NCM 113N LEC PRELIMS | JEWEL ANN T.
GARANCHON
OVERVIEW OF COMMUNITY HEALTH NURSING
Health as a Key Concept
 Health as a concept and as a reality
 “A state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity.”
(WHO, 1958)
 Social means “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
 Health is 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.
(WHO, 1986)
 WHO in 1986 emphasize recognition of the social
implications of health.
 Thus health is: 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
Nursing Definitions of Health
 “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,
Zentner, and Yakimo, 2009)
 “Realization of human potential through goaldirected
behavior, competent self-care, and satisfying relationships
with others” (Pender, Murdaugh, and Parsons, 2011)
 A state of a person that is characterized by soundness or
wholeness of developed human structures and of bodily and
mental functioning (Orem, 2001)
Health as a Human Right
“The enjoyment of the highest standard of health is one of the
fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition (WHO, 2017)
1. Availability
- Operational public health and channels of service
delivery, products and services as well as programs be
adequate for all.
2. Accessibility
- Health facilities, services and goods must be made
possible and obtainable to everyone
Nondiscriminatory, physically accessible, affordable
and information accessible
3. Acceptability
- Respect for the medical ethics, culturally appropriate
and gender sensitive Peoplecentered, able to
accommodate the community’s diverse needs
4. Quality
- Health facilities, commodities and services must be in
accordance with scientific and medical standards
CLINICAL MODEL
What Is Clinical Model All About?
 Health is a state of not being sick.
 It is the conventional model of the discipline of medicine.
 It emphasizes the alleviation of disease-related signs and
symptoms.
How Does The Model View Health And Illness?
 People are viewed as physiologic systems with related
functions, and health is identified by the absence of signs
and symptoms of disease or injury
 A person ' s subjective state of wellness can be measured
using health-illness.
 People travel back and forth along this continuum on a
daily basis.
 It emphasizes the importance of preventive care and early
diagnosis.
How Can The Model Beused As A Framework For Community
Health?
Clinical model can be used as a framework for community health by
serving as a roadmap to provide guidance to the client in applying the
principles by:
 Creating interventions
 Providing safe treatment
 Reliable and effective care
 Improving the health status of the individuals in the
community
Lesson Learned
The clinical model is crucial for both individuals and medical
professionals as it guides them to obtain high-quality care and
healthcare services. It is essential for community healthcare settings
as it focuses on the absence of disease and the body's physiological
well-being. It aids in the early detection and management of health
issues, promoting overall well-being and it forms the foundation of
medical practices, ensuring individuals receive appropriate care when
ailments arise. While holistic models of health are gaining
importance, the clinical model remains crucial in addressing
immediate medical concerns and maintaining the basic health status
of individuals, contributing to a healthier society overall. Also, it
encourages both medical workers and patients to work together to
achieve successful outcomes. Medical workers need to consider the
patient's lifestyle, family, and social history, as well as their physical
symptoms and other medical conditions. Patients need to take an
active role in their own health care and be open and honest with
medical workers. Open communication and collaboration between
medical workers and patients can help provide the best possible care
for the patient. Thus, the clinical model of health is a valuable tool for
promoting health education, appropriate treatments, and evidence-
based interventions in community healthcare settings. By focusing on
the importance of maintaining overall health, the model helps to
change the perception of individuals seeking help and promotes a
healthier society.
ROLE PERFORMANCE MODEL
Role Performance Model
NCM 113N LEC PRELIMS | JEWEL ANN T. GARANCHON
 A person is considered in good health and healthy when
they are able to fulfill their multiple roles without
disruption; and a person is considered ill when they cannot
fulfill their roles and responsibilities.
Example: A young mother is able to adequately carry out her
childcare activities, she would be deemed healthy. If she cannot
perform these activities, she would be considered ill
Health
 Health is seen as the ability to perform social roles
Illness
 Illness is seen as a result of the inability to fulfill
meaningful roles or engage in purposeful activities
Framework for Community Health
 The Role Performance Model can be applied as a
framework for community health by assessing the roles and
activities that are significant to a community ' s members.
