CHN-Theory

NCM 104

What is a community?
Community a group of people with common characteristics or interests living together within a
territory or geographical boundary place where people under usual conditions are found derived
from a latin word “comunicas” which means a group of people.
- place where people under usual conditions are found.

The community is the object or

focus of care in CHN, with the
family as the basic unit of service

What is Health?
What influences OLOF?
Behavioral (culture, habits, mores, ethnic customs)

Socio-economic (employment, education, housing)

Political (safety, oppression, people, empowerment)

Hereditary (genetic endowment, familial, racial)

Health Care Delivery System (promotive, preventive, curative, rehabilitative)

Environment (air, food, water, wastes, noise, radiation, pollution, congestion)

It operates within the realm of health care both independently and interdependently.

The objective of nursing is to assist clients to achieve, maintain, or recover a high level of functioning.

Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
(Henderson)

Health is a basic human right. On the 6th Global Conference on Health Promotion in 2005 the
UNs affirmed its recognition that the enjoyment of the highest standard of health is one of the
fundamental rights of every human being (The Bangkok Charter for Health Promotion, 2005).

HEALTH

Health which is viewed as a continuum, is considered as the goal of public health in general, and CHN,
in particular.
It is an important prerequisite (and consequence) of development.
By promoting health and preventing disease, CHNs therefore, contribute to the country’s economic and
social development.

is a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity
(WHO, 1995).
State characterized by Soundness and wholeness of human structures and bodily and mental functions
(Dorothea Orem, in Pender, 1985
Physical health implies a mechanistic functioning of the body.
Mental health means the ability to think clearly and coherently and has to do with your thinking and
feeling and how you deal with your problem.
A mentally healthy person has a capacity to live with other people to understand their needs, and to
achieve mutually satisfying relationships.

Social health refers to the ability to:

Make and maintain relationship with others:
Interact well with people and the environment.

HEALTH

“An integral method of functioning which is oriented toward maximizing the potential which the
individual is capable.
It requires that the individual maintain a continuum of balance and purposeful direction within the
environment where he is functioning”. (Dunn(1959, in Pender, 1987).
“ A quality of life, involving social, emotional, mental, spiritual and biological fitness on the part of
the individual, which results from adaptations to the environment. (Rene Dubos)

Florence Nightingale looked into health and illness in relation to the environment – ventilation,
noise, light, cleanliness, diet and restful bed.
She prescribed ways to improve health by manipulating the environment.

Factors Affecting Health/Determinants of health (WHO)

1. Income and social status
Higher income and social status are linked to better health
2. Education
Low education levels are linked with poor health, more stress and lower self-confidence
3. Physical environment
Safe water and clean air, healthy work places, safe houses, communities and roads all contribute to
good health.
4. Employment and working conditions
People in employment are healthier, particularly those who have more control over their working
conditions.
5. Social Support Networks
Greater support from families, friends and communities is linked to better health.
6. Culture, customs and traditions, and the belief of the family and community all affect health.
9. Health Services
Access the use of services that prevent the treat diseases influences health
10. Gender
Men and women suffer from different types of diseases at different ages.
7. Genetics
Inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain
illnesses
8. Personal behavior and coping skills
Balanced eating, keeping active smoking, drinking, and how we deal with life’s stresses and
challenges all affect health.
 Nursing
is the protection, promotion, and optimization of health and abilities, prevention of illness and
injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human
response, and advocacy in the care of individuals, families, groups, communities, and populations.

What is nursing?
The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980).

Nursing, together with public health, is one of the helping professions in the health care system which
operates at three levels of clientele – individuals, families or groups, and communities

It operates within the realm of health care both independently and interdependently.
The objective of nursing is to assist clients to achieve, maintain, or recover a high level of functioning.

Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
(Henderson)

What is nursing?
- assisting sick individuals to become healthy and healthy individuals achieve optimum wellness

 What is community health?

part of paramedical and medical intervention/ approach which is concerned on the health of the
whole population.
aims:
1. health promotion
2. disease prevention
3. management of factors affecting health

Community Health Nursing in the Philippines

is established as a professional field since many decades.
Conceptually it unites elements of nursing sciences and Public Health.
Community Health Nurses, which are officially called Public Health Nurses are linked into a
net of governmental and non-governmental national health services.
The incorporation of Community Health Nursing into the BSN Curriculum Community
Health Nursing is an integral component of the Philippine Curriculum of Bachelor of Science
in Nursing (in accordance with memorandum CHED order No. 10 Series of 1998).

