NCM104: Community Health

Nursing II

Community health
nursing
Presented by: Group 7

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 Content
• Introduction

• A Typology of Nursing

Problems in Family Nursing

Practice

• Family Health Assessment

What is community ?

A collection of people who interact

with one another & whose common
interests or characteristics form the
basis for a sense of unity or
belonging. (Allender et al)
What is community ?

A group of people who shares

common interests, who interact with
each other & who function
collectively within a defined social
structures to address common
concerns. (Clark)
HEALTH A state of complete physical, m
& social well-being & not mere
ental
ly the
absence of disease or infirmit
y”.
(WHO)

Public Health Nursing: the term

us ed
before Community Health Nursi
ng - Pr
evention of
Disease
According to Dr. C.E.
- Prolonging life
Winslow, Public
Health is a science &
- Promotion of health
art of 3 P’s and efficiency through
organized community
effort
 COMMUNITY HEALTH NURSING

• Special field of nursing that combines the skills of

• The utilization of the nursing process in the different
nursing, public health, and some phases of social
levels of clientele-individuals, families, population
assistance and functions as part of the total public
groups and communities, concerned with the
health program for the promotion of health, the
promotion of health, prevention of disease and
improvement of the conditions in the social and
disability and rehabilitation.
physical environment, rehabilitation of illness and
disability. (WHO Expert Committee of Nursing)
Mission of CHN
• Health Promotion

• Health Protection

• Health Balance

• Disease prevention

• Social Justice
Philosophy of CHN

hy o f C H N i s b as e d
• The phi lo s o p
r t h a n d d i g n i ty of
on t h e w o
M . S h et l a n d )
man.(Dr.
Basic
Principles of
CHN
• The community is the patient in CHN, the family is
the unit of care and there are four levels of
clientele: individual, family, population group (those
who share common characteristics, developmental
stages and common exposure to health problems –
e.g. children, elderly), and the community.
• In CHN, the client is considered
as an ACTIVE partner NOT
PASSIVE recipient of care
 • CHN practice is affected by
developments in health technology, in
particular, changes in society, in
general
• The goal of CHN is achieved through
multi sectoral effort.
• CHN is a part of health care system
and the larger human services system.
ROLES AND
RESPONSIBILITIE
S OF A
COMMUNITY
HEALTH NURSE
The seven major roles are:

• Manager

• Collaborator

• Clinician • Leader

• Educator • Researcher
• Advocate
FIRST LEVEL
ASSESSMENT
Presented by: Group 7

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 I. PRESENCE OF WELLNESS
CONDITION
Stated as potential or Readiness-a clinical or nursing judgment about a
client in transition from a specific level of wellness or capability to a
higher level. Wellness potential is a nursing judgment on wellness state or
condition based on client’s performance, current competencies, or
performance, clinical data or explicit expression of desire to achieve a
higher level of state or function in a specific area on health promotion
and maintenance. Examples of this are the following
II. POTENTIAL FOR ENHANCED
CAPABILITY FOR:
• Healthy lifestyle-e.g. nutrition/diet, exercise/activity

• Healthy maintenance/health management

• Parenting

• Breastfeeding

• Spiritual well-being-process of client’s developing/unfolding of

mystery through harmonious interconnectedness that comes

from inner strength/sacred source/God (NANDA 2001)

 III. READINESS FOR
ENHANCED CAPABILITY FOR:
• Healthy lifestyle

• Health maintenance/health management

• Parenting

• Breastfeeding

• Spiritual well-being

• Others. Specify.
 IV. PRESENCE OF HEALTH
THREATS
conditions that are conducive to disease and accident, or
may result to failure to maintain wellness or realize
health potential.

