MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca, Cagayan

Telefax. No. (078) 304-1010 Website: www.mcnp.edu.ph
E-Mail Address: adminoffice@mcnp.edu.ph

COMMUNITY HEALTH NURSING

I. CONCEPTS ON HEALTH PROMOTION AND DISEASE PREVENTION

A. RELATED TERMINOLOGIES
A. HEALTH
 WHO
A state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity (WHO)
- SOCIAL - “of or relating to living together in organized groups or similar close
aggregates” and refers to units of people in communities who interact with one
another
- SOCIAL HEALTH - Connotes community vitality and is a result of positive interaction
among groups within the community with an emphasis on health promotion and
illness prevention.
- Mid-1980s, the WHO expanded the definition of health:
“the extent to which an individual or group is able, on the one hand, to realize
aspirations and satisfy needs; and, on the other hand, to change or cope with the
environment. Health is, therefore, seen as a resource for everyday life, not the
objective of living; it is a positive concept emphasizing social and personal
resources, and physical capacities.”
 “A state of well-being in which the person is able to use purposeful, adaptive
responses and processes physically, mentally, emotionally, spiritually, and
socially.” (Murray)
 “Actualization of inherent and acquired human potential through goal-directed
behavior, competent self-care, and satisfying relationship with others.” (Pender)
*Health as a human right
 Health is a right of every human – WHO
 “The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition” (Dr. Ghebreyesus, WHO Director-
General 2017)
 According to the Committee on Economic, Social and Cultural Rights (United
Nations, CESCR, 2000) the right to health consists of interconnected and
indispensable components:
-Availability – operational public health and channels of service delivery,
products and services as well as programs be adequate
-Accessibility – entails that health facilities, services and goods must be made
possible and obtainable to everyone, being non-discriminatory, physically
accessible, economically accessible (affordable) and information accessible are
the four intersecting features of accessibility.
-Acceptability – corresponds to respect for the medical ethics, being culturally
appropriate and gender sensitive.
-Quality – implies that the health facilities, commodities and services must be in
accordance with scientific and medical ethics.
  Is the ability to maintain homeostasis or dynamic equilibrium. Homeostasis is
regulated by the negative feedback mechanism (Walter Cannon
 Is the ability to maintain the internal milieu (Claude Bernard)

 Is being well and using one’s own power to the fullest extent. Health is being
maintained through prevention of disease by enmvironmental health factors
(Nightingale
 Positive health symbolizes wellness. It is a value termed by the culture or
individual (Rogers)
 Is a state and a process of becoming and being an integrated and whole person
(Roy)- Is a state characterized by soundness or wholeness of developed human
structures and of bodily and mental functioning (Orem)
 Is a dynamic state in the life cycle; illness is an interference (King)
 Wellness is the condition in which all parts and subparts of an individual are in
harmony with the whole system (Neuman)
 Is an elusive, dynamic state influenced by biologic, physiologic and social factors.
(Johnson)

B. WELLNESS AND WELL-BEING

 Wellness is well-being. It involves engaging in attitude and behaviors that
enhance QOL and maximize personal potential
 Subjective perception of balance, harmony and vitality
 Is a choice
 Is a way of life
 Is the integration of boy, mind and spirit
 Is the loving acceptance of one’s self

C. DISEASE
 An alteration in body functions resulting in reduction of capacities or a
shortening of the normal life span
 Common causes of disease
a. Biologic agents
b. Inherited genetic defects
c. Developmental defects
d. Physical agents
e. Chemical agents
f. Response to irritation/injury
g. Faulty chemical/metabolic process
h. Emotional/physical reaction to stress

 Risk factor
- Any situation, habit, social or environmental condition, physiological or psychological condition,
developmental or intellectual condition or spiritual or other variable that increases the
vulnerability to illness or accident
- The presence will not mean that a disease will develop BUT increase the chances
1. Genetic/Physiological factors
 Heredity or genetic disposition to specific illness—major risk factor
2. Age
 Increases or decreases susceptibility
3. Environment
 Where a person lives or works – can increase the risk
 4. Lifestyle
 Activities, habits and practices
 It can have a positive or negative effect