Community Health Nursing

for students

Their task is to assess the health status of a community with multi perspective methods and
together with the community members identifying health problems, setting objectives and
planning activities that will reduce health problems and can be used for health promotion in
the community.

The independence of students is an educational intention, the realization and responsibility

devolves on students.

Community Health Nursing

for students
 record the organizational structures of health care in the assigned area.

They call on the official representatives of the local government unit to be able to get an
official permission for the planned project to the allocated population group.

Additionally the students are supposed to identify the functions of the respective persons of
health care.

In the next step they will build up arelationship to the employee of the Rural Health Office.

students become acquaintance to tasks and functions of responsible employees: =Doctor,

midwife, Public Health Nurse and Barangay Health Worker.

students are to inform about the objectives and the content of the planned project and to
elaborate possibilities for cooperation.

Finally during the entire time of the project the students will stay together with their
perceptor in the community - a selected rural area of about 100 households.
Health data of the community are collect about numerous tools and sources

The college encourages the students in making family care plans, as far as they consider it is
necessary. Also health service's are supposed to be delivered during home visits.

So students project can achieve an additional contribution to improve of the health situation
in the community.

Following Public Health concepts guides the field of Community Health Nursing:
1. emphasis on the importance of the "greatest good for the greatest number"
2. assessing health needs, planning, implanting and evaluating the impact of health services on
population groups
3. priority of health-promotive and disease-preventive strategies over curative interventions
4. tools for measuring and analyzing community health problems
5. application of management principles and organization in delivery of health services to the
community
(Cruz in Maglaya of 2000 pp. 14)

What is Community Health Nursing?

“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.” - Maglaya, et al

Salient Features of CHN

is a specialized field of nursing practice.

Its basic knowledge and skills are anchored on nursing theories and important concepts from
the science of public health such as:
1.Emphasis on the importance of the "greatest good for the greatest number"
2.Assessing health needs, planning, implementing and evaluating the impact of health services on
population groups
3.Priority of health-promotive and disease-preventive strategies over curative interventions
4. Tools for measuring and analyzing community health problems
5.Application of principles of management and organization in the delivery of health services to the
community.

Community Health Nursing

is unique and distinguishes itself from other fields of nursing as follows:
“it is concerned with the health status of a distinct population rather than focuses on
individualized care

it addresses the personal and environmental aspects of health while dealing with the community
factors that inhibit or facilitate healthy living

health services are rendered within the milieu of the client giving priority to care of vulnerable
groups through the partnership approach”
(Cruz in Maglaya 2000, p. 14

Community Health Nursing

-A service rendered by professional nurse to individuals, families, communities and population

groups in health centers, clinics, schools, and the workplace in order to promote health, prevent
illness, provide care for the sick at their respective homes, provide effective rehabilitation

COMMUNITY HEALTH NURSING

“a synthesis of nursing knowledge and practice and the science and practice of public health,
implemented via a systematic use of the nursing process and other processes to promote health and
prevent illness in population groups. “ (Clark)

COMMUNITY HEALTH NURSING

as an art - the practice of CHN, entails active interaction and partnership between the nurse and the
client.

Such partnership recognizes the autonomy of both parties and the potential of each one in enriching
their relationship.

COMMUNITY HEALTH NURSING

As science- Community health nurses should use practice-based and evidence-based methods and
tools.

They also need to engage in generating evidence to support their practice through research

COMMUNITY HEALTH NURSING

It refers to “a 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).

COMMUNITY HEALTH NURSING

 “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).

COMMUNITY HEALTH NURSING (CHN):

a specialized field of nursing practice

a science of Public Health combined with Public Health Nursing Skills and Social Assistance with the
goal of raising the level of health of the citizenry, to raise optimum level of functioning of the citizenry
(Characteristic of CHN)

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 Expert Committee of Nursing)

ANAs definition of CHN

highlights the following important points:

1.The goal of professional practice is the promotion and preservation of the health of populations
2.The nature of practice is comprehensive, general, continual and not episodic
3.The knowledge base comes from nursing and public health
4.The different levels of clientele individuals, families and groups
5.The practitioner's recognition of the primacy of the population as a whole.

Community Health Nursing

-A field of nursing that is a blend or synthesis of nursing practice with public health using primary
health care as the tool in the delivery of health services.

