Community 1

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COMMUNITY
 A group of people with common characteristics or interests living together within a

territory or geographical boundary
 A place where people under usual conditions are found.
 Derived from a Latin word “communitas” which means to give among each other.
HEALTH
WHO – a state of complete physical, mental, and social well - being and not merely the
absence
of a disease.
Modern concept of health refers to Optimum Level Of Functioning { OLOF } of individuals,
families and communities
Factors affecting this OLOF:
1. Political – politics influences the social climate in which people live. Political jurisdiction
has the power to regulate the environment.
2. Behavioral – certain habits that an individual has, affect the person’s level of
functioning.
Examples of habits:
 smoking
 alcoholic drinking
 substance or drug abuse
 lack of exercise
Culture and ethnic heritage greatly shape the people’s lifestyle, health care and child-
rearing practices.
3. Hereditary – involves understanding of genetically – influenced diseases.
Early knowledge of the genetic risks makes it possible to anticipate and counteract
genetic outcomes.
4. Health Care Delivery System – Primary Health Care is a partnership approach to
providing effective health services that are community – based, accessible,
acceptable, sustainable and affordable.
Promotive and preventive health actions and measures are emphasized.
Availability and accessibility of curative and rehabilitative services also affect
people’s health.
5. Environmental Influence – Pollution has greatly affected the health of the people.
Most diseases are man-made. Communicable diseases are caused by:
 Poor sanitation

Poor garbage disposal

Smoking

Air pollution

Utilization of chemicals such as pesticide

Cutting of trees has brought drought and floods.
dumping of organic wastes, detergents
and pesticides continue to threaten man’s supply of food, drinking water
and his health.
6. Socio-economic Influence – Families from the lower income group are the most served
in public health services and by the CHNurse.
This is due to people from this group level tend to have a greater number of
illness
and health problems than those in higher income group.
For the middle and upper income groups, they also have problems such as drug
abuse and life style diseases.
COMMUNITY HEALTH-
Part of paramedical and medical interventions/ approaches which is concerned
on
The health of the whole population.
Aims:
 Health Promotion
 Disease Prevention
 Management of factors affecting health
NURSING – Both profession and vocation. Assisting sick individuals to become healthy and
healthy individuals achieve optimum wellness.
PUBLIC HEALTH – directed towards assisting every citizen to realize his birth rights and
longevity.
THE science and art of preventing diseases, prolonging life, promoting health
efficiency through organized community effort for:
 the sanitation of the environment,

 control of Communicable Diseases
 the education of individual in personal hygiene
 the organization of medical and nursing services for the early dx and preventive
treatment of the disease
 the development of social machinery to ensure everyone a standard of living
adequate for maintenance of health to enable every citizen to realize his
birth right of health and longevity.
Primary Health Care – an essential health care based on practical, scientifically sound and
socially
acceptable methods and technology universally accessible to individuals and families in
the community through their full participation and at a cost that the community can
afford to maintain at every stage of their development in the spirit of self-reliance
and self-determination.
Concepts of PHC:
 accessibility
 community participation or partnership
 appropriate technology
 multi-sectoral linkages
These are all integrated into community health practice
Two major reasons for people’s failure to access essential health care are:
 poverty
 inadequate allocation for health care
Political commitment – there is a need to increase the national health budget until
the total population has access to essential health care.
The National Health Situation – this gives us an idea about the health situation in the
communities
where nurses work.
COMMUNITY HEALTH NURSING :

Accdg. to the WHO Expert Committee of Nsg:r
It is a special field of Nsg that /23combines the skills of nursing, public health ,
some phases of social assistance and functions as part of the total public health
programme for the promotion of health, the improvement of the conditions in the
social, and physical environment, rehabilitation of illness and disability.
Accdg. to Jacobson:
It is a learned practice discipline with the ultimate goal of contributing, as
individuals
and in collaboration with others, to the promotion of the client’s optimum level
of functioning through teaching and delivery of care.
Accdg. to Maglaya et al:
It is 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 diseases and disability, and rehabilitation.
Accdg: to Dr. Ruth B. Freeman:
It is a service rendered by a professional nurse to individuals, families, communities,
population groups in health centers, clinics, schools, workplace for the promotion
of health, prevention of illness, care of the sick at home, and rehabilitation.
GOAL : Ultimate
To raise the level of health of the citizenry by helping communities and families to
cope with the discontinuities in health and threats in such a way as to maximize
their potential for high level wellness and to promote reciprocally supportive
relationship between people and their physical and social environment.
The 2 major fields of Nursing in the Philippines:

1. Community Health Nursing is nursing practice outside the hospital.
 Community health nurses – those who work in RHUs or health centers. They are
officially called Public Health Nurse.
The two subspecialties of CHN are:
1. Occupational Health Nursing or Company Nursing – nursing in the workplace. It
provides and delivers health care services to workers and worker population.
The practice focuses on promotion, protection and restoration of workers
within the context of a safe and healthy work environment.
2. School Health Nursing – aims at promoting the health of school children and
preventing health problems that would hinder their learning and performance
of their developmental tasks.
 Hospital Nursing -
MISSIONS OF CHN:
1. Health Promotion
2. Health Protection
3. Health Balance
4. Disease Prevention
5. Social Justice
PHILOSOPHY OF CHN: Accdg. to Dr. M. Shetland
It is based on the worth and dignity of man.
OBJECTIVES OF CHN:
 Participate in the development in the over-all health plan for the community, in its
implementation and evaluation.
 Provide quality nursing services to individuals, families and communities utilizing
the standards set for community health nursing practice.
 Coordinate nursing services with various members of the health team, community
leaders and SOs, gov’t and non – gov’t agencies/ organizations in achieving the aims
of public health services within the community.
 Participate or conduct researches relevant to community health and community
health nursing services, disseminate their results for improvement of health care.
 Provide community health personnel with opportunities for continuing education
and professional growth through staff development.
PRINCIPLES OF CHN:
1. The community is the patient in CHN. There are four levels of clientele… individual,
family, population group ( children, elderly) and the community.
2. The client is considered as an ACTIVE PARNER NOT PASSIVE RECIPIENT of care.