Examples of this are the following:

IV. PRESENCE OF HEALTH
THREATS
A. Presence of risk factors of specific diseases (e.g.
lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from communicable disease
case
C. Family size beyond what family resources can
adequately provide
IV. PRESENCE OF HEALTH
THREATS
D. Accident hazards specify:
-Broken chairs
-Pointed /sharp objects, poisons and medicines
improperly kept
-Fire hazards
-Fall hazards
-Others specify:
IV. PRESENCE OF HEALTH
THREATS
:E. Faulty/unhealthful nutritional/eating habits or
feeding techniques/practices. Specify:
-Inadequate food intake both in quality and quantity
-Excessive intake of certain nutrients
-Faulty eating habits
-Ineffective breastfeeding
-Faulty feeding techniques
IV. PRESENCE OF HEALTH
THREATS
F. Stress Provoking Factors. Specify:
-Strained marital relationship
-Strained parent-sibling relationship
-Interpersonal conflicts between family members
-Care-giving burden
IV. PRESENCE OF HEALTH
THREATS
G. Poor Home/Environmental Condition/Sanitation.
Specify:
-Inadequate living space
-Lack of food storage facilities
-Polluted water supply
-Presence of breeding or resting sights of vectors of
diseases
IV. PRESENCE OF HEALTH
THREATS
-Improper garbage/refuse disposal
-Unsanitary waste disposal
-Improper drainage system
-Poor lightning and ventilation
-Noise pollution
-Air pollution
 IV. PRESENCE OF HEALTH
THREATS

H. Unsanitary Food Handling and Preparation

 IV. PRESENCE OF HEALTH
THREATS
I. Unhealthy Lifestyle and Personal
Habits/Practices. Specify:
-Alcohol drinking
-Cigarette/tobacco smoking
-Walking barefooted or inadequate footwear
-Eating raw meat or fish
-Poor personal hygiene
IV. PRESENCE OF HEALTH
THREATS
-Self medication/substance abuse
-Sexual promiscuity
-Engaging in dangerous sports
-Inadequate rest or sleep
-Lack of /inadequate exercise/physical activity
-Lack of/relaxation activities
-Non use of self-protection measures (e.g. non use of
 IV. PRESENCE OF HEALTH
THREATS
J. Inherent Personal Characteristics-e.g. poor impulse
control

K. Health History, which may Participate/Induce the

Occurrence of Health Deficit, e.g. previous history of
difficult labor.
 IV. PRESENCE OF HEALTH
THREATS
L. Inappropriate Role Assumption- e.g. child assuming
mother’s role, father not assuming his role.

M. Lack of Immunization/Inadequate Immunization

Status Specially of Children
 IV. PRESENCE OF HEALTH
THREATS
N. Family Disunity such as:
-Self-oriented behavior of member(s)
-Unresolved conflicts of member(s)
-Intolerable disagreement
-Others. Specify._________
 V. PRESENCE OF HEALTH
DEFICITS
instances of failure in health maintenance.
Examples include:

A. Illness states, regardless of whether it is diagnosed

or undiagnosed by medical practitioner.

B. Failure to thrive/develop according to normal rate

 V. PRESENCE OF HEALTH
DEFICITS
C. Disability - whether congenital or arising from illness;
transient/temporary (e.g. aphasia or temporary
paralysis after a CVA) or permanent (e.g. leg
amputation secondary to diabetes, blindness from
measles, lameness from polio)
 VI. PRESENCE OF STRESS
POINTS/FORESEEABLE CRISIS
SITUATIONS
Anticipated periods of unusual demand on the individual
or family in terms of adjustment/family resources.
Examples of this include:
 VI. PRESENCE OF STRESS
POINTS/FORESEEABLE CRISIS
A. Marriage SITUATIONS
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
 VI. PRESENCE OF STRESS
POINTS/FORESEEABLE CRISIS
I. Menopause
SITUATIONS
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________
SECOND-LEVE
L ASSESSMENT
Presented by: Group 7

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 I. INABILITY TO RECOGNIZE
THE PRESENCE OF THE
CONDITION
A. Lack of or inadequate OR PROBLEM DUE
knowledge

