Community Health Nursing 1 (individual And
Family as Clients) NCM 104
Community Health Nursing: The 3 Broad Concepts
1. What is a community?
 a group of people with common characteristics
or interests living together within a territory or
geographical boundary
 place where people under usual conditions are
found
 The community is the object or focus of care in
CHN, with the family as the unit of service.
 Derived from a latin word "comunicas" which
means a group of people
2. What Is Health?
 A state of complete physical, mental, and social
well being and not merely the absence of disease
and infirmity (WHO, 1995).
 It carries the mandate that health is a basic
human right.
 It is seen as a spectrum or a continuum
 The modern concept of health refers to Optimum
Level a Functioning (OLOF) of individuals,
families, and communities, which is influenced
by the ecosystem through a myriad
What influences LOF?
 Behavioral (culture, habits, mores, ethnic
customs)
 Socio-economie (employment, education,
housing)
 Political (safety, oppression, people,
empowerment) ereditary (genetic endowment,
familial, racial)
 Health Care Delivery System (promotive,
preventive, curative, rehabilitative)
 Environment (air, food, water, wastes, noise,
radiation. pollution, congestion)
What is Health ?
1. Health-Illness Continuum Models: Dunn's
High-Level Wellness Grid:
 describes a health grid in which a health axis
and an environmental axis intersect. The
grid demonstrates the interaction of the
environment with the illness-wellness
continuum.
 The axis extends from peak wellness to
death. and the environment axis extends
from very favorable to very unfavorable.
The Intersection of the two axes forms four
quadrants of health
1. High-level wellness in a favorable
environment:
 Example is a person who implements
healthy lifestyle behaviors and has the
biopsychosocial, spiritual, and economic
resources to support his lifestyle.
2. Emergent high-level wellness in an
unfavorable environment:
 Example is a woman who has the
knowledge to implement healthy
lifestyle practices but does not
implement adequate self-care practices
bec of family responsibilities, job
demands, or other factors.
3. Protected poor health in a favorable
environment:
 Example is an ill person whose needs
are met by the health care system and
who has access to appropriate
medications, diet, and health care
instruction.
4. Poor health in an unfavorable
environment:
 Example is a young child who is
starving in a drought stricken country.
Requires the individual to maintain a continuum
of balance and purposeful direction with the
environment.
* Involves progress towards a higher level of
functioning, an open-ended and even expanding
challenge to live at the fullest potential.
DUNN'S HIGH-LEVEL WELLNESS AND
GRID MODEL
Contd
• Two axes
-X-axis is health: it extends from peak wellness to death
- Y-axis is environment: it extends from very favorable
environment to very unfavorable environment.
B. Travis' Illness-Wellness Continuum:
Ranges from high-level wellness to premature death. It
demonstrates two arrows pointing in opposite directions
and joined at a neutral point. Movement to the right of
the neutral point indicates increasing levels of health and
well-being for an individual achieved in three steps:
1. Awareness
2. Education
3. Growth
In contrast, movement to the left of the neutral point
indicates progressively decreasing levels of health and
premature death.
Degree of client wellness that exists at any point in time
ranging from optimal wellness condition, with
availability of energy at its maximum, to death which
represents total energy depletion.
A dynamic state that continuously alters as a person
adapts to changes in the internal and external
environment to maintain a state of physical, emotional,
intellectual, social, developmental and spiritual well-
being (Holistic).
Variables influencing health status, beliefs and
practices:
1. Internal variables: include those which are usually
non-modifiable such as:
a. Biologic dimension - genetic makeup, sex. age, and
developmental level all significant to a person's health.
b. Psychological dimension - emotional factors which
include mind-body interactions and self-concept.
c. Cognitive dimension - intellectual factors which
include lifestyle choices and spiritual and religious
beliefs.
2. External variables: the macrosystem which
include:
a. Environment: geographical locations determine
climate, and climate affects health; environmental
hazards.
b. Economics: standards of living reflecting Occupation,
income and education is related to health, morbidity and
mortality.
c. Family and cultural beliefs: the family passes on life
patterns of daily living and lifestyles to offsprings (e.g.
physical/emotional abuse or climate of open
communication). Culture and social interactions also
influence how a person perceives, experiences, and
copes with health and illness.
d. Social support networks: political/systems of
governance; religion/church: mass med
 Health and illness can be viewed as the
opposite. ends of a health continuum
 From high level of health a person's
condition can move through good health
normal health -- poor health --
extremely poor health to death. . People
move back and forth within this
continuum day by day.
 How people perceive themselves and
how others see them in terms of health
and illness will also affect their
placement on the continuum.
Agent-Host-Environment
The epidemiologic triad Model
 The epidemiologic triangle or triad is the
traditional model of infectious disease causation.
 It has three components: an external agent, a
susceptible host, and environmental factors
that interrelate in a variety of complex ways to
produce disease & alter production & utility in
animals.
Agent-Host-Environment Model
 Each factor constantly interacts with the others
 When in balance, health is maintained
 When not in balance. disease occurs
 Used primarily in predicting illness rather than
promoting wellness
 Model is composed of three dynamic, interactive
elements.
Health Belief
Health Belief Model by Rosentock
 Based on motivational theory
 Concerned with what people perceive about
themselves in relation to their health
 Consider perceptions (influences individuals
o Perceived susceptibility
o Perceived seriousness
o Perceived benefit out of the action
4. Evolutionary-based Model: States that illness and
