WEEK 1: COMMUNITY HEALTH NURSING  DISEASE PREVENTION: Maintain the level of health of an individual to avoid sickness as

 Difference From Community Health Nursing 1: The target client will be wider and well as for protection such as sue of PPE, handwashing, vaccination, isolation
broader because CHN 2 will focus on wider population in the community  MANAGEMENT OF FACTORS AFFECTING HEALTH:

PRIMARY SECONDARY TERTIARY

COMMUNITY HEALTH: SUSTAINABLE DEVELOPMENT GOALS (SDG)
– Millennium Development Goals (MDG) was created in year 2000 and composed of eight An intervention An intervention An intervention
(8) goals and should be achieved until 2015 then SDG was revised in year 2015 implemented before implemented after a implemented after
– There are seventeen (17) Sustainable Development Goals (SDG) that are connected with there is evidence of a disease has begun, but a disease or injury
each other disease or injury before it is symptomatic is established
DEFINITION
Reduce or eliminate Early identification Prevent sequelae
WHAT IS A COMMUNITY?
causative risk factors (through screening) (stop bad things
 A group of people with common characteristics or interest living together within a INTENT (risk reduction) and treatment from getting
territory or geographical boundary worse)
 A place where people under usual conditions are found Encourage exercise Check body mass index
 Group of people with three (3) elements to be called community and healthy eating to (BMI) at every well
1. There are group of people prevent individuals check up to identify
2. With commonalities, interests, and characteristics from becoming individuals who are
3. Living with any territorial or geographical boundary EXAMPLE
overweight overweight or obese

DEFINITION OF HEALTH:
PUBLIC HEALTH NURSING
1. OPTIMUM LEVEL OF FUNCTIONING (OLOF)
 The term used before Community Health Nursing
– Modern definition of health, health is being influenced by ecosystem through number  CHN is broader because it is the mother where PHN is only a sub–component or just
of factors: part of CHN
 Political Factors: Safety, oppression, people – if people feel safe and no war  According to DR. C.E. Winslow, Public health is a science and art of 3 P’S
around them, their health will be much better  Prevention of Disease
 Behavioral Factors: Whatever behavior an individual have, it will affect their  Prolonging Life
health  Promotion of Health
 Hereditary Factors : Disease can be passed such as Trisomy 21 (Down Syndrome,
Turner Syndrome (lack of x chromosome)
DIFFERENT SETTING/COMPONENTS OF CHN
 Healthcare Delivery System Factors: If the community has a good healthcare
delivery system, there will be increase level of health and functioning in the Occupation health nurse
community School health nurse (nasa canvas readings)
 Environment Factors: If there is no pollution
 Socio–Economic Status Factors: It depend on the living of and individual in the WHAT IS COMMUNITY HEALTH NURSING?
community  MAGLAYA: The utilization of the Nursing process in the different levels of clientele –
Individuals, Families, Population Groups, and Communities, concerned with the
2. HEALTH–ILLNESS CONTINUUM promotion of health, prevention of disease and disability and rehabilitation
– The proponent for this model is Neuman  NISCE: GOAL – “To raise the level of citizenry by helping communities and families to
– Continuum means to changes through time, you are healthy now but you have poor cope with the discontinuities in and threats to health in such a way as to maximize their
lifestyle therefore at any point of time you can be healthy or well and could also be ill potential for high–level wellbeing”
and worse is death  WHO EXPERT COMMITTEE OF NURSING: 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
3. HIGH–LEVEL WELLNESS
the condition in the social and physical environment, rehabilitation of illness and
– Halbert Dunn disability
– It is oriented towards maximizing the health potential of an individual through  JACOBSON: A learned practice discipline with the ultimate foal contributing as
continuum of balance and direction within the environment individuals and in collaboration with others to the promotion of the client’s optimum
level of functioning through teaching and delivery of care
4. AGENT–HOST–ENVIRONMENT  DR. RUTH B. FREEMAN: A service rendered by a professional Nurse to IFCs, population
– It is used in epidemiology groups in health centers, clinics, schools, workplace for the promotion of health,
– Agent–Host–Environment are interaction or interrelated which causes the disease prevention of illness, care of the sick at home and rehabilitation
