COMMUNITY HEALTH NURSING Rehabilitative

FOCUS: Promotion and Preservation of BEHAVIORAL

the health of populations Components
NATURE OF PRACTICE: comprehensive, Culture
general, continual and not episodic Habits
KNOWLEDGE BASE: from nursing and Ethnic customs
public health Examples
LEVELS OF CLIENTELE: Individuals, Smoking
Family, Population groups, and Intake of alcoholic drinks
Community as a whole Substance abuse
COMMUNITY -A group of people Lack of exercise
sharing common geographic boundaries
and common values and interests. SOCIOECONOMIC INFLUENCES
HEALTH -state of complete physical, Components
mental and social well-being, not merely Employment
the absence of disease or Education
infirmity Housing
WORLD HEALTH ORGANIZATION -
Optimum level of individuals, families ENVIRONMENTAL INFLUENCES
and communities Components
MODERN CONCEPT OF HEALTH -This Air
factor pertains to the power and Food
authority to regulate the environment Water waste
Urban/rural noise
FACTORS AFFECTING LEVEL OF Radiation
FUNCTIONING Pollution
POLITICAL -This factor pertains to the HEREDITY 
power and authority to regulate the Components
environment Genetic endowment
Examples: Defects
Safety Strengths
Oppression Risks:
People empowerment Familial
Ethnic
HEALTH CARE DELIVERY SYSTEM Racial
-One component of this factor is the
primary health care which is a PUBLIC HEALTH NURSING
partnership approach Public health as the science and art of
Goal: Effective provision of health preventing disease, prolonging life and
services that are community-based and efficiency to enable every citizen to
accessible realize his birthright of health
Components: and longevity (Winslow)
Promotive
Preventive Public health is dedicated to the
Curative common attainment of the highest
level of physical, mental and
social well-being and longevity   Community health nursing must
GOAL: contribute to the most effective
total development and life of the
individual land his society. (Hanlon)
Community health nursing is a learned
practice discipline
Ultimate Goal: contribute to the
promotion of client’s optimum level
of functioning through teaching and
delivery of care. (Jacobson)
Community health nursing is a service
rendered by a professional nurse with the
community, groups, families and
individuals
GOAL: promotion of health, prevention
of illness, care of the sick at home and
rehabilitation (Freeman)
Philosophy of community health
nursing is based on the worth and
dignity of man. (Shetland)
CONCEPTS OF COMMUNITY HEALTH
NURSING
HEALTH PROMOTION –primary focus
of community health nursing practice
Practice is extended to benefit not
only the individual but the whole family
and community
 Community health nurses are
GENERALISTS
PRINCIPLES OF COMMUNITY HEALTH
NURSING
Community health nursing is based on
recognized needs of communities,
families, groups and individuals
The community health nurse must
understand fully the objectives and
policies of the agency she represents
 FAMILY –unit of care/service
be available to all
 HEALTH TEACHING- primary
responsibility of the community
health nurse
 Works as a member of the health
team
 There must be periodic
evaluation
 Continuing staff education
program must be provided
 Make use of available community
health resources
 Utilize existing active groups in
community
 Educative supervision
 Accurate recording and reporting
ULTIMATE GOAL: Raise the level of
health of the citizenry
ROLES OF THE NURSE IN COMMUNITY
HEALTH NURSING
Clinician –focus on the health of the
individuals on the larger context of the
community
Advocate –promote self-care and self-
determination
Collaborator –brings together strengths
and weaknesses of people involved
toward a common goal
Researcher –utilizes data to predict
future phenomenon and modify
interventions
Counselor –key tasks include
listening and providing feedback and
information
Case Manager –oversees all aspects of
care to facilitate delivery of cost-efficient
care; to individualize and coordinate
care
Educator –provide knowledge, skills and
attitudes that people need to make
appropriate choices or decision
Hospice Care –providing care skills in a
home and other settings and balancing
client’s needs
THE NURSING PROCESS
ASSESSMENT -Process of collecting
and processing data/information about
the client
STEPS:
Initiate contact
Demonstrate caring attitudes
Develop mutual trust and confidence
Collect data from all possible sources
Identify problems
Analyze and interpret data
PLANNING -formulation of steps to be
undertaken to achieve desired end
STEPS:
Prioritize needs
Establish goals based on needs and
capabilities
Construct action and operation plan
Devise evaluation parameters
Revise plan as needed
IMPLEMENTATION -translation of care
plan into action
STEPS:
Put nursing plan to action
Coordinate care / services
Utilize community resources
Delegate and supervise
Monitor health services provided
Provide health education and training
Document responses to nursing action
EVALUATION -process of
making judgments as to the extent the
objectives are met
STEPS:
Care outcomes
Performance appraisal
Estimate cost benefit ratio
Assessment problems
Identify needed alterations
Revise plans as necessary
CATEGORIES OF HEALTH PROBLEMS
HEALTH DEFICIT
A gap between actual and achievable
