Community Health ffiursing Reviewer

Introduction

Community Health Nursing

- Totality of its philosophy and beliefs.
- Influenced by healthcare delivery systems.
- Entails active interaction.
- Partnership and collaboration between the nurse and client is visible.
- Autonomy of both and potential of each.
- WHO: special field of nursing that combines the skills of nursing, public health, ans some phases of social assistance
and functions as part of the total PH program for the:
1. Promotion of health
2. Improvement of the conditions in the social and physical environment
3. Rehabilitation of illness and disability
- GOAL: raise the level of health of the citizenry by helping communities and families to cope with the discontinuities in
and threats to health to maximizetheir potential for high-level wellness.

Philosophy of CHN (Dr. Margaret Shetland)

- Is based on the WORTH and DIGNITY of a man.

CHN according to:

1. Maglaya = utilization of nursing process in the different levels of clientele; concerned with: Promotion of health,
Prevention of Diseases, and Disability & Rehab.
2. Jacobson = is learned practice discipline with the ultimate goal of contributing, as individual & in collaboration with
others, to the promotion of the client’s optimum level of functioning through teaching & delivery of care.
3. Freeman = Unique blend of nursing & public health practice aimed at developing & enhancing health capabilities of the
people, service rendered by a professional nurse at home, in HC, clinics, school, places for work.

Basic concepts of CHN:

1. Primary focus: Health Promotion and Disease Prevention.
 2. CHN practices are done to benefit the individual, family, special groups, and community; CHN is integrated and
comprehensive.
3. CHN are generalists in terms of practice throughout life’s continuum.
4. Contact with clients continues over a long period ofwhich includes all types and levels of HC (PHC, SHC, THC).
5. Nature of CHn requires knowledge on biological andsocial sciences.
6. Implicit in CHN is the nursing process (ADPIE) - anindependent nursing function.

Community health
- Identification of needs, along with the protection and improvement of collective health, within an geographically
defined area.

Concepts of Community
- Community: collection of people who interact with one another and whose common interests or characteristics form the
basis for a sense of unity or belonging.
- Function: its members’ collective sense of belonging and their shared identity, values, norms, communication, and
common interests and concerns.
- Ex. citizens of a town, community of farmers, and prison community.
- 3 types of communities:
1. Geographic community
- Geographic boundaries.
- City, town, or neighborhood.
2. Common interest community
- Church, professional organization, and people with mastectomies.
3. Community of solution
- Come together to solve a problem that affects all of them.
- Population: all of the people occupying an area, or to those who share one or more characteristics; Do not necessarily
interact and do not necessarily share a sense of belonging to the group.
 - Aggregate: mass or grouping of distinct individuals who are considered as a whole and who are loosely associated with one
another.

Concepts of HEALTH
- Holistic state of well-being, which includes soundness of mind, body, and spirit.
1. The Health Continuum: Wellness-Illness
- Wellness: relative concept; not absolute.
- Illness: relatively unhealthy.
- Health: range of degrees from optimal health - detath.
- Health continuum: applies to individuals,families, and communities.
2. Health as a State being
- State being = different qualities and characteristics.
- Total person or a community.
- Involves a group's physical state, psychological, spiritual, and socioeconomic factors.
3. Subjective and Objective Dimensions of Health
- How people feel (subjective) and how well they can function in their environment (objective).
4. Continuous and Episodic Health Care Needs
- Continuous needs: assistance with providing a toddler-proof home, toilet training techniques, etc.
- Episodic needs: one-time specific, negative health event; illness or injury.

Components of Community Health practice

1. Promotion of Health
- Recognized as one of the most importantcomponents of public health and community health practice.
- Health promotion includes:
➢ All efforts to seek to move people closer to optimal well-being or higher levels ofwellness.
- Include many forms of health education.
- Development and management of preventive health care services that are responsive to community health
needs.
- Ex. wellness programs.
 - Goal: Raise levels of wellness for individuals, families, populations, and communities.
- Accomplished through:
➢ Increase the span of healthylife for all citizens.
➢ Reduce health disparities among population groups.
➢ Achieve access to preventiveservices for everyone.
2. Prevention of Health problems
- Anticipating and averting problems or discovering them as early as possible in order to minimize potential
disability andimpairment.

