COMMUNITY HEALTH NURSING CONCEPTS

Definition of Community Health Nursing

According to Jacobson:

• It is a learned practice discipline with the ultimate

goal of contributing to the promotion of the client’s
OLOF (Optimum Level of Functioning) through
teaching and delivery of care
Definition of Community Health Nursing
According to WHO:

• It is a special field of nursing that combines

the skills of nursing, public health and some
phases of social assistance and functions for
the promotion of health, improvement of
social and physical conditions and
rehabilitation of illness and disability
Definition of Community Health Nursing
According American Nurses Association (ANA)

• “The synthesis of nursing practice and public health

practice applied to promoting and preserving the
health of the populations.”
 PHILOSOPHY OF COMMUNITY HEALTH
NURSING

• “The philosophy of CHN is based on the

worth and dignity of man.”(Dr. M. Shetland)
 PRINCIPLES OF COMMUNITY HEALTH NURSING
1.Community Health Nursing is based on the recognized
needs of communities, families, groups and individuals.
2.The Community Health Nurse must fully understand
the objectives and policies of the agencies she represents.
3.In Community Health Nursing, the family is the unit of
service.
 PRINCIPLES OF COMMUNITY HEALTH NURSING
4. Community Health Nurse must be available to all.
5.Health teaching is the PRIMARY responsibility of the
Community Health Nurse
 PRINCIPLES OF COMMUNITY HEALTH NURSING
6.The Community Health Nurse works as a member of the
health team
7.There must be provision for periodic evaluation of
Community Health Nurse services
8. Opportunities for continuing staff education programs
for nurses must be provided by the agency.
 PRINCIPLES OF COMMUNITY HEALTH NURSING
9.The Community Health Nurse makes use of available community
health resources
10.The Community Health Nurse utilizes the already existing active
organization in the community
11. There should be accurate recording and reporting in Community
Health Nursing
DIFFERENT FIELDS OF CHN
PUBLIC HEALTH NURSING

Seen as a subspecialty nursing practice generally delivered

within “official” or government agencies.
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 of their
OCCUPATIONAL HEALTH NURSING

• 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.
COMMUNITY MENTAL
HEALTH NURSING

- The application of specialized

knowledge to population and
communities to promote and
maintain mental health and
rehabilitate community.
 GOAL OF COMMUNITY HEALTH NURSING
• Promote healthy lifestyle
• Prevent disease and health problems
• Provide direct care
• Educate community about managing chronic conditions and making healthy
choices
• Evaluate a community’s delivery of patient care and wellness projects
• Institute health and wellness programs
• Conduct research to improve healthcare
THEORETICAL MODELS / APPROACHES
Health Belief Model (HBM)
q Health Belief Model is a theoretical model that can be used to
guide health promotion and disease prevention programs.
q It is used to explain and predict individual changes in health
behaviors.
q It is one of the most widely used models for understanding
health behaviors.
THE KEY VARIABLES OF THE HEALTH BELIEF MODEL:
1. Degree of perceived risk of a disease. This variable
includes perceived susceptibility of contracting a health
condition and its perceived severity once contracted.
2. Perceived benefits of diet adherence. A second benefit is
the believed effectiveness of dietary strategies designed to
help reduce the threat of disease.
THE KEY VARIABLES OF THE HEALTH BELIEF MODEL:
3. Perceived barriers to diet adherence. This variable
includes potential negative consequences that may
result from taking particular health actions
THE KEY VARIABLES OF THE HEALTH BELIEF MODEL:
4.Cues to action. Events that motivate people to take
action in changing their dietary habits are crucial
determinants of change.

5.Self-efficacy. A very important variable is the belief in

being able to successfully execute the dietary behavior
required to produce the desired outcomes
THE KEY VARIABLES OF THE HEALTH BELIEF MODEL:
6. Other variables. Demographic, socio-psychological,
and structural variables affect an individual's
perceptions of dietary change
MILIO’S FRAMEWORK FOR PREVENTION
• Includes concepts of community – oriented,
population-focused care