Primary goal of CHN

is to help a community protect and preserve the health of its members
Secondary goal of CHN

is to promote self-care among individuals and families

ULTIMATE GOAL of CHN

“To raise the level of citizenry”
by helping communities and families cope with discontinuities in health and threats
To assist the individual, family and community in attaining their highest level of holistic health
which is attained through multidisciplinary effort and to promote reciprocally supportive
relationship between people and their physical and social environment
Maximize their potential for high level of wellness

GOAL - CHN
 To raise the level of health of the citizenry by helping communities and families cope with the
discontinuities in and threats to health in such a way as to maximize the potential for high-
level wellness
Nisce, Reyala, et al.

Objectives of CHN
To participate in the development of an overall health plans for the community and its
implementation and evaluation.

To provide quality nursing services to individuals, families and communities utilizing as basis,
the standards set for community health nursing practice

To continue nursing services with various members of the health team, community leaders and
significant others, government and non-government agencies/organization in achieving the aims
of public health services within the community
To participate and/or conduct researches relevant to community health and CHN services and
disseminate their results for improvement of health care.
To provide CHN personnel with opportunity for continuing education and professional growth
through staff development
To provide basic health services to individuals, families and communities

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 what's, the whys, and the how's 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

PHILOSOPHY OF COMMUNITY HEALTH NURSING

-The philosophy of CHN is based on the worth and dignity of men.

-This philosophy of care is based on the belief that care directed to the individual, the family, and
the group contributes to the healthcare of the population as a whole
 The PRIMARY FOCUS of CHN
health promotion wherein health teaching is the primary responsibility of the communityhealth nurse,
who is a generalist in terms of practice.

Principles of CHN
E – ducation as primary tool and responsibility
M – ade available to all regardless of race, creed and socio- economic status
P – olicies and objectives of the agency is fully understood by the nurse
O – rganizing for health, with the family as the unit of service
W – orks as a member of the health team (PHN)
E – xisting active organizations are utilized
R – ecording and reporting are accurate
M – onitoring and evaluation of services is periodically done
E – xisting indigenous resources of the community is used
N – eeds of clienteles is recognized and serves as basis for CHN
T – raining and development as opportunities for continuing staff education programs
• Principles of CHN

•CHN is based on recognized needs of individuals, families, groups and communities.

•The CHNurse must understand fully the objectives and policies of the agency he/she represents.
•In community health nursing, the family is the unit of care.
•Community health nursing must be available to all regardless of race, creed, and socioeconomic
status.
•The CHNurse makes use of available health resources
•There must be provision for educative supervision in CHN.
•The CHNurse utilizes the already existing active organized groups in the community.
•There should be accurate recording and reporting in CHN

Basic PRINCIPLES of chn : 

Primary Goal: Self reliance Ultimate

Goal: Raise the level of Citizenry
Primary Focus: Health Promotion
Client in the CHN: Community
Basic Unit of care : FAMILY
Philosophy of CHN: Worth and Dignity of Man .”(Dr. M. Shetland)

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 efforts
CHN is a part of health care system and the larger human services system.

Mission of CHN
• Health Promotion
• Health Protection
• Health Balance
• Disease prevention
• Social Justice

Characteristics of CHN
1. Promotion of health and prevention of disease goals of professional practice.
2. CHN practice is comprehensive, general, continual, and not episodic
3. There are different levels of clientele:
Individuals,
families
population groups
community
-Practitioner recognizes the primacy of the population as a whole

4. The nurses and the client have greater control in making decisions related to health care and they
collaborate as equal
5. The nurse recognizes the impact of the different factors on health and has a greater awareness of his/her
client’s lives and situations.
• CHARACTERISTICS OF CHN:

1.Promotion of health and prevention of diseases are the goals of professional practice;
2.Community health nursing practice is comprehensive, general, continual and not episodic;
3.There are different levels of clientele-individuals, families and population groups and the practitioner
recognizes the primacy of the population as a whole;
4.The nurse and the client have greater control in making decisions related to health care and they
collaborate as equals;
5.The nurse recognizes the impact of different factors on health and has a greater awareness of his/her
clients’ lives and situations.

Characteristics of CHN
Community health nursing is an integral part of community health
Community health nursing is a specialized field of nursing
Community health nursing synthesizes community health with nursing
In community health nursing, the whole community is the client
Community health nursing promotes self-care responsibility
Community health nursing involves multidisciplinary team approach
Community health nursing is working for people, with people and by people Community
health nursing is seeking support from giving support to personnel from other sectors
working for welfare and development in the community
Community health nursing is dealing with wide range of health problems and health needs
and providing need based generalized health services.