3 levels in community health:

1. Primary prevention
- Obviates the occurrence of a health problem.
- Measures taken to keep illness or injuries from occurring.
- Applied to a generally healthy population and precedes disease or dysfunction.
- Examples:
➢ Instructing overweight individuals on how to follow a well-balanced diet while losing weight.
➢ Teaching safe-sex practices or the dangers of smoking and substance abuse.
➢ Working through a local health department to control or prevent by providing regular
immunizations.
- Involves anticipatory planning and actionon the part of community health professionals.
2. Secondary prevention
- Efforts to detect and treat existing health problems at the earliest possible stage, when disease is already
present.
- Attempts to discover a health problem at a point when intervention may lead to itscontrol or eradication.
- Examples:
 ➢ Identifying high-riskindividuals and encouraging early treatment.
➢ Encouraging breast and testicular self-examination.
➢ Regular mammograms.
➢ Pap smears and skin testing for TB.
➢ Water and soil samples.
➢ Watch for early signs of child abuse, emotional disturbances among widows, or alcohol ordrug abuse
among adolescents.
3. Tertiary prevention
- Reduce the extent and severity of a health problem to its lowest possible level, to minimize stability and
restore or preserve function.
- Individuals have an existing illness or disability whose impact on their lives is lessened through tertiary
prevention.
- Minimize the effects of an existing unhealthy community condition.
- Examples:
➢ Treatment and rehabilitationof a stroke patient.
➢ Postmastectomy exercise.
➢ Early treatment andmanagement of diabetes.
➢ Businesses provide wheelchair access.
➢ Warning urban residents about the dangers of a chemical spill.
➢ Recalling a
➢ contaminated food or drugproduct.
➢ Preventing injuries fromsurvivors and volunteersduring rescue.

CHN Characteristics:
1. The client or “unit of care” is the population.
2. The primary obligation is to achieve the greatest good for the greatest number of people or the population as a whole.
 3. The processes used by public health nurses includeworking with the client(s) as an equal partner.
4. Primary prevention is the priority in selecting appropriate activities.
5. Selecting strategies that create healthy environmental, social, and economic conditions in which populations may
thrive is the focus.
6. There is an obligation to actively reach out to all who might benefit from a specific activity or service.
7. Optimal use of available resources to assure the best overall improvement in the health of the population is a key
element of the practice.
8. Collaboration with a variety of other professions, organizations, and entities is the most effective way to promote and
protect the health of people. (ANA, 2005, pp. 12–14)

Historical development of CHN (see book because too much info)

1. The Early Home Care nursing stage (Before Mid-1800s)
- Reduce suffering and promote healing.
- Began with religious and charitablegroups.

Friendly visitor volunteers (1600s)

- Directed by Madame de Chantel and assisted by wealthy people who cared for the sick poor in their homes.

Elizabethan Poor Law (1601)

- Medical and nursing care for the poor and disabled.

Sisters charity (1670)

- St. Vincent de Paul
- Nuns and lay women serving the poor and needy.
- Undersupervisition of Mademoiselle Le Gras (1634), promoted the goal of teaching people.
- Preparing nurses, supervising care, anddetermining causes and solutions for problems.
- Laid a foundation for modern community nursing.

- Late 1600s to mid 1800s = serious setback in the status of nursing and careof the sick.
 - Industrial revolution - created more problems: epidemics, high infant mortality, occupational diseases and
injuries, and increasing mental illness.
- Martin Chuzzlewit - Charles Dickens - Sairy Gamp.
- Much of the foundation for modern CHN practice was laid through Nightingale’sremarkable accomplishments.

Nightingale's accomplishments:
1. Worked during the Crimean war (1854-1856).
2. Organized competent nursing care and establishedkitchens and laundries.
3. Worked as a reformer, reactionary, and aresearcher; Used Biostatistics.
4. Notes on Nursing: What It Is and What It Is Not (1859).
5. Established nonreligious school for nursing (1860).