 CLASSIFICATIONS OF DISEASE
A. According to biologic factors
a. Hereditary – defect in the genes of one or two parents
b. Congenital – developmental defects
c. Metabolic – disturbance or abnormality in metabolism
d. Deficiency – inadequate dietary factors
e. Traumatic – injury
f. Allergic – abnormal response of body to stimuli
g. Neoplastic – abnormal cell growth
h. Idiopathic – unknown
i. Degenerative – changes
j. Iatrogenic – results from treatment of disease

B. According to duration/onset
a. Acute
 Short (6 months or less) and severe; s/sy appear abruptly, intense
b. Chronic
 Longer than 6 months
 Characterized by remission and exacerbation
c. Subacute
 Symptoms are pronounced, but longer than acute
B. Other classifications
a. Organic – changes in normal structure, anatomical changes
b. Functional – no anatomical changes, abnormal responses
c. Occupational – associated with occupation
d. Familial – same family
e. Venereal – sexual relation
f. Epidemic – attacks a large number of individuals in a community at the same time
g. Endemic – present more or less continuously; constant
h. Pandemic – nationwide
i. Sporadic – occasional cases, “on and off”

D. ILLNESS
 a personal state in which the person feels unhealthy
 a state in which a person’s functioning is diminished or impaired
 NOT synonymous with disease

 Stages of illness
1. Symptom experience
 Transition stage
 Believes something is wrong
 Experiences some symptoms (physical, cognitive,emotional)
2. Assumption of sick role
 Acceptance of the illness
 Seeks advice, support for decisions
 3. Medical contact
 Seeks advice to health care professionals
 Validation, explanation, reassurance, prediction
4. Dependent patient role
 Dependent on health professionals
 Accepts/rejects suggestions
 Passive, accepting, regress
5. Recovery/rehabilitation
 Gives up sick role and returns to former roles

IV. Other terminologies related

i. Morbidity – condition of being diseased
ii. Mortality – condition or quality of being subject to death
iii. Susceptibility – degree of resistance
iv. Etiologic agent – one that possesses the potential for producing disease
v. Pathogenicity –
vi. Virulence – power or degree of pathogenicity
vii. Symptom –
viii. Sign –
ix. Syndrome – set of signs and symptoms

B. HEALTH AS A MULTI-FACTORIAL PHENOMENON

 Factors that affect the level of functioning or health of an individual or of a population
1. POLITICAL – great influence
 Has the power/authority to regulate
 E.g. safety, oppression, people empowerment, safety/crime

2. BEHAVIORAL – habits, lifestyle

 Smoking, substance abuse, liquor, etc.

3.HEREDITARY – genetically influenced diseases

 Understanding, increase knowledge – preventive measure
 Anticipate and counteract

4.HEALTH CARE DELIVERY SYSTEM

 PHC >effective provision of essential health services that are available, accessible, acceptable
and affordable
 promotive and preventive, curative, rehabilitative

5. ENVIRON MENTAL INFLUENCES –pollution, sanitation, logging, waste disposal

 Diseases nowadays are man-made

6. SOCIO-ECONOMIC INFLUENCES – lower income groups/families are ones mostly served

 Low income families have greater number of illnesses or health problems
 Middle-upper income-> drug abuse and lifestyle diseases

DETERMINANTS OF HEALTH
1. Income and Social Status
• Higher-income and social status are linked to better health. The greater the gap
between the richest and poor health, the greater differences in 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 workplaces, safe houses communities and
roads all contribute to good health.
4. Employment and Working Conditions
• People in employment are healthier, particularly those who have 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 beliefs of the family and community all affect
health.
7. Genetics
Nursing Care of the Community (Famorca et al., 2013) sacrodriguez2020
• Inheritance plays a part in determining lifespan, healthiness, and the likelihood
of developing 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.
9. Health Services
• Access and use of services that prevent and treat disease influences health.
10. Gender
• Men and women suffer from different types of diseases at different ages.