Concepts of CHN
1. The primary focus of CHN practice is on health promotion
Opportunity and responsibility for evaluating the health status of people and groups and relating them to
practice

2. CHN practice is extend to benefit not only the individual but the whole family and community

3. CH Nurses are generalist in terms of their practice through life’s continuum – its full range of health
problems and needs.

4. Contact with the client and/or the family may continue over a long period of time which include all
ages and all types of health care.

The nature of CHN practice requires that current knowledge derived from the biological and
social sciences, ecology, clinical nursing and community health organizations be utilized.

The dynamic process of assessing, planning, implementing and intervening, provide periodic
measurements of progress, evaluation and a continuum of the cycle until the termination of
nursing is implicit in the practice of CHN

Concepts on Community Health Nursing:

 CLIENTS of Community Health Nurse
 Composed of different levels of clientele: Individual, family, population group, and
community
Community as a SETTING for CHN PRACTICE
 School Health Nursing- School
 Occupational Health Nursing- Workplace
 Public Health Nursing-Home
 3 Elements considered in CHN
Science of Public Health (core foundation in CHN),
Public Health Nursing Skills and
Social Assistance Functions

FRAMEWORK FOR CHN - four components:

1. The health care delivery system, with its CHN subsystem;

= The private for profit and non-profit providers
= and public which is largely financed through a tax-based budgeting system at both national and local
levels
2. The clients:
Individual
Family
Population group
community
3. Health which is the goal of the health care delivery system (HCDS)
4. The economic, sociocultural, political and environmental factors that affect the HCDS, the practice of
CHN and people’s health
•
CLIENTS OF COMMUNITY HEALTH NURSES
1.Individual – sick or well – on a daily basis. Since the health problems of individuals are intertwined
with those of the other members of the family and the community, they are also considered as an “entry
point” in working with these clients.

2.Family - a collection of people who are integrated, interacting and interdependent. Family members
interact with each other and the action of one affects the other members.

3.Population group - a group of people who share common characteristics, developmental stage or
common exposure to particular environmental factors, and consequently common health problems, issues
and concerns.

Allender and Spradley(2001) identified populations “aggregates’ with developmental needs and
those that are vulnerable . Population groups are the usual targets or beneficiaries of social services
and health programs.

4.Community - a group of people sharing common geographic boundaries and/or common values and
interests within a specific social system. This social system includes health system, family system,
economic system, educational system, religious system, welfare system political system, recreational
system, legal system and communication system

LEVELS OF CLIENTELE

1. Individual :
a. Patient : an individual who is sick.
b. Client : an individual who is well/not sick.

2. Family : a very important social institution that performs 2 major functions (reproduction and
socialization)
- the basic unit of care in CHN
Reasons:
• Contributory factor : health problems of its family member
• Performs health promoting/maintaining & disease prevention activities.
• Locus of decision making on health matters
• Source: solid support & care to its members
3. Population group
- group of people who share common characteristics, developmental stage or common exposure to
particular environmental factors and consequently common health problems.
4. Community - group of people sharing common geographic boundaries and/or common values and
interests.
• No two communities are alike
• Urban or Rural

Philosophy of Community Health Nurse

-The philosophy of CHN is based on the worth and dignity of men.

-This philosophy of care is based on the belief that care directed to the individual, the family, and
the group contributes to the healthcare of the population as a whole
 Goals of Community Health Nurse

-To assist the individual, family and community in attaining their highest level of holistic health
which is attained through multidisciplinary effort and to promote reciprocally supportive
relationship between people and their physical and social environment

Roles and Responsibilities of a Community Health Nurse

1. The main focus of community health nurse is health promotion.

Programmer/Planner

Identifies the needs and concerns of individuals, groups, families, and the community
Formulates health plans, especially in the absence of a community physician
Interprets and implements nursing plans and programs
Assists other health team members in implementing health programs in the setting

Health Educator/Trainer/ Counsellor

Acts as resource speaker on health and health-related services

Advocates health programs in the community through dissemination of IEC or Information
Education and Communication materials
Conducts advocacy educations concerning premarital, breastfeeding, and immunization
counselling
Organizes orientation/ training of concerned groups like pregnant mothers
Identifies and interprets training needs of health team members and formulate appropriate
training program for them
Conducts and facilitates necessary training or educational orientation to other health team
members in the community

2. The recipient of care of community public health nursing practice is extended not only to the
individual but also to benefit the whole family and community.