 Host can be human or animal which is susceptible to get the disease
 Environment are external environments or factors outside the host that could 4 CLIENTS OF COMMUNITY
affect the health of the host 1. Individuals
2. Families
5. HEALTH BELIEF MODEL 3. Population and Population Aggregates : Group of people with common
– The belief of an individual based on their perception, what they feel, see, taste, etc. can 4. Communities
affect their health
 PHNs with a bachelor’s degree or higher are equipped to handle numerous
6. EVOLUTIONARY–BASE MODEL determinants of health and to fully participate in the challenges of achieving and
– Illness and death serve as evolutionary functions maintain public health
– There are certain factors that are interconnected or interrelated that will affect the  The scope of their responsibilities include community–building, health promotion, policy
health and wellness of an individual reform, and implementing system–level changes to promote and protects public health
 Life events  PHNs as the leaders in the improvement of health and the promotion of healthy
 Lifestyle determinants equality, play crucial role in the future of healthcare (KUO, 2021)
 Evolutionary viability
 Viability emotion  Public Health is directed towards assisting every citizen to realize his birth rights and
 Health outcomes longevity. The science and art of preventing disease, prolonging life and efficiency
through organized community effort for:
 The sanitation of the environment
7. HEALTH PROMOTION
 The control of communicable infections
– Directed at increasing level of well–being through health protium behaviors  The education of the individual in personal hygiene
 The organization of medical and nursing services for the early diagnosis and
8. WORLD HEALTH ORGANIZATION (WHO) preventive treatment of disease
– It is a complete state of physical, mental, and social well–being, and not merely an  The development of a social machinery to ensure the standard of living, adequate
absence of disease or infirmity for maintenance of health to enable every citizen to realize his birth rights of
health and longevity
COMMUNITY HEALTH
 It is a part of paramedical and medical intervention/approach which is concerned on the MISSION OF COMMUNITY HEALTH NURSING
health of the whole population  Health Promotion
 Health Protection
IT AIMS TO:  Health Balance
 HEALTH PROMOTION: The goal is to make an individual level of health is to be higher  Disease Prevention
through health teaching, health education, or wellness and lifestyle related activities  Social Justice

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 PHILOSOPHY OF COMMUNITY HEALTH NURSING: The Philosophy of CHN is based on
the worth and dignity of man (DR. M. Shetland) THREE (3) ELEMENTS IN HEALTH EDUCATION
1. INFORMATION: To share ideas to keep population group knowledgeable and aware
THREE (3) ELEMENTS CONSIDERED IN MISSION OF COMMUNITY HEALTH NURSING 2. EDUCATION: Change within the individual
1. Science of Public Health (core foundation in CHN) – Three (3) Key Elements of Education : Knowledge, Skills, Attitude
2. Public Health Nursing Skills 3. COMMUNICATION: Interaction involving two (2) or more persons
3. Social Assistance Functions – Elements of Communication: Message, Sender, Receiver

OBJECTIVES OF PUBLIC HEALTH: CODES

– Control of communicable diseases PUBLIC HEALTH WORKERS (PHW)
– Organization of medical and nursing services PHWs are members of the health team who are professionals namely:
– Development of social machineries – Medical Officer (MO): Registered Nurse
– Education of IFC on personal hygiene – health education is the essential task of ever – Public Health Nurse (PHN): Registered Midwife
health worker – Dentist
– Sanitation of the environment – Nutritionist
– Medical Technologist
BSIC PRINCIPLES OF COMMUNITY HEALTH NURSING – Pharmacists
– The community is the patient in CHN, the family is the unit of care and there are four (4) – Rural; Sanitary Inspector (RSI): Must be a sanitary
levels of clientele: Individual, Family, Population Group (those who share common
characteristics, developmental stages, and common exposure to health problems – ex: DEPARTMENT OF HEALTH (DOH) FIVE (5) MAJOR FUNCTIONS
children, elderly), and the Community 1. Ensure equal access to basic health services
– In CHN, the client is considered as an active partner not passive recipient of care 2. Ensure formulation of national policies for proper division of labor and proper
– CHN practice is affected by developments in health technology, in particular, changes in coordination of operations among the government agency jurisdictions