Mary Seacole
- Black nightingale.
- Daughter of a well-respected “doctress” who practiced Creole or Afro-Caribbean medicine in Jamaica, and began
helping her mother at an early age.

2. The District nursing stage (Mid 1800s to 1900)

- Formal organization of visiting nursing.

William Rathbone
- Employed Mary Robinson; An English philanthropist.
- With the help of Nightingale, he opened a training school for nurses connected with the Royal Liverpool Infirmary and
established a visiting nurse service for the sick poor in Liverpool.
- Health visitors were the backbone of primary healthcare systems in the second half of the 1800s.

3. The Public Health nursing stage (1900 to 1970)

- Reba Thelin (1903) = visited homes of the TB patients to ensure that patients followthe prescribed regimens.
- Jessie Sleet = pioneer in early CHN practice and forged the way for many; First PH nurse.
- Specialized programs were developed.
Lilian Wald
- Leading figure in the expansion and used the term PHN to describe this specialty.
- Together with Mary Brewster started the Henry Street Settlement in 1893 to provide nursing and welfare services.
- Sleet recommended Elizabeth Tyler (first black nurse in Henry st.).
- School nurse: Lina Rogers
- Promoted rural nursing and family-focused nursing.
- Encouraged improved coursework at the Teacher’s College of Columbia University.
- Founded and was the first president of the National Organization for Public Health (NOPHN).

The Profession evolves:

- American Society of Superintendents of Training Schools for Nurses in the United States and Canada (Isabel Hampton Robb,
1893) -> National League of Nursing Education (1912) -> National League for Nursing (merged with NOPHN of Wald and
Mary Gardner; 1952).
- Nurses’ Associated Alumnae of the United States and Canada (1899) -> American Nurses’ Association (ANA).

4. The Community Health nursing stage (1970 to the Present)

- Broader term, all nurses practicing in thecommunity, regardless of their educational preparation.

Public Health Nursing

- An advanced level.
- Term used before CHN.
- According to Dr. C.E. Winslow, it is a SCIENCE and ART OF 3P’s:
1. Prevention of disease
2. Prolonging life
3. Promotion of health and e ciency through organized community effort
- The science and art of preventing disease, prolonging life, promoting health and e ciency through organized
community effort.
- Qualifications: BSN and RN in the Ph.
 - Aims:
1. Sanitation of the environment.
2. Control of communicable diseases.
3. Education in personal hygiene.
4. Organization of medical and nursing services for early diagnosis and preventive treatment.
5. Development of social machinery to ensure a standard of living adequate for the maintenance of health.
6. Organizing these benefits as to enable every citizen to realize his birthright of birth and longevity.

Theorists and meaning of PHN:

1. Winslow
- Science and art of Preventing disease, Prolonging life, Promoting health and e ciency through organized
community effort.
2. Hanlon
- Most effective goal towards total development & life of the individual & hissociety.
3. Purdom
- Applies holism in early years of life, young, adults, mid year & later.
- Prioritizes the survival of human being.

Roles of PHN:
1. Clinician - HCP; Taking care of the sick at home of RHU.
2. Health educator - aims toward health promotion and illness prevention through dissemination of correct people.
3. Facilitator - establishes multi-sectoral linkages by referral system.
4. Supervisor - monitors and supervises the performance of midwives.
5. Take over of MHO’s responsibilities if the MHO is not available.

Objectives of PHN:
1. Control of communicable disease.
2. Organization of medical and nursing services.
3. Development of social machineries.
4. Education on personal hygiene.
 5. Sanitation of the environment.

SETTING THE STAGE FOR CHN

Three Essential Responsibilities that direct the work of CH nurses:
1. Assessment
- CH nurse must gather and analyze information that will affect the health of the people to be served.
- Systematic collection, assembly, analysis, and dissemination of information about the health of a
community.
- Data gathering: interview, survey, from public records, and using research findings.
2. Policy development
- Enhanced by the synthesis and analysis of information obtained during assessment.
3. Assurance
- Activities that make certain that services are provided - often consume most of the CH nurse’s time.
- CH nurses perform assurance functions, improve quality assurance activities, maintain safe levels of
communicable disease surveillance and outbreak control, and collaborate with community leaders in the
preparation of community disaster plans.
- CH nurses also participate in the outcome research, provide expert consultation, promote EBP, and
provide services within the community based on standards of care.