This model can help identify areas of need within the
community, allowing for targeted resources and
interventions that can improve health outcomes.
 It also helps to identify potential areas of collaboration
among stakeholders and organizations, promoting a unified
effort to improve community health.
ADAPTIVE MODEL
In her theory, Sister Callista Roy Adaptation Model sees the
individual as a set of interrelated systems that maintain a balance
between various stimuli.
 Consider the concept of a system as applied to an
individual. Roy conceptualizes the person in a holistic
perspective. Individual aspects of parts act together to form
a unified being.
 Additionally, as living systems, persons are in constant
interaction with their environments. Between the system
and the environment occurs an exchange of information,
matter, and energy
What is the Model About?
 The adaptive model views the individual as a set of
interrelated sytems that maintains balance between various
stimuli
Adaptive Model in Nursing
 The development of adaptation for individuals and groups
in each of the four adaptive modes is the aim of nursing,
which also helps people live healthy lives and pass away
with dignity.
How Does the Model View Health and Illness?
 It is stated that this model views health as an inevitable
dimension of a person’s life, and is represented by a health-
illness continuum. Health is also described as a state and
process of being and becoming integrated and whole.
Health is also defined as the state where humans can
continually adapt to stimuli.
 Because illness is a part of life, health results from a
process where health and illness can coexist. If a human
can continue to adapt holistically, they will maintain health
to reach completeness and unity within themselves. If they
cannot adapt accordingly, the integrity of the person can be
affected negatively
How Can the Model Be Used as A Framework for Community
Health?
 Adaptive model in nursing can be effectively used as
frameworks for community health by promoting a patient-
centered and holistic approach to care. This model
recognizes that communities have unique characteristics,
needs, and resources that impact health outcomes.
Here are some ways adaptive model can be applied in community
health:
1. Assessing Community Needs — it primarily emphasizes
the assessment of community needs and assets.
2. Collaboration And Partnership — it encourages
collaboration among healthcare providers, community
organizations, and stakeholders.
3. Cultural Competence — adaptive models prioritize
cultural competence in healthcare delivery
4. Health Promotion and Prevention — clearly emphasizes
health promotion and disease prevention strategies.
5. Community Empowerment — aim to empower
communities by involving them in decision-making
processes related to their health.
6. Continuous Evaluation and Adaptation — stresses the
importance of ongoing evaluation and adaptation of
interventions.
EUDAIMONISTIC MODEL
What is the Model About?
 It comes from the Greek word "eudaimonia," which
translates to " well-being " or "flourishing." The
eudaimonistic model is a philosophical concept that focuses
on the idea of living a fulfilling and flourishing life.
 According to this model, true happiness and well-being are
achieved by pursuing and living in accordance with one ' s
highest potential and virtues. It emphasizes personal
NCM 113N LEC PRELIMS | JEWEL ANN T. GARANCHON
growth, self-actualization, and the cultivation of positive
character traits.
 The eudaimonistic model suggests that living a virtuous
life, with strong moral values, leads to a deep sense of
fulfillment and purpose. It promotes the idea of seeking
intrinsic rather than extrinsic rewards and prioritizes
longterm well-being over short-term pleasures. This model
has been influential in various fields, including psychology,
ethics, and positive psychology
How does the model view health and illness?
 According to the eudaimonistic approach is wide as its
model incorporates a comprehensive view of health and
wellness. The eudaimonistic concept regards health as well-
being as opposed to just the absence of any sickness. It is a
holistic approach which not only applies in the body itself
but in the mind and spirit
SELF AWARENESS - Self-awareness is the ability to focus on
yourself and how your actions, thoughts, or emotions do or don 't
align with your internal standards. SELF-
maintenance of individuals, families and groups within the
community
 CPHN is associated with health and the identification of
populations at risk rather than with an episodic response to
patient demand Requires identifying the factors which
make people at risk and what keeps them well
Biology
 an individual’s genetic makeup, family history and any
physical and mental health problems developed in the
course of life
 Heredity, aging, physical activity, smoking, stress, alcohol,
or drug abuse, injury, etc
Behaviors
 the individual’s responses to internal stimuli and external
conditions
 interacts with biology - one may influence the other