death sometimes serve an evolutionary function.
Elements considered in the theory are:
1. Life events: developmental variables and
variables associated with changes such as
accidents/relocation.
 2. Lifestyle determinants
3. Evolutionary viability within the social
context reflects the extent to which an individual
functions to promote survival and well-being.
4. Control perceptions: the extent to which a
person can influence circumstances in life.
5. Viability emotions: affective reactions
developed for life events or lifestyle
determinants. 6. Health outcomes: physiological,
behavioral and psychological status resulting
from the interplay of those elements.
Health Promotion (cont)
 Model is proposed by Pender (1996)
 It defines health as a positive, dynamic state, not
merely the absence of disease
 The model was proposed as a framework for
integrating the perspectives of nursing and
behavioral science and the factors that influence
health behavior
 Health promotion is desire to increase well-
being and actualize human health potential,
whereas health protection is behavior that is
motivates by a desire to avoid illness, detect it
early or maintain function within the constraints
of an illness.
6. WHO definition (1978): a state of complete physical,
mental, and social well-being, not merely the absence of
disease or infirmity (sickness).
 Health is a social phenomenon.
 It is an outcome of multi-causal theories of
health and disease.
 It is an outcome or by-product of the interplay of
societal factors:
a. Ecological:
1. Biological
2. Physical
b. Economic
1. Political
2. Socio-cultural
3. What is Nursing?
 The diagnosis and treatment of human responses
to actual or potential health problems (ANA,
1980).
 Nursing, together with public system which
operates at three levels of clientele health, is one
of the helping professions in the health care
individuals, families or groups, and
communities.
 It operates within the realm of health care both
independently and interdependently.
 The objective of nursing is to assist clients to
achieve maintain or recover a high
 Assisting sick individuals to become healthy and
healthy individuals achieve optimum wellness
(Henderson)
Nursing
 Both profession & a vocation. Assisting sick
individuals to become healthy and healthy
individuals achieve optimum wellness.
What Is Community Health and Why Is It
Important?
Community Health
 Part of paramedical and medical
intervention/approach which is concerned on the
health of the whole population.
Aims:
 Health promotion
 Disease prevention
 Management of factors affecting health
Various definition: Community Health Nursing
“The utilization of the nursing process in the different
levels of clientele-individuals, families, population
groups and communities, concerned with the promotion
of health, prevention of disease and disability and
rehabilitation." (Maglaya, et al)
Goal: "To raise the level of citizenry by helping
communities and families to cope with the
discontinuities in and threats to health in such a way as
to maximize their potential for high-level wellness"
(Nisce, et al)
A learned practice discipline with the ultimate goal of
contributing as individuals and in collaboration with
others to the promotion of the client's optimum level of
functioning thru' teaching and delivery of care
(Jacobson)
-Special field of nursing that combines the skills of
nursing, public health and some phases of social
assistance and functions as part of the total public health
program for the promotion of health, the improvement of
the conditions in the social and physical environment,
rehabilitation of illness and disability (WHO Expert
Committee of Nursing)
A service rendered by a professional nurse to IFCs,
population groups in health centers, clinics, schools,
workplace for the promotion of health, prevention of
illness, care of the sick at home and rehabilitation (DR.
Ruth B. Freeman)
FACTS of CHN
Focus : promotion and preservation of health
Area of Content: skills and knowledge relevant to both
nursing and public health
Clients: general populations (individuals. families,
communities)
Time: continual, not limited to episodic care
Scope: comprehensive and general, not limited to a
particular age or group.
Concepts on Community Health Nursing:
CLIENT of Community Health
 Composed of different levels of clientele:
Individual, family, population group, and
community
Community as a SETTING of CHN PRACTICE
 School Health Nursing School
 Occupational Health
 Nursing Workplace
 Public Health Nursing Home
Concept and Principles
1. FAMILY
 Is the primary unit of care or basic unit of
 Community Health Care where primary
prevention is given priority
 The individual client or patient is a member of
the family
 The family may be part of a population group
like
 members of a regional group which in turn is
part of the bigger group which is the community
2. PARTNERSHIP
 THE CHNurse works with, not for, the
individual patient, family, group or community
as active partners and not passive recipient of
care
 These clients are actively involved in the
organizing, planning, implementation,
management, and evaluation phases of their care
 All processes must include partnership with
representatives of the people
3. CHANGE
 The practice of CHN is affected by changes in
society in general, and by developments in the
health field in particular
 The environment and socioeconomic status have
been shown to affect the health of the
community
4. HEALTH CARE DELIVERY SYSTEM
 CHN is part of the community health system and
of the larger human services system
 The CHN shores with other members of the
health team and other sectors in the community
the responsibility of delivering health care
services
 The CHN interacts, collaborates and coordinates
using the multidisciplinary approach with
teamwork as the deriving force in the efficient,
effective and equitable delivery and utilization
of the services
Philosophy of CHN
This philosophy of care is based on the belief that care
directed to the individual, the family, and the group
contributes to the health care of the population as a
whole
Knowledge-base of CHN
 Biological and social sciences
 Ecology
 Clinical Nursing
Utilizes COMMUNITYHEALTH
ORGANELLING
It is population-focused - "the greatest good for the T-raining and development as opportunities for
greatest number" continuing staff education programs.