Essential services
- Initial effort to define the service components of the core functions provided an organized service delivery plan for public
health providers across thecountry.

10 Essential services of Public Health

1. Monitor the health status to identify community health problems.
 2. Diagnose and investigate health problems and health hazards in the community.
3. Inform, educate, and empower people about health issues.
4. Mobilize community partnerships to identify and solve health problems.
5. Develop policies and plans that support individual and community health efforts.
6. Enforce laws and regulations that protect health and ensure safety.
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
8. Assure a competent public health and personal health care workforce.
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
10. Research for new insights and innovative solutions to health problems.

Standards of Practice
- The Essentials of Baccalaureate Education for Professional Nursing Practice
➢ Document was a major step in providing clear guidelines as to what constituted professional nursing education.
➢ Associated with CHN is emphasized.
➢ Articulates the growing need to prepare nurses to assume a variety of roles in thecommunity.
- 3 board areas of roles of beginning professional practice:
1. Provider of direct and indirect care to individuals, families, groups, communities, and populations.
2. Designer, manager, and coordinator of care.
3. Member of a profession.
- Quad council
➢ Comprised of representatives from the ANA, Council on Nursing Practice and Economics; the American Public
Health Association, Public Health Nursing Section; the Association of Community Health Nursing Educators;
and the Association of State and Territorial Directors of Nursing.
 ➢ Quad Council Public Health Nursing Competencies = tool to evaluate nursing practice.

Roles of Community Health Nurses

1. Clinician
- Most familiar role.
- The nurse ensures health services are provided not just to individuals and families, but also to groups
and populations.

Holistic practice
- Considering the broad range of interacting needs that affect the collective health of the “client” as a larger system.
- encompasses the comprehensive and total care of the client in all areas, such as physical, emotional, social, spiritual, and
economic.
- From an aggregate perspective.

Focus on wellness
- Protecting and promoting the health of vulnerable populations.

Expanded skills
- Requires skills in collaboration with consumers and other professionals, use of epidemiology and biostatistics,
community organization and development, research, program evaluation, administration, leadership, and effecting
change.

2. Educator
- Second important role.
- Useful in promoting the public’s health.
- Information is shared with clients bothformally and informally.

3. Advocate
- Pleading their cause or acting on theirbehalf.
- Guide individuals through thecomplexities of the system, and assure the satisfaction of their needs.
- Particularly true for minorities and disadvantaged groups.
Advocacy goals:
- To help clients gain greater independence or self-determination - by showing them what services are available,
those to which they are entitled, and how to obtain them.
- To make the system more responsive and relevant to the needs of clients - by calling attention to inadequate,
inaccessible, or unjust care, community health nurses can influence change.

4. Manager
- Exercises administrative direction toward the accomplishment of specified goals by ASSESSING CLIENT’S
NEEDS,
PLANNING and ORGANIZING to meet those needs, DIRECTING and LEADING to achieve results, and CONTROLLING
and EVALUATING the progress to ensure that goals are met.
- Managing is like Nursing Process.
- Participative managers: participate with clients, other professionals, or both to plan and implement services.

Nurse as a:
- Planner
➢ sets the goals and direction for the organization or project and determines the means to achieve them.
➢ Defining goals and objectives, strategy, coordinating, implementing, andevaluating.
➢ Strategic: broader, more long-rangeterms.
➢ Operational: short-term planning needs.
- Organizer
➢ Designing a structure within which people and tasks function to reach the desired objectives.
➢ Provides a framework for the various aspects of service.
➢ Evaluate effectiveness.
- Leader
➢ Directs, influences, or persuades others to effect change that will positively impact people’s health and move
them toward a goal.
 ➢ Persuading, motivating, directing, ensuring effective communication, resolving conflicts, and coordinating
the plan.
- Controller and Evaluator
➢ Monitors the plan and ensures it stays oncourse.
➢ Monitoring, comparing, and adjusting.
➢ Compare and judge.