ACTUALIZATION - according to Maslow, it is viewed as the level Social environment

where one is motivated to seek the ideals in life. Self-actualization
involves the need to progress and grow rather than to be static. It is  includes interactions and relationships with family, friends,
seeking meaning and purpose in life coworkers and others in the community

SELF-FULFILLMENT - If self-actualization is done, self-  social institutions (law enforcement, religious

fulfillment will come next as it will fulfill the desire of a person to
achieve holistic well-being.  communities, schools, govt agencies, housing, safety,
public transport, availability of resources
ACTUALIZATION - Eudaimonistic health emphasizes well-being
and flourishing, transcending biological fitness. It suggests that Physical environment
achieving eudaimonic well-being involves activities that promote
 what is experienced by the senses (seen, smelled, touched,
personal growth, meaning, and purpose. These activities include
heard and tasted)
pursuing passions, cultivating positive relationships, altruism, and
participating in community or religious groups  can affect health positively or positively
How Can the Model Be Used as A Framework for Community  presence of poisonous and infectious agents, sanitation, etc
Health?
Policies and interventions
 The eudaimonistic model of health emphasizes well-being
and flourishing rather than solely focusing on the absence  have a profound effect on the health of individuals, groups,
of disease. and communities
 It suggests that eudaimonic well-being can be achieved by
engaging in activities that promote personal growth,  policies on smoking, seatbelt, littering, health care, etc
meaning, and purpose in life
 These activities can include pursuing personal passions,
cultivating positive relationships, engaging in altruism, and
participating in community or religious groups. It
emphasizes using community assets and individuals '
strengths, rather than just focusing on deficits or problems.
 This model in community health promotes a comprehensive
approach that addresses all aspects of individuals ' lives and
community needs

DETERMINANTS OF HEALTH
Major goal of CPHN

 to preserve the health of the community and surrounding

populations by focusing on health promotion and health SOCIAL DETERMINANTS OF HEALTH
NCM 113N LEC PRELIMS | JEWEL ANN T. GARANCHON
 the conditions in which people are “born, grow, work, live,
and age, and the wider set of forces and systems”
 economic, social policies, and political systems that shape
the conditions of daily life (WHO, 2019
 refers to the connection between where a person lives
(housing, neighborhood, and environment) and their health
and wellbeing
 Key issues include

 These SDH affect a person’s health, functioning, and a) quality of housing,

quality of life outcomes and directly result in health
inequities which could be avoided if all individuals are b) access to transportation,
provided with equal access to social and/or economic c) availability of healthy foods,
resources
d) quality of air and water, and

e) neighborhood crime and violence

Health Care Access and Quality

 refers to the connection between people’s access to and

understanding of health services and their own health.

 The key issues include

a) access to healthcare,

b) access to primary care,

c) health insurance coverage, and

d) health literacy

Economic Stability

 refers to the connection between the financial resources
people have (income, cost of living, and socioeconomic
status) and their health
 Key issues include
Social and Community Context
 refers to the connection between characteristics of the
contexts within which people live, learn, work, and play,
and their health and wellbeing

a) poverty,  Key issues include

b) employment, a) social cohesion within a community,

c) food security, and b) civic participation,

d) housing stability. c) discrimination,

d) workplace conditions, and

Education Access and Quality e) incarceration

 refers to the connection of education to health and

wellbeing.
FOUNDATION OF CPHN
 The key issues include
KEY CONCEPT OF CPHN
a) high school graduation,
Hierarchy of Nursing Science
b) enrollment in higher education,
 a strong knowledge base is essential
c) general educational attainment, and early
childhood education and development  other fields are focused on individuals and their specific
health issues

