Community Health Nursing 1

INTRODUCTION TO COMMUNITY HEALTH NURSING

Community health nurses are in a position to
assist in the transition of the Philippine health
care system from a disease oriented system to a
health oriented system
Nurses constitute a large group of health care workers,
therefore they are in a position to create a health care
delivery system that will meet the health oriented needs of
the people.
Community health and public health nursing is the synthesis of
nursing practice and public health practice.
The major goal of CHN practice is to preserve the health of the
community and surrounding population by focusing on health promotion
and disease prevention and health maintenance of individuals families and
groups with the community. Thus, community/public health nursing is
associated with health and the identification of population at risks rather
than with an episodic response to patient demand.
The mission of public health is social justice that entitles all people to
basic necessities such as adequate income and health protection and
accepts collective burdens to make this possible
Definition of Health

 Health is a state of complete physical, mental and social well being and not
merely the absence of any disease or infirmity. This is considered as a classic
definition that set the trend in defining health in social terms
( WHO)
Paradigms of Health Influencing WHO
Definition
A. Medical Model
B. Health Illness Continuum
C. High level wellness model
D. Role performance Model
E. Eudaemonistic Model
F. Agent Host Environment Model
Determinants of Health

A. Income and social status- higher income and social status are linked to
better health
B. Education-low education levels are linked to poor health, more stress
and lower self confidence
C. Physical environment-safe water and clean air, healthy work places, safe
houses, communities and roads all contribute to good health.
D. Employment and working conditions-people in employment are
healthier, specially those who have control of their working conditions
E. Social support networks-greater support from families, friends and
communities is linked to better health
Determinants of Health

F. Genetics -inheritance plays a part in determining lifespan, healthiness and the

likelihood of developing illness
G. Personal behavior and coping skills-balanced eating, keeping active, smoking,
drinking and how we deal with life’s stresses and challenges all affect
health
H. health services- access on the use of services that prevent and treat diseases
influences health
I. Gender-men and women suffer from different types of diseases at different ages
J. Culture- customs and traditions and belifs of family and community linked to better

health
Definitions and focus of Public Health and Community Health
 

 C.E.Winslow defines public health as “ the science and art of preventing

diseases, prolonging life and promoting health and efficiency through
organized community effort
Definitions and focus of Public Health and Community
Health

1. sanitation of the environment

2. control of communicable infection
3. Health education in personal hygiene
4. Organization of medical and nursing services for early detection and
preventive treatment of diseases
Key Functions of the Nurse in Public Health

a. Assessment- regular collection, analysis and information sharing about

health conditions, risks and resources in a community
b. Policy development- use of information gathered during assessment to
develop local and state health policies and to direct resources towards
policies
c. Assurance- focuses on the availability of the necessary health services
throughout the community. It includes maintaining the ability of both
public health agencies and private providers to manage day to day
operations and having the capacity to respond to the critical situations
and emergencies
Public health efforts focus on preventive and promotion of population
health at the national and local levels. These efforts at the national level
concentrate on providing support and advisory services to public health
structures at the local level. The local level structures provide direct
services to communities through
1. Environmental health services which protect the public from hazards
such as polluted water, air and tainted food
2. Personal health care services such as immunization, and family planning
services, well infant and maternal care and treatment prevalent health
conditions, both communicable and non communicable
  
Essential Public Health Functions

a. Health situation monitoring and analysis

b. Epidemiological surveillance/ disease prevention and control
c. Development of policies and planning in public health
d. Strategic management of health systems and services for for population health
gain
e. Regulation and enforcement to protect public health
Essential Public Health Functions

f. Human resource and development planning in public health

g. Health promotion, social participation and empowerment
h. Ensuring the quality of personal and population based services
i. Research, development and implementation of innovative public health solutions
Health Promotion and Levels of Prevention

