COMMUNITY HEALTH NURSING

Health - state of complete physical, mental and social well-being and not merely the
absence of diseases and infirmity. (WHO)

Social Health - a community vitality and is the result of positive interaction among groups
in a community with an emphasis on health promotion and illness prevention.

Community - geographical boundaries combined with social attributes of people.

- collection of people who interact with one another and whose common characteristics
and interests form a basis of unity and belonging.

- a group of people who share something in common and interact with one another and
share commitment and geographic boundaries.

4 Attributes:
1. People
2. Place
3. Interaction
4. Common characteristics, interest, goals

Geographical Communities - "territorial community" formed by a natural and man-made

boundaries.

Ex. Barangay, municipality, cities, provinces, regions and nations

Phenomenological Communities - "functional community" refers to relational, interactive

group in which the setting is more abstract.

Ex. Schools, colleges, universities, churches, org

Two Terms Commonly used in Public Health and CHN

1. Population - "group of people"

2. Aggregates - or subgroup/subpopulation that
nave common characteristics

Ex. Age-groups, elderly, pregnant, teens

Public Health - a science and art of:

1. Preventing disease
2. Prolonging life
3. Promoting health and efficiency through organized community effort for:
a) Sanitation and environment
 b) Control of communicable disease
c) Education of the individual
d) Organization of medical and nursing services for early diagnosis and treatment
e) Development of the social machinery to ensure everyone a standard of living
adequately for the maintenance of health.

3 Primary Functions of PHN

1. Assessment - regular collection, analysis and information sharing about health

condition, risk and resources in the community. (Survey, Data collection)

Ex. Stray dogs in the community

2. Policy Development - use of information gathered during assessment to develop local

and state policies. (Develop policies based on data gathered to solve problem gathered in
the assessment

Ex. All dogs should be inside a cage or inside the

owners nouse

3. Assurance - focuses in the availability of necessary health service throughout the

communities.

Ex. Sustained and permanent ang mga ipinatupad na health programs as well as the
regulations.

3 Levels of Prevention

Level 1: Primary - preventive measure; to decrease risk of exposure of individual to disease.

- consists of activities aimed at maintaining or enhancing people's physical, mental or
social well-being.

Ex. Health education, vaccines, immunization

Level 2: Secondary - early identification and intervention; halting disease progress,

minimizing severity of the disease, prevent or reduce complication, bring about cure.
- consists of activities for early diagnosis and prompt treatment of disease which has not
been prevented.

Ex. Exam screening for STD

Level 3: Tertiary - correction and prevention of deterioration of a disease state. Restore

patient to an optimum level of functioning
- consist of activities which are done when the disease process has already exacted its
damage and ill effects.
Ex. Teaching diabetic monitoring, insulin injection

Community Health Nursing - synthesis of nursing practice and public health practice
applied to promoting and preserving health of population.
(American Nursing Association)

- Utilization of the nursing process in the different level of clientele-individuals, families,

population groups and communities, concerned with the promotion of health, prevention
of disease and disability and rehabilitation. (Maglaya, et al)

- "Community Health Nursing-global or umbrella- Public Health Nursing- component or

subset or subspecialty nursing practice.

Public Health Nursing - a field of professional practice in nursing in public health in which
technical nursing and organizational skills are applied to problem of health as they affect
the community.
- part of community health nursing

Community-based Nursing - application of the nursing process in caring for individuals,

families and groups where they live, work as they move to the health care system.
- "it emphasizes managing acute or chronic conditions"
- practice area, home health nursing and nursing in outpatient settings

Principles of CHN:

1. An established community activity based on recognized needs and functioning within

the total community health program.
- it coordinates with the other agencies to determines trends to meet needs of community
and develop new programs
- Nurses support and lead the community to identify their problems and priorities.

2. Clearly defined and stated objectives and purposes for its services. This is so done, to
avoid or prevent duplication and omission of community service.

FUNCTIONS OF FAMILY

- protects the physical health of its member by providing adequate nutrition and health
care services. Providing an environment conducive to physical growth and health, creates
an atmosphere that influences the cognitive and psychosocial growth of its member.