3. It is based on recognized needs of Individuals, communities, families and population
groups.
4. It must be available to all regardless of race, creed, and socio-economic status.
5. The goal of CHN is achieved through multi-sectoral efforts.
6. It is affected by developments in health available technology, changes in society.
7. The CHNURSE works as a member of the health team.
8. There should be accurate recording and reporting.
9. CHN is a part of health care system and the larger human services system.
ROLES OF THE PUBLIC HEALTH NURSE:
 CLINICIAN – a health care provider, takes care of the sick at home or t the RHU
 HEALTH EDUCATOR – aims towards health promotion and illness prevention
through
dissemination of correct information, educating the people.
 FACILITATOR – establishes multi-sectoral linkages by referral system
 SUPERVISOR – monitors and supervises the performance of midwives
 HEALTH ADVOCATOR – speaks on behalf of the client
 ADVOCATOR – acts on behalf of the client
 COLLABORATOR – works with other member of the health team
*In the event that the Municipal Health Officer is unable to perform his/her duties or functions,
or is not available, the PHN will take charge of his/her responsibilities.
RESPONSIBILITIES OF THE Community Health Nurse

 Be a part in developing an overall health plan, its implementation and evaluation for
communities
 Provide quality nursing services to the three levels of clientele
 Maintain coordination/linkages with other health team members, NGO, gov,t 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
OTHER SPECIFIC RESPONSIBILITIES OF A NURSE, SPELLED BY THE IMPLEMENTING RULES ND

REGULATIONS OF RA 7164 ( PHILIPPINE NURSING ACT OF 1991 )
 Supervision and care of women during pregnancy, labor and puerperium

 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of a physician
 Provision of first aid measures and emergency care
 Recommending herbal and symptomatic meds…etc.
IN THE CARE OF THE FAMILIES:
 Provision of Primary Health Care

 Developmental / utilization of Family Nursing Care Plan in the provision of care
IN THE CARE OF THE COMMUNITIES:
 Community organizing mobilization, community development and people

empowerment
 Case finding and epidemiological investigation
 Program planning, implementation and evaluation
 Influencing executive and legislative individuals or bodies concerning health and
development
STANDARDS IN CHN:
1. Theory
 Applies theoretical concepts as basis for decisions in practice
2. Data Collection
 Gathers comprehensive, accurate data systematically
3. Diagnosis
 Analyzes collected data to determine the needs, health problems of
individuals, families and the community
4. Planning
 At each level of prevention, develops plans that specify nursing actions
unique to needs of clients
5. Intervention
 Guided by the plan, intervenes to promote, maintain or restore health,
prevent illness and institute rehabilitation
6. Evaluation
 Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnoses and plan.
7. Quality Assurance and Professional Development
 Participates in peer review and other means of evaluation to assure quality
of nursing practice
 Assumes professional development
 Contributes to the development of others
8. Interdisciplinary Collaboration
 Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and
evaluating programs for community health
9. Research
 Indulges in research to contribute to theory and practice in community
health nursing
THEORETICAL MODELS/APPROACHES:
1. Health Belief Model – a theoretical model that can be used to guide health
promotion and disease prevention programs.
It is used to explain and predict individual changes in health behaviors.
It is one of the most widely used models for understanding health behaviors.
It shows that people will not change their health behaviors unless they believe that
they are at risk.
It motivates people to take positive health actions that uses the desire to avoid a
negative health consequence as the prime motivation.
According to this model, an individual beliefs about health and health conditions
play a role in determining the health-related behaviors.
The HBM was created in the 1950s by social scientists who wanted to understand
why few people responded to a campaign for TB Screening. They discovered that
people were not participating because they neither have symptoms nor recognized
their susceptibility or risk.
The people thought that taking time for screening is a burden.
The barriers ( not having symptoms and the need to take the test ) outweighed the
perceived benefits. Treatment for TB is needed.
Examples of barriers:
 Amount of effort required

 Danger
 Discomfort
 Expense
 Inconvenience
 Social consequences
Major Concepts of HBM:

1. Perceived susceptibility – defined as one’s belief of the chances of getting a
condition.
Ex. Young people who do not think that they are at risk of lung cancer are less
likely to stop smoking
2. Perceived severity – one’s belief of how serious a condition and its consequences
are.
Ex. Men are less likely to consider or use condom when they think that STDs are
a minor inconvenience.
3. Perceived benefits – one’s belief in the efficacy of the advised action to reduce
risk or seriousness of impact
Ex. People may not get vaccinated if they do not think there is a benefit for
them.
4. Perceived barriers – one’s belief in the tangible and psychological costs of the
advised behavior
Ex. Amount of effort, danger, discomfort, expense, inconvenience, social
consequences
5. Cues to action – strategies to activate readiness. These are external events that
prompt a desire to make a health change.
Ex. Seeing a poster about someone who died of cancer due to smoking
6. Self–efficacy – confidence in one’s ability to take action
Ex. A person gets a vaccine shot once advised
Perceived barrier- refers to a person’s feelings on the obstacles to performing a
recommended health action.
Example: a man who undergoes colonoscopy for the first time might overestimate the
barrier of pain or discomfort he is likely to experience, and this judgment might
cause him to delay scheduling the test.
Perceived benefit – refers to an individual assessment of the value or efficacy of engaging in
a health-promoting behavior to decrease risk of disease.
Example: individuals who believe that wearing sunscreen prevents skin cancer are more
likely
to wear sunscreen.
How does the HBM overcome these barriers?
Disease Prevention Programs can overcome them by:
 Increasing accessibility
 Reducing costs
 Promoting self-efficacy beliefs
2. Milio’s Framework for Prevention – This was developed by Nancy Milio
 It includes community—oriented , population – focused care
 Behavioral patterns of the populations and individuals who make up
populations are a result of habitual selection from limited choices
 The main determinant for unhealthful behavioral choice is lack of knowledge
 It described a sometimes neglected role of community health nursing to
examine the determinants of a community’s health and attempt to influence
those determinants through public policy.
This framework provides that the health status existing in the population occurs due
to too little or excess critical health sustaining resources whereby people who
have enough and safe food, shelter, water and environment are vulnerable to
infectious diseases and too much food will lead to obesity.
Population behavior patterns also affect health since knowledge and perception
are influenced by informal and formal learning and also by experience.
Health is influenced by organizational behavior which includes policy makers since
they provide NOLA options available therefore influencing selections made by
individuals.
3. Nola Pender’s Health Promotion – developed by Nola Pender, a nursing theorist,
author and professor emeritus in nursing.
It notes that each individual has unique personal characteristics and experience
that affect subsequent actions.
Health- promoting behavior is the desired behavioral outcome and is the
end – point in the HPM. It should result in:
 Improved health
 Enhanced functional ability
 Better quality of life at all development stages
This is also designed:
 To be a complementary counterpart to models of health

protection
 To incorporate behaviors for improving health and applies across
the lifespan
Purpose: To help nurses know and understand the major determinants of
health behaviors as a foundation for behavioral counselling to promote
well-being and healthy lifestyles.
Pender’s HPM defines health as a positive dynamic state and not merely
the absence of disease.
Health Promotion is directed at increasing a client’s of well-being.
It describes the multi-dimensional nature of persons as they interact within the
environment to pursue health.
Health-promoting behavior – an end-point or action-outcome toward attaining
positive health outcomes such as optimal wellbeing, personal
fulfillment, and productive living.
Major Concepts of the HPM:

Health promotion – defined as behavior motivated by the desire to increase well-being and
actualize human health potential. It is an approach to wellness.
Health protection or illness prevention – defined as behavior motivated desire to actively
avoid illness, detect it early, or maintain functioning within illness constraints.
This model focuses on the following areas:
 Individual characteristics and experiences – prior- related behavior and personal

factors
 Behavior-specific cognition and affect – perceived benefits of action, perceived
barriers to action, perceived self – efficacy, activity- related affect, interpersonal
influences, and situational influences
 Behavioral outcomes – commitment to a plan of action, immediate competing
demands and health-promoting behavior
Community health care setting is the best avenue in promoting health and preventing illnesses.
Using this model, community health programs may be focused on activities that can
improve people’s well being.
Health promotion and disease prevention can be more easily carried out in the community
programs that aim to cure disease conditions.
4. Lawrence W. GREEN’S PRECEDE – PROCEED MODEL - a cost-benefit evaluation
framework proposed in 1974 by Lawrence W. Green that can help health program
planners, policy makers, and other evaluators, analyze health programs and design
health programs efficiently.
Goals of the model:
 To explain health – related behaviors and environment

 To design and evaluate the interventions needed to influence both the behavior and
living conditions that influence them and their consequences
This model is a comprehensive structure for assessing health needs for designing,
implementing, and evaluating health promotion and other public health programs to
meet those needs.
PRECEDE – provides the structure for planning a targeted and focused public health program.
PROCEED – provides the structure for implementing and evaluating the public health program.
PRECEDE stands for PREDISPOSING,REINFORCING, ENABLING CONTRUCTS in EDUCATIONAL
DIAGNOSIS and EVALUATION.
It involves assessing the following community factors: the 5 phases
 Social assessment: Determine the social problems and needs of a given population and
identify desired results.
 Epidemiological assessment: Identify the health determinants of the identified problems
and set priorities and goals.
 Ecological assessment: Analyze behavioral and environmental determinants that
predispose, reinforce and enable the behaviors and lifestyles identified.
 Identify administrative and policy factors that influence implementation and match
appropriate interventions that encourage desired and expected changes.
 Implementation of interventions.
PROCEED stands for POLICY, REGULATORY and ORGANIZATIONAL CONSTRUCTS in

ENVIRONMENTAL DEVELOPMENT.
It involves the identification of desired outcomes and program implementation: the 4 phases
 Implementation: Design intervention, assess availability of resources, and implement

program.
 Process evaluation: Determine if program is reaching the targeted population and
achieving desired goals.
 Impact evaluation: Evaluate the change in behavior.
 Outcome evaluation: Identify if there is a decrease in the incidence or prevalence of
the identified negative behavior or an increase in identified positive behavior.
This model is community – oriented, participatory model for creating successful health
promotion interventions.
DIFFERENT FIELDS OF NURSING:

Classification of Fields of Nursing in General
1. Hospital or Institutional Nursing
2. Public Health Nursing or Community Health Nursing
3. Private Duty or Special Duty Nursing
4. Industrial or Occupational Health Nursing
5. Nursing Education
6. Military Nursing
7. School Nursing
8. Clinic Nursing
9. Independent Nursing Practice
 Hospital or Institutional Nursing:
Nursing in hospital and related health facilities such as extended care facilities, nursing
homes, neighborhood clinics, comprises all of the basic components of comprehensive
patient care and family health. The concept of the modern hospital as a community health
center where in-patient and out-patient care are continuous, describes the goal of medical
care in most general hospitals.
The educational qualification for beginning practitioner is a Bachelor of Science in
Nursing degree. The nurse as a member of the health care team, participates in all phases of
patient care of the acutely ill, the convalescing and the ambulatory patient. The nurse cares
for the patient in the hospital or in the out-patient department and plans for the nursing
care needs of the patient about to be discharged. The nurse performs the nursing measures
that will meet the patient’s physical, emotional, social and spiritual health needs while in
the institution, and helps the patient and his family plan for his further health care needs
when he returns home. The nurse’s function involve assessment of the patient’s needs for
nursing, and planning for giving or providing the care indicated whether this be personal
care, rehabilitation measures or health instructions. These functions include participation in
the research and training carried on in the hospital, teaching auxiliary personnel, and
assisting in
teaching and supervision of nursing and/or midwifery students, if there are affiliates in the
said institution.
Advantages of Staff Nursing in Hospitals:

1. There is always a supervisor whom one can consult if problems exist.
2. Nurses are updated with new trends in in medicine and in nursing care of
patients.
3. They undergo rotation of different units and have a chance to determine
their special area of choice before they are assigned permanently in one area
such as Medicine, Pediatrics, Surgery, ICU-CCU, Obstetrics, OR, DR, etc.
4. They have 8-hour day and forty-hour week duty which provide for two days
rest away from duty. They have provisions for sick leaves, holidays, and
vacations according to personnel policies of the institution.
5. They have the chance to be promoted to higher positions if they are
qualified.
6. Salary increase are given periodically according to merit system thereby
increased their initiative and best efforts.
7. They are considered an important member of the health team in providing
care to the patient.
8. Most staff development are available in hospitals.
Disadvantages of Staff Nursing in Hospitals:
The disadvantages usually do not outweigh the advantages.
1. There is a great possibility of understaffing which may require nurse to put in
overtime work and sacrifice some of their plans. This is especially true in
hospitals where budget for personnel is limited.
2. Because of the bulk of works, some staff nurses do not find time to improve
their skills through continuing educational programs, or of the hospitals are
far- flung, no continuing education programs are provided.
3. Administrative problems and overwork may tend to dissatisfy the staff nurse.
 Public Health Nursing:
Public health nursing is also called Community health nursing. The National Health
Program of the Philippines gives as much emphasis on the promotion of health and
prevention of diseases rather than care of the sick. It needs a deeper involvement and close
cooperation with all members of the health team such as physicians, nurses,
epidemiologists, dentists, sanitary inspectors, engineers, nutritionists, health educators,
social workers, the community and the barangay leaders.
Effective coordination can be best achieved if all members have an understanding of,
and respect for each other’s function.
Advantages of Public Health Nursing:

1. The focus of nursing care is only on family and community health rather of
than on individual basis. Here, the nurse will be able to see the total picture
of family and community health.
2. It gives the nurse a better perspective of the health conditions of the
community and health programs conceived and implemented by the
government, and to appreciate the nurse’s role in nation building.
3. It maximizes efforts to improvise where there are no sufficient facilities,
supplies, and equipment.
4. It enables the nurse to utilize various community resources and maximize
coordination with other members of the health team.
5. Focus of care is more on educational and preventive aspects. The nurse have
the privilege of contributing to the program for healthy citizenry especially
among the rural poor.
6. Individuals, families and communities are motivated to assume responsibility
for their own health care.
Disadvantages of Public Health Nursing:

1. Cases found in public health nursing are limited mostly to chronic and / or
communicable diseases.
2. There are more hazards in public health than in hospital nursing, such as
exposure to elements ( inclement weather, heat of sun, rain ), dog or snake
bites, accidents, etc.
3. There are no fixed hours of work. The nurse may be called upon any time of
the day or night.
4. Some claim that public health nursing is not as exciting or as glamorous as
hospital work.
5. Facilities for care of the sick are limited so that practice or skills may also be
limited.
6. The PHN may not be immediately aware of changes or trends in the fields of
medicine or nursing.
7. Public health nursing is not a place for introverts. A nurse has to be outgoing
to meet people.
8. There is no immediate supervisor to consult in case of emergency.
 Nurses in In-Service Education Programs:

These are nurses who are in charge of staff development training and research
especially in tertiary hospitals and public health agencies.
They should be skilled in nursing practice, teaching, supervision and consultation.
 Private Duty Nursing:

This is an independent nursing duty that gives comprehensive nursing care to a client on
one-to one ratio. She is an independent contractor. She may provide care to the patient.
They are expected to be expert clinicians as well as expert generalist in nursing. They
use the title Private Duty Nurse, Private Nurse Practitioner, Special Duty Nurse or
Private Duty Nurse Specialist.
 Occupational Health Nursing or Industrial Nursing:
Once called Industrial nursing. It is the specialty practice that provides and delivers
health care services to workers.
It focuses on promotion, protection and supervision of workers’ health within the
context of a safe and healthy work environment.
It is autonomous and Occupational Health Nurses make independent nursing judgments
in providing health services.
Since the nurse works alone in situations where she may have to give immediate care to
serious injuries, she needs to be fully informed about her legal responsibilities.
The patient’s welfare is the first consideration.
The nurse must make use of whatever first aid and nursing measures she judges
necessary bearing in mind her professional limitations.
Emergency or more extreme measures may be used during life -and – death situations.
 Nursing Education:
Refers to formal learning and training in the science of nursing
It is teaching nursing which consists of theoretical and practical training with
the purpose of preparing for the duties as nursing care professionals.
The career ladder in nursing education starts with a Clinical Instructor’s
position up to the Dean of a college of Nursing.
 Military Nursing: The Nurse Corps

It is nursing in the Military. The function is to provide comprehensive and quality
nursing care to military personnel, their dependents and authorized relatives.
 School Health Nursing:
It is providing health care to school children and faculty.

The health program of each school is geared toward making the students and the
faculty understand those programs which emphasize health promotion, prevention
of diseases, and follow-through of any findings that may indicate a need for medical
care and treatment.
It also includes a variety of services like basis screening for vision, hearing and risk
factors that would interfere with the development of a healthy lifestyle.
 Clinic Nursing:
Practice performed in clinics that requires a nurse to possess general skills.
The nurse works for the doctor, acts as a receptionist, answers phone, does the billing,
performs ECGs, changes dressings, give injections, { such as vaccines}, assist in
physical examinations, may even do autoclaving of instruments, keep records, order
and store supplies, make follow up calls and referrals for patients.
Teaching patients and their families has become an important function of the nurse,
therefore, the nurse must have excellent teaching and communication skills, exhibit
organizational and leadership ability, possess good assessment skills, and good
insight in order to anticipate and interpret the needs of the patient.
 Advance Practice Nursing:
It is synonymous with specialization.

It is a practice with specialized education and experience beyond the basic nursing
program.
It is a practice that required the knowledge and skills and supervised skills obtained
through graduate study in nursing (either master’s or doctoral degree ).
It covers the role of the clinical nurse specialist, who is also known as nurse specialist,
nurse clinician or clinical specialist.
The clinical specialist is an expert practitioner within the specialized field of nursing
like nurses who concentrate on cancer, rehabilitation, care of patients with
ostomies, neurological conditions, psychiatry, and other subspecialists.
 Independent Nursing Practice:

The nurse is self- employed and provides professional nursing services to clients or
patients and their families.
The nurse reaches out and offers her services rather than expect clients to seek her
help.
The nurse performs independent and collaborative roles.
The nurse makes referrals and collaborate with physicians and other health members
as needed by the client or family.
The nurse is accountable for her decisions.
Collaborative work is needed for effective, efficient and economical care.
It is therefore essential that an independent nurse practitioner acquire nursing
knowledge of the skills and expertise of other health workers.
COMMUNITY: a group of people sharing common geographic boundaries and / or common

values and interests.
No two communities are alike. The physical environment differs from each other, and
so with the people’s way of coping and behaving. The people are different
from each other.
A community has its own stages of development just like a person.
The development of some communities is fast while others are slow. Therefore, the
responses to problems are inappropriate, inadequate or delayed.
a. Types of community:
1. Rural – an open area of land that has few homes or other buildings and not very
many people. This is often an agricultural or farming area. It is also called
countryside.
2. Urban – an area
 with high density of population
 with availability of basic requirements
 of good resources
 has lots of opportunity of employment
which can be considered as life-giving for luxurious desires of human
or individual
3. Suburban – an area
- of lower density that separates residential and commercial
areas from one another.
 either part of a city or urban area or as a separate residential community
within commuting distance of a city.
In the Philippines, the two kinds of community are:
 rural
 urban
They differ in terms of characteristics:
 physical environment
 population size and density
 economy
 culture political dynamics
 availability and adequacy of social services
 availability and accessibility of health resources
b. Characteristics of a Healthy Community: be it a rural or urban

