Module 1: Community Health Nursing Concepts

A. Definition (Bailon-Reyes p.3)

Is a field of nursing practice where services are delivered outside of purely curative
institutions ( ex. hospital), but in the community settings such as home, the school,
places of work, health centers, and clinics. The scope of services provided covers the
whole range of health promotive, preventive, curative and rehabilitative nursing
services, with bias towards priority given to health promotion and disease prevention
especially for the underserved and high-risk individuals, families, population groups and
areas of the community.

B. Philosophy and Principles (CHN service in the Philippines p.17)

The philosophy of Community Health Nursing is based on the worth and dignity of a
man. (According to Dr. Margaret Shetland)

Basic Principles: (Community health nursing rnpedia)

1. 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 (Ex: children, elderly and
pregnant women) and the community.
2. In CHN, the client is considered as ACTIVE partner and NOT PASSIVE recipient of
care.
3. CHN practice is affected by developments in health technology, in particular,
changes in society, in general.
4. The goal of CHN is achieved through multi-sectoral efforts.
5. CHN is a part of health care system and the larger human services system.

While the following principles of CHN were adapted from those formulated by Mary S.
Gardner and by Leahy, Cobb and Jones. (CHN service in the Philippines p.17)

1. CHN is based on recognized needs of communities, families groups and individuals.

2. The CH nurse must understand fully the objectives and policies of the agency she
represents.
3. In CHN, the family is the unit of service
4. CHN must be available to all regardless of race, creed and socio-economic status.
5. Health teaching is a primary responsibility of the CH nurse.
6. The CH nurse works as a member of the health team.
7. There must be provision for periodic evaluation of CH nursing service.
8. Opportunities for continuing staff education programs for nurses must be provided
by the CHN agency. The CHN also has a responsibility for her/his own professional
growth.
9. The community health nurse makes use of available community health records.
10. The CHN utilizes the already existing active organized groups in the community.
11. There must be provision for educative supervision in the CH nursing.
12. There should be accurate recording and reporting in CHN.
 C. Features of CHN (Maglaya p.2)

1. Greater control for both the nurse and the client in making decisions related to
health care
2. Collaboration between nurse and client as equals
3. Recognition of the impact of different factors on health
4. Nurses greater awareness of their clients lives and situations

Characteristics of Community Health Nursing:

 It is a specialty field of nursing.

 Its practice combines public health with nursing.
 It is population based.
 It emphasizes on wellness and other than disease or Illness.
 It includes inter-disciplinary collaboration.
 It amplifies client's responsibility and self-care.

D. Theoretical Models / Approaches

1.Nightingales Environmental Theory

External influences and conditions can prevent, suppress, or contribute to disease or

death
Her goal was to help patient retain her own vitality by meeting her basic needs through
control of her environment

2.Health belief Model (HBM)

The health belief model is a theoretical model that can be used to guide health
promotion and disease prevention. It used to explain and predict individual changes in
health behaviors. People will not change their behaviors unless they believe that they
are at risk. Example: those who do not think that they are at risk of acquiring HIV from
unprotected sexual intercourse are unlikely to use condom.

3.Milio’s Framework for Prevention

 
Nancy Milio a nurse and leader in public policy and public health education developed a
framework for prevention that includes concepts of community-oriented, population
care (1976, 1981).

The basic treatise is that behavioral patterns of populations and individuals who make
up populations are a result of habitual selection from limited choices.

She challenged the common notion that a main determinant for unhealthful behavioral
choice is lack of knowledge. Governmental and institutional policies, she said set the
range of options for personal choice making.
It neglected the role of community health nursing, examining the determinants of
community health and attempting to influence those determinants through public
policy.

4. Nola Pender’s Health Promotion Model (Nursing Theorists and their work 5 th
edition p.624)
Nola J. Pender graduated her BSN course in 1964 at Michigan State University, earned
her M.A. In Human Growth and Development in the same university. She finished her
Ph. D. in psychology and education in 1969 at Northwestern University. Pender’s
Health Promotion Model focuses on three areas: Individual characteristics and
experiences, behavior-specific cognitions and affect, and behavioral outcomes. The
theory notes that each person has unique personal characteristics and experiences
that affect subsequent actions.

5.Lawrence Green’s PRECEDE – PROCEED MODEL ( PROCEDE = Predisposing,

Reinforcing, enabling Constructs in Educational Diagnosis and Evaluation)
Is a cost-benefit evaluation framework which helps program planners, policy makers
and other evaluators, analyze situations and design health programs efficiently. It 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 stands for Predisposing, Reinforcing, and Enabling Constructs in Educational

Diagnosis and Evaluation. It involves assessing the following community factors:

Social assessment – Determine the social problems and needs of a given population
and identify desired results.

Epidemiological assessment – Identify the health determinants of the identified

problems and set priorities and goals.

Ecological assessment – Analyze behavioral and environmental determinants that

predispose, reinforce, and enable the behaviors and lifestyles are identified.

Match appropriate interventions – identify administrative and policy factors that

influence implementation and match appropriate interventions that encourage
desired and expected changes.

Implementation of interventions

6.(POCEED + Policy, Regulatory and Organizational Constructs in Educational and

Environmental Development)
It involves the identification of desired outcomes and program implementation:

Implementation – design intervention, assess availability of resources, and implement

program.
 Process Evaluation – determine if program is reaching the targeted population and
achieving desired goals.

Impact evaluation – evaluate the change in behavior.

Outcome evaluation- identify if there is a decrease in the incidence or prevalence of

the identified behavior or an increase in identified positive behavior.

The PRECEDE-PROCEED model invites participation from community members, and

has the potential to increase community ownership of program. When determining
whether to use PRECEDE-PROCEED as a model for health promotion or disease
prevention program, it is important to consider whether all parts of the model are
appropriate for the program and resources available to support the program.

E. Different Fields (Maglaya p.3-4)

1. school Health Nursing
School health nursing is primarily determined by the characteristics of their clientele, which
is their age, developmental stage and their common health problems and concerns.
 
School health nursing aims at promoting the health of school children and preventing health
problems that would hinder their learning and performance of their developmental tasks.
2. Occupational Health Nursing
Occupational health nursing is nursing in the work place; it is community health nursing
focused on people in their places of work.
 
Occupational health nursing is the specialty practice that provides for and delivers health
care services to workers and worker population.

The practice focuses on promotion, protection, and restoration of worker's health within the
context of a safe and healthy work environment.

The foundation of occupational health nursing practice is research-based with an emphasis

on optimizing health, preventing illness and injury, and reducing health hazards.
 
Occupational health nursing is “aimed at assisting workers in all occupations to cope with
actual and potential stresses in relation to their work and work environment.

3. Community Mental Health Nursing

Is the application of specialized knowledge to population communities to promote and
maintain mental health, rehabilitate population at risk. The psychiatric nurse must possess
knowledge about community resources.