1. Physical function
2. Economic function
3. Reproductive function
4. Socialization function
5. Affection function
6. Perform economic, education, recreational, religious, and political function.
 FAMILY FUNCTIONAL TYPE

Family Orientation- family where you came from

Family of Procreation- family you yourself
created

TYPES OF FAMILY AND ITS STRUCTURES

1. Nuclear or Traditional Family- father, mother, children

2. Dyad Family- young adult living together for financial stability; newly married couples

3. Cohabitation Family- heterosexual couples who live together but remain unmarried
.
4. Extended Family- nuclear family + grandmothers, grandfathers, uncles, aunt,
grandchildren

5. Intra generational Family- incorporated a new member in the family

6. Polygamous Family- a marriage with multiple wives

7. Single-Parent Family

> Stresses:
a) Child care concern
b) Financial concern
c) Role overload and fatigue in managing daily tasks
d) Social isolation

8. Blended Family- also called remarriage or reconstituted family. Divorced or widowed

person with children marries someone who also has children

9. Communal Family- formed by groups of people who choose to live together as an

extended family.
Relationship to each other is motivated by social or religious values rather than kinship.

10. Gay or Lesbian Family- homosexual unions, individuals of the same sex living together
as partners for companionship.

11. Foster Family

PHASES OF DIVORCE

Phase 1: Antagonistic time

Phase 2: Actual Separation
Phase 3: Reshaping lives

STAGES OF GRIEF
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

DESCENT
- cultural norms which affiliates a person with a particular group of a certain social
purposes.
1. Patrilineal
2. Matrilineal
3. Bilatelineal

AUTHORITY
-the one who makes the decision

1. Patriarchal- full authority on the father or any male member of the family e.g eldest son,
grandfather

2. Matriarchal- full authority of the mother or any female member of the family e.g eldest
sister

3. Egalitarian- husband and wife exercise a more or less amount of authority

4. Democratic- everybody is involved in decision making

5. Laissez-Faire- "full autonomy"

6. Matricentric- the mother decides/takes charge in absence of the father (e.g father is
working overseas

7. Patricentric- the father decides in absence of mother

RESIDENCE OR LOCATION

1.Patrilocal
2.Metrilocal
3.Neolocal

NAMING
- the names of the children are derived from their names

1. Patronymic
2. Matronymic
3. Bynimic

TYPES OF RELATIONSHIP FROM FAMILY

1. Affinal
2. Consanguinal - brought about by ceremony; more on blood relations
3. Fictive or Ritual relationship- ceremony

CHARACTERISTICS OF A FILIPINO FAMILY

1. Extension of relationship and descent patterns is bilateral

2. Kinship is felt in all segment of social organization
3. Extended family has a profound effect on daily decision
4. There is a great degree of equality between husband and wife
5. Children not only have to respect their parents but also obey them
6. God-fearing and conservative
7. Has high value for education

FUNCTIONS OF DEVELOPMENTAL STAGES

Stage 1: Marriage
- establish a mutually satisfying relationship
- learn to relate well to their families or orientation

Stage 2: Early Childbearing

- having and adjusting to infant
- support needs of all three members

Stage 3: Family w/ Pre-school Child

- adjusting to cost of family life
- adapting to needs of pre-school children to stimulate growth

Stage 4: Family w/ School-Age Child

- adjusting to the activity of growing children
- promoting joint decision making between children and parents
- supporting children's educational achievements

Stage 5: Family w/ Adolescent

- maintaining open communication among members
- supporting ethical and moral values
- balancing freedom with responsibilities

Stage 6: Launching or Post Parental Family

- children leave to establish their own households
- may represent a loss of self-esteem for parents

Stage 7: Family of Middle Years

- partners might view this stage as either the prime of their lives (an opportunity to travel,
economic independence, and time to spend on their hobbies) or period of gradual
decline (lacking the constant activity and stimulation of children in the home, finding life
boring without them)

