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UNIT 1: CONCEPT OF THE COMMUNITY

1.0 Intended Learning Outcomes

a. Integrate principles and concepts of physical, social, natural and health
sciences and humanities in the care of population groups and communities.

1.1. Introduction

The definitions of community are also numerous and variable. Baldwin et al. (1998)
outlined the evolution of the definitions that appeared in community health nursing texts.
They determined that, before 1996, definitions of community focused on geographical
boundaries, combined with social attributes of people. Through citing several sources from
the later part of the decade, the authors observed that geographical location became a
secondary characteristic in the discussion of what defines a community (Famorca, Z., Nies,
M. & McEwen, M., 2013; p.6).

In recent nursing literature, community has been defined as a collection of people who
interact with one another and whose common interests or characteristics for the basis for a
sense of unity or belonging (Allender et al., 2009, p. 6); “ a group of people who share
something in common and interact with one another, who may exhibit a commitment with
one another and may share a geographic boundary” (Lundy and Janes, 2009, p. 16); “ a
group of people who share common interests, who interact with each other and who
function collectively within a defined social structure to address common concerns” (Clark,
2008, p. 27); and a locality based entity, composed of systems of formal organizations
reflecting society’s institutions, informal group and aggregates”(Shuster and Goeppinger,
2008, p. 344).

Maurer and Smith (2009) further addressed the concept of community and identified four
defining attributes: (1) people, (2) place, (3) interaction, and (4) common characteristics,
interests or goals. Combining ideas and concepts, in this text, community is seen as a
group or collection of locality-based individuals, interacting in social units and sharing
common interests, characteristics, values, and/or goals (Famorca, Z., Nies, M. & McEwen,
M., 2013; p.7).

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1.2 Topics/Discussion (with Assessment/Activities)

TYPES OF COMMUNITIES

Maurer and Smith (2009) noted that there are two main types of communities: geo-political
communities and phenomenological communities. Geopolitical communities are most
traditionally recognized or imagined when considering the term community. Geopolitical
communities are defined or formed by both natural and man-made boundaries and include
barangays, municipalities, cities, provinces, regions and nations. Other commonly
recognized geopolitical communites districts and neighborhoods. Geopolitical
communities may also be called territorial communities. Phenomenological communities,
on the other hand, refer to relational, interactive groups, in which the place or setting is
more abstract, and people share a group perspective or identity based on culture, values,
history, interests and goals. Examples of phenomenological communities include schools,
colleges and universities; churches and mosques; and various groups or organizations.
These communities may also be described as functional communities. A community of
solution is a type of phenomenological community, and is a collection of people who form
a group specifically to address a common need or concern. The Gawad Kalinga, whose
members aim to alleviate poverty by community development, and a group of indigenous
people who lobby against environmental degradation of their ancestral land are examples.
These groups or social units work together to realize a level of potential “health” and to
address identified actual and potential health threats and health needs. (Famorca, Z., Nies,
M. & McEwen, M., 2013; p.7).

Population and aggregate are related terms that are often used in public health and
community health nursing. Population is typically used to denote a group of people
having common personal or environmental characteristics. It can also refer to all of the
people in a defined community (Maurer and Smith, 2009). Aggregates are subgroups or
subpopulations that have some common characteristics or concerns (Clark, 2008). These
common characteristics or concerns may make the members of an aggregate vulnerable to
similar health problems. Examples of aggregates are age groups or groups undergoing
similar physiologic processes like pregnancy and menopause. Depending on the situations,
needs and practice parameters, community health nursing interventions may be directed
toward a community (e.g., residents of a small town), a population (e.g., all elders in a rural
region), or an aggregate (e.g., pregnant teens within a school district) (Famorca, Z., Nies, M.
& McEwen, M., 2013; p.7).

