Principles Of Community Health Nursing Nursing Process in the Community:

1. Focus on the community as the unit of care. 1.Assessment

2. Give priority to community needs. (use
assessment tool to determine health problems
like demographics & vital statistics)
3. Work with the community as an equal partner of
the health team.
4. In selecting appropriate activities, focus on
primary prevention. (Preventive treatment of
disease)
5. Promote a healthful physical and psychosocial
environment.
6. Reach out to all who may benefit from a specific
service.
7. Promote optimum use of resources.
8. Collaborate with others working in the
community.
Assessment of Community Health Needs
2.Diagnosis
3.Planning and outcome identification
4.Implementation
5.Evaluation
Assessment
is the act of reviewing human situation from a data base
in order to affirm clients wellness state, diagnose &
determine potential problem, affirm illness state, and
determining the wellness aspect of the ill client.
is the determination of client health problems.
Identification of strengths & weaknesses of the clients
state of health.
prior to nursing action, client is assessed to determine
health status and the need for nursing intervention.

3 features affecting the health status of the

community

1. People – includes the size, composition

rate of growth, cultural characteristics,
mobility, social class and educational level.

2. Location – (Urban or rural) consider the

quality of the soil, air water, and the location
of health facilities.

3. Social system – The patterned series of

interrelationship between individuals.

Overcrowding – easy spread of

communicable diseases; rapid degradation of housing Tools for Community Assessment
facilities and water, air, soil pollution; health needs of Collecting primary data
communities varies according to population composition ➢ Observation
– professionals to farmers; reproductive age and young ➢ Survey
children to elderly people; culturally homogenous ➢ informant interview
population – cohesive action; belongingness – ➢ Community Forum
participation; ➢ Focus Group
Geographic features; climates; seasonal diseases; Secondary data sources
natural disasters; plant-animal populations – allergens, ➢ Registry of vitals events
medicinal properties, vectors and reservoirs of infectious ➢ Health Records and reports
diseases; poverty in urban areas compared to rural; ➢ Disease Registries
urban – malnourished sometimes abused; ➢ Census Data
Example – infant mortality rate at the brgy level (health
care system works in relation to the provision of maternal Observation – ocular, riding, walking – take note of
and child services to what degree is it implemented) environmental conditions, existing community facilities,
people, participant observation (brgy assemblies, PTC,
church meetings)
The Community Health Nursing process – it is an Survey – when no available information to be studied
efficient method of organizing thought for clinical decision Informant interview – structured or unstructured
making and problem solving. It directs the community Community Forum – medium in expressing their views
health nurses in providing care to meet a clients health and developing their capacity to influence decision
needs whether it is an individual, family, group or makers (data validation, inform about secondary data,
community. feedback
Focus group – first-time pregnant women
Registry of vital events – civil registration; births and
deaths
Disease Registries – basis for monitoring, decision
making and program management
Census Data
Determinants of Health
Health Status – A range of age-specific and condition
specific mortality rates, as well as derived indicators.
Examples include infant mortality, life expectancy,
potential years of life lost, circulatory deaths,
unintentional injury deaths. It is also associated with
environmental issues and cultural practices.
Health resources - Health resources includes financial
resources (health spending) and human resources.
Health spending measures the consumption of health
services and goods, including outpatient care, hospital
care, long-term care, pharmaceuticals and other medical
goods, prevention and public health services, and
administration.
Diagnosis
Community diagnosis is the identification and
quantification of health problems in a given population
using health indicators to define those at risk or those in
need of care and the opportunities and resources
available to address these factors
2 Types of Community Diagnosis
1. Comprehensive Community Diagnosis - It is more
focused on obtaining general information about the
community. It takes the community as a whole and gives
emphasis on all of the aspects, strengths and
weaknesses. (demographical data, the socio-economic
and cultural variables affecting health, the economic
status of the community, the status of the community’s
environment, the health and illness patterns, the health
resources including health manpower and material
resources, and the political and leadership patterns.) Ex.
Alteration in community Health status related to improper
waste disposal sec. to a disease process.
2. The Problem-Oriented Community Diagnosis –
Respond to a particular need & deals with problems that
are readily seen and should be acted upon immediately.
Steps in Community Diagnosis
Determine the Objective
Define the study Population
Determine the data to be collected
Collect the data – records review, survey, & observation,
interview/Participant interview
Developing the instruments – obs. Checklist,
questionnaire, interview guides
Actual data gathering
Data collection & summarization
Data presentation
Data Analysis
Problem Identification
Tools used in diagnosing community problem
Demography – is the statistical study of human
populations. Demography examines the size, structure,
and movements of populations over space and time.
Demography is useful for governments and private
businesses as a means of analyzing and predicting
social, cultural, and economic trends related to
population.
Vital & Health Statistics – Vital statistics incorporates a
number of some significant vital events that take place in
human life, for example, birth, death, fetal death,
marriage, divorce, judicial separation, adoption,
legitimation, and recognition that combinedly generate an
excessive amount of data and can be analyze.
Epidemiology - the study of how often diseases occur in
different groups of people and why. Epidemiological
information is used to plan and evaluate strategies to
prevent illness and as a guide to the management of
patients in whom disease has already developed.
Planning of Community Health Nursing Services
It is an essential component of health planning to have a
strong level of community involvement. The nurse is
responsible for advocating client empowerment
throughout the assessment, planning, implementation,
and evaluation phase of the process. You have to
consider :
 11. Supervision of nursing services by qualified
CHN personnel; provides guidance and
direction to the work to be done.