 CPHN focuses on all population groups: children, adults,

Neighborhood and Built Environment elderly, their families
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 the people in the community are primarily responsible for
their health

 educate to do self-care and maintain optimum level of

functioning

 Health education is a primary activity

CPHN is multidisciplinary

 Nurse fosters collaboration with different professionals and

sectors from society

 Working within and among government agencies or

departments in a private organization

Community as a Client CPHN is ecology oriented

 community: group of people living in a particular area with  Care is provided in the natural environment of people
common beliefs, values and traditions
 Setting includes homes, schools, workplaces, even prisons
 geographic boundaries and shared belief system or culture and churches

Health as a Goal CPHN promotes Social Justice

 Healthcare needs to be holistic, the nurse foster multi-  All people should enjoy access to healthcare
disciplinary efforts to address determinants of health
 Protect the interest of all by advocating for equitable
 Healthcare should be universal to achieve health as a healthcare
human right
CPHN values consumer involvement
Nursing as the Vehicle
 People in the community are not merely public consumers
 Nursing is the art and science of caring or end-users of healthcare service, they are considered as
partners in health
 Grounded on the works of nurse theorists
 Active participation at all levels is essential
 Florence Nightingale, Virginia Henderson, etc
CPHN uses repayment mechanism

 Not free, funded by taxes of people

DEFINITION OF CPHN
 Healthcare is a basic social service provided to all
 Specialized field of nursing practice that renders care to
individuals, families, and communities CPHN focuses on preventive services

 health promotion and disease prevention through people  Services are not limited to attending to health needs of the
empowerment: the core of CPHN practice community

 Help people reduce their risks from developing disease and  Reduce risks for vulnerable population
maintain their optimum functioning
CPHN offers comprehensive care
 Preventive measures: vaccination and screening
 From womb to tomb; holistic care
 Sharing information to help them manage their own
 Cannot choose patients and cannot predict cases
healthcare needs
 Requires the nurse to be skilled and knowledgeable on the
 Empowerment
broad areas of nursing
 Enabling people to do things on their own: utilization of
health education
Philosophical and Ethical Underpinnings

 Worth and dignity of man

 Responsibility for health rests primarily on people

CHARACTERIZATION AND FEATURES OF CPHN

CPHN is developmental  Attainment of independence and self-reliance in health

NCM 113N LEC PRELIMS | JEWEL ANN T. GARANCHON
 Requires active participation of the people 2. Families

Philosophical and Ethical Underpinnings 3. Population Groups

 Adheres to the tenets of social justice – promoting good 4. Communities

 Observance of universal ethical principles – beneficence, PUBLIC HEALTH

nonmaleficence, veracity, fidelity, autonomy
Public health is the Science and Art of (1) preventing disease, (2)
ROLES OF CPHN prolonging life, and (3) promoting health and efficiency through
organized community effort for:
Healthcare Provider
a. sanitation of the environment
 providing care
b. control of communicable infections,
 use of nursing process
c. education of the individual in personal hygiene,
Health Educator
d. organization of medical and nursing services for the early
 communicating information diagnosis and preventive treatment of disease, and

 to help clients make informed choices regarding their development of the social machinery to ensure everyone a standard of
health living adequate for the maintenance of health, so organizing these
benefits as to enable every citizen to realize his birthright of health
Program Implementer and longevity

 delivery of healthcare to the grassroots *Charles Edward Winslow

 execute programs initiated by the DOH at all levels FIELDS OF CPHN

 e.g. immunization Public Health Nursing

 submission of reports  A field of professional practice in nursing and in public

Community Organizer
 working with people in the community
 providing them ownership of their healthcare needs and to
act collectively on their issues
Manager/Leader
 employs principles of management to maximize resources
effectively and efficiently
Researcher/ Epidemiologist
 the health monitor of the community
 keeps track with illnesses encountered in their areas
 Conducts investigation to identify etiology
health in which technical nursing, interpersonal, analytical,
and organizational skills are applied to problems of health
as they affect the community
Occupational Health Nursing
 The promotion and maintenance of the highest degree of
physical, mental, and social well-being of workers in all
occupations
 Occupational Safety and Health (OSH) – DOLE as the lead
agency
School Health Nursing
 Education and health are interrelatedness
 To learn effectively, children need good health (WHO,
1950)

