hospitals
Regional Health
Services,
Regional Medical
Centers
and Training Hospital
Provincial/City Health Services, Provincial /City SECONDAR
Hospitals
Y
B. Family
-defined by Murray and Zentner is a small social system and
primary reference group made up of two or more persons living
together who are related by blood, marriage or adoption or who are
living together by arrangement over a period of time.
C. Population Groups
- a group of people sharing the same characteristics,
developmental stage or common exposure to particular environmental
factors thus resulting in common health problems
* Vulnerable groups:
• Infants and young children
• School age
• Adolescents
• Mothers
• Males
• Older People
D. Community
-a group of people sharing common geographic boundaries
and/or common values and interests
MAJOR PLAYERS
• Public Sector- largely financed thru tax-based budgeting system at
both the national and local levels and where health care is generally
given free at the point of service
a. National Level – Department of Health as lead agency
b. Local Health system run by local government units
MAYOR
• Conceptual Framework:
a. Health is a fundamental human right
b. Health is both an individual and collective responsibility
c. Health should be an equal opportunity to all
d. Health is an essential element of socio-economic
development
• Translated into action, the PHC APPROACH focuses
on:
Partnership with the community
Equitable distribution of health resources
Organized and appropriate health system infrastructure
Prevention of disease and promotion of health as focus
Linked multisectorally
Emphasis on appropriate technology
Ulasimang Bato
Indications: lowers serum uric acid in cases of gouty
arthritis
Preparation: Salad or decoction
Bawang
Indications: lowers serum cholesterol
Preparations: may be roasted, soaked in vinegar or used
for sautéing
Bayabas
Indications: its antiseptic properties is best used for wound
cleansing, as mouthwash in cases of oral cavity infections
and gingivitis
Preparation: decoction
Yerba Buena
Indications: for muscle pain
Preparation: decoction
Sambong
Indications: its diuretic effect is good for edema and
against urolithiasis
Preparation: decoction
Ampalaya
Indications: for diabetes mellitus or non-insulin dependent
diabetes
Preparation: decoction or steamed
Niyug-niyogan
Indications: for intestinal infestation with ascaris
lumbricoides
Preparation: prepare dried, mature niyug-niyugan seeds
Tsaang gubat
Indications: stomachache
Preparation: decoction
Akapulko
Indications: ringworm, tinea flava, athlete’s foot and other
types of fungal infection
Preparation: poultice or Ointment
*GUIDELINES
• Chemical pesticides or insecticides may leave toxic
residues on plants. These should not be used on herbal
plants
• Use palayok or clay pots and wooden spoon when cooking
herbal medicines, Remove the pot cover when the herbal
preparation starts to boil
• Use only the plant part recommended
• Use the appropriate herbal plant for each sign and
symptom observed
• Watch out for allergic reactions. STOP the use of herbal
plant preparation when allergic and untoward reactions are
observed
• Always keep the herbal medicine containers properly
labeled
• Always keep the herbal preparations out of reach of
children
• RA 8423: utilization of medicinal plants as alternative for
high cost medications
Policies:
The indications/uses of plants
The part of plant to be used
Preparation of herbal medicines
Part 9 Family Nursing Process
Initial Data base
a. Family structure and characteristics
b. Socio-economic and cultural factors
c. Environmental factors
d. Health assessment of each member
e. Value placed on prevention of disease
Problem Prioritization
a. Nature of the Problem
Wellness condition
Health deficits
Health threats
Foreseeable crisis
b. 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
c. Modifiability of the Condition – refers to the probability of
success in enhancing the wellness state, improving the
condition, minimizing, alleviating or totally eradicating the
problem through intervention
d. Salience – refers to the family’s perception and evaluation of
the problems in terms of seriousness and urgency of attention
needed
4. Health Resources
-refer to manpower, institutional and material resources provided
not only by the state but also those that are contributed by the
private sector and other non-government organizations
2. Implementation
a. Actual data gathering
b. Collation/ organization of data
c. Presentation of data
d. Analysis of data
e. Identifying the community health nursing problems
i. Health Status Problems – may be described in terms
of increased or decreased morbidity, mortality or
fertility
Part 11 COPAR
A. Definitions
A social development approach that aims to transform the
apathetic, individualistic, and voiceless poor into dynamic,
participatory and politically responsive community
A process by which a community identifies its needs and
objectives, develops confidence to take action in respect to them