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CHARACTERISTICS OF A HEALTHY COMMUNITY

A healthy organism has all its body parts contributing to its well-being by carrying out
their specific functions. In the same manner, all systems of a community need to function
effectively and work together to maintain the health of the community. A healthy
community has mechanisms that assure all citizens a decent way of life in all aspects
(Rabinowitz, 2012). Certain observable traits allow health workers to ascertain whether an
individual or a family is healthy. A community, likewise may be observed for evident
traits that indicate its health. Characteristics of a healthy community include (adapted from
Hunt, 1997; Duhl, 2002):
 A shared sense of being a community based on history and values. Despite the
presence of subgroups, members of the community have a feeling of belonging and
that they make up one community. Recognition and respect for these subgroups
make this possible.
 A general feeling of empowerment and control over matters that affect the
community as a whole.
 Existing structures that allow subgroups within the community to participate in
decision making in community matters.
 The ability to cope with change, solve problems, and manage conflicts within the
community through acceptable means.
 Open channels of communication and cooperation among the members of the
community.
 Equitable and efficient use of community resources, with the view towards
sustaining natural resources.

A healthy community is, in fact, the context of health promotion defined in the Ottawa
Charter (WHO, 1986) as “the process of enabling people to increase control over, and to
improve, their health.” Further, the Charter states, “To reach a state of complete physical,
mental and social well-being, an individual or group must be able to identify and to realize
aspirations, to satisfy needs, and to change or cope with the environment. Health is,
therefore, seen as a resource for everyday life, not the objective of living. Health is a
positive concept emphasizing social and personal resources, as well as physical capacities.
Therefore, health promotion is not just the responsibility of the health sector, but goes
beyond healthy life-styles so well-being.” The Ottawa Charter was one of the documents
that paved the way for the Healthy Setting movement. Healthy Settings initiatives, such as
the Healthy Cities movement, have been undertaken in different parts of the world (WHO,
2012a). A healthy city is one that is continually creating and improving those physical and
social environments and expanding those community resources that enable people to
mutually support each other in performing all the functions of life and developing to their
maximum potential. It aims to (1) achieve a good quality of life, (2) create a health-
supportive environment, (3) provide basic sanitation and hygiene needs, and (4) supply
access to health care. Being a healthy city does not depend on existing structures, but a
commitment to improve the city environment and create the necessary networks for health
(WHO, 2012B). The Philippines is a member nation of the WHO Western Pacific Region,

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which has advocated for the Healthy Cities and Healthy Islands movement, especially
because of rapid economic, environmental and social changes (WHO WPR, 2010).

Health is affected by many factors that cannot be controlled by individuals all by

themselves. Effectively functioning systems within the community go a long way toward
health promotion, disease prevention, and access to resources needed for health. Knowing
that a healthy community is essential to health promotion gives the community health
nurses further motivation in their work (Famorca, Z., Nies, M. & McEwen, M., 2013; pp.133-
134).

FACTORS AFFECTING HEALTH OF THE COMMUNITY

A community has three features: people, location, and social system (Allender et al., 2009;
Hunt, 2009). Factors these features affect the health status of the community.

People

Population variables that affect the health of the community include size, density,
composition, rate of growth or decline, cultural characteristics, mobility, social class and
educational level (Allender et al., 2009). Population size and density influence the number
and size of health care institutions (Allender et al., 2009). This explains the concentration
of health care institutions in urban areas. Negative effects of overcrowding include: easy
spread of communicable diseases; increased stress among members of the community;
rapid degradation of housing facilities and water, air, and soil pollution. On the other
hand, sparsely populated areas, like rural areas, have limited resources, resulting in
difficulty in providing health services. Health needs of communities vary because of
differences in population composition by age, sex, occupation, level of education and other
variables (Allender et al., 2009). For example, a community with a large number of women
of reproductive age and young children has different needs compared to a community with
a large number of elderly people. Likewise, a community of farmers may present health
needs that are not observable in a community composed largely of professionals. Rapid
growth or decline of a population affects the health of the community (Allender et al.,
2009). Rapid population growth usually results from migration of a large number of people
into a community, as can be seen in migration from rural areas to the city. This results in
increased demand for services that existing health care institutions may find hard to cope
with. A rapid decline in population may result from disturbances brought about by
circumstances like disasters, political instability, or economic changes, such as closure of an
industrial area. Rapid population decline usually means a decrease in economic activity in
the community and lower government revenue. In turn, this results in a decrease in
resources accessible to the community. Cultural characteristics of the community are
mentioned here in reference to whether members of the community belong to a similar
cultural group (cultural homogeneity) or are multicultural (Allender et al., 2009). Feeling of
belongingness and participation in community action are more readily achieved in a
culturally homogenous population, facilitating cohesive action in dealing with a health
threat to the community. Providing care to a multicultural community is more challenging,