Basis for developing a Community Health

Plan

A community health improvement plan (or

CHIP) is a long-term, systematic effort to
address public health problems based on the
results of community health assessment
activities and the community health
improvement process.

1. Analyze the Health Issue

Principles in community health planning
1.The recognized need of individuals, families and
communities
2. Knowledge and understanding of the objectives and
policies of the agency facilities goal achievement.
3. CHN considers the family as the unit of service.
2. Inventory Health Resources
3. Develop a Health Improvement Strategy
4.Establish Accountability for Health
Improvement Activities
5.Develop a Set of Performance Indicators
6.Implement the Improvement Strategy
7. Monitor Process and Outcomes of the
Improvement Strategy.
Steps in making a plan: The planning cycle
The Planning Cycle offers a framework for a research
project up to a certain level of complexity. It is an
eight-step process that you can use as tool to plan and
implement fully considered, well-focused, practical, and

4. Respect for the values, customs and beliefs

5. CHN integrated health education and counseling as

vital parts of functions.

6. Collaborative work relationships with the co-workers

and members of the health team facilities
accomplishments of goals.

7. Periodic and continuing evaluation provides the means

for assessing the degree to which CHN goals and
objectives are being attained.

8. Continuing staff education program quality services to

client and are essential to upgrade and maintain sound
nursing practices in their setting.

9. Utilization of indigenous and existing community

resources maximizing the success of the efforts of the
Community Health Nurses.