society, in general 3. Ensure a minimum level of implementation nationwide of services regarded as public
– The goal of CHN is achieved through multi–sectoral efforts health goods
– CHN is a part of health care system and the larger human services system 4. Plan and establish arrangements for the public health systems to achieve economies of
scale
ROLES OF THE PUBLIC HEALTH NRUSE (PHN) 5. Maintain a medium of regulation and standards to protect consumers and guide
 CLINICIAN: Who is a health care provider, taking care of the sick people at home or in providers
the RHU
 HEALTH EDUCATIOR: Who aims towards health promotion and illness prevention EO 103: THREE (3) MAJOR FUNCTIONS
through dissemination of correct information; educating people  LEADERSHIP IN HEALTH: Policies in Health
 FACILITATOR: Who establishes multi–sectoral linkages by referral system  ENABLER AND CAPACITY BUILDER: New strategies and Training
 SUPERVISOR: Who monitors and supervises the performance of midwives  ADMINISTRATIVE FUNCTION: Manages Tertiary Facilities
 HEALTH ADVOCATOR: Who speaks on behalf of the client
 ADVOCATOR: Who act on behalf of the client VISION: Filipinos are healthiest in Southeast Asia in 2022, in Asia in 2040
 COLLABORATOR: Who working with other health team member MISSION: To lead the country in the development of productive, resilient, equitable and
 Other specific responsibilities of a Nurse, spelled by the implementing rules and people–centered health system for universal health care
regulations of RA 7164 (Philippine Nursing Act of 1991) includes:
 Supervision and care of women during pregnancy, labor, and puerperium
MODULE WEEK 1: COMMUNITY HEALTH NURSING CONCEPTS
 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence and emergency care
 Recommending herbal and symptomatic medicines DEFINITION OF COMMUNITY HEALTH NURSING
COMMUNITY HEALTH NURSING ACCORDING TO JACOBSON:
IN THE CARE OF THE FAMILIES: – It is a learned practice discipline with the ultimate goal of contributing to the promotion
 Provision of primary health care services of the client’s OLOF (Optimum Level of Functioning) through teaching and delivery of
 Developmental/utilization of family nursing care plan in the provision of care care

IN THE CARE OF THE COMMUNITIES: COMMUNITY HEALTH NURSING ACCORDING TO WHO:

 Community organizing mobilization, community development, and people development – It is a special field of nursing that combines the skills of nursing, public health and some
 Case finding and epidemiological investigation phases of social assistance and functions for the promotion of health, improvement of
 Program planning, implementation and evaluation social and physical conditions and rehabilitation of illness and disability
 Influencing executive and legislative individuals or bodies concerning health and
development COMMUNITY HEALTH NURSING BY AMERICAN NURSES ASSOCIATION (ANA)
– “The synthesis of nursing practice and public health practice applied to promoting and
RESPONSIBILITIES OF COMMUNITY HEALTH NURSING preserving the health of the populations.”
1. Be a part in developing an overall health plan, its implementation and evaluation for
communities PHILOSOPHY OF COMMUNITY HEALTH NURSING
2. Provide quality nursing services to the three levels of clientele  A philosophy is defined as “a system of beliefs that provides a basis for and guides
3. Maintain coordination/linkages with other health team members NGO/Government action.” A philosophy provides the direction and describes the whats, the whys and the
agencies in the provision of public health services hows of activities within the profession
4. Conduct researches relevant to CHN services to improve provision of health care  PHILOSOPHY: According to Margaret Shetland, the philosophy of CHN is based on the
5. Provide opportunities for professional growth continuing education for staff worth and dignity of a man
development
PRINCIPLES OF COMMUNITY HEALTH NURSING
STANDARDS OF COMMUNITY HEALTH NURSING by Mary S. Gardner and Cobb/Jones Leahy
 THEORY: Applies theoretical concepts as basis for decision in practice 1. Community Health Nursing is based on the recognized needs on recognized needs of
 DATA COLLECTION: Gathers comprehensive, accurate data systematically communities, families, groups and individuals
 DIAGNOSIS: Analyzes collected data to determine the needs/health problems of IFC 2. The Community Health Nurse must fully understand the objectives and policies of the
 PLANNING: At each level of prevention, develops plans that specify nursing actions agencies she represents
unique to needs of clients 3. In Community Health Nursing, the family is the unit of service.