Community Organizer

Promotes self- reliance of community and emphasizes their involvement and participation in
planning, organizing, implementing and evaluating of health services
Initiates and implements community development activities

Coordinator of services

Coordinates health services with concerned individuals and families through the community health
team members, government organizations and non- government organizations
Coordinates nursing plans and  programs with other health programs

3. Community health nurses are generalists in terms of their practice through life’s continuum.

Provider of Nursing Care

  Renders direct care to various clients with different needs, may it be at home, in school,
clinics or work settings

 Involves the family in the care of the sick or dependent individual, i.e., sick child

4. Continuity of care with the client, family or and the community extends for a longer time involving
individuals of all ages and health needs.

Health Monitor

Monitors and detects the presence of health concerns in the community through contacts or
home visits.

Utilizes various effective data gathering techniques in keeping an eye on the health status of
all recipients of care.

Records and reports health status and presence of health problems in the community

5. The nature of nursing practice in the community needs the knowledge of biological and social
sciences, ecology, clinical nursing, and community organizing, for it to be effective.

Researcher

Follows a systematic process of monitoring the health status of the community through the conduct
of surveys and home visits
Conducts researches concerning the health of the community
Coordinates with government and non- government organizations in the conduct and
implementation of studies

Statistician

Records data systematically and ensures its validity through accurate and complete data gathering
Reports prepared reports to concerned organizations i.e. government organization for immediate
necessary plans or programs
Consolidates and reviews reports efficiently.
Analyzes and interprets consolidated data for monitoring the development in the health matters of
the whole community

6. This field of nursing practice utilizes a dynamic process (assessment, planning, implementation, and
evaluation) in the provision of continuous care until termination is implicit.

Change Agent

Promotes and motivates change in the community in their health practices and lifestyle behaviors
for them to promote and maintain good health, be knowledgeable and has the initiative in accessing
health services
Inculcates self- reliance to brought about development and improvement in the community
 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

Responsibilities of 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

Classifications of a Community

•Rural communities
•Urban communities
•Suburban or urban or the capitals

CHARACTERISTICS OF A HEALTHY COMMUNITY

“Everything that affects the individual affects the family and eventually the
community”

Characteristic of a Healthy Community

Awareness “we are a community”

Conservation of natural resources
Recognition & respect for the existence of subgroups
Participation of SG in community affairs
Preparation to meet crises
Ability to solve problems
Open communication (open channels)
Resources available to all
Setting of disputes thru legitimate mechanism
Participation by citizens in decision-making
Wellness of a high degree among its members

General characteristics of a community

•Geographic boundaries within certain identifiable characteristics

 Made up of institution organized into a social system with the institutions and organizations
linked in a complex network
Regarded as an organism which has its own stages and development and responses to
problems may be adequate, inadequate, inappropriate or delayed
Has common and shared interests that bind the members together
Has an area with fluid boundaries within w/c a problem can be identified and resolved
Has a population aggregate concept
Conducts researches concerning the health of the community
Coordinates with government and non- government organizations in the conduct and
implementation of studies

Community vs Public Health Nursing

-Deliver health services to individuals, groups, and families
-Diagnosis is based on the needs of individuals, family, or group

- Work to promote health and prevent illness in groups and families with the main goal being to
increase community health.
- For example, meeting with a group of young mothers to provide information on immunizations.
-Assessing the populations health needs
-Diagnose and develop policy in relation to community health needs.
-Plan for the community as a whole in order to prevent disease and disability and preserve the
health of the community.
For example, after an illness outbreak, the public health nurse will assess the need and develop a program
for an immunization clinic.

CHN vs PHN
- Implementation is based on individual needs. For example, a new diabetic who is a kinesthetic learner
would be taught how to give insulin injections by practicing with an orange.

-Evaluate whether health needs were met on the individual, family or group level

-Implementing the plan means the nurse ensures the resources are available to all who need them within
the community.

-Evaluate the health status of the whole community and whether planned goals and objectives were met.

CHN vs Public Health Nursing

How do they relate?

Public health nursing is an umbrella term that encompasses community health nursing.
Both have the main goal of promoting, preserving, and maintaining the community’s health
What boundaries exist?
• Boundaries between these two concepts exist in relation to the level of assessment.
• Public health nurses are trained and educated to assess the population overall.
Whereas the community health nurse's knowledge lies within assessing the needs of individuals and
families within the population that they work.
References:
Community Health Nursing Services in the Department of Health Philippines (2000). Community
Health Nursing. 9th Edition. National League of Government Nurses, Inc.
Maglaya, A.S., Nursing Practice in the Community, 5th Edition, Argonauta Corporation, 2009.