10. Active participation of the individual, family and

community in planning and making decisions for their
health care needs, determine, to a large extent, the
success of the CHN programs.
cost-effective research project. It also helps you to learn
from any mistakes you make, and to feed this knowledge
back into your future planning and decision making.
Community Health Nursing Care Plan
Philippine Health Care Delivery System
a. Executive Order 102 (The Departmentof Health)
The Department of Health (DOH) is mandated to be the
over-all technical authority on health. The major mandate
of DOH is to provide national policy direction and develop
national plans, technical standards and guidelines on
health. It is also a regulator of all health services and
products; and provider of special or tertiary health care
services and of technical assistance to other health
providers specially to Local Government Units (LGU).
With other health providers and stakeholders, the DOH
shall pursue and assure the following:
1. Promotion of the health and well-being for every
Filipino;
2. Prevention and control of diseases among population
at risk;
3. Protection of individuals, families and communities
exposed to health hazards & risks; and
Functions of Local Health Boards
1.Proposing to the sanggunian annual budgetary
allocations for the operation and maintenance of health
facilities and services within the province, city,
municipality
2.Serving as an advisory committee to the sanggunian on
health matters
3.Creating committees that shall advise local health
agencies on various matters related to health service
operations
4. Treatment, management and rehabilitation of
individuals affected by diseases and disability.
5. Lead agency in articulating national objectives for
health, to guide the development of local health systems,
programs and services;
6. Direct service provider for specific programs that affect
large segments of the population, tuberculosis, malaria,
schistosomiasis, HIV-AIDS and other emerging infections
and micronutrient deficiencies;
7. Lead agency in health emergency response services,
including referral and networking systems for trauma,
injuries and catastrophic events;
8. Technical authority in disease control and prevention;
9. Lead agency in ensuring equity, access and quality of
health care services through policy formulation,
standards development and regulations;
10.Technical oversight agency in charge of monitoring
and evaluating the implementation of health programs,
projects research, training and services;
11.Administrator of selected health facilities at
sub-national levels that act as referral centers for local
health systems i.e., tertiary and special hospitals,
reference laboratories, training centers, centers for health
promotion, center for disease control, and prevention,
regulatory offices among others;
12.Innovator of new strategies for responding to
emerging needs;
13.Advocate for health promotion and healthy life styles
for the general population;
14.Capacity-builder of LGUs, the private sector,
non-governmental organizations, peoples organizations,
national government agencies in implementing health
programs, services, through technical collaborations,
logistical support, provision of grants and allocation and
other partnership mechanism;
15.Lead agency health and medical research;
16.Lead agency in health emergency preparedness and
response;
17.Protector of standards of excellence in the training
and education of health care providers at all levels of the
health care system;
18.Implementer of the National Health Insurance Law;
providing administrative and technical leadership in
health care financing; and
19.Expressing national objectives for health to lead the
progress of local health systems, programs and services.
20.Formulate national policies and standards for health;
21.Prevent and control leading causes of death and
disability;
22.Develop disease surveillance and health information
systems;
23.Maintain national health facilities and hospitals with
modern and advanced capabilities to support local
services;
24.Promote health and well-being through public
information and to provide the public with timely and
relevant on health risks and hazards;
25.Develop and implement strategies to achieve
appropriate expenditure patterns in health as
recommended by international agencies;
26.Develop sub-national centers and facilities for health
promotion, disease control and prevention, standards,
regulations and technical assistance;
27.Promote and maintain international linkages for
technical collaboration;
28.Create the environment for the development of a
health industrial complex;
29.Assume leadership in health in times of emergencies,
calamities, and disasters and system failures;
30.Ensure quality of training and health human resource
development at all levels of the health care system;
31.Oversee financing of the health sector and ensure
equity and accessibility to health services; and
32. Articulate the national health research agenda and
ensure the provision of sufficient resources and logistics
to attain excellence in evidenced-based intervention for
health.
Classification of Health Facilities
(DOH AO- 0012A)
Outcome 1: Improved Financial Risk Reduction
The National Health Insurance Program (NHIP)which is
the Philhealth covered 92% or 93.45 million principal
members & dependents of the country’s 101.45 million
population.
Philhealth Benefits:
-Expanded Z Benefit Package for Colon & Rectum
Cancers
-Point of Care (POC) Enrolment Program
- Enhance Primary Care Package (Tsekap)
- Extended Dialysis Coverage
Outcome 2: Greater Access to Health Care Services
In 2018, DOH took steps to upgrade facilities to meet
licensure & Philhealth Accreditation requirements.
★ Received Essential Equipment Items/Packages
•685- LGU Hospitals
•70 DOH Hospitals
•Receive Tsekap Equipment: 17,541 – Brgy. Hx Stations
•2459 – RHU’s & Health Centers
★ Infrastructure Projects:
•596- Brgy. Hx Stations
•138 – LGU Hospitals
•207 – Rural Hx Units/ Hx Centers
162 DOH funded, fully equipped Mobile Dental vans for
Hx Facilities
13 Drug Abuse & treatment Rehabilitation Centers,
ongoing procurement/ Construction
Outcome 3: Public Health Development Goals
(MDG’s) Achieved
1.MDG-4 Reduce Child Mortality – 83% of the targeted
Population was fully immunized
2.National School-based immunization Campaign
3.Micronutrients Supplementation
4.Mass Deworming
5.MDG-5 Improved Maternal Health
6.MDG 6 – Combat HIV/AIDs, Malaria and other
diseases
7.Disease Free Zone Initiatives : Rabies, Malaria,
Dengue, Filariasis
8.Emerging and Re-emerging Disease
9.Disaster Preparedness and A Changing Climate
Outcome 4: Improved Health Governance
ISO Certification As of December 2015, 45 out of 70
Department of Health hospitals were ISO certified.
National Health Summit
Local Government Unit Awards
World Health Organization Executive
Board Secretary of Health Dr. Janette
Loreto-Garinrepresented the Philippines
as a member of the WHO Executive
Board.
Fifth Asia Pacific Economic
Cooperation (APEC) High Level
Meeting 5 on Health and the Economic
National Barangay Health Workers
Convention
Global Health Situation MDG’s & SG
Millennium Development Goals (MDGs)
The United Nations Millennium
Development Goals are eight goals that
all 191 UN member states have agreed to try to achieve
by the year 2015. The United Nations Millennium
Declaration, signed in September 2000 commits world
leaders to combat poverty, hunger, disease, illiteracy,
environmental degradation, and discrimination against
women. The MDGs are derived from this Declaration,
and all have specific targets and indicators.
The MDGs are inter-dependent; all the MDG influence
health, and health influences all the MDGs. For example,
better health enables children to learn and adults to earn.
Gender equality is essential to the achievement of better
health. Reducing poverty, hunger and environmental
degradation positively influences, but also depends on,
better health.
Millennium Development Goals
 Levels of Health Care facility