3 sets of Management behaviors:

- Decision making:
➢ Entrepreneur role when initiating new projects.
➢ Disturbance handler when they manage disturbances and crises.
➢ Resource allocator by determining the distribution and use of human, physical, and financial resources.
- Transferring information
➢ Monitor role requires collecting andprocessing information, such asgathering ongoing evaluation data to
determine whether a program is meeting its goals.
➢ Disseminator role, nurses transmit the collected information to people involved in the project or organization.
➢ Spokesperson role, nurses shareinformation on behalf of the project or agency with outsiders.
- Interpersonal behaviors
➢ Figurehead role, the nurse acts in a ceremonial or symbolic capacity.
➢ Leader role, the nurse motivates and directs people involved in the project.
➢ Liaison role, a network is maintained with people outside the organization or project for information
exchange and project enhancement.

3 Management skills:
- Human skills - ability to understand, communicate, motivate, delegate, and work well with people.
- Conceptual skills - mental ability to analyze and interpret abstract ideas for the purpose of
 understanding and diagnosing situations and formulating solutions.
- Technical skills refer to the ability to apply special management-related knowledge and expertise to a particular situation or
problem.

Case management
- Systematic process by which a nurse assesses clients’ needs, plans for and coordinates services, refers to other
appropriate providers, and monitors and evaluates progress to ensure that clients’ multiple service needs are met in a
cost-effective manner.
- Managed care: a cost-containing system of health care administration.

5. Collaborator
- Working jointly with others in a common endeavor, cooperating as partners.
- Skills in communicating, interpreting the nurse’s unique contribution to the team, and acting assertively as an
equal partner.
- Functioning as a consultant.

6. Leader
- Effecting change; Agent of change.
- Seek to initiate changes that positively affect people’s health.
- Seek to influence people to think and behave differently about their health andthe factors contributing to it.

7. Researcher
- Community health nurses engage in the systematic investigation, collection, and analysis of data for solving
problems andenhancing community health practice.
- Helps to determine needs, evaluate effectiveness of care, and develop a theoretic basis for community
health nursing practice.
- Gathering data for health planning—investigating health problems to design wellness-promoting and
disease-preventing interventions for community populations.
Research process
1. Identify an area of interest
2. Specify the research question or statement
3. Review the literature
4. Identify a conceptual framework
5. Select a research design
6. Collect and analyze data
7. Interpret the results
8. Communicate the findings

Fundamental attitudes of a Researcher:

1. A spirit of inquiry
2. Careful observation - develop a sharpened ability tonotice things as they are (norm and subtle changes).
3. Analytic skills - seeking out needed data; Studying the pieces and fitting them together.
4. Tenacity - persists in investigation.

Settings:
1. Homes - all of the CHN roles are performed to varying degrees.
2. Ambulatory service settings - variety of venues for day and evening services that do not include overnight stays.
3. Schools - roles in this setting are changing; Assume managerial and leadership roles and to recognize that the
researcher should be an integral part of their practice.
4. Occupational health settings - variety of roles: clinician role (health education), advocates, collaborators, leaders,
and managers; Range from industries and factories.
5. Residential institutions - halfway houses and inpatient hospice programs; Continuing care and functions as advocate
and collaborator; Provide unique settings for the CH nurse to practice health promotion.
6. Faith communities - the practice focal point remains the faith community and the religious belief system provided by
the philosophical frame- work; examples: church-based health promotion, parish nursing, etc; Enhance accessibility to
available health services in the community while meeting the unique needs of the members of that religious community.
 7. Community at large - for nurses who work at health care planning committees, lobbies for health legislation at the state
capital, runs for a school board position, or assists with flood relief in another state or another country.

Note: CHN is not limited to a specific site; Defined by the nature of its practice.

TRANSCULTURAL NURSING
Culture
- beliefs, values, and behavior that are shared by members of a society and provide a design or “roadmap” for living.
- Tells what is acceptable or unacceptable.
- What to do, say, or believe.
- Learned.
- Way of organizing and thinking about life.
- Gives a sense of security.

Cultural diversity
- Also called cultural plurality (variety of cultural patterns).
- Other terms:
➢ Race - biologically designated groups (distinguishable features).
➢ Ethnic group - common origins and shared culture identity (may share a common geographic origin, race,
language, religion, traditions, values, and food preferences).
➢ Ethnicity - group of qualities that mark association with a particular ethinic group (history, political system,
religion, language, geographical origin, traditions, myths, behaviors, foods, genetic similarities, and physical
features)

Ethnocentrism
- Belief and feeling that one’s own culture is best.
- Judge other people’s belief and behaviors usingvalues of our own native culture.
- Ethnorelativism: seeing all behavior in a cultural context.
Characteristics of culture:
1. Learned - acquired, not inherited; Enculturation: person learns culture through socialization.
2. Integrated - interrelated and interdependent.
3. Shared - product of aggregate behavior, not individual; Value: notion or idea designating relative worth or
desirability.
4. Mostly tacit - provides a guide for human interaction; Mostly unexpressed and at the unconscious level; Cues, not
written set of rules.
5. Dynamic - undergoes change, not entirely static; Functional aspects are retained; Less functional ones are eliminated.

Ethnocultural health care practices

- Relied on natural elements.

The World Community

- Beliefs, effects, health practices and behaviors are all influenced by a person’s, a group’s, or a community’s
perception.

3 major views:
1. Biomedical view
- Western societies.
- Relies on scientific principles and sees diseases and injuries as life events controlled by physical and
biochemicalprocesses that can be manipulated.
2. Magicoreligious view
- Control of health and illness by supernatural forces are prominent in some cultural groups.
- Diseases are caused by sins.
- Good health = gift by God; Illness = punishment.
3. Holistic view
- View the world as being in harmonious balance.
- If the principles guiding natural laws to maintain order are disturbed, imbalance in the forces of nature =
chaos and disease.
4. Folk medicine and Home remedies
- Folk medicine: body of preservedtreatment practices that has been
 handed down verbally from generation to generation; First line of treatment.
- Home remedies: individualized caregiving practices that are passed down within families.
5. Herbalism
- Using herbal preparations in the form of self-selected over-the-counter (OTC) products for therapeutic or
preventive purposes.
- Herbs: not regulated as drugs and are not risk free.
6. Prescription and OTC drugs
- Not risk free.
- Prescription drugs: reviewed and tested; Expensive.
- OTC drugs: less-rigorous process.
- E cacy must be assessed.
7. Complementary therapies and Self-carepractices
- Also called alternativemedicine/therapies.
- Used to complement contemporary Western medical and nursing care and are designed to promote comfort,
health, and well-being.
- Includes:
➢ Therapies
➢ Treatments
➢ Exercise activities
➢ Exposure
➢ Manipulation
- Integrated health: combination ofcomplementary therapies withbiomedical or western health care.
- Very common.
- Self-care activities (uniquely individual):
➢ Complementary therapies
➢ Medications
➢ Spiritual and cultural practices.

Role of CH nurse:
1. Preparation of the CH nurse - to be effective when working with clients in the area of cultural health care and spirituality.
 2. Assessment - enhance your aggregate care by doing an ethnocultural or self-care assessment.
3. Teaching - important in acute care setting and in home; Health care education is vitally important to communities,
groups, and families; Become ethnoculturally focused and prepared.