Emerging Fields of CPHN

Client Advocate  Hospice home care/home health care; faith community

nursing, correctional nursing, entrepreneurship in nursing
 ensures that the right to health of the population is realized (EntrepreNurse)
and protected
HEALTH PROMOTION AND DISEASE PREVENTION
 engages stakeholders in clamoring and lobbying for
Health Promotion
policies that impact health
 any combination of health education and related
 initiates formation of coalitions and linkage
organizational, economic, and environmental supports for
LEVELS OF CLIENTELE behavior of individuals, groups, or communities conducive
to health (Parse, 1990
RA 9173- Philippine Nursing Law of 2002

1. Individuals
NCM 113N LEC PRELIMS | JEWEL ANN T. GARANCHON
 motivated by the desire to increase well-being and to reach
the best possible health potential
 The core of CPHN
Health Protection
 consists of those behaviors in which one engages with the
specific intent to prevent disease, to detect disease in the
early stages, or to maximize health within the constraints of
disease (Parse, 1990)
 Immunizations and cervical cancer screening are examples
of health protection activities.
Ottawa Charter on Health Promotion
 WHO organized the first International Conference on
Health Promotion at Ottawa, Canada on Nov 17-21, 1986
 The Charter calls for a commitment to health promotion to
achieve the Health for All by the year 2000 and beyond
 It built on the progress made through the Declaration on
Primary Health Care at Alma-Ata, the World Health
Organization's Targets for Health for All document
 Health Promotion is the process of enabling people to
increase control over, and to improve, their health
 To reach a state of complete physical, mental and social
well-being, an individual or group must be able to identify
and to realize aspirations, to satisfy needs, and to change or
cope with the environment
 Health is a resource for everyday life, not the objective of
living.
 Health is a positive concept emphasizing social and
personal resources, as well as physical capacities.
 Therefore, health promotion is not just the responsibility of
the health sector, but goes beyond healthy life-styles to
well-being.
The fundamental conditions and resources (essentials for health) for
health are:
 peace, shelter,
 education, food,
 income,
 stable eco-system,
 sustainable resources,
 social justice, and equity
Basic Strategies For Health Promotion
 Advocacy for health to provide for the conditions and
resources essential for health
 Enabling all people to attain their full health potential
 Mediating among different sectors of the society in efforts
to achieve health
5 Priority Action
1. Build healthy public policy
2. create supportive environments for health
3. Strengthen community actions for health
4. Develop personal skills
5. Re-orient health services
THEORIES OF HEALTH PROMOTION
 a working knowledge of theory is important
 to understand why people act as they do and why they may
or may not follow the advice given to them by medical
professionals
 to help clients progress from knowledge to behavior
change.
Pender’s Health Promotion Model
 1980s and revised in 1996
 by Nola Pender
 explores the myriad biopsychosocial factors that influence
individuals to pursue health promotion activities
 depicts the complex multidimensional factors with which
people interact as they work to achieve optimum health.
 Model contains variables related to health behaviors as well
as individual characteristics that may influence a behavioral
outcome
The Health Belief Model
 Provides the basis for much of the practice of health
education and health promotion today.
 developed by a group of social psychologists to attempt to
explain why the public failed to participate in screening for
tuberculosis (Hochbaum, 1958)
 Individuals must know what to do and how to do it before
they can take action and the information must be related in
some way to the individual’s needs
 One of the most widely used conceptual frameworks in
health behavior, used to explain behavior change and
maintenance of behavior change and to guide health
promotion interventions
 several constructs: perceived seriousness, perceived
susceptibility, perceived benefits of treatment, perceived
barriers to treatment, cues to action, and self-efficacy
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 the probability that a specific event will occur in a given
time frame” (Oleckno, 2002)

Risk Factor

 an exposure that is associated with a disease

3 criteria for establishing a risk factor

1. The frequency of the disease varies by category, or amount

of the factor.