Category A – Primary Care facility - first

Sustainable Goals
contact health care facility that offers basic services
including emergency services & provision for normal
b. RA 7160 (Local Health Systems/Local Gov’t Code)
deliveries
– was enacted to bring genuine and meaningful local
Example:
autonomy in order to:

1.Without in patient beds like health centers, out-patient

1. Attain a fullest development of self-reliant communities
clinics and dental clinics
and make them a more effective partners in the
attainment of national health goals.
2. Short stay facility where the patients spends on the
2. Mandates devolution of basic services from the
average of 1-2 days before discharge. Like infirmaries
national government to the LGU’s
and birthing clinics (lying in) facilities
Devolution – refers to the act by which the national
government confers power & authority upon the Various
Category B- Custodial Care facility – A health facility
LGUs to perform specific functions & responsibilities.
that provides long term care, including basic services like
3. Provided for the creation of The provincial health board
food and shelter to patients with chronic condition
or local health Boards
requiring on going health and nursing care due to
Headed by: Governor, Mayor, members of the local
impairment & reduced degree of independence in ADL &
health boards and the private sector or NGO involve in
patients in need of rehabilitation.
health services.

Example:
Functions of Local Health Boards
Psychiatric facilities, substance/drug abuse treatment,
Rehab Centers & Nursing Homes.
1.Proposing to the sanggunian annual budgetary
allocations for the operation and maintenance of health
Category C. Diagnostic and therapeutic Facility - a
facilities and services within the province, city,
facility for examination of a human body, specimens from
municipality
human body for diagnosis, sometimes treatment of
disease. The test covers the pre analytical phases of
2.Serving as an advisory committee to the sanggunian on
examination. This is classified into:
health matters

1. Laboratory facility – clinical laboratory, HIV testing lab,

3.Creating committees that shall advise local health
Blood service facility, drug testing lab, NBS lab & lab for
agencies on various matters related to health service
drinking water analysis
operations

2. Radiologic Facility – X-ray, CT scan, Mammography,

C. Levels of Health Care & Referral System
MRI & ultrasonography
DOH – issued AO 2012-0012 (Rules & regulations
3. Nuclear medicine facility – Regulated by the Philippine
Governing the new classification Hospital and other
Nuclear Research utilizing applications of radioactive
health facilities in the Philippines that provides for a basic
materials in diagnosis & treatment like radiation therapy.
classification scheme of health facilities. Although the
levels of health care delivery have remained basically the
Category D. Specialized Outpatient Facility – a facility
same as Primary, Secondary & Tertiary
that performs a highly specialized procedures on an
out-patient basis. Example are, dialysis clinic, ambulatory
surgical clinic, cancer chemotherapeutic clinic, physical
medicine & rehabilitation center.

