NCM 113: COMMUNITY

HEALTH NURSING II
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• GOAL OF CHN:
• --is to assist the individual, family and community in attaining their
highest level of holistic health which is attained through
multidisciplinary effort and to promote reciprocally supportive
relationship between people and their physical and social
environment.
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• CONCEPTS AND PRINCIPLES:

• 1.Family – is the primary unit of care or basic unit of service of
community health care where primary prevention is given priority.
• 2.Partnership – the community health nurse works with, not for,
the individual patient , family , group or community as active
partners and not passive recipient of care. This clients are actively
involved in the organizing, planning, implementation, management
and evaluation phases of their care.
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• 3. Change – the practice of community health nursing is affected by changes in

society in general, and developments in the health field in particular. The
environment and socio- economic 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 shares with the 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 driving force in the
efficient, effective and equitable delivery and utilization of services.
• 
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Theoretical Models / Approaches

• Health Belief Model (HBM)

• Milio’s Framework for prevention
• Nola Pender’s Health Promotion
• Lawrence Green’s PRECEDE-PROCEED MODEL
(PRECEDE= Predisposing, Reinforcing, Enabling Constructs in
Educational Diagnosis and Evaluation) (PROCEED=Policy,
Regulatory and Organizational Constructs in Educational and
Environmental Development
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• Health Belief Model (HBM)

This model is based on the premise that for a behavioral
change to succeed, individuals must have the incentive to
change, feel threatened by their current behaviour, and feel
that a change will be beneficial and be at acceptable cost.
They must also feel competent to implement that change .
The purpose of the model is to explain and predict preventive
health behavior. 
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Health Belief Model (HBM)

It pertains to three components of an

individual’s perception :
1. Susceptibility to an illness
2. Seriousness of an illness
3. Benefits of taking the action
Example: In one HIV infection study
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• Milio’s Framework for prevention

 Nancy Milio developed a framework for prevention that
includes concepts of community – oriented, population-
focused care.
 Milio stated that behavioural patterns of the populations-and
individuals who make up populations – are a result of habitual
selection from limited choices.
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 She challenged the common notion that a

main determinant for unhealthful 
behavioural choice is lack of knowledge.
 Milio’s framework described a sometimes
neglected role of community health nursing
to examine the determinants of a
community’s health and attempt to influence
those determinants through public policy.
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Nola Pender’s Health Promotion

•  Health Promotion Model notes that each person has unique personal
characteristics and experiences that affect subsequent actions. The set of
variables for behavioral specific knowledge and effect have important
motivational significance. These variables can be modified through
nursing actions. Health-promoting behavior is the desired behavioral
outcome and is the endpoint in the Health Promotion Model. Health-
promoting behaviors should result in improved health, enhanced
functional ability, and better quality of life at all development stages.
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• Health promotion is defined as behavior motivated by the

desire to increase well-being and actualize human health
potential. It is an approach to wellness.

• On the other hand, health protection or illness prevention is

described as behavior motivated desire to actively avoid
illness, detect it early, or maintain functioning within illness
constraints.
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3 Focus of the model

• Individual characteristics and experiences (prior related behavior and

personal factors).

• Behavior-specific cognitions and affect (perceived benefits of action,

perceived barriers to action, perceived self-efficacy, activity-related
affect, interpersonal influences, and situational influences).

• Behavioral outcomes (commitment to a plan of action, immediate

competing demands and preferences, and health-promoting behavior).
• https://nurseslabs.com/nola-pender-health-promotion-model/
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• Lawrence Green’s PRECEDE-PROCEED

MODEL (PRECEDE= Predisposing,
Reinforcing, Enabling Constructs in
Educational Diagnosis and Evaluation),
(PROCEED=Policy, Regulatory and
Organizational Constructs in Educational and
Environmental Development)
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The PRECEDE-PROCEED Model

• is a comprehensive structure for assessing
health needs for designing, implementing,
and evaluating health promotion and
other public health programs to meet
those needs. PRECEDE provides the
structure for planning a targeted and
focused public health program.
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Lawrence Green – PRECEED PROCEED MODEL

PRECEED/PROCEED is a community – oriented,

participatory model for creating successful
community health promotion interventions. It
incorporates a multi-level evaluation which means
you have the chance to constantly monitor and
adjust your evaluation.
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• Preceed has 5 phases:

Phase1: Social
  Diagnosis
• You ask the community what it wants and needs to improve its quality of
life.
• Methods use for social diagnosis may be one or more of the following:
1.Community Forums
2. Focus Groups
3. Survey
4. Interviews
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Phase 2: Epidemiological Diagnosis

• You identify the health and other issues that most clearly
influence the outcome the community seeks.
Phase 3: Behavior and Environmental Diagnosis
• You identify the behaviors and lifestyles and/or
environmental factors that must be changed to affect the health
and other issues identified in phase2 and determine which of them
are most likely to be changeable.
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Phase 4: Educational Diagnosis

• You identify the predisposing, enabling and enforcing factors that
act as supports for or barriers to changing the behaviors and
environmental factors you identified in phase 3.
• In these 2 phases, you can plan the intervention.
Phase 5: Administrative and Policy Diagnosis
• You identify (and adjust where necessary) the internal
administrative issues and internal and external issues that can
affect the successful conduct of the intervention
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• PROCEED has 4 phases:

Phase 6: Implementation
 . You carry out the intervention.

Phase 7: Process Evaluation

• You evaluate the process of intervention. ie, you determine
whether the intervention is preceeding according to the plan and
adjust accordingly.
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Phase 8: Impact Evaluation

• You evaluate whether the intervention is having the intended
impact on the behavioural and environmental factors its aimed at
and adjust accordingly.
Phase 9: Outcome Evaluation
• You evaluate whether the interventions effect are in turn
producing the outcome the community identified in phase 1.
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Different Fields in Nursing

1. School Health Nursing

2.Occupatonal Health Nursing
3.Community Mental Health
Nursing
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Different Fields in Nursing

•1 . School Health Nursing – is the

application of nursing theories and principles
in the care of the school population. It aims
to promote and maintain the heath of the
school populace by providing
comprehensive and quality nursing care.
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2. Occupational Health Nursing– is the

application of nursing principle and procedures
in conserving the health of workers in all
occupations. It aims to assist the workers in all
occupation to cope with actual and potential
stresses in relation to their work environment.
The focus is on promotion, protection and
restoration of workers health.
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Community Mental Health Nursing- is a

• 3.

unique process which include an

integration of concept from nursing. It
focuses on mental health promotion and
aims to increase mental wellness of
people.
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Some legal bases of the school health programs:

1. Executive Order #14,s.1946 – creation of

the Medical and Dental Services granting
voluntary contribution of 50 cent per pupil
for the maintenance of the service.
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Some legal bases of the school health programs:

• 2. RA #951 s. 1947 – Medical inspection of

school children enrolled in private schools,
colleges and universities in the Philippines
• 3.RA # 847 s. 1953 – Return of the Medical and
Dental services from the DOH to the
Department of Education
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Some legal bases of the school health programs:

• 4. P.D. 491 S. 1974 – Nutrition Act of the

Philippines
• 5. LOI #764 s. 1977 – creation of the School
Health Guardian Program mandated the
training of teachers to assume responsibility in
providing school health services in the absence
of school health personnel.
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6. RA 1054 – Occupational Health Act

• Requires the owner, lessee or operator of
any commercial, industrial or agricultural
establishment to furnish free emergency,
medical and dental assistance to his
employees and laborers.
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Mental Health in the Philippines

• The first known organized for the mentally was established in the
late 19th century at the Hospicio de San Jose , for sailors, for
Spanish and naval fleet. The Americans in the 1900, they gradually
transformed the treatment of mental illness from the use of
traditional indigenous medicines to a more specific approach, 2
American physicians opened a clinic for mental disorders using
somatic treatments such as fever therapy, insulin shock therapy,
barbiturates and electro-convulsive treatment.
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• 1904 – the first “insane Department” was opened in a government hospital

• 1918 – the City Sanitarium was built
• 1950 – the Phillippine Mental Health Association was organized
• 1986 – the newly appointed Secretary of Health created a project team for
mental health
• 1988-1990 a multi sectoral consultation led to the organization of the
National Program for Mental Health (NPMH) at the Department of Health
• 2002- the NPMH was revived and renamed National Mental Health
Program (NMHP)