 INTERVENTION: Guided by the plan, intervenes to promote, maintain, or restore health, 4. Community Health Nurse must be available to all.
prevent illness, and institute rehabilitation 5. Health teaching is the PRIMARY responsibility of the Community Health Nurse
 EVALUATION: Evaluates responses of client to interventions to note progress toward 6. The Community Health Nurse works as a member of the health team
goal achievement, revise data base, diagnosis, and plan 7. There must be provision for periodic evaluation of Community Health Nurse services
 QUALITY ASSURANCE AND PREOFESSIONAL DEVELOPMENT: 8. Opportunities for continuing staff education programs for nurses must be provided by
– Participates in peer review and other means of evaluation to assure quality of the agency
nursing practice 9. The Community Health Nurse makes use of available community health resources
– Assumes professional development 10. The Community Health Nurse utilizes the already existing active organization in the
– Contributes to development of others community
 INTERDISCIPLINARY COLLABORATION: collaborates with other members of the health 11. There should be accurate recording and reporting in Community Health Nursing
team, professional and community representative in assessing, planning, implementing,
and evaluating programs for community health FEATURES OF COMMUNITY HEALTH NURSING
 RESEARCH: Indulges in research to contribute to theory and practice in community
 Preventive Approach to health
health nursing
 It is characterized by being population or aggregate – focused.
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 It is developmental in nature
 With existence of prepayment mechanism for consumers of community health nursing
services
 Care for different levels of clientele
DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING
 Community Health Nursing is considered broader and more general specialty area that
encompasses subspecialties which includes:
1. PUBLIC HEALTH NURSING
– Seen as a subspecialty nursing practice generally delivered within “official” or
government agencies
2. SCHOOL HEALTH NURSING
– Aims to promote the health of school personnel and pupil / students
– It aims to prevent health problems that could hinder students learning and performance
a. LEGAL BASIS: Republic Act 124 mandates that all schools are to provide school
clinics for the treatment of minor ailments and emergency cases
b. EIGHT COMPONENTS OF SCHOOL HEALTH SERVICES ARE: Health Education,
Physical Education Health Services, Nutrition Services, Counselling, psychological
and social services Healthy School Environment, Health Promotion for Staff.
Lastly, the Family & Community Involvement
c. HEALTH APPRAISAL ACTIVITIES TO BE PERFORMED BY THE SCHOOL NURSE:
 Health Assessment : Done once a year. Priority should be given to Grade I enrollee
 Rapid Classroom Inspection : It should be done after a long vacation, between
health examination, or when there is an impending or actual epidemic
 Vision Testing: Test for visual acuity should be done once a year, preferably at the
beginning of school year
 Height and Weight Measurement
– Measurement of height, weight is done at beginning & end of school year
– Pupils who are recipients of rehabilitative supplementary feeding program
should be weighted every quarter
d. HEALTH STATUS OF PUBLIC SCHOOL PUPILS IN PUBLIC SCHOOLS: infectious
diseases (respiratory tract infections and diarrhea), worm infestations and Dental
caries
3. OCCUPATIONAL HEALTH NURSING
– As defined by American Association of Occupational Health Nurses (AACHN) as a
specialty practice that focuses on promotion, prevention and restoration of health
within the context of a safe and healthy environment
– It includes the prevention of adverse health effects from environmental hazards
– It provides for and delivers occupational health and safety programs and services to
clients
4. COMMUNITY MENTAL HEALTH NURSING
– Unique clinical process that includes concepts of nursing, mental health, social
psychology and community networks including social sciences
– Focus is on the Mental Health Promotion
THEORETICAL MODELS/APPROACHES
1. HEALTH BELIEF MODEL (HBM)
 Developed in the 1958 by group of U.S. Public Health Service social psychologists
 Believed that individual must know what to do and how to do it before they can take
actions
 Major limitation of HBM is that it places burden of action exclusively on the client
KEY CONCEPT AND DEFINITIONS OF HBM
– PERCEIVED SUSCEPTIBILITY: One's belief regarding the chance of getting a given
condition
– PERCEIVED SEVERITY: One's belief regarding the seriousness of a given condition
– PERCEIVED BENEFITS: One's belief in the ability of an advised action to reduce the
health risk or seriousness of a given condition
– PERCEIVED BARRIERS: One's belief regarding the tangible and psychological costs of an
advised action
– CUES TO ACTION: Strategies or conditions in one's environment that activate readiness
to take action
– SELF–EFFICACY: One's confidence in one's ability to take action to reduce health risks
2. MILIO’S FRAMEWORK FOR PREVENTION