2. The risk factor must precede the onset of the disease

3. The association of concern must not be due to any source of

error

Risk Assessment
The Transtheoretical Model
 to determine the health risks to individuals, groups, and
 combines several theories of intervention, giving it the populations
name transtheoretical
 a systematic way of distinguishing the risks posed by
 based on the assumption that behavior change takes place potentially harmful exposures
over time, progressing through a sequence of stages

 assumes that each of the stages is both stable and open to

1. hazard identification
change one may stop in one stage, progress to the next
stage, or return to the previous stage 2. risk description

3. exposure assessment

4. risk estimation

2 types of risks:

1. modifiable risks

2. nonmodifiable risks

Risk Reduction

 a proactive process in which individuals participate in

Theory of Reasoned Action
 developed by Fishbein and Ajzen
 attempts to predict a person’s intention to perform or not to
perform a certain behavior
 based on the assumption that all behavior is determined by
one’s behavioral intentions
 these intentions are determined by one’s attitude regarding
a behavior and the subjective norms associated with the
behavior
behaviors that enable them to react to actual or potential
threats to their health (Pender, 1996)
Risk Communication
 the process through which the public receives information
regarding possible or
 actual threats to health affected by the way individuals and
communities perceive, process, and act on their
understanding of risk
Health Promotion
 activities enhance resources directed at improving well-
being

 attitude is determined by one’s beliefs about the outcomes Disease Prevention

of performing the behavior, weighed by one’s assessment of
the outcomes  activities protect people from disease and the effects of
disease

three levels of prevention in nursing practice:

HEALTH PROMOTION AND LEVEL OF PREVENTION
1. primary prevention,
Risk
2. secondary prevention, and
NCM 113N LEC PRELIMS | JEWEL ANN T. GARANCHON
3. tertiary prevention  aims to keep health problems from getting worse, to reduce
the effects of disease and injury, and to restore individuals
Primary Prevention to their optimal level of functioning
 activities directed at preventing a problem before it occurs  teaching how to perform insulin injections and disease
by altering susceptibility or reducing exposure for management to a patient with diabetes
susceptible individuals
 referral of a patient with spinal cord injury for OT and PT
 consists of 2 elements:
 leading a support group for grieving parents
1. general health promotion and

2. specific protection

 done by preventing exposures to hazards that cause disease

or injury, altering unhealthy or unsafe behaviors that can
lead to disease or injury, and increasing resistance to
disease or injury should exposure occur

 legislation and enforcement to ban or control the use of

hazardous products (e.g. asbestos) or to mandate safe and
healthy practices (e.g. use of seatbelts and bike helmets);
education about healthy and safe habits (e.g. eating well,
exercising regularly, not smoking); immunization against
infectious diseases

Secondary Prevention

 early detection and prompt intervention during the period

of early disease pathogenesis

 aims to have early and prompt treatment to reduce the

impact of a disease or injury that has already occurred.

 detecting and treating disease or injury as soon as possible

to halt or slow its progress

 encouraging personal strategies to prevent reinjury or

recurrence

 implementing programs to return people to their original

health and function to prevent long-term problems

 implemented after a problem has begun but before signs

and symptoms appear and targets those populations that
have risk factors

 exams and screening tests to detect disease in its earliest

stages (Mammography, blood pressure screening, scoliosis
screening, and Papanicolaou smears)

 daily, low-dose aspirins and/or diet and exercise programs

to prevent further heart attacks or strokes

 suitably modified work so injured or ill workers can return

safely to their jobs

Tertiary Prevention

 targets populations that have experienced disease or injury

and focuses on limitation of disability and rehabilitation

 aims to keep health problems from getting worse, to reduce

the effects of disease and injury, and to restore individuals
to their optimal level of functioning

 targets populations that have experienced disease or injury

and focuses on limitation of disability and rehabilitation.