C. LEVELS OF PREVENTION

I. PRIMARY PREVENTION - encourage optimum health and increase person’s resistance to illness
 Prevents disease; stop something to happen
 Health promotion and specific protection
 E.g.: quit smoking, avoid/limit alcohol intake, exercise, eat well-balanced diet, avoid
overexposure to sun, maintain IBW, complete immunization program, wear hazard devices

II. SECONDARY PREVENTION – health maintenance

 Identify specific illnesses or conditions at early stage
 Prompt intervention to limit or prevent disability
 Early diagnosis/detection/screening and prompt treatment
 E.g.: annual PE, Pap’s smear,BSE, TSE, sputum exam, stool and rectal exam

III. TERTIARY PREVENTION – occurs after disease or disability

 Stop the disease or injury process and assist patient in attaining optimal health
 E,g,: self-monitoring of blood sugar, PT, rehabilitation, therapy

 ACTIVITIES TO PROMOTE HEALTH AND PREVENT ILLNESS/DISEASE

1. Eat well-balanced diet
2. Exercise regularly
3. Do not smoke, avoid second hand smoke
4. Avoid alcohol, say no to drugs
5. Regular physical examination
6. Annual dental exam
7. Male: TSE; female: BSE, Pap’s smear
 8. Maintain IBW
9. Reduce fat and increase fiber in diet
10. Sleep regularly 6-8 hours/night

B. THEORIES RELATED TO HEALTH PROMOTION/HEALTH EDUCATION

1. HEALTH PROMOTION MODEL
- Multi-dimensional nature of persons as they interact within the environment to pursue health
 Focus:
A. Individual perception
B. Modifying factors
C. Participation in health
Activities involved:
1. Efforts to assist individuals in taking control of and responsibility for their health risks
and improve QOL
2. Activities to improve the health of those who are not healthy and as well as those who
are healthy
3. Individual and community activities to promote healthful lifestyles
4. Self-responsibility, nutritional awareness, stress reduction, physical fitness
5. Health promotion activities:
6. Illness prevention activities:

2. DUNN’S HEALTH-ILLNESS CONTINUUM THEORY

-
- high level wellness ->integrated method of functioning that is oriented towards maximizing
one’s potentialities within the limitations of his environment
 PRECURSOR OF ILLNESS
1. Heredity
2. Behavioral factors
3. Environmental factor
3. HEALTH BELIEF MODEL
- Relationship between belief and behavior
- Individual perceptions and modifying factors may influence health beliefs and preventive health
behavior

 Individual perceptions:
- Perceived susceptibility (history of disease)
- Perceived seriousness of the disease (lifelong)
- Perceived threat (complications)

 Modifying factors
- Demographic variables (age, sex, race)
- Sociophysiologic variables (social pressure on peers)
- Structural variables (knowledge on disease)
- Cues to action (internal: fatigue, symptoms; external: media, advice from others)

4. SMITH’S MODELS OF HEALTH

A. CLINICAL MODEL – views people as physiologic system with related functions and identifies
health as the absence of signs and symptoms of disease or injury
B. ROLE PERFORMANCE MODEL – defines health in terms of ability to fulfill societal roles
C. ADAPTIVE MODEL – focuses on adaptation; health is a success/creative process and illness a
maladaptation; aim is to adapt/cope
 D. EUDAMONISTIC MODEL – actualization or realization of person’s potential

5. AGENT-HOST-ENVIRONMENT MODEL
- AGENT (any factor/stressor -> disease)
- HOST (may or may not be affected)
- ENVIRONMENT (external factor that may or may not predispose the person to a disease

6. SELF-EFFICACY

-based on the idea that people will do only what they think they can do

Four variables:

Performance accomplishments-mastery

Vicarious experience-observation

Verbal persuasion-coach, encouragement

Physiological state

>most important determinant of behavior change is learning a new behavior by doing it

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