 Nancy Milio (1976) provides complement to the HBMs
6 PROPOSITIONS OF THIS FRAMEWORK ARE RELATED TO THE FOLLOWING:
1. Population health deficits results from deprivation &/or excess of critical health
resources
2. Organizational Dimension & policies dictate many of the options available and influence
their choices
3. Alterations in pattern of behavior resulting from decision – making of significant
number of people in a population can result in social change
4. Behavior of population result from selection from limited choices; arise from actual &
perceived options available as well as beliefs & expectations, resulting from
socialization, education and experience
5. Individual choices related to health promotion or health damaging behaviors are
influenced by efforts to maximize – valued resources
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6. Without concurrent availability of alternative health-promoting options, for investment
of personal resources, health education will be largely ineffective on changing behavior
patterns
 It stated that diseases associated with excess (ex: obesity and alcoholism) afflict
affluent societies, and the diseases that result from inadequate or unsafe food, shelter
and water afflict the poor
 The range of available health choices is critical in shaping a society’s overall health
status
 National level policy making was the best way to favorably impact the health of most
people rather that concentrating efforts on imparting information in an effort to change
individual patterns of behavior
 Health – promoting choices must be readily available and less costly than health-
damaging options
 Health Deficits results from an imbalance between a population’s health needs and its
health sustaining resources
 Compared to HBM, Milio’s framework includes economic, political and environmental
health determinants
 Lifestyle are patterns of choices made from available alternatives according to people
socioeconomic circumstances and how easily they are able to choose some over others
3. NOLE PENDER’S HEALTH PROMOTION (HPM)
 Developed in 1980’s and revised in 1996
 Explores many biophysical factors that influence individuals to pursue health promotion
activities but does not include threat as a motivator
 PENDER'S MODEL FOCUSES ON THREE CATEGORIES: individual characteristics and
experiences, behavior–specific cognitions and affect, and behavioral outcomes. Details
are as follow:
INDIVIDUAL CHARACTERISTICS AND EXPERIENCES
Prior Related Behavior Personal Factors
– This influence subsequent behavior – This are Biological, Psychological,
through perceived self–efficacy Sociocultural in nature
BEHAVIOR – SPECIFIC COGNITION AND AFFECT
– PERCEIVED BENEFITS OF ACTION: These are strong motivators through intrinsic and
extrinsic benefits
– PERCEIVED BARRIERS TO ACTION: Are perceived unavailability, inconvenience,
expense, difficulty or time regarding health behaviors
– PERCEIVED SELF–EFFICACY: Is one’s belief that he or she is capable of carrying out
behavior
– ACTIVITY-RELATED AFFECT: Feeling associated with behavior likely affect individual to
repeat/maintain behavior
– INTERPERSONAL INFLUENCES (family, peers, provident), NORMS, SUPPORT, MODEL:
These are feelings or thoughts regarding the beliefs or attitudes of others
– SITUATIONAL INFLUENCES (Options, Demand characteristics, Aesthetics): These are
perceived options available, demand characteristics and aesthetics features of the
environment where the behavior will take place
– COMMITMENT TO A PLAN OF ACTION: This initiates a behavioral event
BEHAVIORAL OUTCOME
Immediate Competing Demands (Low Health Promoting Behavior
Controls) & Preferences (High Control)
– These are alternative behavior – Goal/outcome
Immediately prior to engaging in the
intended, planned behavior
4. PRECEDE – PROCEED Model
 Developed by Dr. Lawrence Green and colleagues
 PRECEDE which stands for Predisposing, Reinforcing and Enabling Constructs in
Educational Diagnosis and Evaluation, is used for community diagnosis
 PROCEED, an acronym for Policy, Regulatory, and Organizational Constructs in
Educational and Environmental Development, is a model for implementing and
evaluating health programs based on PRECEDE
– Predisposing Factors refer to people’s characteristics that motivate them toward
health-related behavior. This includes attitudes, beliefs and values
– Enabling Factors refer to conditions in people and the environment that facilitate
or impede health related behavior. This includes skills, availability, accessibility &
referrals
– Reinforcing Factors refer to feedback given by support persons or groups
resulting from the performance of the health–related behavior. This includes
Support from family, peers, teachers, employers, health care providers
TERMINOLOGIES:
 AGGREGATE: It is literally defined as the sum or the whole. Community – is a part of that
whole
 GEOPOLITICAL COMMUNITY: It is a community with defined geographical and
jurisdictional boundaries, such as rural municipalities, towns or city communities. A is
the procedure of systematically acquiring and recording information about the
members of a given population.