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requiring cultural competence on the part of the nurse and the other members of the health
team. People move from one place to another for various reasons, such as to start a family,
to take a new job, or to join another family member. Again, the feeling of belongingness
and participation in community action are less likely when a large segment of the
community is composed of new or transient residents. The level of education and social
class affect health status because of differences in living conditions and degree of access to
resources and opportunities. In addition, different social classes display distinctive health
problems (Allender et al., 2009).

Location

The health of the community is affected by both natural and man-made variables related to
location. Natural factors consist of geographic features, climate, flora and fauna.
Community boundaries, whether the community is urban or rural, the presence of open
spaces, the quality of the soil, air and water and the location of health facilities are
influenced by human decisions and behavior (Benson, 1980; Allender et al., 2009).

Geographic features consist of land and water forms that influence food sources and
prevalent occupations in the community. Geography plays an important role in disasters,
such as earthquakes, landslides, and floods. The Philippines has a tropical and maritime
climate. Temperature, humidity (i.e., the moisture content of the atmosphere), the rainfall
are the most important elements in the weather and climate of the country. The mean
temperature in the Philippines is 26.6 C, with January being the coolest month and May the
warmest. The country has a relatively high humidity due to the high ambient temperature
and the fact the Philippines is surrounded by bodies of water. Although distribution varies
from one region to another, the country generally has an abundant rainfall. Based on
rainfall distribution, the Philippines has two seasons: the rainy season (tag-ulan) from June
to November and the dry season (tag-araw) from December to May (PAGASA, 2004a).

The National Statistical Coordination Board (NSCB) of the Philippines has redefined an
urban area as a barangay that has (1) a population of 5,000 or more, (2) at least one business
establishment with a minimum of 100 employees or 5 or more establishments with a
minimum of 10 employees, (3) and 5 or more facilities within the 2-km radius from the
barangay hall. All barangays in the National Capital Region are classified as urban (NSCB,
2003). Factors that contribute to health problems in urban communities include: a higher
population density with the resulting congestion; concentrated poverty and slum
formation; and greater exposure to health risks and hazards leading to violence, traffic
injuries, and obesity (DOH, 2011b).

The 2010 Census of Population and Housing showed a population density of 19,137
persons per square kilometer at the National Capital Region, which is about 62 times the
national average of 308 persons per square kilometer. Rural areas are characterized by
wide-open spaces and low population density, but inequities in resources and economic
opportunites hinder rural development. Health facilities and health workers are
concentrated mainly in urban areas. Also, poverty is more prevalent in rural areas with

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almost 80% of the poor in the country residing in rural areas (IFAD, 2012). This is backed
up by other studies. For instance, poverty incidence among children residing in rural areas
is more than twice that of their urban counterparts. Children living in poverty tend to be
malnourished and are vulnerable to abuse (PIDS-UNICEF, 2009). Considerable
government resources have been devoted to the delivery of services to the population who
do not have access to health services and education. However, there are still not enough
roads in rural areas, limiting access to health facilities (WHO, 2011) (Famorca, Z., Nies, M.
& McEwen, M., 2013; pp.130-132).