health status
Instances of failure in health
maintenance
Possible precursors of health deficit:
 History of repeated infections or
miscarriages
 No regular health check-up
Examples:
ILLNESS states, diagnosed or
undiagnosed
Failure to thrive/develop
Disability
Transient (aphasia or temporary
paralysis after a CVA)
Permanent (leg
amputation
secondary to diabetes,
blindness from
measles, lameness from
polio)
HEALTH THREAT -conditions that are
conducive to disease, accident or failure
to realize one’s potential
Examples:
Family history of hereditary
disease
Threat of cross infection
Accident hazards
Faulty eating habits
Poor environmental sanitation
Unhealthy lifestyle/personal
habits
FORESEEABLE CRISIS -anticipated
periods of unusual demand on the
individual or family in terms of
adjustment/family resources
Examples:
Marriage
Pregnancy EVALUATION OF CARE AND SERVICES
Parenthood PROVIDED
Divorce or separation
Loss of job STRUCTURAL ELEMENTS -include the
Menopause physical settings, instrumentalities and
Death conditions through which nursing care is
given
PRIORITIZING HEALTH Components:
Philosophy
PROBLEMSNATURE OF THE PROBLEM Objectives
–categorized into health deficit, health Building
threat and foreseeable crisis Organizational structure
Health deficit 3 Financial resources (budget,
Health threat  2 equipment, staff)
Foreseeable crisis  1
PROCESS ELEMENTS -steps of the
MODIFIABILITY OF THE PROBLEM nursing process (assessment, planning,
–refers to the probability of success in implementing and evaluating)
minimizing, alleviating or totally Components:
eradicating the problem through Taking the family health database
intervention Performing physical examination
Easily modifiable 2 Making a nursing diagnosis
Partially modifiable  1 Determining nursing goals
Not modifiable 0 Writing a nursing care plan
Performing nursing interventions
PREVENTIVE POTENTIAL Coordination of services
–refers to the nature and magnitude of Measuring success of nursing actions
future problems that can be minimized
or totally prevented if intervention is OUTCOME ELEMENTS -changes in the
done on the problem under client’s health status that result from
consideration nursing interventions
High 3 Components:
Moderate 2 modification of signs and symptoms
Low 1 Knowledge
Attitude
SALIENCE Satisfaction
–refers to the family’s perception and Skill level of client
evaluation of the problem in terms of Compliance with treatment regimen
seriousness and urgency of attention
needed NURSING PROCEDURES
A serious problem, immediate attention 
needed 2 PRE-CONSULTATION CONFERENCE
A problem, but not needing immediate a 1. Greet and make client at ease
ttention 1 2. Take clinical history
Not a felt need / problem  0 3. Take temperature, blood
pressure, height and weight
4. Perform physical assessment5.Do
laboratory examinations6.Write findings
on client records
MEDICAL EXAMINATION
1. Assist client before, during and after
examination by physician
2. Inform physician of relevant findings
gathered in pre-conference
3. Work with the physician during
the examination
4. Ensure privacy, safety and comfort of
patient throughout procedure
5. Observe confidentiality of
examination results
Nursing Intervention:
1. Carry out physician’s orders as giving
medication or injection
2. Explain and reinforce
physician’s orders and advises
3. Teach patient measures to promote
and maintain health as proper diet,
exercise and Personal hygiene.
4. Seek information regarding health
status of other family members
5. Counseling
PRE-CONSULTATION CONFERENCE
1. Explain findings and needed care or
intervention
2. Refer patient
to other health worker/agency
3. Make appointment
for next clinic/home visit
DEPARTMENT OF HEALTH
VISION: Filipinos are among the
healthiest people in Southeast Asia by
2022, and Asia by 2040
MISSION: To lead the country in the
development of a productive, resilient,
equitable and people-centered health
system for a Universal Health Care
NATIONAL HEALTH OBJECTIVES
Improve the general health status of
the population
Reduce morbidity, mortality, disability
and complications
Eliminate the following diseases as
public health problems (schistosomiasis,
malaria, filariasis, leprosy, rabies,
measles, tetanus, diphtheria, pertussis,
vitamin A and iodine deficiency)
Eradicate poliomyelitis
Promote healthy lifestyle
Promote health and nutrition
of families and special populations
Promote environmental health and
sustainable development
BASIC PRINCIPLES TO ACHIEVE
IMPROVEMENT IN HEALTH
Ensure universal access to basic
health services
Epidemiological shift from infectious to
degenerative disease must be managed
Enhance the performance of the
health sector
Ensure the prioritization of the health
and nutrition of vulnerable groups
PRIMARY STRATEGIES TO ACHIEVE
HEALTH GOALS
Support for frontline health workers
and local system development
Assurance of health care
Increasing investment for
primary health care
PRIMARY HEALTH CARE
Essential health care made
universally acceptable to individuals and
families in the community
By means acceptable to them and
through their full participation
At a cost that the community and Private Practitioners
country can afford at every stage of Community Hospitals
development Rural Health Unit