Stage 8: Family in Retirement or Old Age

- adjusting to retirement
- adjusting to loss of spouse
 FAMILY TASKS
1. Physical maintenance
2. Socialization of family member
3. Allocation of resources
4. Maintenance of order
5. Division of labor
6. Reproduction, recruitment, and release of family
7. Placement of member into larger community
8. Maintenance of motivation and morale

FAMILY ROLES
1. Nurturer
2. Provider
3. Decision maker
4. Financial manager
5. Problem solver
6. Health manager
7. Culture bearer
8. Environmentalist
9. Gate keeper

THE FAMILY CODE OF THE PHILIPPINES

Executive Order no. 209 was signed into law by President Corazon Aquino on July 6, 1987.
Behaviors indicating a well family

* HEALTH CARE PROCESS

Process- a series of actions that lead toward a particular resort
- this process of decision making results in the optimal health care for the client to whom
the nurse applies the process.

Phases of Health Care

1. Health Promotion
2. Health Prevention- early detection of disease
3. health Restoration
4. Health Rehabilitation- recovery stage

INDIVIDUAL'S HEALTH STATUS

A. Health History
B. PE
C. Physical fitness assessment
D. Lifestyle assessment
E. Health risk appraisal
F. Health beliefs review
G. Life stress review
FAMILY HEALTH STATUS
A. Develop its own lifestyle
B. Operates as a group
C. Accommodates to the needs of the individual
D. Relates to the community
E. Growth cycle and behaving, functioning organism

STAGES OF FAMILY HEALTH NURSING PROCESS

I. Assessment
II. Planning
III. Implementation
IV. Evaluation

DOCUMENTATION - an important function of the community health nurses. This provides

data which is needed to plan the client care and ensure its continuity.

FAMILY HEALTH ASSESSMENT

- involves a set of actions by which the

a. status of a family as client, its ability to maintain wellness

b. its ability to maintain itself as a system and functioning unit
c. to maintain control
d. prevent or resolve problems in order to achieve health and well-being among its
members are measured.

Data Collection - there are 2 important things to ensure effective and efficient data
collection in family health assessment:

Types and Kinds of Data needed:

1. Family Structure, Characteristics, and Dynamics

● Members of the household and relationship to the head of the family Demographic
data
● Place of residence of each member
● Type of family structure; matriarchal or patriarchal, nuclear or extended
● Dominant family members in terms of decision making
● General family relationships or dynamics

2. Socio-Economic and Cultural Characteristics

Income and expenses
- occupation and place of work of each member
- adequacy to meet basic needs
- who makes decision about family expenditure
Educational attainment of each member
Ethnic background and religious affiliation
Significant others and roles they play in the family
Relationship of the family to a larger community
3. Home and Environment Housing
- Adequacy of living space
- sleeping arrangement
- presence of breeding or resting sites of vectors of diseases
- presence of accident hazards
- food storage and cooking facilities

4. Health status of each Family Member

● Medical history indicating current or past significant illnesses or beliefs and
practices conducive to health and illness
● Nutritional assessment (anthropometric data, dietary history, eating/feeding
habits/practices)
● Risk factor assessment indicating presence of major and contributing modifiable
risk factors for specific lifestyle diseases
● Physical assessment indicating presence of illness states
● Results of laboratory/diagnostic and other screening procedures supportive of
assessment findings.

5. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

Immunization status Healthy lifestyle practices
Adequacy of:
- rest and sleep
- exercise/activities
- use of protective measures
Use of promotive-preventive health services

6. Family APGAR
● Adaptational
● Partnership
● Growth
● Affection
● Resolve

7. Genogram
- a diagram that details family structure and provides information about the family's
health history and roles of various family members across several generation.

8. Family Coping Index

Data Gathering Methods and Tools

1. Observation
2. Physical examination
3. Interview
4. Record Review
5. Laboratory/Diagnostic Tests

FIRST LEVEL ASSESSMENT

- the process whereby existing and potential health conditions or problems of the family
are determined
- it relates what health problems exist and will exist.
Categories:
A. Wellness state
B. Health threats
C. Health deficits
D. Foreseeable crisis

A. Presence of Wellness Condition

- clinical judgement about a client in transition from a specific level of wellness or
capability to a higher level

Wellness Potential - based on client's current performance, current competencies, or

clinical data but NO explicit expression of client desire

Readiness for Enhanced Capability - explicit expression of desire to achieve a higher

level of state or function.

