FUNDAMENTAL

CONCEPTS OF
COMMUNITY
HEALTH NURSING
Learning Outcomes
• Define health and community
• Discuss the focus of public health
• Explain the differences between community health nursing and public
health nursing
• Cite the distinguishing features of community health nursing
• Discuss public health nursing practice in terms of health core
functions and essential public health functions
• Apply the competency standards of nursing practice in the Philippines
in community health nursing practice
Community
• Derived from a Latin word “communicas” which means a group of
people
• A group of people sharing common geographic boundaries and/or
common values and interests. It functions within a particular
sociocultural context, which means that no two communities are
alike.
• A place where people under usual conditions are found
Characteristics of a Community
• It is defined by its geographic boundaries within certain identifiable
characteristics
• It is made up of institutions organized into a social system with the
institutions and organizations linked in a complex network having a
formal and informal power structure and a communication system
• A common or shared interest that binds the members together exist
• It has an area with fluid boundaries which a problem can be identified
and solved
• It has a population aggregated concept
• Is a state of complete physical, mental and social well-being and not
merely the absence and not merely the absence of disease or
infirmity (WHO, 1995)
• Is an integrated method of functioning which is oriented toward
maximizing the potential of which the individual is capable (Dunn,
1959)
• State characterized by soundness and wholeness of human structures
and bodily and mental functions (Orem, 1985)
UNIVERSAL DECLARATION OF
HUMAN RIGHTS
• Health is a basic human right.
• Article 25, Section 1 states that: “Everyone has the right to a standard
of living adequate for the health and well-being of himself and of his
family, including food, clothing, housing and medical care and
necessary social services, and the right to security in the event of
unemployment, sickness, disability, widowhood, old age or other lack
of livelihood in circumstances beyond his control”
COMMUNITY HEALTH
• Part of paramedical and medical intervention/approach which is
concerned with the health of the whole population

Aims
• Health Promotion
• Disease Prevention
• Management of factors affecting health
NURSING is both
profession and a
vocation.
COMMUNITY HEALTH NURSING
• 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
• It is the service rendered by a professional nurse with the community,
groups, families, and individuals at home, in health centers, clinics, in
places of work for the promotion of health, prevention of illness, care
of the sick at home and rehabilitation.
 OTHER
DEFINITIONS OF
COMMUNITY
HEALTH NURSING
WHO Expert Committee of Nursing

• Special field of nursing that combines the skills of nursing and some
phases of social assistance and functions as part of the total PH
programs for the:
• Promotion of Health
• Improvement of the conditions in the social and physical environment
• Rehabilitation of illness and disability
MAGLAYA
• The utilization of the nursing process in the different levels of
clientele-individuals, families, population groups, and communities
concerned with:
• Promotion of Health
• Prevention of diseases
• Disability and rehabilitation
JACOBSON
• Nursing practice in a wide variety of community services and
consumer advocate areas, and in a variety of roles, at times including
independent practice
• CHN is certainly not confined to public health nursing agencies
• CHN is learned practice discipline with the ultimate goal of
contributing, as an individual and in collaboration with others, to the
promotion of the clients’ optimum level of functioning through
teaching and delivery of care
NURSING FUNCTIONS

• Independent
• Collaborative or interdisciplinary – Health Team Approach
FREEMAN
• Unique blend of nursing and public health practice aimed at
developing and enhancing the health capabilities of the people,
service rendered by a professional nurse with the community groups,
families, and individuals at home, in health centers, in clinics, in
schools, in places of work for the following:
• Promotion of health
• Prevention of illness
• Care of the sick at home and rehabilitation
• Self - reliance
PUBLIC HEALTH NURSING

• Refers to the practice of nursing in national and local government

health departments (which includes health centers and rural health
units), and public schools. It is community health nursing practice in
the public sector.
• Science and art of preventing disease, prolonging life, and promoting
health and efficiency through organized community effort for:
• The sanitation of the environment
• The control of communicable diseases
• The education of individuals in personal hygiene
• The organization of medical and nursing services for early diagnosis and
preventive treatment for a disease
• The development of social machinery to insure everyone has a standard of
living adequate for the maintenance of health
GOAL OF CHN

• 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 awareness
• Health Promotion
• Health Protection
• Health Balance
• Disease Prevention
• Social Justice
• The philosophy of CHN is
based on the worth and
dignity of man. (Dr.
Margaret Shetland)
PRINCIPLES OF CHN

• The community is the patient in CHN, the family is the unit of care
and there are four levels of clientele: individual, family, population
group (those who share common characteristics, development stages,
and common exposure to health problems – e.g. children, elderly),
and the community.
• In CHN, the client is considered as an ACTIVE partner NOT a PASSIVE
recipient of care.
• CHN practice is affected by developments in health technology, in
particular, and changes in society, in general.
• The goal of CHN is achieved through multi-sectoral efforts.
• CHN is a part of health care system and the larger human services
system
BASIC CONCEPTS OF CHN
• The primary focus of CHN is HEALTH PROMOTION AND DISEASE
PREVENTION.
• Primary goal – self-reliance in health or enhanced capabilities
• Ultimate goal – raise the level of the number of citizenries

• CHN practices - to benefit the individual, family, special groups, and

community. CHN is integrated and comprehensive.

• CHN are generalists in terms of practice throughout life’s continuum –

its full range of health problems and needs
• Contact with the client continues over a long period which includes all
types and levels of health care.
• Primary – prevention of illness or promotion of health
• Secondary–curative
• Tertiary – rehabilitative

• Nature of CHN practice requires knowledge of biological, and

social sciences
• Implicit in CHN is the Nursing Process (ADPIE) – an independent
nursing function
• Dependent – with the supervision of a medical doctor/physician
• Independent – without the supervision of a medical doctor
• Interdependent – in collaboration with other healthcare teams, interdisciplinary,
intersectoral)
LEVELS OF CLIENTELE

FAMILY COMMUNITY
(CENTER OF (POINT OF ENTIRE
DELIVERY OF CARE) CARE)

INDIVIDUAL
(POINT OF ENTRY) GROUP
(POINT OF SPECIFIC
CARE)
KEY PRINCIPLES IN CHN
1. Recognized needs of individual families and common provider is the
basis for CHN practice.

ASSESSMENT

-data collection (family, community) Community diagnosis

-data analysis – health problems
health needs
health deficit – gap
between actual and achievable
outcomes
2. Knowledge and understanding of agency objectives and
policies facilitate goal achievement

PRIORITIZATION
OBJECTIVES
EVALUATION /
PLANNING OUTCOME

ACTIONS

GOAL SETTING
3. Family is a unit of service (the focus of service)
4. Respect the values, customs, and beliefs of clients.
Implementation – patient/client communication
The focus of care: individuals, families, population
Attitude: non-judgmental approach
5. Health education and counseling – vital parts of CHN – role: Implementation

Health Educator – gives advice Counselor– gives options

BEHAVIORAL
CHANGE
6. Collaborative working relationship with the healthcare team
7. Periodic and containing evaluation is necessary – monitoring and
assessment
8. Continuing staff – education – upgrade nursing practice
9. Indigenous and existing community resources must be utilized
10. Individuals, families, and the community must actively participate in
decision-making.
11. Supervision of nursing practice by qualified personnel provides
guidance and direction for work
12. Accurate recording/reporting serves as an evaluation and guide for
future actions.
MAYOR
(Management and
Administration)

DOCTOR
(Project/program
Implementation)

RN Supervision
(Community Health Nursing
Practice)
SPECIALIZED FIELDS OF CHN
• Community Mental Health
• Community mental health is the application of specialized knowledge to
population and communities to prevent mental illness, promote and maintain
mental health, and to rehabilitate population at risk that continue to have
residual effects of mental illness.
COMMUNITY MENTAL HEALTH
NURSING
• Is the application of knowledge of psychiatric nursing in promoting
and maintaining mental health of community people, to help in early
diagnosis and care and to rehabilitate the clients after mental illness
(Bimala Kapoor).
PURPOSES OF COMMUNITY MENTAL
HEALTH NURSING
• Provide prevention activities to population for the purpose of
promoting mental health.
• Provide prompt interventions
• Helps individuals develop a sense of self worth and independence
• Anticipate emotional problems
• Identify and change social and psychological factors that influence
human interactions
• Develop innovative approach to primary preventive activities
• Provide mental health education and how to assess the mental health
OBJECTIVES
• Basic mental health care to all the needy.
• Encourage application of mental health knowledge
• Promote community participation
• Prevention and treatment of mental and neurological disorders and
their associated disabilities
• Use of mental health terminologies to improve general health
services
• Application of mental health principles in total national development
to improve quality of life
OCCUPATIONAL HEALTH NURSING
• Someone who provides for and delivers health and safety programs
and services to workers, worker populations and community group.
The practice focuses on promotion and restoration of health,
prevention of illness and injury, and protection from work-related and
environmental hazards.
PURPOSES OF OCCUPATIONAL
HEALTH NURSING
• Coordinate and deliver services and programs
• Promote an interdisciplinary approach to health care and advocate for the
employee’s right to prevention-oriented, cost-effective health and safety
programs
• Encourage workers to take responsibility for their own health through health
education and disease management programs, such as smoking cessation,
exercise/fitness, nutrition and weight control, stress management, control of
chronic illnesses and effective use of medical services
• Monitor the health status of workers, worker populations and community groups
• Conduct research on the effects of workplace exposures, gathering health and
hazard data.
SCHOOL HEALTH NURSING
• A specialized practice of professional nursing that advances the well-
being, academic success, and lifelong achievement to students.
School nurse facilitate positive student responses to normal
development; promote health and safety; intervene with actual and
potential health problems; provide case management services; and
actively collaborate with others to build student and family capacity
for adaptation, self-management, self-advocacy, and learning
PURPOSES OF SCHOOL HEALTH
NURSING
• The school nurse provides direct care to students.
• The school nursed provides leadership for the provision of health
services.
• The school nurse provides screening and referral for health conditions
• The school nurse promotes a healthy school environment
• The school nurse promotes health education
• Serves in a leadership role for health policies and programs
• Liaison between school personnel, family, health care professionals
and the community.
ATOMISTIC APPROACH
• Views man as an organisms of different organ systems, made up of
tissues, made up of cells which are basic unit of life

HOLISTIC APPROACH
• Studies man in all aspect of his behavior and his relationship with
others in his environment
FAMILY BASED ON COMPOSITION
• Nuclear family – a household consisting entirely of a single family
nucleus (married couple with or without children)
• Extended family – family including grandparents, aunts and uncles
• Beanpole family – a multi-generational family that is long and thin
with few aunts, uncles and grandparents.
• Single-parent family –comprised of a parent / caregiver and one or
more dependent children without the presence and support of a
spouse or adult partner
• Step family / blended / reconstituted – a family that is reformed on
the remarriage of a divorced or widowed person and that includes
one or more children
• Same sex or homosexual family – homosexual couple living together
with children
• Cohabiting or communal family – a couple that lives together in an
intimate and committed relationship, who are not married to each
other.
BASED ON LOCUS OF POWER
• Patrifocal family is one in which the father takes the lead role in
making decisions and raising children
• Matrifocal family is one in which the mother takes the lead role in
making decisions and raising children
• Egalitarian – familial decision making power is shared equally among
the participants in an ongoing activity
• Matricentric – centering around the mother
BASED ON PLACE OF RESIDENCE
• Patrilocal
• Matrilocal
• Bilocal – when a married couple lives with or near either spouses’
family or alternates between families
• Neolocal – newly married couple establishes their home independent
of both sets of relatives.
• Avunlocal – the couple lives with or near the husband’s mother’s
brother