 PHENOMENOLOGICAL COMMUNITY: A phenomenological community is said to be a
group of people who are defined by sharing values, customs, interests, religion or
academic interests. It is a phenomenological community because members share
common beliefs and interests allocates them to the place where enumerated—normally
where they spend the night of the day enumerated
THIRD YEAR:
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 WEEK 2: THEORETICAL MODELS/APPROACHES OF COMMUNITY
HEALTH NURSING PRACTICE
 In the hospital ward, ideal ratio according to Department of Health
(DOH) is one (1) Nurse to twelve (12) patients – 1:12
 In the community setting, ideal ratio is one (1) Nurse to ten thousand
(10,000) of the population patients – 1:10,000
DEFINITIONS OF THEORY:
BY CHINN AND KRAMER
– Theory is the ideas, explanations, and concepts that main objective or
goal according to Chinn and Kramer is to: Improve Nursing practice
– Theory or part of theoretical framework will guide practice achieve the
goal
BY BARNUM
– Theory is like a Map …not in full terrain but picks out area that are
important for a given purpose
 Theory will allow to traverse these areas or specific points to
reach the destination
– Using theory in NCP guides in assessing Nursing situation – allows to
plan and not get lost
BY SCHWARTZ – BARCOTT
– Ruling In and Ruling Out Concept
 Process of Elimination , it will help us to improve the practice specifically
in the community or community health nursing
– Theory–based practice guides data collection and interpretation
BY WOODS AND CATANZARO
– A systematic vision of reality, a set of interrelated concepts (magkaka–
dugtong na konsepto) that is useful for prediction and control
– It helps to predict the future and control what will happen
BY TORRES
– Theory provides a way of thinking about and looking at the world
around us
– Theory organizes relationships between complex events that occur in
Nursing situation so that we can assist human being
BY DICKOFF AND JAMES
– Conceptual System or framework invented for purpose
– The purpose varies, so too the structure and complex of system
BY CHINN AND KRAMER
– Creative/Rigorous structuring of ideas
– Projects tentative, purposeful, systematic of phenomena
BY CHINN AND KRAMER
– Set of ideas, hunches, hypotheses
– Provides prediction, explanation of the world
1. HEALTH BELIEF MODEL (HBM)
 Developed in the 1958 by group of U.S. Public Health Service social
psychologists
 They wanted to explain why so few people participate in programs to
prevent and detect Tuberculosis
– HBM is all about perception or belief of an individual, family, or
community regarding to health
 Believed that individual must know what to do and how to do it before
they can take actions
– 100% of accountability (sisi) is to patient because they know hat to
do and how to do it
 Major limitation of HBM is that it places burden of action exclusively on
the client
KEY CONCEPT AND DEFINITIONS OF HBM
– PERCEIVED SUSCEPTIBILITY: One's belief regarding the chance of
getting a given condition
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 Since takot yung tao, nag–iingat yung mga tao sa sakit
– PERCEIVED SEVERITY: One's belief regarding the seriousness of a given
condition
 Gaano ka–severe kung ano yung pwedeng mangyari
– PERCEIVED BENEFITS: One's belief in the ability of an advised action to
reduce the health risk or seriousness of a given condition
 Paniniwala na kapag uminom ng herbal medication, pwedeng hindi
magdulot ng malalang sakit
– PERCEIVED BARRIERS: One's belief regarding the tangible and
psychological costs of an advised action
 Kung gaano kamahal yung pagbili ng gamot o herbal medicine
– CUES TO ACTION: Strategies or conditions in one's environment that
activate readiness to take action
 Cues means signals or indications in one’s environment such as
isolation due to Covid–19
– SELF–EFFICACY: One's confidence in one's ability to take action to
reduce health risks
2. MILIO’S FRAMEWORK FOR PREVENTION
 Nancy Milio (1976) provides complement to the HBMs
 He wanted to provide additional information or complement to the
Health Belief Model (HBM)
 Health deficits results from an imbalanced between a population’s
health needs and its health–sustaining resources
– Pangangailangan vs. Resources, anything that is lacking or too
much resources could lead to health imbalances which does not