B. Presence of Health Threats

- conditions that are conducive to disease and accident, or may result to failure to
maintain wellness or realize health potential.

C. Presence of Health Deficits

- instances of failure in health maintenance

D. Presence of Foreseeable Crisis

- anticipated periods of unusual demand on the individual or family in terms of
adjustment/family resources.

SECOND LEVEL ASSESSMENT

- defines the nature or type of nursing problems that the family encounters in performing
the health tasks with respect to a given health condition or problem, and the etiology or
barriers to the families' assumption of these tasks.
- explains the family's problems related to maintaining health and wellness.
- it specified the measures that the family did not do due to inability.

& TYPOLOGY OF PROBLEMS IN FAMILY HEALTH

FIRST LEVEL ASSESSMENT
Wellness Condition
1. Potential for enhanced capability for:
2. Readiness for enhanced capability for:
a) Healthy lifestyle
b) Health Maintenance
c) Parenting
d) Breastfeeding
e) Spiritual well-being
Health Threats
1. Presence of risk factors of specific diseases
2. Threat of cross infections from a communicable
disease
3. Family size beyond what resources can adequately provide
4. Accident hazards
5. Faulty/unhealthful nutritional/eating habits for feeding techniques/practices
6. Stress provoking factors
7. Poor environmental condition
8. Unsanitary food handling and preparation
9. Unhealthful lifestyle and personal habits
10. Inherent personal characteristics
11. Inappropriate role assumption
12. Lack of communication
13. Family disunity

Health deficits
1. Illness state (wellness diagnosed or undiagnosed)
2. Failure to thrive/develop according to normal rate
3. Disability

Foreseeable Crisis
1. Marriage
2. Pregnancy
3. Parenthood
4. Additional family member
5. Abortion
6. Entrance to school
7. Adolescence
8. Divorce
9. Menopause
10. Loss of job
11. Hospitalization
12. Death of a member
13. Resettlement in a new community

SECOND LEVEL ASSESSMENT

Inability to recognize the presence of the condition or the problem due to:
1. Lack of inadequate knowledge
2. Denial about its existence or severity as a result of fear of consequences of diagnosis
of problem.
3. Attitude/philosophy in life which hinders recognition/acceptance of a problem
Inability to make decisions with respect to taking appropriate health action due to:
1. Failure to comprehend the nature/magnitude of the problem/condition
2. Low salience of the problem
3. Feeling of confusion, helplessness, and/or resignation brought about by perceived
magnitude/severity of the situation or problem
4. Lack of knowledge as to alternative courses of action open to them
5. Inability to decide which action to take from among a list of alternatives
6. Conflicting opinions among family members
7. Lack of knowledge of community resources for care
8. Fear of consequences
9. Negative attitude towards the health condition or problem.
10. Inaccessibility of appropriate resources for care
11. Lack of trust/confidence in the health personnel/agency
12. Misconceptions of erroneous information about proposed courses of action

IMCI - Integrated Management of Childhood

Illnesses (WHO collaboration w/ UNICEF)

Focus:
1. Nutrition
2. Malnutrition
3. Immunization
4. Disease prevention
5. Health promotion - delegation of info

Objectives of IMCI
- Reduce death, severity of illness, and improve growth and development

Components of IMCI
1. Upgrading case management and counseling skills of health care provider.
2. Strengthen the health system for effective managemnet of childhood illnesses.
3. Improving family and community practice related to child health and nutrition.

Color Code Triage System:

PINK - Severe; Urgent Referral System

YELLOW - Specific medical treatment
GREEN - Home management

Elements of IMCI Case Management Process

1. Assessment
2. Classify - categorize the color
3. Identify which body part has the problem
4. Treatment - management
5. Counseling - health teaching
6. Give follow up care