National Health Situation
The Philippines has joined the bandwagon of pursuing
the various reforms to strengthen the local health care
delivery and improve health outcomes of the population
this includes:
FOURMula One - started from 2005 to 2010, Kalusugan
Pangkalahatan from 2010 to 2015 & the Duterte Health
Agenda or Philippine Health Agendain 2016. Formula 1
Plus (F1 Plus ) is the latest in the series.
F1 Plus – has outlined the direction and provided the
guidelines to help achieve the universal healthcare in the
Philippines. It centers on pursuing the 3 goals:
1.Better Health outcomes
2.A more responsive health system
3.A more equitable healthcare financing
The DOH shall organized health sector initiatives into (4)
Pillars, namely;
Financing, Service Delivery, Regulation, Governance
Plus a cross-cutting initiative on Performance
Accountability.
Primary Health Care as an approach to health
Primary Health Care (PHC) – is defined as essential
healthcare base on practical, scientifically sound and
socially acceptable methods and technology made
universally accessible to individuals and families in the
community trough their full participation and at cost that
the community & country can afford to maintain at every
stage of their Development in the spirit of self-reliance
and self determination WHO,2008).
It advocates for a health care system characterized by
5A’s namely:
Accessible, Available, Affordable, Acceptable and
Appropriate
The core values of PHC :
Social Justice
Equity
Respect for Human Dignity & Human Rights
Solidarity
Self-reliance
Principles of Primary Health Care
● Accessible healthcare
● Intersectoral collaboration
● Appropriate technology
● Cultural sensitivity and safety
● Community participation
● Health promotion
Essential Health Services of PHC
E - Education for health
L - Locally endemic disease control
E - Expanded program for immunization
M - Maternal and child health including
responsible parenthood
E - Essential drugs
N - Nutrition
T - Treatment of communicable and non-
communicable diseases
S - Safe water and sanitation
Essential Public Health Services
1 . Monitor Health Status to identify and solve community
health Problems
2. Diagnose & investigate health problems & health
hazards in the community
3. Inform, educate & empower people about health
issues
4. Mobilize community partnerships & action to identify &
solve health problems
5. Develop policies & plans that supports individual &
community health efforts
6. Enforce laws & regulations that protect health &
ensure safety
7. Link people to needed personal health services &
assure the provision of health care when otherwise
unavailable
8. Assure competent public & personal health care
workforce
9. Evaluate effectiveness, accessibility & quality of
personal & population-based health services
10. Research for new insights & innovative solutions to
health problems
Three main Elements to define PHC
1.Primary Health care and essential public health
functions as the core of integrated services
2. Multi-sectoral Policy and action
3.Empowered people and communities
COPAR
Community Organizing Participatory Action Research – is
a community dev’t approach that allows the community
(participatory) to systematically analyze the situation
(research), plan a solution, and implement
projects/programs (action) utilizing the process of
community organizing
Community Organizing
Is a process of educating and mobilizing members of the
community to enable them to resolve community
problems
In the context of community health nursing, community
organizing is teaching the community to apply the nursing
process (assess, diagnose, plan, implement and
evaluate) on its own, utilizing resources that are available
to it, hereby allowing the community to be an active
participant in the process of dev’t, rather than just being a
passive recipient of services or care

Basic Values in Community Organizing

Human Rights
Social Justice
Social Responsibility

Community Organizing is:

Participative
Democratic
Developmental
Process-oriented

Phases of Community Organizing

Pre-entry
Entry
Community Integration
Social Analysis
Community Organization
Action Phase
Evaluation
Exit and expansion Phase
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