meet the health needs of an individual where the problems start
6 PROPOSITIONS OF THIS FRAMEWORK ARE RELATED TO THE
FOLLOWING:
1. Population health deficits results from deprivation &/or excess of critical
health resources
– In the Philippines, there are a lot of lacking resources
2. Organizational Dimension & policies dictate many of the options available
and influence their choices
– The policies of the government or DOH dictates direction of many
options available depending on the distribution
3. Alterations in pattern of behavior resulting from decision – making of
significant number of people in a population can result in social change
– Due to lacking of resources, the decision–making about something
depends to the individual which can affect their health The
4. Behavior of population result from selection from limited choices; arise from
actual & perceived options available as well as beliefs & expectations,
resulting from socialization, education and experience
– There is one proven study regarding joining with Mother Nature
where if you go with the nature, it will improve or maintain healthy
body and wellness of an individual
5. Individual choices related to health promotion or health damaging
behaviors are influenced by efforts to maximize – valued resources
– A public health nurse should be creative enough to maximize the
limited resources provided in the community
6. Without concurrent availability of alternative health-promoting options, for
investment of personal resources, health education will be largely
ineffective on changing behavior patterns
– We educate patient and provide information and at the same time,
they also need resources which is the problem because of limited
resources a community have such as in Mindanao, mabubundok na
lugar
3. NOLE PENDER’S HEALTH PROMOTION (HPM)
 Developed in 1980’s and revised in 1996
 Explores many biophysical factors that influence individuals to pursue
health promotion activities but does not include threat as a motivator
 PENDER'S MODEL FOCUSES ON THREE CATEGORIES:
1. Individual Characteristics and Experiences
2. Behavior–Specific Cognitions and Affect
3. Behavioral Outcomes
4. PRECEDE – PROCEED MODEL
 Developed by Dr. Lawrence Green and colleagues
PRECEDE
THIRD YEAR:
– Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis  Open channel of communication
and Evaluation – Being connected and open with other people
– Precede is used for community diagnosis  Equitable and efficient use of community resources
– Precede has five (5) sub–components: – The priority of the government is the marginalized (mahihirap) people
1. Social Assessment
2. Epidemiological Assessment
3. Ecological/Environmental Assessment
4. Implementation of Intervention FACTORS AFFECTING HEALTH OF THE COMMUNITY
5. Identify Administrative and Policy Factors Community has 3 features. It includes population, location and social systems:
1. CHARACTERISTICS OF THE PEOPLE/POPULATION
PROCEED  Population size and density influences the number and size of health care
– Policy, Regulatory, and Organizational Constructs in Educational and institutions
Environmental Development – Kung gaano ka–congested yung community and kung gaano na karami
– Proceed is a model for implementing and evaluating health programs based yung population sa isang community
on Precede  Health needs of community varies because of differences in population
 IMPLEMENTATION: It is the execution of the plan composition by age, sex, occupation, level of education and other variables
 EVALUATION: Evaluate if the goal was fully met, partially met, or not  Other factors are rapid growth or decline of a population
met at all – Mas maraming bata ang pinapanganak, mas maganda kasi mas
– Proceed has five (5) sub–components: maraming beneifts
1. Implementation  The feeling of belonging and participation in community action including
2. Process Evaluation level of education and social class
3. Impact Evaluation – These are more readily achieved in a culturally homogenous
4. Outcome Evaluation population
– PREDISPOSING FACTORS: It refers to people’s characteristics that motivate  Level of education and social class affiliates health status because of
them toward health–related behavior differences in living condition and degree of access to resources
 This includes attitudes, beliefs and values
 Examples: High blood pressure, high bad cholesterol, obesity, etc.