 awareness that “ we are community “
 conservation of natural resources
 recognition of, and respect for, the existence of subgroups
 participation of subgroups in community affairs
 preparation to meet crises
 ability to problem-solve
 communication through open channels
 resources available to all
 setting of disputes through legitimate mechanisms
 participation by citizens in decision making
 wellness of a high degree among its members
c. Components of a Community: These vary from town to town but these are keys to
discuss when determining a community profile.
1. Effective Community Leadership
 Health communities have and develop leaders who work together to
enhance long term future of the community.
 Leadership must be responsive, honest, efficient, enlightened, fair and
accountable.
 It should have the ability to bring the community together to participate
In open, neutral dialogue on important issues.
 Leaders should be representative of their community and be able to
envision an economically secure environmentally sound and socially
viable future.
 Leaders should understand the challenges facing the community and in
cooperation with neighboring ones.
 Leadership should empower community members to assist in resolving
community issues.
2. Informed Citizen Participation
 Citizens actively participate through voting in local elections, serving on
local boards.
 Attend public hearings
 Be involved in civic organizations and community activities
 All sectors – private, public, and non-profit – must each take responsibility
for the civic education and exchange information with the public.
 All citizens need to develop skills and knowledge to contribute to
community.
3. Sense of Community
 An intangible component but vital of a healthy community
 It encompasses image, spirit, character and pride.
 Increased communication and understanding of different perspectives
among groups is an important factor in establishing a sense of community.
 All members contribute to and hold a common vision for the future
 Villages, towns and cities respect and celebrate their heritage, diversity and
resources
These, share information, develop and sustain an abundance of social networks
and relationships.
4. Fostering Healthy Families
 Addressing concerns such as social issues ( substance abuse, domestic abuse,
poverty, concerns related to the elderly, youth and families) effectively is a
coordinated efforts of the public, private and non-profit sectors.
 Support services such as adequate child day care, comprehensive after-
school, youth, teen and senior programs, preventive health and substance
abuse programs, parenting and family support programs and effective human
service networks help strengthen the social aspect of a community.
 Effective communication, compassionate leadership, active citizen
participation, and intergroup cooperation and a comprehensive supportive
services will enable to nurture healthy community members.
5. Lifelong, Education and Learning

 It is a lifelong endeavor.
 It starts at home, continues through childhood and teen years, and
progresses throughout adult life.
 People of all ages need to develop knowledge and skills in order to improve
their quality of their lives.
 Formal and informal learning opportunities allow community members to
discover their hidden talents and develop interest and skills.
 It allows citizens to manage their lives more effectively.
 It allows citizens to participate in complex municipal operations with greater
knowledge and skills.
6. Community Services, Facilities and Utilities

 A community provides many essential facilities to its members particularly
public facilities such as municipal buildings, schools, parks, pathways and
trails, roads, cemeteries.
 It also provides services and utilities such as police, fire, ambulance, road
maintenance, water and sewer.
These functions consume the majority of taxes and greatly influence the
community’s way of life.
7. Recreation and Cultural Heritage
 Recreational and cultural activities nurture the body and soul – arts, crafts
music, dance, theater, holidays, festivals and celebrations.
 Recreational opportunities allow community members to experience and
appreciate the community’s diversity of natural and human resources.
 Cultural activities reflect and build a community’s positive sense of itself and
strengthen the social interactions within the community.
8. Working Landscape and the Natural Environment
 Recognizes the importance of assets and takes appropriate actions or
measures to assure their continuance
 These assets are the natural resources and historical assets that contribute
significantly to the quality of life for residents and play an important part in
defining community character.
 The lakes, streams, rivers, working farms, forests, clean air wildlife, historic
buildings and ruins, and open lands contribute to the everyday pleasures of
community life.
9. Economic Vitality
 Includes access to a variety of environmentally sound businesses, industries,
and institutions that provide reasonable wages and benefits to workers,
engage in family-friendly policies, provide workers with opportunities to
develop marketable skills and contribute to the overall wellbeing of the
community.
 The private, public and nonprofit sectors are all important in attracting new
investments and in developing new businesses that fits the character of the
community and meet its needs.
 The more money circulating within the community, the more the community
benefits.
 The need to sustain successful workplaces is an important factor to the
health of the community.
10. Growth and Development

 Can manage more effectively its growth through the use of local zoning
districting, ordinances, and planning regulations that guide how land is
divided, used and developed.
 These tools allow the community to regulate the development of residential
areas, commercial districts, and the village centers.
 Diversity of the housing – another important factor in the development of a
community. This encompasses availability, affordability and location which all
affect the lives of the members especially the elderly, low-income families
and the disabled.
11. Transportation
 Roads are needed to get most of us where we need and want to go.
 More vehicles sharing the roads results in increased highway maintenance,
air pollution, and traffic congestion.
 Pedestrian and bicycle travel, broadband/internet based ordered and
delivered goods and services, bus and rail transportation are alternatives to
automobile travel.
d. Factors Affecting Health of the Community
The four major factors are: These are also determinants of health.
 Physical environment
It is where individuals live, learn, work and play. People interact with their
environment through the air they breathe, water they drink, houses they live
in, and the transportation they access to travel.
Clean air and safe water re necessary for good health.
A clean healthy environment is important for people’s physical and emotional
wellbeing.
 Economic environment
This involves factors such as income, employment, education. These
factors affect our ability to make healthy choices, afford medical care and
housing, manage stress and others.
 Social environment
This refers to the culture that the individual was educated or lives in, and
the people and institutions with whom they interact.
It is their society and all surroundings influenced by humans.
It also includes relationships and physical structures.
A well-designed social environment:

 helps foster positive peer relationships
 creates positive interactions between adults and children to achieve
their social goals
 The person’s individual characteristics and behaviors
This refers to a person’s trait, ways, manners, habit, or customs, etiquette
or practices that affect health or mortality.
Specific behaviors are associated with increased risk of specific diseases
and related conditions.
Ex: tobacco use, alcohol consumptions inadequate physical activity, high-fat
diet or low-fiber diet are unhealthful.
Characteristics of a Community:
1. A group of people:
It is the most fundamental or essential characteristics or element of a community.
It may be large or small but community always refer to a group of people.
2. A definite locality:
A group of people forms a community only when they reside in a definite
territory.
Majority of communities are settled and a strong bond of unity and solidarity is
derived from their living in a definite territory.
3. Community Sentiment:
It refers to strong sense of awe feeling or a feeling of belonging together.
4. Naturality:
Communities are naturally organized. It grows spontaneously.
5. Permanence:
Community is always a permanent group.
It refers to a permanent living of individuals within a definite territory.
It is not temporary like a crowd or association.
6. Similarity:
The members of the community are similar in number of ways.
They lead a common life and share some common ways.
They are similar in language, culture, customs, and traditions and others.
Similarities in these respects are responsible for the development of community
sentiment.
7. Wider ends:
Members relate with each other not for the fulfillment of a particular end but
for a variety of ends.
8. Total organized social life:
It means that a community includes all aspects of social life.
Therefore, a community is a miniature society.
9. A Particular Name:
Every community has a particular name by which it is known to the world.
Members of that community are also identified by that name.
Example: people living in the Philippines are known as Filipinos.
10. No Legal Status:
A community has no legal status because it is not a legal person.
It has no rights and duties in the eyes of the law
It is not created by the law of the land.
11. Size of Community:
It is classified on the basis of its size.
It may be big or small.
Village is a small community while a nation or the world is a big community.
Both are essential for human life.
12. Concrete Nature:
Its existence can be seen as people can be seen living in a particular locality.
13. A community exists within society and possesses distinguishable structure which
differentiates it from others.
Location of a Community:
It can be a neighborhood, town, workplace, gathering place, public space, or any
geographically specific place that a of people share, have in common or visit frequently.
Roles of the Community Health Nurse:
1. Clinician
2. Health educator
3. Facilitator
4. Supervisor
5. Health advocator
6. Advocator
7. Collaborator
Activities of the Community Health Nurse:
1. Identifies needs, priorities and problems of individuals, families and communities.
2. Formulates municipal health plan in the absence of the municipal health officer or
the medical doctor.
3. Interprets and implements nursing plan, program policies, memoranda and circular
for the concerned staff personnel.
.
COMMUNITY
HEALTH
absence
of a disease.
functioning.
Examples of habits:
 smoking
rearing practices.
genetic outcomes.
people’s health.
 Poor sanitation
 Poor garbage disposal
 Smoking
 Air pollution
Utilization of chemicals such as pesticide
Cutting of trees has brought drought and floods.
 dumping of organic wastes, detergents
and his health.
illness
COMMUNITY HEALTH-
on
Aims:
longevity.

birth right of health and longevity
Accdg. to the WHO Expert Committee of Nsg:
It is a special field of Nsg that combines the skills of nursing, public health , some
phases of social assistance and functions as part of the total public health
Accdg. to Jacobson:
individuals
and in collaboration with others, to the promotion of of the client’s optimum level
of
GOAL : Ultimate

MISSIONS OF CHN:
6. Health Promotion
8. Health Balance
10. Social Justice
OBJECTIVES OF CHN:
PRINCIPLES OF CHN:
groups.
through
communities
development




empowerment
development
STANDARDS IN CHN:
10. Theory
11. Data Collection
12. Diagnosis
13. Planning
14. Intervention
15. Evaluation
of nursing practice
18. Research
health nursing
they are at risk.

 Danger
 Discomfort
 Expense
 Inconvenience

condition.
are.
them.
advised behavior
consequences
likely
to wear sunscreen.
 Reducing costs
individuals.
 Improved health

protection
the lifespan

factors
Goals of the model:

meet those needs.


program.

15. Military Nursing
16. School Nursing
17. Clinic Nursing
assisting in
said institution.

patients.
qualified.
epidemiologists, dentists, sanitary inspectors engineers, nutritionists, health educators,


the day or night.
hospital work.
limited.
to meet people.




care and treatment.
 Clinic Nursing:

program.

patients and their families. The nurse reaches out and offers her services rather than expect
clients to seek her help.

from each other.
COMMUNITY

HEALTH
absence
of a disease.
functioning.
Examples of habits:
 smoking
rearing practices.
genetic outcomes.
people’s health.
 Poor sanitation
 Smoking
 Air pollution
 Utilization of chemicals such as pesticide
 Cutting of trees has brought drought and floods.
and his health.
illness
COMMUNITY HEALTH-
on
Aims:
longevity.
Accdg. to Jacobson:
individuals
of
GOAL : Ultimate

MISSIONS OF CHN:
11. Health Promotion
13. Health Balance
15. Social Justice
OBJECTIVES OF CHN:
PRINCIPLES OF CHN:
groups.
through
communities
development




empowerment
development
STANDARDS IN CHN:
19. Theory
20. Data Collection
21. Diagnosis
22. Planning
23. Intervention
24. Evaluation
of nursing practice
27. Research
health nursing
they are at risk.

 Danger
 Discomfort
 Expense
 Inconvenience
condition.
are.
them.
advised behavior
consequences
likely
to wear sunscreen.
 Reducing costs
individuals.
 Improved health

protection
the lifespan


factors
Goals of the model:
meet those needs.


program.

25. School Nursing
26. Clinic Nursing
assisting in
said institution.
patients.
qualified.


the day or night.
hospital work.
limited.
to meet people.



care and treatment.
 Clinic Nursing:

program.

help.

from each other.
COMMUNITY

HEALTH
absence
of a disease.
functioning.
Examples of habits:
 smoking
rearing practices.
genetic outcomes.
people’s health.
 Poor sanitation
 Smoking
 Air pollution
 Utilization of chemicals such as pesticide
 Cutting of trees has brought drought and floods.
and his health.
illness
COMMUNITY HEALTH-
on
Aims:
longevity.