and in doing so, extends and develops cooperative and
collaborative attitudes and practices in the community
B. Importance of COPAR
As important tool for community development and people
empowerment as this helps the community workers to generate
community participation in development activities
Prepares people/clients to eventually take over the management
of a development program/s in the future
Maximizes community participation and involvement; community
resources are mobilized for community services
C. Principles of COPAR
People, especially the most oppressed , exploited and deprived
sectors are open to change, have the capacity to change, and
are able to bring about change
COPAR should be based on the interests of the poorest sectors of
society
COPAR should lead to self-reliant community and society
Health Indicators
Birth
Death
Marriages
Migration
Mortality Rates
CrudeNumber
DeathofRate
deaths in a
year
= X
Midyear Population, 1000
same year
a. Crude because death is affected by different factors
b. Widely used because of availability of data
Specific Mortality Rate
Number of deaths in
specified group
= X
Midyear Population, 1000
same year
a. Made specific according to:
Age
Sex
Occupation
Education
Exposure to risk factors
Combination of the above
b. More valid than CDR when comparing mortality experiences
between group
Cause-of-Death Rate
Number of deaths in
specified cause
= X
Midyear Population, 1000
a. same
Crudeyear
rate since the denominator includes the whole
population
b. Could be made specific by relating the deaths from a specific
cause and group to the mid-year population of that specific
group
Swaroop’s Index
Morbidity Rates
Incidence Rate
No. of NEW CASES of disease developing from a
=
period of time
X 100,000
Population in the area during the same period of time
a. Measures the development of a disease in a group exposed to
the risk of the disease in a period of time
b. Can be made specific for age and sex
Attack Rate
No. of NEW CASES of disease developing from a
period of time
= X 100
Population at risk of developing the disease
during the same period of time
a. Used for a limited population group and time period, usually
during an outbreak or epidemic
Prevalence Rate
a. Useful in describing the occurrence of chronic conditions and
as basis for making decisions in the administration of health
services
b. Useful also in computing for carrier rates and antibody levels
A. Point Prevalence
No. of existing (Old and New Cases) of a disease
=
at a given time
X 100
Population examined during that time
B. Period Prevalence
No. of existing (Old and New Cases) of a
= disease at a given interval time
X 100
Population examined during that interval time
Part 14 Epidemiology
A. VERIFICATION OF A DIAGNOSIS
-stating one’s definition of a disease/ diagnosis based on the
presenting signs and symptoms
Consider Two Factors:
1. Sensitivity – indicates the strength of association between a
sign/ symptom and the disease; picks up most cases and
avoids FALSE NEGATIVES
2. Specificity – shows the uniqueness of the association
between a sign/ symptom and the disease; excludes non
cases or avoids FALSE POSITIVES
Part 15 Demography
A. DEMOGRAPHY
The empirical, statistical and mathematical study of human population;
derived from two Greek word snyos, which means people and ypagly
which means to draw or write
= Number of females
X
100
2. Population Distribution
a. Urban – Rural Distribution – shows the proportion of people
living in urban compared to the rural areas
3. Population Size
a. Natural Increase – difference between the number of births
and the number of deaths that occurred in a specific population
within a specified period of time
TARGET-SETTING
-Involves the calculation of the eligible population for immunization
services. Since the Universal Child Immunization goal of 80% was achieved
in 1989, the target for immunizations since 1992 onwards has increased to
90%. The two most important goals are the following:
Sustainability of the high coverage and,
Maintenance of quality immunization Services
A. Eligible Population
1. Infants – for EPI in a barangay, municipality, district, province/city
and region, target setting is based on 3% of the total population
3. Pregnant Women – All pregnant women are eligible for EPI. Target
Setting must include the number of pregnancies that will terminate
in live births (3% of the total population) plus the number of the
pregnancies (0.5% of the total population); thus, the percentage of
eligible women in the total population is 3.5%
ANNUAL VACCINE NEEDS PER VIAL DOSE = Annual Vaccine / Dose per
ENVIRONMENTAL SANITATION
-is defined as the study of all factors in man’s physical environment which
may exercise a deleterious effect on his health, well-being and survival
COMPONENTS:
Water Supply Sanitation Program
Proper Excreta and Sewage Disposal Program
Insect and Rodent Control
Food Sanitation Program
Hospital Waste Management Program
Strategies on Health Risk Minimization due to Environmental Pollution