2. LOCATION OF THE COMMUNITY
– ENABLING FACTORS: It refers to conditions in people and the environment
 Health of community is affected by both natural and man–made variables
that facilitate or impede health related behavior
related to location
 This includes skills, availability, accessibility & referrals
– Natural Factors consist of geographic features, climate, flora, and
– REINFORCING FACTORS: It refers to feedback given by support persons or
fauna
groups resulting from the performance of the health–related behavior
 Geographic features consist of land and water forms that influence food
 This includes Support from family, peers, teachers, employers, health
sources and prevalent occupations
care providers
 Geography plays an important role in disasters
 Effects of climate change on human health are evidenced by seasonal
WEEK 2: CONCEPTS OF THE COMMUNITY diseases
WHAT IS A COMMUNITY?  Geographic location of the Philippines makes it vulnerable to natural
– Group of people with common characteristics or interests hazards
– Living together within territory or geographical boundary – The country in the so called “Ring of Fire,” in which volcanic eruptions
– A place where under usual conditions are found and earthquakes are frequent
 Other factors that affect health of community are plants and fauna
TYPES OF COMMUNITY – It also includes community boundaries, air water and soil pollution
1. GEOPOLITICAL COMMUNITY  Community boundaries , which is the clear demarcation is necessary since
– Territorial there are basis for determining catchment area of community health
– It is a spatial designation – a geographical or political area or place (Maurer workers
and Smith, 2013) – Catchment Area: Location of health centers
– Examples: Barangay, purok, bilibid, there is a physical place you can see – Demarcation: Kung hanggng saan lang yung isang barangay
municipality
 Factors that contribute to health problem in urban are: higher population
2. PHENOMENOLOGICAL COMMUNITY
density with resulting congestion
– Functional – Concentrated poverty and slum formation
– A community where individual with common characteristics but here is no a – Greater exposure to health risk/hazards
physical place  Factors that contribute to health problem in rural are: inequalities of
– It is functional because they go together based on their function in the resources and economic opportunities
society – Poverty more prevalent
– Examples: Social Groups, Profession, Religious Groups – Limit access to health facilities
INFORMAL SETTLEMENTS
CHARACTERISTICS OF HEALTHY COMMUNITY
As informal (and often illegal) housing, slums are defined by:
ADAPTED FROM HUNT, 1997 AND DUHL, 2002 – Unsafe and/or unhealthy homes for examples lack of windows, dirt floor,
 Shared sense of being a community based on history and values leaky walls and roofs
– Where individual has their own function in the community and with a – Overcrowded homes
great bonding with unity – Limited or no access to basic services such as toilets, electricity,
 General feeling of empowerment and control over matters affecting the transportations
community as a whole – Unstable homes such as weak structures often destroyed during storms and
– If the community is empowered to have a freedom of expression, earthquakes
empowered to help the community, if the individual is concerned in – No secure land tenure such as the land rights to live there
the community
 Existing structures that allow subgroups in the community
3. SOCIAL SYSTEMS WITHIN THE COMMUNITY
– A high–risk aggregate is a sub–group or sub–population of the
 SOCIAL SYSTEM: A Social System is an interdependent set of cultural and
community that has a high–risk commonality among its members
structural elements that can be thought of as a unit
– Sub–group to refer to smaller, regionalizes groups (Tyler, 2013)
– Heart of the community is the family
 Ability to cope with change, solve problems & manage conflicts within the
 Social system is the patterned series of interrelationships existing between
community
individuals, groups and institutions and forming a coherent whole
– Especially after Covid–19 pandemic on how to cope up with the
 This includes the following : Family economic, educational, communication,
changes happened
political, legal, religious, recreational and health system
CHNN312: PRELIM LECTURE THIRD YEAR:
FIRST SEMESTER (2023 – 2024)
 – Air, water and soil pollution poses health hazard to the population

ROLES AND ACTIVITIES OF COMMUNITY HEALTH NURSE

– Roles and activities of community health nurse and its sub–specialty is
connected with following:
 Clinician/Care Provider
 Educator
 Advocate
 Manager
 Researcher
 Collaborator
 Leader

CHNN312: PRELIM LECTURE THIRD YEAR:

FIRST SEMESTER (2023 – 2024)