 Health Promotion- enhance resources directed at improving well being

 
 Disease Prevention- protect people from disease and effects of disease
I. Primary level- relates to activities directed at preventing a problem before it
occurs by altering susceptability or reducing exposure for susceptible individuals.
The 2 elements are 1. genaral health promotion and 2. specific protection Ex.
Immunization
II. Secondary level-refers to early detection and prompt intervention or early
treatment during the early period of disease pathogenesis. Ex. Screening for
Sexually Transmitted Infection
  
Health Promotion and Levels of Prevention

 
 
III. Tertiary level-targets population that has experienced diseases or injury and
focuses on limitation of disability and rehabilitation. Ex. Teaching insulin
administration at home
Community Health Nursing

 The American Nurses Association ( ANA) defines Community Health

Nursing as a synthesis of nursing practice and public health practice
applied to promoting and preserving the health of the population. It is
considered to be a broader and more general specialty area that
encompasses subspecialties that include
a. Public health nursing
b. School nursing
c. Home health nursing
d. Hospice care
e. Independent nursing practice
Community Health Nursing

 Community Health Nursing practiced is Population Focused. This

means it concentrates on a specific group of people and focuses in
health promotion and disease prevention. The characteristics are:
a. Focuses on entire population
b. Is based on assessment of the population health status
c. Considers broad determinant of health
d. Emphasizes on local level prevention
e. Intervenes with the communities, systems, individuals and families
Community Health Nursing

 Types of information useful for population focus

a. Demographic data
b. Groups at high risk
c. Services/ providers available
Community Health Nursing

 Levels of Clientele in Community Health Nursing

a. Individual
b. Family
c. Groups/aggregate
d. Community
Community Based Nursing

 Refers to application of the nursing process in caring for individuals, families and
groups where they live, work or go to school as they move through the health
care system. It is setting spefic and emphasis is on acute and chronic care. Ex
Outpatient nursing
Public Health Interventions

a. Surveillance- describes and monitors health events through assessment,

analysis, and interpretation of health data for planning, implementing
and evaluatig public health interventions
b. Disease and other health event investigation- systematically gathers and
analyzes data regarding threats to health of populations, ascertains the
source of the threat, identifies cases and others at risk and determines
control measures
c. Outreach- locates population of interest and provides information, what
can be done
and how services are obtained
d. Screening- identifies individuals with unrecognized health risk factors or
asymptomatics
Public Health Interventions

e. Case finding- locates individuals and families with identified risk factors
and connects them with resources
f. Referral and follow up- assists individuals, families, oups, organizations
and community to identify and access necessary resources to resolve
problems
g. Case management- optimizes self care capabilities of individuals and
families and the capacity of systems and communities to coordinate and
provide service
h. Delegated functions- tasks that a registered nurse do uner the authority
of another health re professional as allowed by law
Public Health Interventions

i. Health teaching- communicates facts, ideas and skills

j. Counseling- establishes interpersonal relationships with a community, a system and
a family or individual with the intention of enhancing heir capacity for self care and
coping
k. Consultation- seeks information and generates optional solutions to perceived
problems or issues through interactive problem solving
l. Collaboration-commits two or more persons or an organization to achieve a commo
goal through enhancing the capacity of one r more members
Public Health Interventions

m. Coalition building- promotes and develops alliances among

organizations or constituents for a common purpose
n. Community organizing- helps community groups identify common
problem r goals, mobilize resources and develop d implement strategies for
realizing they ve collectively set
o. Advocacy-acting on someone's behalf
p. Social marketing-utilizes marketing principles and technology for
programs designed to influence the knowledge attitudes, values and beliefs
q. Policy development and enforcement- places issues on decision makers.
Compels others to comply with laws, rules, regulation, ordinances and
policies
 
Competency Standards in Community Health Nursing

a. safe and quality nursing care

b. Managing of resources and environment
c. Health education
d. Legal responsibility
e. Ethicomoral responsiility
f. Personal and professional development
g. Quality improvement
h. Research
i. Records management
j. Communication
k. Collaboration and teamwork