TO:
B. Denial about its existence or severity as a result of fear of
consequences of diagnosis of problem, specifically:
-Social-stigma, loss of respect of peer/significant others
-Economic/cost implications
-Physical consequences
 I. INABILITY TO RECOGNIZE
THE PRESENCE OF THE
CONDITION OR PROBLEM DUE
C. Attitude/Philosophy in life, which hinders
TO:
recognition/acceptance of a problem

D. Others. Specify _________

 II. INABILITY TO MAKE DECISIONS
WITH RESPECT TO TAKING
APPROPRIATE HEALTH ACTION DUE
TO:
A. Failure to comprehend the nature/magnitude of the
problem/condition

B. Low salience of the problem/condition

 II. INABILITY TO MAKE DECISIONS
WITH RESPECT TO TAKING
APPROPRIATE HEALTH ACTION DUE
C. Feeling of confusion, helplessness and/or resignation
brought about by perceive TO:magnitude/severity of the
situation or problem, i.e. failure to breakdown problems into
manageable units of attack.

D. Lack of/inadequate knowledge/insight as to alternative

 II. INABILITY TO MAKE DECISIONS
WITH RESPECT TO TAKING
APPROPRIATE HEALTH ACTION DUE
TO: to take from among a
E. Inability to decide which action
list of alternatives

F. Conflicting opinions among family members/significant

others regarding action to take.
 II. INABILITY TO MAKE DECISIONS
WITH RESPECT TO TAKING
APPROPRIATE HEALTH ACTION
G. Lack of/inadequate knowledge of community resources
DUE
for care. TO:

H. Fear of consequences of action, specifically:

-Social consequences
-Economic consequences
-Physical consequences
 II. INABILITY TO MAKE DECISIONS
WITH RESPECT TO TAKING
APPROPRIATE HEALTH ACTION DUE
TO:
I. Negative attitude towards the health condition or
problem-by negative attitude is meant one that
interferes with rational decision-making.
 II. INABILITY TO MAKE DECISIONS
WITH RESPECT TO TAKING
APPROPRIATE HEALTH ACTION DUE
J. In accessibility of appropriate resources for care,
TO:
specifically:
-Physical Inaccessibility
-Costs constraints or economic/financial
inaccessibility
 II. INABILITY TO MAKE DECISIONS
WITH RESPECT TO TAKING
APPROPRIATE HEALTH ACTION
K. Lack of trust/confidence in the health DUE
personnel/agency TO:

L. Misconceptions or erroneous information about

proposed course(s) of action
 III. INABILITY TO PROVIDE
ADEQUATE NURSING CARE TO THE
SICK, DISABLED, DEPENDENT OR
VULNERABLE/AT RISK MEMBER OF
THE FAMILY DUE TO:
A. Lack of/inadequate knowledge about the
disease/health condition (nature, severity,
complications, prognosis and management)

B. Lack of/inadequate knowledge about child

development and care

C. Lack of/inadequate knowledge of the nature or

extent of nursing care needed
D. Lack of the necessary facilities, equipment and supplies of
care

E. Lack of/inadequate knowledge or skill in carrying out the

necessary intervention or treatment/procedure of care (i.e.
complex therapeutic regimen or healthy lifestyle program).

F. Inadequate family resources of care specifically:

-Absence of responsible member
-Financial constraints
G. Significant persons unexpressed feelings (e.g.
hostility/anger, guilt, fear/anxiety, despair,
rejection) which his/her capacities to provide care.