Transcultural Community Health Nursing Principles

1. Develop cultural self-awareness
- Crucial for the nurse working with peoplefrom other cultures.
- Means recognizing the values, beliefs, and practices that make up one’s ownculture.
- Becoming sensitive.
- Norms: expected cultural practices.
2. Cultivate cultural sensitivity
- Requires recognizing that culturally based values, beliefs, and practices influence people’s health and
lifestylesand need to be considered in plans forservice.
3. Assess the client’s group culture
- All clients’ actions, like one’s own, are based on underlying culturally learned beliefs, values, and ideas.
- Guide:
➢ Ethnic/racial background
➢ Language and communicationpatterns
➢ Cultural values and norms
➢ Biocultural factors
➢ Religious beliefs and practices
➢ Health beliefs and practices
4. Show respect and patience while learning about their cultures
- Minority group: part of a population that differs from the majority and oftenreceives different and unequal
treatment.
- Cultural relativism: recognizing and respecting alternative viewpoints and understanding values, beliefs,
and practices within their cultural context.
 5. Examine culturally derived health practices
- Involves scrutiny of the client group’s cultural practices, as they affect the group’s health status.
- Cultural assessment and aggregate health assessment must go hand in hand.

Department Of Health5 Major Functions:

1. Ensure equal access to basic HS.
2. Ensure formation of national policies for proper division of labor and proper coordination of operations among the
government agency jurisdictions.
3. Ensure a minimum level of implementation nationwide of services regarded as public healthgoods.
4. Plan and establish arrangements for the public health systems to achieve economies of scale.
5. Maintain a medium of regulations and standards toprotect consumers and guide providers.

Basic Health Services under OPHS of DOH

1. E - Education regarding health.
2. L - Local endemic diseases.
3. E - Expanded program on immunization.
4. M - Maternal and child HS.
5. E - Essential drugs and herbal plants
6. N - Nutritional health services (PD 491): Creatio of nutrition council of the Phils.
7. T - Treatment of communicable and noncommunicable diseases
8. S - Sanitation of the environment (PD856): Sanitary code of the Ph.
9. D - Dental health promotion.
10. A - Access to and use of hospitals as Centers ofwellness.
11. M - Mental health promotion

Vision by 2030 (DREAM OF DOH)

- A global leader for attaining better health outcomes, competitive and responsive health care systems, and equitable
health financing.
Mission
- To guarantee EQUITABLE, SUSTAINABLE and QUALITY health for all Filipinos, especially the poor and to lead the quest for
excellence in health.

Principles to attain the vision of DOH:

1. Equity - equal health services for all - nodiscrimination.
2. Quality - not over quantity.
3. Philosophy of DOH - Quality is above quantity.
4. Accessibility - utilization of strategies for delivery of health services.

DEFINITIONS OF HEALTH BASED ON DIFFERENT THEORISTS

WHO Definition of Health

- a state of complete physical, mental, & social well-being and not merely the absence of a disease, illness or infirmity.
- A social phenomenon.
- An outcome of many theories.
Declaration of Alma Ata (1978)
- Fundamental human right.
- Must be raised for all countries in order for any society to improve their health.
Bircher
- Dynamic state of wellbeing.
Sriracha
- Basic and universal human right.
Bangkok charter for health
- A basic human right.
Dunn
- High level of wellness.
- Integrated method of functioning oriented toward maximizing the potential.
Rene Dubos
- Quality of life
- Involves social, mental, spiritual, biological fitnesswhich results in adaptation to the environment.
Florence NIghtingale
- Looked into health and illness in relation to theenvironment.
- Improve health by manipulating the environment.
Dorothea Orem
- State characterized by soundness and wholeness ofhuman structures and bodily and mental functions.
➢
Health:
- Guide in identifying areas for assessments and
interventions.
- Important prerequisite.
- Healthy = Contribute to the economy of the country.

BAG TECHNIQUE
Community Health Nursing Bag
- Indispensable tool that should be organized to save
time and effort.
- To prevent cross infection and contamination.

Guiding Principles:
1. Content - should be prepared by the nurse. KEEP BP
APPARATUS SEPARATELY.
2. Cleaning - the inner part should be clean and
sterile. Done every after visit. NEVER ENDORSE THE
BAG.
3. Contamination - less opens = less contamination;
Open 3 times only: PUTTING OUT FOR HANDWASHING,
PUTTING OUT FOR MATERIALS, and RETURNING ALL
WHAT HAVE BEEN USED.
4. Care of communicable cases - disinfected with
70% alcohol or Lysol at HEALTH CENTER NOT AT
HOME.