 Community diagnosis QRX

 Vital statistics
In terms of CHN practice, the nurse in the community is
 Priority setting trained as
it is a promotive-preventive service a. Certified in public health
- adheres to Primary Health Care b. Specialist in CHN
C.4-year BSN graduate
 Health education d. Generalist in nursing
 Preventive Treatment
The thrusts of CHN must be embodied in the hearts of
It is a generalist practice- deals with all cases.
health care providers. Which one strengthens the health
The ULTIMATE GOAL of CHN By: care system?

 help communities and families cope with
discontinuities in health and level of health of
threats
 Maximize their potential for high level wellness
 Promote reciprocally supportive relationship
between people and their citizenry..
a. Supporting conditions for healthy habits
b. Increasing opportunities to be healthy Letting
the people manage their own
c. Increasing opportunities to be healthy Letting
the people manage their own health
d. d. Financing health care program

RAISE the level of Health of citizenry Ans: c.Letting the people manage their own health

The PRIMARY FOCUS of CHN As a Public Health Nurse, what is your primary function
or responsibility?
health promotion wherein health teaching is the primary
responsibility of the community health nurse, who is a a. Reporting of cases
generalist in terms of practice b. Health Promotion:
c. Community Diagnosis
Principles of CHN d. Health Teaching
E-ducation as primary tool and responsibility Ans: D Health Teaching
M-ade available to all regardless of race, creed and The philosophy of CHN practice is based on the belief
socio-economic status that the family is the smallest unit in a democratic
society. Which age group should be the priority of the
P-olicies and objectives of the agency is fully
nurses in the community?
understood by the nurse
a. Older persons and terminally ill
O-rganizing for health, with the family as the unit of
service b. Adolescents and adults
W-orks as a member of the health team (PHN) E-xisting C. d. Infants and children
active organizations are utilized
d. All ages regardless of status
R-ecording and reporting are accurate
ans: d all ages regardless of status
M-onitoring and evaluation of services is periodically
done
E-xisting indigenous resources of the community is used HIGHLIGHTS in CHN Concepts