H. Philosophy in life which negates/hinder caring for

the sick, disabled, dependent, vulnerable/at risk
member
I. Member’s preoccupation with on
concerns/interests

J. Prolonged disease or disabilities, which exhaust

supportive capacity of family members.
K. Altered role performance, specify.
-Role denials or ambivalence
-Role strain
-Role dissatisfaction
-Role conflict
-Role confusion
-Role overload
 IV. INABILITY TO PROVIDE A HOME
ENVIRONMENT CONDUCIVE TO
HEALTH MAINTENANCE AND
PERSONAL DEVELOPMENT DUE TO:
A. Inadequate family resources specifically:
-Financial constraints/limited financial resources
-Limited physical resources-e.i. lack of space to
construct facility

B. Failure to see benefits (specifically long term

ones) of investments in home environment
improvement
C. Lack of/inadequate knowledge of importance of
hygiene and sanitation

D. Lack of/inadequate knowledge of preventive

measures

E. Lack of skill in carrying out measures to improve

home environment
F. Ineffective communication pattern within the
family

G. Lack of supportive relationship among family

members

H. Negative attitudes/philosophy in life which is not

conducive to health maintenance and personal
I. Lack of/inadequate competencies in relating to
each other for mutual growth and maturation (e.g.
reduced ability to meet the physical and
psychological needs of other members as a result of
family’s preoccupation with current problem or
condition.

J. Others specify._________
V. FAILURE TO UTILIZE COMMUNITY
RESOURCES FOR HEALTH CARE
DUE TO:
A. Lack of/inadequate knowledge of community
resources for health care

B. Failure to perceive the benefits of health

care/services

C. Lack of trust/confidence in the agency/personnel

D. Previous unpleasant experience with health

E. Fear of consequences of action (preventive,
diagnostic, therapeutic, rehabilitative) specifically :
-Physical/psychological consequences
-Financial consequences
-Social consequence
F. Unavailability of required care/services

G. Inaccessibility of required services due to:

-Cost constrains
-Physical inaccessibility
H. Lack of or inadequate family resources,
specifically
-Manpower resources, e.g. baby sitter
-Financial resources, cost of medicines prescribe

I. Feeling of alienation to/lack of support from the

community, e.g. stigma due to mental illness, AIDS,
etc.
J. Negative attitude/ philosophy in life which hinders
effective/maximum utilization of community
resources for health care

K. Others, specify __________

FAMILY HEALTH
ASSESSMENT
Presented by: Group 7

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 Keep This involves a set of action by
which the
status of a family as a client,

Moving
its ability to
maintain itself as a system and
functioning
unit and its ability to maintain
wellness
prevent ,control or resolve pr
oblems in
order to achieve health in well
being among
its member are measured.
• Data
Type of family health Collection
assessment
• Data Analysis

• Diagnosis
 Data Collection

There are important things to

ensure effective and efficient
data collection in family health
assessment:
TYPES AND KINDS OF
DATA NEEDED:
1. Family Structure, Characteristics and Dynamics
• Demographic data
• Members of the household and relationship to the
head of the family.
• Place of residence of each of member
• Type of Family Structure (Nuclear, Bended, Single
Parent Family, Extend, Childless Family, Stepfamily,
Grandparent Family)
• Dominant Family members in terms of decision making
2.Socio-economic and cultural characteristics
• Income and expenses
• Educational attainment
• Ethnic background and religious affiliation
• Significant others and roles the play in the
family
• Relationship of the family to a larger group
3. Home and Environment
• Housing
• Kind of neighborhood
• Social and health facilities available
• Communication and transportation of facilities
available
4.Health status of each family member
• Medical history indicating current or past
significant illnesses or beliefs and practices
conductive to health and illness
• Nutritional assessment (anthropometric data,
dietary history, eating/feeding habits/practice
• Risk factors assessment indicating presence of
major and contributing modifiable risk factors
for a specific lifestyle disease
• Physical assessment indicating presence of illness
states
• Result laboratory /diagnostic and other
screening procedures supportive of assessment
5.values, habits, practices on health promotion
maintenance and disease prevention
• Immunization status
• Health lifestyle practice
• Adequacy of :
• Rest sleep
• Exercise/activities
• Use of protective measure
Data gathering methods and tools
• Observation
• Physical examination
• Interview
• Record review
• Laboratory /diagnostic test
 Quiz
Presented by: Group 7

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