4.

Community Health Nursing

According to the book of Araceli Maglaya (2009) entitled Nursing Practice in the
Community, she defined Community Health Nursing as “the utilization of the nursing process in
the different levels of clientele concerned with the promotion of health, prevention of disease and
disability and rehabilitation”. In addition to this, the essence of nursing is the same even if
practiced in a different setting and that it caters to all people in the community.

Nursing is known to be the science and art of caring. Nursing as an art is reflected in the
nurses’ interactions and communication with clients that are geared towards the improvement not
just of their health but also their ability to deal with the determinants and consequences of their
health problems. Thus, the practice of community health nursing entails active interaction and
partnership between the nurse and the client. Such partnership recognizes the autonomy of both
parties and the potential of each one in enriching their relationship. At the same time, Nursing is
also a science which means that community health nurses should use practice-based and
evidenced-based methods and tools. They also need to engage in generating evidence to support
their practice through research.

Basic 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, developmental 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,
Changes in Society, in General. The goal of CHN is achieved through Multi-Sectoral Efforts.
CHN is a part of the Health Care System and the larger Human Services System.

Focus, Responsibility, Methodology, Philosophy, Objectives of CHN

A philosophy is defined as a system of beliefs that provides a basis for a guides action. A
philosophy provides the direction and describes the whats, the whys, and the hows of activities
within a profession. CHN Practice is guided by the following beliefs: Humanistic values of the
nursing profession upheld Unique and distinct component of health care Multiple factors of
health considered Active participation of clients encouraged Nurse considers availability of
resources Interdependence among health team members practiced Scientific and up-to-date
Tasks of CHN vary with time and place Independence or self-reliance of the people is the end
goal Connectedness of health and development regarded.

Be a part in developing an overall health plan, its implementation and evaluation for
communities. Provide quality nursing services to the four levels of clientele. Maintain
coordination/linkages with other health team members, NGO/government agencies in the
provision of public health services. Conduct researches relevant to CHN services to improve
provision of health care. Provide opportunities for professional growth and continuing education
for staff development.
Levels of Clientele
Individual
The community health nursing deals with individuals- sick or well- on a daily
basis. Since the health problems of individuals are intertwined with those of the other
members of the family and community, they are also considered as an “entry point” in
working with these clients.

Family
From systems, perspective, a family is defined as a collection of people who are
integrated, interacting and interdependent. Just like other systems, the family members
interact with each other and the action of one affects the other members. The family has a
boundary which means that other people can recognize its members and those who are
not. In fact, a person may be identified primarily as a member of a particular family.

There have been many changes in the social context of the Filipino family and
these may be modified how it performs its health tasks and its capacity to remain as the
primary source of supports to its members.

Population Group
A population group is a group of people who share common characteristics,
developmental stage or common exposure to particular environmental factors, and
consequently common health problems, issues and concerns. According to Allender and
Spardley (2001) in the book of Nursing Practice in the Community, the identified
population “aggregates” with developmental needs such as maternal, prenatal, newborn
populations; infant, toddler and preschool populations; school-age and adolescents; adults
and working populations; older adult populations. In line to this are those that are
vulnerable such as rural clients, the poor, migrant workers, minority populations
experiencing health disparities, those with mental health issues, those living with
addiction, those in correctional facilities and those in long-term care settings. Population
groups are the usual targets or beneficiaries of social services and health programs.

Community
A community is a group of people sharing common geographic boundaries and/or
common values and interests within a specific social system. Although each community
is unique because it functions within a specific sociocultural, political, economic, and
environmental context.

5. Community

What is Community?
 A collection of people who interact with one another and whose common interest or
characteristics for the basis of a sense of unity or belonging. A group of individuals and families
living in the same geographic location or boundaries with or have the same culture, values,
beliefs, customs and traditions. They also vary in terms of community dynamics—citizen
participation, power and decision making structures and community collaboration efforts.

Community Health Nursing Process

Community Diagnosis and its Elements

As a profile, it is a description of the community’s state of health as determined by its

physical, economic, political and social factors. It defines the community and states community
problems. As a process, it is a continuous learning experience for the nurse/program coordinator
and the staff, as well as the community people. To have a clear picture of the problems of the
community and to identify the resources available to the community people. Community
diagnosis enables the nurse/program coordinator to set priorities for planning and developing
programs of health care for the community.

The following are the elements of community diagnosis: 1) Demographic Variables, this
should show the size, composition and geographical distribution of the population; 2) Socio-
Economic and Cultural Variables, there are no limits that may directly or indirectly affect the
health status of the community. However, the nurse should consider the essential information
such as Social indicators, Economic indicators, Environmental indicators, and Cultural
indicators; 3) Health and Illness Patterns, wherein analyzing the health and illness patterns, the
nurse may collect primary data about the leading causes of illness and deaths and their respective
rates of occurrence; 4) Health Resources, wherein the health resources that are available in the
community are an important element of the community diagnosis mainly because they are the
essential ingredients in the delivery of basic health services. The nurse needs to determine
manpower, institutional and material resources provided not only by the state but those which are
contributed by the private sector and other non-government organizations; and lastly 5)
Political/Leadership Patterns, this is a vital element in achieving the goal of high level wellness
among the people. It reflects the action potential of the state and its people to address the health
needs and problems of the community. It also mirrors the sensitivity of the government to the
people’s struggle for better lives.

Identification of Community Health Nursing Problems

Data analysis should lead the nurse and the team to have a better grasp of the
community’s health situation. Defining the community health nursing problems will help the
nurse and the team to decide with the people what actions will effectively address and improve
community’s health. Community health nursing problems are categorized as: Health Status
Problems, Health Resources Problems, Health Related Problems.
 Health Status Problems- described in terms of increased or decreased morbidity,
mortality, fertility, or reduced capability for wellness.

Health Resources Problems - described in terms of lack of or absence of manpower,

money, materials or institutions necessary to solve health problems.

Health Related Problems- described in terms of existence of social economic,

environmental and political factors that aggravate the illness-inducing situations in the
community.

Prioritization of Community Health Nursing Problems

After the problems have been identified, the next task for the nurse and the community is
to prioritize which health problems can be attended to considering available resources,
limitations and constraints. In priority setting, the nurse makes use of the following criteria:
Nature of the condition/problem presented- problems are classified as health status,
health resources or health related problems.

Magnitude of the problem- refers to the severity of the problem which can be measured
in terms of the proportion of the population affected by the problem;

Modifiability of the problem- refers to the probability of reducing, controlling or

eradicating the problem;

Preventive potential- refers to the probability of controlling or reducing the effects

posed by the problem;

Social concern- refers to the perception of the population or the community as they are
affected by the problem and their readiness to act on the problem.

Each problem will be scored according to each criterion and divided by the highest
possible score multiplied by the weight. Then the final score for each criterion will be added to
give the total score for the problem. The problem with the highest total score is given high
priority by the nurse.

6. Malnutrition

Malnutrition is an imbalance between the nutrients the body needs and the nutrients it
gets. Thus, malnutrition also includes overnutrition. The consumption  of too many calories or
too much of any specific nutrient, protein, fat, vitamin, mineral or other dietary supplement as
well as undernutrition. In developed countries undernutrition is usually far less common than
overnutrition. However, undernutrition does occur especially in people who are very poor such
as the homeless and in those who have psychiatric disorders. Also, people who are very ill may
be unable to eat enough food because they have lost their appetite or because their body’s need
for nutrients is greatly increased. Infants, children and adolescents are at risk of undernutrition
because they are growing and thus need a lot of calories and nutrients (Merck, 2017).

The latest strategies are the Nutritional Guidelines for Filipinos (NGF), popularly known
as “Ten Kumainments” and the “Pinggang Pinoy”. The Nutritional Guidelines for Filipinos,
consisting of ten key messages includes both food based and behavior driven guidelines and
addresses current nutritional dietary problems. The Nutritional guidelines aim to address and
prevent malnutrition and diet related noncommunicable diseases such as cancer, diabetes and
cardiovascular diseases. The NGF was simplified, shortened and translated into “10
KUMAINMENTS (Sigla at Lakas ng Buhay)” with simple, concise and clear key messages and
NGF icon. With messages like “Kumain ng iba’t ibang pagkain”, Kumain ng gulay at prutas
araw-araw”, and “Panatilihin ang tamang timbang”,individuals are encouraged to eat the right
foods, exercise right and pursue a healthy. “Pinggang Pinoy” is a new, easy to understand food
guide that uses a familiar food plate model to convey the right food group proportions on a per
meal basis, to meet the body’s energy and nutrient needs of Filipino adults. “Pinggang Pinoy” is
used as a visual tool to help Filipinos adopt healthy eating habits at meal times by delivering
effective dietary and healthy lifestyle messages. The “Pinggang Pinoy” can be used side by side
with the existing Daily Nutritional Guide (DNG) Pyramid for Filipinos but it will not replace it.
According to Food and Nutrition Research Institute (FNRI), “Pinggang Pinoy” is a quick and
easy guide on how much to eat per mealtime, while the DNG Pyramid shows at a glance the
whole day food intake recommendation. Both the “Pinggang Pinoy” and the DNG Pyramid for
Filipinos are based on the latest science about how our food, drink, and activity choices affect
our health (NCM, 2016).