ESSENTIAL HEALTH CARE SERVICES SECONDARY 

GOAL: Health for all Filipinos and Emergency/District Hospitals
Health in the Hands of the People by the Provincial/City Hospitals
year 2020
MISSION: To strengthen the health care TERTIARY 
system wherein people will manage Regional Medical Centers and
their own health care Training Hospitals
CONCEPT: Partnership and National Medical Centers
empowerment of the people Teaching and Training Hospital
LEGAL BASIS:
Letter of Instruction 949 TWO LEVELS OF PHC WORKER
President Ferdinand Marcos
October 19, 1979 VILLAGE / BARANGAY HEALTH
First International Conference WORKERS (V/BHWs)
on Primary Health care -Trained community health workers
Alma Ata, USSR -Health auxiliary volunteer
September 6-12, 1978 -Traditional birth attendant or healer
Sponsored by the World
Health Organization and INTERMEDIATE LEVEL HEALTH
UNICEF WORKERS
-General medical practitioner
ELEMENTS/COMPONENTS of PHC -Public health nurse
-Education for Health -Rural sanitary inspector
-Locally Endemic Disease Control -Midwives
-Expanded Program on Immunization
-Maternal and Child Health TRADITIONAL MEDICINES (LUBBY SANTA)
-Essential Drugs and Elderly Care
-Nutrition Lagundi Sambong
-Treatment of CD and Non-CD Ulasimang bato Akapulko
-Sanitation: Water and Environment Bawang Niyog-niyogan
Bayabas Tsaang gubat
ORGANIZATIONAL STRATEGY  Yerba Buena Ampalaya
Framework for meeting the goal
of primary health care
Calls for active and continuing
partnership among the communities,
private and government agencies
in health development

LEVELS OF HEALTH CARE SERVICES

PRIMARY  
Barangay Health Station