Accdg. to Jacobson:
individuals
of
GOAL : Ultimate

MISSIONS OF CHN:
18. Health Balance
20. Social Justice
OBJECTIVES OF CHN:
PRINCIPLES OF CHN:
groups.
through

communities
development




empowerment
development
STANDARDS IN CHN:
28. Theory
29. Data Collection
30. Diagnosis
31. Planning
32. Intervention
33. Evaluation
of nursing practice
36. Research
health nursing
they are at risk.

 Danger
 Discomfort
 Expense
 Inconvenience

condition.
are.
them.
advised behavior
consequences
likely
to wear sunscreen.
 Reducing costs
individuals.
 Improved health

protection
the lifespan


factors
Goals of the model:

meet those needs.

program.

34. School Nursing
35. Clinic Nursing
assisting in
said institution.

patients.
qualified.


the day or night.
hospital work.
limited.
to meet people.




care and treatment.
 Clinic Nursing:

program.

help.

from each other.
COMMUNITY
HEALTH
absence
of a disease.
functioning.
Examples of habits:
 smoking
rearing practices.
genetic outcomes.
people’s health.
 Poor sanitation
 Smoking
 Air pollution
Utilization of chemicals such as pesticide
Cutting of trees has brought drought and floods.
and his health.
illness
COMMUNITY HEALTH-
on
Aims:
longevity.

Accdg. to Jacobson:
individuals
of
GOAL : Ultimate

MISSIONS OF CHN:
23. Health Balance
25. Social Justice
OBJECTIVES OF CHN:
PRINCIPLES OF CHN:
groups.
through
communities
development




empowerment
development
STANDARDS IN CHN:
37. Theory
38. Data Collection
39. Diagnosis
40. Planning
41. Intervention
42. Evaluation
of nursing practice
45. Research
health nursing
they are at risk.

 Danger
 Discomfort
 Expense
 Inconvenience

condition.
are.
them.
advised behavior
consequences
likely
to wear sunscreen.
 Reducing costs
individuals.
 Improved health

protection
the lifespan

factors
Goals of the model:

meet those needs.


program.

43. School Nursing
44. Clinic Nursing
assisting in
said institution.

patients.
qualified.


the day or night.
hospital work.
limited.
to meet people.




care and treatment.
 Clinic Nursing:

program.

help.

from each other.

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 A group of people with common characteristics or interests living together within a

 the sanitation of the environment,

COMMUNITY HEALTH NURSING :

The 2 major fields of Nursing in the Philippines:

2. The client is considered as an ACTIVE PARNER NOT PASSIVE RECIPIENT of care.

RESPONSIBILITIES OF THE Community Health Nurse

OTHER SPECIFIC RESPONSIBILITIES OF A NURSE, SPELLED BY THE IMPLEMENTING RULES ND

 Supervision and care of women during pregnancy, labor and puerperium

 Provision of Primary Health Care

 Community organizing mobilization, community development and people

 Amount of effort required

Major Concepts of HBM:

This is also designed:

 To be a complementary counterpart to models of health

Major Concepts of the HPM:

 Individual characteristics and experiences – prior- related behavior and personal

 To explain health – related behaviors and environment

PROCEED stands for POLICY, REGULATORY and ORGANIZATIONAL CONSTRUCTS in

 Implementation: Design intervention, assess availability of resources, and implement

DIFFERENT FIELDS OF NURSING:

 Hospital or Institutional Nursing:

Advantages of Staff Nursing in Hospitals:

 Public Health Nursing:

Advantages of Public Health Nursing:

Disadvantages of Public Health Nursing:

 Nurses in In-Service Education Programs:

 Private Duty Nursing:

 Occupational Health Nursing or Industrial Nursing:

 Military Nursing: The Nurse Corps

 School Health Nursing:

It is providing health care to school children and faculty.

 Advance Practice Nursing:

It is synonymous with specialization.

 Independent Nursing Practice:

COMMUNITY: a group of people sharing common geographic boundaries and / or common

b. Characteristics of a Healthy Community: be it a rural or urban

5. Lifelong, Education and Learning

6. Community Services, Facilities and Utilities

10. Growth and Development

A well-designed social environment:

 the sanitation of the environment,

The 2 major fields of Nursing in the Philippines:

RESPONSIBILITIES OF THE Community Health Nurse

OTHER SPECIFIC RESPONSIBILITIES OF A NURSE, SPELLED BY THE IMPLEMENTING RULES ND

 Supervision and care of women during pregnancy, labor and puerperium

 Provision of Primary Health Care

 Community organizing mobilization, community development and people

 Amount of effort required

Major Concepts of HBM:

This is also designed:

 To be a complementary counterpart to models of health

 Individual characteristics and experiences – prior- related behavior and personal

 To explain health – related behaviors and environment

PROCEED stands for POLICY, REGULATORY and ORGANIZATIONAL CONSTRUCTS in

 Implementation: Design intervention, assess availability of resources, and implement

DIFFERENT FIELDS OF NURSING:

 Hospital or Institutional Nursing:

Advantages of Staff Nursing in Hospitals:

 Public Health Nursing:

Advantages of Public Health Nursing:

Disadvantages of Public Health Nursing:

 Nurses in In-Service Education Programs: