COMMUNITY HEALTH NURSING PRACTICE -education of the individual in personal hygiene
The essence of community health practice:
● The american nurses association wrote that: promotes
and preserves the health of populations by integrating
the skills and knowledge relevant to both nursing and
public health. (Clark, 1999:50)
● The practice is comprehensive and general, and is not
limited to a particular age or diagnostic group; it is
continual, and is not limited to episodic care,
● Community health practice includes nursing directed to
individuals, families, and groups, the dominant
responsibility is to the population as a whole. (Clark
1999:50)
Community health nursing highlights important points:
1. The goal of a professional practice is the promotion
and preservation of the health of populations;
2. The nature of a practice is comprehensive, general,
continual and not episodic;
3. The knowledge base comes from nursing and public;
4. The different levels of clientele: individuals, families
and groups;
5. The practitioner’s recognition of the primacy of the
population as a whole.
COMMUNITY HEALTH
-part of paramedical and medical intervention/approach which
is concerned on the health of the whole population.
Aims:
-Health promotion
-Disease prevention
-Management of factors affecting health
PUBLIC HEALTH NURSING (Dr. C.E. Winslow, 1920)
-the science and art of 3P;s preventing disease, prolonging
life, and promotion of health and efficiency through organized
community effort.
-sanitation of the environment
-control of communicable diseases
NCM 113j: Community Health Nursing Population, Groups & Community as Clients (Week 2)
-the organization of medical and nursing services for the early
diagnosis and preventive treatment of disease
-the development of a social machinery to ensure everyone a
standard of living, adequate for maintenance of health to
enable every citizen to realize his birth right of health and
longevity. (Dr. CE Winslow)
COMMUNITY HEALTH NURSING
-”The 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.”
(Maglaya, et al)
-”A service rendered by a professional nurse to IFC’s
(Individual, Family & community), population, groups in health
centers, clinics, schools, workplace for the promotion of health,
prevention of illness, care of the sick at home and
rehabilitation.” (Dr. Ruth B. Freeman)
PRIMARY HEALTH CARE
-is “essential health care based on practical, scientifically
sound and socially acceptable methods and technology made
universally accessible to individuals and families in the
community through their full participation and at a cost that the
community can afford to maintain at every stage of their
development in the spirit of self reliance and self
determination.” (WHO/UNICEF 1978, in Stanhope and
Lancaster, 1992:172)
PUBLIC HEALTH NURSING
-The World Health Organization Expert Committee of Nursing
defined, 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.”
 COMMUNITY HEALTH NURSING- SERVICE RENDERED
BY A NURSE: TARGET POPULATION(IFC)
● Individuals
● Families
● Communities
A. PHILOSOPHY AND PRINCIPLES
● “The philosophy of CHN is based on the WORTH AND
DIGNITY OF MAN.” (Dr. M. Shetland)
● Community-based nursing is a philosophy of care that
is characterized by collaboration, continuity of care,
client and family responsibility for self-care and
preventive health care(Hunt, 2005). Community-based
nursing focuses on an individual and is family-centered
in orientation.
OBJECTIVES OF PUBLIC HEALTH (CODES)
● C: control of communicable diseases
● O: organization of medical nursing service
● D: development of social machineries
● E: education of IFC on personal hygiene- health
education is the essential task of every health worker
● S: sanitation of the environment
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-eg. Children, elderly),
and the community.
-In CHN, the client is considered as an ACTIVE partner
NOT 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 part of the healthcare system and the larger human
services system.
ROLES OF THE PUBLIC HEALTH NURSE
NCM 113j: Community Health Nursing Population, Groups & Community as Clients (Week 2)
● Clinician: a health care provider, taking care of the
sick people at home or in the RHU
● Health Educator: aims towards health promotion and
illness prevention through dissemination of correct
information; educating people
● Facilitator: establishes multi-sectoral linkages by
referral system
● Supervisor: monitors and supervises the performance
of midwives
● Health Advocator: speaks on behalf of the client
● Collaborator: working with other health team member
PUBLIC HEALTH WORKERS(PHW)
PHW’s: members of the health team who are professionals
namely:
● Medical officer(MO)- Physician
● Public health nurse(PHN)- Registered nurse
● Rural health midwife(RHM)- Registered midwife
● Dentist
● Nutritionist
● Medical technologist
● Pharmacist
● Rural sanitary inspector(RSI)- must be a sanitary
engineer
“In the event that the Municipal Health Officer(MHO) is unable
to perform his duties/functions or is not available, the Public
health nurse will take charge of the MHO’s responsibilities.
-Other specific responsibilities of a nurse, spelled by the
implementing rules and regulations of RA 9173(The
Philippine Nursing Act of 2002) includes:
● Supervision and care of women during pregnancy,
labor and puerperium
● Performance of internal examination and delivery of
babies
● Suturing lacerations in the absence of a physician
● Provision of first aid measures and emergency care
● Recommending herbal and symptomatic meds...etc.
IN THE CARE OF THE FAMILIES:
-provision of primary health care services
-developmental/utilization of family nursing care plan in the
provision of care
IN THE CARE OF THE COMMUNITIES:
-community organizing mobilization, community development
and people empowerment
-case finding and epidemiological investigation
-program planning, implementation and evaluation
-influencing executive and legislative individuals or bodies
concerning health and development
RESPONSIBILITIES OF CHN
-be a part in developing an overall health plan, its
implementation and evaluation for communities
-provide quality nursing services to the 3 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.
B. FEATURES OF CHN PRACTICE
-in addition to its preventive approach to health, community
health nursing is characterized by:
● Its being population- or aggregate-focused,
● Its developmental nature, and existence of a
prepayment mechanism for consumers of community
health nursing services
● Unlike nurses who work in the hospital settings,
community health nurses care for different levels of
clientele.
CHARACTERISTICS OF COMMUNITY HEALTH NURSING
● It is a specialty field of nursing
● Its practice combines public health with nursing
● It is population-based
NCM 113j: Community Health Nursing Population, Groups & Community as Clients (Week 2)
● It emphasizes wellness and other than diseases or
illness
● It includes interdisciplinary collaboration
● It amplifies the client’s responsibility and self-care.
C. THEORETICAL MODELS/APPROACHES
● THE HEALTH BELIEF MODEL
-theoretical model that can be used to guide health promotion
and disease prevention programs. It is used to explain and
predict individual changes in health behaviors. It is one of the
most widely used models for understanding health behaviors.
-initially proposed in 1958.
-provides the basis for much of the practice of health
education and health promotion today.
-was developed by a group of social psychologists to explain
why the public failed to participate in screening for
tuberculosis(Hochbaum, 1958).
-Hochbaum and his associates had the same questions that
perplex many health professionals today: Why do people who
may have a disease reject health screening? Why do
individuals participate in screening if it may lead to the
diagnosis of disease?
-this model explains and predicts individual change in health
behaviors. It is one of the most widely used models for
understanding health behaviors.
-the model defines the key factors that influence health
behaviors as an individual’s perceived threat to:
*sickness or disease(perceived susceptibility)
*belief of consequence(perceived severity)
*potential positive benefits of action(perceived benefits)
*perceived benefits of preventive action(cues to action)
*self-efficacy
 -Milio asserted that health deficits occur when there is an
imbalance between a community’s health needs, and its
health-sustaining resources.
-All human beings make health choices that are the easiest for
them to make, most of the time.
MILIO’S FRAMEWORK FOR PREVENTION
-describes the neglected role of community health nursing to
examine the determinants of a community’s health and attempt
to influence those determinants through public policy.
-includes concepts of community-oriented, population-focused
care.
-basic treatise was that behavioral patterns of the populations
and individuals who make up populations-are a result of
habitual selection from limited choices.
-challenged the common notion that a main determinant for
unhealthy behavioral choice is lack of knowledge.

● MILIO’S FRAMEWORK FOR PREVENTION

-Milio,N.(1976) A framework for prevention: Changing
health-damaging to health generating life patterns.
-Nancy Milio outlined 6 propositions relating to health
promotion and disease prevention.

NCM 113j: Community Health Nursing Population, Groups & Community as Clients (Week 2)
 ● NOLA PENDER’S HEALTH PROMOTION MODEL
(HPM)
-developed in the 1980s, revised in 1996
-explores many biopsychosocial factors that influence
individuals to pursue health promotion activities.
-depicts the complex multidimensional factors with which
people interact as they work to achieve optimum health.
-defines health as a positive dynamic state rather than
simply the absence of disease.
-focuses on helping people achieve higher levels of well-being.
It encourages health professionals to provide positive
resources to help patients achieve behavior specific changes.
-focuses on 3 areas such as individual characteristics and
experiences, behavior-specific cognitions, affect and
behavioral outcomes.
-thus, the health promotion model describes the
multidimensional nature of person/s as they interact
within their environment to pursue health.

NCM 113j: Community Health Nursing Population, Groups & Community as Clients (Week 2)
 PRECEDE(“educational diagnosis”) provides the structure
of planning a targeted and focused public health program.
Predisposing factors: refers to people’s characteristics that
motivate them toward health-related behavior,
Enabling factors: refers to conditions in people and the
environment that facilitate or impede health-related behavior.
Reinforcing factors: refer to feedback given by support
persons or groups resulting from the performance of the
health-related behavior.
PROCEED(“ecological diagnosis”) involves the
identification of desired outcomes and program
implementation.
Implementation: design intervention, assess availability of
resources and implement programs.
Process evaluation: determine if the 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 negative behavior or
● LAWRENCE GREEN’S PRECEDE-PROCEED an increase in identified positive behavior.
MODEL -thus, the model is multidimensional and is founded in the
-developed by Dr. Lawrence W. Green and colleagues social/behavioral sciences, epidemiology, administration, and
-provide for community assessment, health education, education.
planning and evaluation.
PRECEDE(Predisposing, Reinforcing, and Enabling
Constructs in Educational Diagnosis and Evaluation):
used for community diagnosis.
PROCEED(Policy, Regulatory, and Organizational
Construct in Educational and Environmental
Development): for implementing and evaluating health
programs based on Precede.
-this 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.

NCM 113j: Community Health Nursing Population, Groups & Community as Clients (Week 2)