N-eeds of clienteles is recognized and serves as basis for  CHN is based on the recognized needs of
CHN communities, families, groups, and individuals.
 "CHN is a unique blend of nursing and public
health practice, and is oftentimes used
 interchangeably with the term "Public Health
Nursing”
Salient Features of CHN
1, POPULATION or AGGREGATE FOCUSED
 the hallmark of CHN
 The wholes community is the patient or client.
o a. Priorities of care when resources or
supplies are primarily allotted for the
health needs and problems of the
individuals or families as they impact or
relate to the total health of the total
population or community
o b. Population-based assessment, policy
development, and assurance processes
are systematic and comprehensive
2.Greatest good for the greatest number
 the emphasis of CHN is on the importance of the
"Greatest good for the greatest number" where
the nurse looks at the health needs and problems
of the community rather than focusing solely on
the needs of an individuals or families.
 when a particular situation is seen as a risk or
hazard to the health of the community or can
afflict a greater number of individuals, this is
now seen as a community health problem which
needs community-wide intervention.
3.UTILIZES THE NURSING PROCESS CHN
 involves the assessment of health needs,
planning, implementation, and evaluation of the
impact of health services on population groups
using the problem-solving methods - NURSING
PROCESS
4. PROMOTIVE PREVENTIVE IN NATURE
 The priority of CHN is on health-promoting
disease preventing strategies over curative and
Interventions
 The health center consultation becomes the
entry point to the health care system and
provides the initial contact between the nurse
and the client.
5.USES A VARIETY OF INSTRUMENTS
 CHN makes use of tools for measuring and
health statistics or vital statistics analyzing
community health problems like public
questionnaires may also be used
 Community map is also a very useful tool
 Interview, schedule, survey forms and
6.REQUIRES MANAGEMENT SKILLS
 CHN applies the principles of management
especially during the organization of the
nursing service in the local health agency
and in activities that require the effective
management of a certain program or health
service
PUBLIC HEALTH
Public Health is directed towards assisting every citizen
to realize his birth rights and longevity. The science and
art of preventing disease, prolonging life and efficiency
through organized community effort for:
a. The sanitation of the environment
b. The control of communicable infections
c. The education of the individual in personal hygiene
d. The organization of medical and nursing services for
the early diagnosis No preventive treatment of disease
e. The development of a social machinery to ensure
everyone a standard of Irving, adequate for maintenance
of health to enable every citizen to realize his birth right
of health and longevity (Dr. C.E Winslow)
PUBLIC HEALTH
 Ecological (environmental) in perspective
(VIEWPOINT), multi-sectoral (division) in
scope and collaborative (2 WAY) in strategy
 It aims to improve the health of community
through an organized (planned) community
effort
 The science and art of preventing disease,
prolonging life and promoting health
through the organized efforts and informed
choices of society, organizations, public and
private communities and individuals.
 It is concerned with threats to the overall
health of a community based on population
health analysis.
 Public health is typically divided into
epidemiology, biostatistics and Health
services. Environmental, social, behavioral,
and occupational health and other important
subfields.
PUBLIC HEALTH NURSING
The practice of nursing in national and local government
health departments (which include health centers and Researcher
rural health units), and public schools. • Epidemiologist, Health Monitor, Recorder,
Statistician
Community Organizer
- Standards of Public Health Nursing in the Philippines, • Change Agent
2005 Trainer
• Health Educator, Counselor
Major concepts: Role Model
 Health promotion
ROLES
 People's participation towards self-reliance
Philosophy of Public Health -Clinician - who is a health care provider, taking care of
Health and longevity as birthrights the sick people at home or in the RHU
Longevity-average lifespan or life expectancy -Health Educator - who aims towards health promotion
and illness prevention through dissemination of correct
information; educating people
 50 years-Swaroop's Index -Facilitator who establishes multi-sectoral linkages by
 Untimely death person died without reaching - referral system
the average lifespan -Supervisor who monitors and supervises the
performance of midwives
Combined (M/F)-69.6 ylo Health Advocator who speaks on behalf of the client
Male-66.74 ylo Advocator who act on behalf of the client
Female 72.61 y/o -Collaborator who working with other health team
member
OBJECTIVES OF PUBLIC HEALTH: CODES
Other function
Control of Communicable Diseases
Organization of Medical and Nursing Services In the event that the Municipal Health Officer (MHO) is
Development of Social Machineries unable to perform his duties/functions or is not available,
Education of IFC on personal Hygiene- Health the Public Health Nurse will take charge of the MHO's
Education is the essential task of every health worker responsibilities.
Sanitation of the environment
In the care of the families:
Public Health Nursing: the term used before for
Community Health Nursing • Provision of primary health care services
• Developmental/Utilization of family nursing
According to Dr. C.E. Winslow, Public Health is a care plan in the provision of care
science & art of 3 P's
 -Prevention of Disease In the care of the communities:
 -Prolonging life
 Promotion of health and efficiency through • Community organizing mobilization,
organized community effort community development and people
empowerment
• Case finding and epidemiological investigation
Functions of the PHN • Program planning, implementation and
evaluation
Manager • Influencing executive and legislative individuals
• Planner, Programmer, Supervisor, Coordinator or bodies concerning health and development
of services Planner/Programmer
Health Care Provider
• Direct nursing care
1.Identifies needs, priorities, and problems of
individuals, families, and communities
2.Formulates municipal health plan in the absence of a
medical doctor
3.Interprets and implements nursing plan, program
policies, memoranda, and circular for the concerned staff
personnel
4.Provides technical assistance to rural health midwives
in health matters
Coordinator
Coordinator of Services

1. Coordinates with individuals, families, and

groups for health-related services provided by
various members of the health team
2. . Coordinates nursing program with other health
programs like environmental sanitation, health
education, dental health, and mental health

Change Agent
• Motivates changes in health behavior in
individuals, families, groups, and communities
that also include lifestyle in order to promote
and maintain health
3 R's
Recorder/Reporter/Statistician

1. 1.Prepares and submits required reports and

records
2. 2.Maintain adequate, accurate, and complete
recording and reporting
3. 3.Reviews, validates, consolidates, analyzes, and
interprets all records and reports
4. 4.Prepares statistical data/chart and other data
presentation