Social System

A social system is the patterned series of interrelationships existing between individuals,

groups and institutions and forming a coherent whole (Merriam-Webster Online
Dictionary, 2012b). Social system components that affect health include the family,
economic, educational, communication, political, legal, religious, recreational and health
systems (Allender et al., 2009) While carrying out several roles simultaneously, an
individual serves as a part of several social system components at the same time. One may
be a son or daughter in the family, a nurse employed in a hospital, a church member, a
member of a neighborhood basketball team, and a citizen all at one time. As in other
systems, the composite parts of the social system of the community affect and interact with
one another. During these interactions, patterns and communication transpire which form
the basis of organizations. Organizations within the social system can be formal or
informal Allender et al., 2009). A government agency, a bank, and a school are examples of
formal organizations, whereas neighborhood friends and volunteers in a barangay clean-up
drive are examples of informal organizations. Organizations that have interactions and
linkages and that carry out similar functions form community systems or subsystems
(Allender et al., 2009). For example, health centers, private clinics, hospitals, health
laboratories and drugstores are elements of the health system of a community. Because of
the multifactorial nature of health, all the components of the social system of a community
influence its health. In providing care to a community, the nurse has to take into account
the totality of its social system. The health care delivery system, however, is considered of
central importance precisely because of its role in community health promotion and
maintenance and risk reduction (Allender et al., 2009). In fact, the nurse is a part of this
system. Community diagnosis requires a study of the health care delivery system. For
example, the infant mortality rate in a particular barangay is higher than the national infant
mortality rate. In addition to factors attributed to the characteristics of the people and the
location of the community, it is important that the nurse determines how well the health
care system is functioning (Allender et al., 2009) in relation to the provision of maternal and
child services, and to what degree are services for maternal and child health promotion
implemented by the health system at the barangay level (Famorca, Z., Nies, M. & McEwen,
M., 2013; pp.132-133).

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Community Health Nurse Roles and Functions

Qualifications

1. Bachelor of Science in Nursing

2. Registered Nurse of the Philippines

Planner/Programmer

1. Identifies needs, priorities, and problems of individuals, families, and communities

2. Formulates municipal health plan in the absence of a medical doctor
3. Interprets and implements nursing plan, program policies, memoranda, and circular
for the concerned staff personnel
4. Provides technical assistance to rural health midwives in health matters

Provider of Nursing Care

1. Provides direct nursing care to sick or disabled in the home, clinic, school, or
workplace
2. Develops the family’s capability to take care of the sick, disabled, or dependent
member

Community Organizer

1. Motivates and enhances community participation in terms of planning, organizing,

implementing, and evaluating health services
2. Initiates and participates in community development activities

Coordinator of Services

1. Coordinates with individuals, families, and groups for health related services
provided by various members of the health team
2. Coordinates nursing program with other health programs like environmental
sanitation, health education, dental health, and mental health

Trainer/Health Educator

1. Identifies and interprets training needs of the RHMs, Barangay Health Workers
(BHW), and hilots
2. Conducts training for RHMs and hilots on promotion and disease prevention
3. Conducts pre and post-consultation conferences for clinic clients; acts as a resource
speaker on health and health related services
4. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health
education purposes
5. Conducts pre-marital counseling

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Health Monitor

 Detects deviation from health of individuals, families, groups, and communities

through contacts/visits with them

Role Model

 Provides good example of healthful living to the members of the community

Change Agent

 Motivates changes in health behavior in individuals, families, groups, and

communities that also include lifestyle in order to promote and maintain health

Recorder/Reporter/Statistician

1. Prepares and submits required reports and records

2. Maintain adequate, accurate, and complete recording and reporting
3. Reviews, validates, consolidates, analyzes, and interprets all records and reports
4. Prepares statistical data/chart and other data presentation

Researcher

1. Participates in the conduct of survey studies and researches on nursing and health-
related subjects
2. Coordinates with government and non-government organization in the
implementation of studies/research

(https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/community-
health-nurse-roles-functions/).

ACTIVITY NO. 1

1. What is your own concept of community?

2. What are the roles and functions of

community health nurse?

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1.3 References

Famorca, Zenaida U., Nies, Mary A. & McEwen, Melanie (2013) Nursing Care of the
Community. (pp. 100-104). Elsevier Mosby.

Bailon-Reyes, Salvacion G., Community Health Nursing The Basics of Practice.

https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/community-
health-nurse-roles-functions/.

1.4 Acknowledgment

The images, tables, figures and information contained in this module were
taken from the references cited above.

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