HS 71- COMMUNITY HEALTH NURSING

Definitions:

• Community – a body of people living in a certain area and having common rights,
responsibilities and interests.
• Health – is defined as a “state of complete physical, mental, and social well-being, not
merely the absence of disease or infirmity (WHO.)”
• Nursing – is primarily assisting the individual (sick or well) in the performance of those
activities contributing to health or its recovery (to a peaceful death) that he would perform
unaided if he had the necessary strength, will or knowledge.
– It is likewise the unique combination of nursing to help the individual to be
independent of such assistance as soon as possible (Virginia Henderson, 1958.)
• Community Health Nursing – refers to a “service rendered by a professional nurse with
communities, groups, families, individuals at home, in health centers, in clinics, in schools,
in places of work for the PROMOTION of HEALTH, PREVENTION of ILLNESS, CARE of the sick
at home and REHABILITATION.” (Ruth B. Freeman, one of the famous definitions of CHN)
• Community Health Nursing – is broader than public health nursing because it
encompasses ‘nursing practice in a wide variety of community services and consumer
advocate areas, and in a variety of roles, at times including independent practice…
community nursing is certainly not confined to public health nursing agencies. (Jacobson,
1975: 6)
• Public Health – the classic definition of public health comes from Dr. C. E. Winslow. He
defines public health as the ‘science and art of preventing disease, prolonging life,
promoting health and efficiency through organized community effort for the sanitation of
the environment, control of communicable diseases, the education of individuals in
personal hygiene, the organization of medical and nursing services for the early diagnosis
and preventive treatment of disease, and the development of the social machinery to
ensure everyone a standard of living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen to realize his birthright of health and
longevity.
• Public Health – is defined by WHO as the ‘art of applying science in the context of politics
so as to reduce inequalities in health while ensuring the best health for the greatest
number.’
• Public Health Nursing – refers to the practice of nursing in local/national health
departments (which includes health centers and rural health units) and schools. It is a
community health nursing practiced in the public sector.
• Public Health Nursing – The WHO Expert Committee of Nursing defined PHN as a ‘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 programme for the promotion of
health, the improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability.’
• Public Health Nursing was coined by LILIAN WALD when she was director of the Henry
Street Settlement in New York City to denote a service that was available to all people.
However, as federal, state and local governments increased their involvement in the
delivery of health services, the term public health nursing became associated with ‘public’
or government agencies and in turn with the care of the poor people.’
• Public Health Nurses – refer to the nurses in the local/national health departments or
public schools whether their official position title is Public Health Nurse or Nurse or School
Nurse.
• Nursing Service – is a separate and distinct unit of the local health agency/ unit which is
composed of nurses, midwives and auxiliaries such as barangay health workers, nursing
aides and volunteers.
• The Central Focus of Nursing – is care provided to the people.
- is man in his entirety.
- is on man, sick or well, of any age, race or creed and at any
setting.
HEALTH PROMOTION and EDUCATION:

The prominence of Health Promotion came about as a result of the changing patterns of
health and the corresponding emphasis on “life style” as a factor.

Life style is a composite expression of the social and cultural circumstances that condition
and constrain behavior.

The behavioral change that health education is able to effect can only be “maintained” if
supportive environment were provided through the effort of other sectors-political, economic,
social, biomedical etc. (Green).

The first use of the term Health Promotion occurred in 1945 when Henry E. Sigerist, the
great medical historian defined the four major tasks of medicine as 1.) The promotion of health;
2.) The prevention of illness; 3.) The restoration of the sick and 4.) Rehabilitation.

According to him, ‘health is promoted by providing a decent standard of living, good labor
conditions, education, physical culture, means of rest and recreation.’ These concepts are fond in
the OTTAWA CHARTER for HEALTH PROMOTION which occurred 40 years later.

In 1986, the WHO, Health and Welfare Canada and the Canadian Public Health Association
organized an International Conference on Health Promotion. The Conference came out with what
is now popularly known as the Ottawa Charter for health promotion which was adopted by 212
participants from 38 countries. This charter remained to be the guiding principle in health
promotion efforts currently.

The OTTAWA CHARTER for HEALTH PROMOTION:

Ottawa Charter defines HEALTH PROMOTION broadly, as the process of enabling people to
increase control over and to improve their health.’ To reach a state of complete physical, mental
and social well-being, and individual or group must be able to IDENTIFY and to REALIZE
ASPIRATION, to SATISFY NEEDS, and to CHANGE or COPE with the ENVIRONMENT.

Health is seen as a resource of everyday life, not the objective of living.

Health is a positive concept, emphasizing social and personal resources, as well as

physical capacities.

Health Promotion is not just the responsibility of the health sector, but goes beyond
healthy lifestyles to well-being.

BASIC PREREQUISITE for HEALTH:

1. Peace 6. A stable eco-system

2. Shelter 7. Sustainable resources
3. Education 8. Social justice
4. Food 9. Equity
5. Income

To operationalize the concept of Health Promotion, the Ottawa Charter recommend the following
action areas:

1. Build Healthy Public Policy. Health promotion goes beyond health care. It puts health
on the agenda of policy makers in all sectors and at all levels direction them to be aware
of the health consequence of their decisions and to accept their responsibilities for health.
2. Creative Supportive Environments. The overall guiding principle for the world, nations,
regions, and communities alike, is the need to encourage reciprocal maintenance-to-take
care of each other, our communities and our natural environment.
3. Strengthen Community Action. Health promotion works through concrete and effective
community action in setting priorities, making decisions, planning strategies and
implementing them to achieve better health.
4. Develop Personal Skills. Health promotion supports personal and social development
through providing information, education for health, and enhancing life skills.
 5. Reorient Health Services. Reorienting health services require stronger attention to
health research as well as changes in professional education and training. This must lead
to a change of attitude and organization of health services which refocuses on the total
needs of the individual as a whole person.

The WHO cites the following principles of Health Promotion:

1. HP involves the population as a whole in the context of their everyday life, rather than
focusing on people at risk from specific disease.
2. HP is directed towards action on the determinants of health.
3. HP combines diverse, but complementary methods or approaches, including
communication, education, legislation, fiscal development and spontaneous local activities
against health hazards.
4. HP aims particularly at effective and concrete public participation.
5. HP is primarily a societal venture and not a medical service although health professionals
have an important role in advocating and enabling health promotion.

The WHO adopts an ecologic view of Health Promotion and state that it is “mediating
strategy between people and their environments, synthesizing personal choice and social
responsibility in health.”

HEALTH EDUCATION – any combination of learning experiences designed to facilitate

voluntary adoptions conducive to health. (Green et al 1980)

HEALTH EDUCATION – the process of assisting individuals, acting separately or collectively,

to make informed decisions about matters affecting the personal health and that of others.
(The National Task Force on the Preparation and Practice of Health Educators, 1983)

HEALTH EDUCATION can take place in various settings:

1. In health care setting such as health centers, clinics, hospital, health maintenance
organizations.
2. Schools where desirable health behaviors is installed from the grades up through health
teachings, supportive hygienic school environment, school health services, teachers
training and the training of health professionals.
3. Communities, where through the community organization approach, communities are able
to identify their health problems.
4. The worksites such as industries, offices, food establishment, entertainment
establishment, hotels etc.

HEALTH PROMOTION MODEL (NOLA J. PENDER)

Pender’s first encounter with professional nursing occurred at the age of seven (7) when
she observed the nursing care given to her hospitalized aunt – influenced her belief that the goal
of nursing was to help people care for themselves – conceptualized HEALTH PROMOTION MODEL.

Pender was born in 1941 in Lansing, Michigan.

She was the only child of parents who were advocates of education for women.

Attended the School of Nursing at West Suburban Hospital in Oak Park, Illinois.

She received her nursing diploma in 1962 and began working on a medical-surgical unit
and subsequently in a pediatric unit in a Michigan Hospital.

In 1964, Pender completed her BSN at Michigan State University in East Lansing.

She earned her M.A. in ‘human growth and development’ from Michigan State University in
EEvanston, Illinois.

Health Promotion – is motivated by the desire to increase well-being and actualize human
potential.
 HEALTH PROMOTIING BEHAVIOR – endpoint or action outcome directed toward attaining
positive health outcomes such as optimal well being, personal fulfillment, and productive living.

MAJOR ASSUMPTIONS:

1. Person seek to create conditions of living through which they can express their unique
human health potentials.
2. Persons have the capacity for reflective self awareness, including assessment of their own
competencies.
3. Persons value growth in directions and attempt to achieve a personally acceptable balance
between change and stability.
4. Individuals seek to actively regulate their own behavior.
5. Individuals in all their biopsychosocial complexity interact with the environment,
progressively transforming the environment, which exerts influence on persons through
out their life span.
6. Health professionals constitute a part of the interpersonal environment, which exerts
influence on persons through out their life span.
7. Self-initiated reconfiguration of person environment interactive patterns is essential to
behavior change.

THEORETICAL ASSERTIONS:

1. Prior behavior and inherited and acquired characteristic influence beliefs, affect, and
enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which they anticipate deriving personality
valued benefits.
3. Perceived barriers can constrain commitment to action, mediator of behavior, and actual
behavior.
4. Individuals seek to actively regulate their own behavior.

DETERMINANTS OF HEALTH: (These factors or things that make people healthy or not. Known
as determinants of health are listed by WHO.)

1. Income
2. Education
3. Physical Environment
4. Employment and working conditions
5. Social support networks
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services

Core business of Public Health:

1. Disease control
2. Injury prevention
3. Health protection
4. Healthy public policy including those in relation to environmental hazards such as in the
workplace, housing, food, water, etc.
5. Promotion of health and equitable health gain

The following are the essentials public health functions:

1. Health situation monitoring and analysis.

2. Epidemiology surveillance/disease prevention and control.
3. Development of policies and planning in public health.
4. Strategic management of health systems and services for population health gain.
5. Regulation and enforcement to protect public health.
6. Human resources development and planning in public health.
7. Health promotion, social participation and empowerment.
8. Ensuring the quality of personal and population based health services.
9. Research, development and implementation of innovative public health solutions.
LEVELS OF PREVENTION

I. Primary Prevention. Providing specific protection against disease to prevent its

occurrence is the most desirable form of prevention. Primary preventive efforts spare
the client the cost, discomfort and the threat to the quality of life that illness poses or,
at least delay the onset of illness. Preventive measures consist of counseling, education
and adoption of specific health practices or changes in life style.
Examples:
1. Mandatory immunization of children belonging to the age range of 0-59 months
old to control acute infectious diseases.
2. Minimizing contamination of the work or general environment by asbestos dust,
silicone dust, smoke, chemical pollutants and excessive noise.

Primary Prevention (to decrease probability of illness by health promotion)

-Health Education. –Adequate housing and recreation and working condition. –

Good Nutrition. –Marriage counseling and sex education. –Personal development. –
Protection against occupational hazards. –Genetic screening. –Avoidance of
carcinogens and allergens. –Immunizations. –Environmental sanitation. –Personal
hygiene.

II. Secondary Prevention. It consist of organized, direct screening efforts or education of

the public to promote early case finding of an individual with disease so that prompt
intervention can be instituted to halt pathologic processes and limit disability. Early
diagnosis of a health problem can decrease the catastrophic effects that might otherwise
result for the individual and the family from advanced illness and its many complications.
Examples:
1. Public education to promote breast self-examination, use of home kits for
detection of occult blood in stool specimens and familiarity with the seven
cancer danger signals.
2. Screening programs for hypertension, diabetes, uterine cancer (Pap Smear),
breast cancer (examination and mammography), glaucoma and sexually
transmitted diseases.

Secondary Prevention (by early diagnosis and prompt treatment, reduce severity of
illness)

-Case-finding measures. –Prevention of spread of communicable disease. –

Screening/Surveys. –Cure and prevention of disease. –Adequate treatment. –
Prevention of complication. –Prevent death. –Shorten period of disability.

III. Tertiary Prevention. It begins early in the period of recovery from illness and consists of
such activities as consistent and appropriate administration of medications to optimize
therapeutic effects, moving and positioning to prevent complications of immobility and
passive and active exercises to prevent disability. Continuing health supervision during
rehabilitation to restore an individual to an optimal level of functioning. Minimizing residual
disability and helping the client learn to live productively with limitations are the goals of
tertiary prevention. (Pender, 1987.)
Tertiary Prevention (restoration and rehabilitation)

-Provision of hospital and community facilities for re-training and education to

maximize use of remaining capacities.
–Public education and industries to use rehabilitated persons to the fullest.
–Selective placement.
–Work therapy in hospitals.
–Use of sheltered colony.