• Main determinant for unhealthful behavioral choice is

a LACK OF KNOWLEDGE

1. The health status of
populations is the result of
deprivation and/ or excess of
critical health-sustaining
resources.
2.Behavior patterns of populations are a
result of habitual selection from limited
choices, and these habits of choice are :
(a)actual and perceived options
available; (b) beliefs and expectations
developed and refined over time by
socialization, formal learning, and
immediate experience.
3. Organizational behavior (decisions or
policy-choices made by Gov’t/ NGO,
national/ LGU’s; organizations) sets the
range of options available to individuals
for their personal choice-making.
4. The choice-making of individuals at a
given point in time concerning potentially
health-promoting or health damaging
selections is affected by their effort to
maximize valued resources
 5. Social change may be thought of as
changes in patterns of behavior
resulting from shifts in the choice-
making of significant numbers of people
within a population.
6. Health education, as the process of
teaching and learning health-supporting
information can have little significantly
extensive impact on behavior patterns
 NOLA PENDER’S HEALTH PROMOTION (HPM)
q It defines health as a positive dynamic state not merely the
absence of disease. Health promotion is directed at increasing a
client’s level of well being

q Pender's model focuses on three categories: INDIVIDUAL

CHARACTERISTICS AND EXPERIENCES, BEHAVIOR-SPECIFIC
COGNITIONS AND AFFECT, and BEHAVIORAL OUTCOMES.
 PERSONAL FACTORS
Personal biological factors
• Include variable such as age, gender, body mass index,
pubertal status, aerobic capacity, strength, agility, or
balance.
Personal psychological factors
• Include variables such as self esteem, self motivation,
personal competence, perceived health status and
definition of health.
Personal socio-cultural factors
• Include variables such as race ethnicity, acculturation,
education and socioeconomic status.
PERCEIVED BENEFITS OF ACTION

• Anticipated positive out comes that will

occur from health behaviour.
PERCEIVED BARRIERS TO ACTION
• Anticipated, imagined or real blocks and
personal costs of understanding a given
behaviour
PERCEIVED SELF EFFICACY
• Judgment of personal capability to
organize and execute a health-promoting
behaviour.
ACTIVITY-RELATED AFFECT
• as the subjective positive or negative feeling that
occurs based on the stimulus properties of the
behavior itself.
Interpersonal influences
q Is the cognition-concerning behaviors, beliefs, or
attitudes of the others.
q Interpersonal influences include: norms
(expectations of significant others), social support
Situational influences
• personal perceptions and cognitions that can
facilitate or impede behavior.
PRECEDE – PROCEED MODEL
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.
 PRECEDE PHASES PROCEED PHASES

Phase 1 – Social Diagnosis Phase 5 – Implementation

Phase 2 – Epidemiological,
Behavioral & Environmental Phase 6 – Process Evaluation
Diagnosis
Phase 3 – Educational & Ecological
Phase 7 – Impact Evaluation
Diagnosis
Phase 4 – Administrative & Policy
Phase 8 – Outcome Evaluation
Diagnosis
PHASE 1 – SOCIAL DIAGNOSIS
• identifying and evaluating the social problems that affect
the quality of life of a population of interest.
• the program planners try to gain an understanding of the
social problems that affect the quality of life of the
community and its members, their strengths, weaknesses,
and resources; and their readiness to change.
PHASE 2 – EPIDEMIOLOGICAL, BEHAVIORAL, AND
ENVIRONMENTAL DIAGNOSIS
• Epidemiological diagnosis deals with determining and focusing on
specific health issue(s) of the community
• Behavioral diagnosis — This is the analysis of behavioral links to the
goals or problems that are identified in the social or epidemiological
diagnosis.
• Environmental diagnosis — This is a parallel analysis of social and
physical environmental factors other than specific actions that could
be linked to behaviors.
PHASE 3 – EDUCATIONAL AND ECOLOGICAL
DIAGNOSIS
• Predisposing factors are any characteristics of a person or
population that motivate behavior prior to or during the
occurrence of that behavior.
• Enabling factors are those characteristics of the environment
that facilitate action and any skill or resource required to attain
specific behavior
• Reinforcing factors are rewards or punishments following or
anticipated as a consequence of a behavior
Phase 4 – Administrative and Policy Diagnosis
• assessment of resources, development and
allocation of budgets, looking at organizational
barriers, and coordination of the program with other
departments
Phase 4 – Administrative and Policy Diagnosis
• Administrative diagnosis assesses policies, resources,
circumstances and prevailing organizational situations
that could hinder or facilitate the development of the
health program.
• Policy diagnosis assesses the compatibility of
program goals and objectives with those of the
organization and its administration.
Phase 5 – Implementation of the Program
Phase 6 – Process Evaluation
• This phase determines whether the program is being
implemented according to the protocol, whether the
objectives of the program are being met.
Phase 7 – Impact Evaluation
• This phase measures the effectiveness of the
program with regards to the intermediate objectives
as well as the changes in predisposing, enabling, and
reinforcing factors
Phase 8 – Outcome Evaluation
• This phase measures change in terms of overall
objectives as well as changes in health and social
benefits or quality of life.
 THANK YOU
HAVE A NICE DAY