2.
Levels of Clientele
Concepts of Community Health Nursing
● The synthesis of nursing practice and public health practice
applied to promoting and presenting the health of the
population.
Community Scenarios
● In CHN, our clients will be individuals, population, population
groups, or aggregates of just the group of senior citizens, group
of mothers, group of diabetes mellitus clients, and the whole
population in a location.
●
● There are varying problems such as psychological, physical,
socioeconomic, and emotional.
● interventions which have proven to be effective.
● Projects wellness.
● A state we aim to promote in our community and its people
● Both pictures need community health nursing to intervene in its
problem, to promote and preserve wellness.
● Wherever we go as nurses, nursing practice is always called for
and will always make use of the nursing process.
Distinguishing Features of Community Health Nursing
● Population - Focused Approach
● Levels of Clientele
● The Framework for Practice
● The Prepayment Mechanism
1. Population - Focused Approach
● Community health nurses use population focused approach to
move beyond providing direct care to individuals and families.
● Concentration is placed on specific groups of people and
focuses on health promotion and disease prevention regardless
of geographical location.
● A population focused community would not have exclusive
interests in assessing the individual or family’s health.
● Example: if a nurse is attending to an individual, he or she will
not only assess that patient but he or she transcends beyond an
extent to asking:
○ “Who are your family members?”
○ “What about your environment?”
○ “Are there sick members in the family?”.
● It is not only individuality but it is always minding the groups for
the group approach.
● Employs ongoing data collection for assessment and
management.
1. The Individual
2. The Family
3. The Group or Aggregate
● Make up the whole population
3. The Framework for Community and Public Health Nursing Practice
● The intervention wheel contains three important elements. It is
population based.
● Three levels of practice
○ Individual focused practice
○ Community focused practice
○ Systems focused practice
● These three levels of practice are gearing towards case findings
and other concerns in the community.
● The framework identifies and defines 17 public health
17 Public Health Interventions
● Surveillance – monitors health events.
● Disease and other health event investigation – systematically
gathers and analyzes data regarding threats to the health of
populations.
● Outreach – locates populations of interests or populations at
risk.
● Screening – identifies individuals with unrecognized health risk
factors.
● Case finding – identifies risk actors and connects them with
resources.
● Referral and follow-up – assists individuals and families,
families, groups, organizations and communities to identify and
access necessary resources.
● Case management – optimizes self-care capabilities of
individuals and families.
● Delegated functions – direct care tasks that the nurse carries
out.
● Health teaching – communicates facts, ideas and skills that
change knowledge, attitudes, values, behaviors and practice.
● Counseling – establishes an interpersonal relationship; with the
intention of increasing or enhancing their capacity for self-care
and coping.
● Consultation – seeks information and generates optimal
solutions to perceived problems.
● Collaboration – commits two or more persons or an
organization.
● Coalition building – develops alliances among organizations.
● Community organizing – helps community groups to identify
common problems or goals, mobilizes resources and develop
and implement strategies.
● Advocacy – pleads someone’s cause or acts on someone’s
behalf.
 ● Social marketing – utilizes commercial marketing principles for
programs.
● Policy development and enforcement – place issues on decision
makers’ agendas, acquires plan of resolution.
4. Prepayment Mechanism
● Community health nursing services are generally free at the
point of care.
○ Public health services are provided by government
agencies. These services are prepaid by the general
population through taxes.
● The prepayment mechanism provides for the means to
“socialize” health services
○ This holds true in some private institutions like some
private schools because enrollment fees at the start
of the school year includes health services. This is
what we call a prepayment mechanism. This provides
means to socialize health services whereby the cost of
health care is shouldered by the entire population or
entire group, and not solely by an individual during
the point of care.
Nursing Theorists and Theories in Community Health Nursing
● Experts are continuously looking for ways to improve nursing
practice and that notion gives birth to nursing theories with the
goal to improve nursing practice.
● Authors have identified some theories that will help achieve the
goals of community health nursing, which is to promote and
preserve the health of the population.
1. Health Belief Model
● This assumes a person’s primary motivation of a positive health
action to avoid getting a disease is based on the likelihood
he/she will take a positive health action based on the following
variables:
● Modifying factors
○ Includes the age, sex, race, ethnicity, gender, etc.
○ All of these play a role whether a person takes a
positive action to avoid getting a disease or not.
● Perceived severity and susceptibility.
○ How a person perceives the severity and how
susceptible they are to get the disease, the more
likely they are to take positive action.
○ Sometimes fear helps us to push ourselves into
performing a positive action to avoid contracting a
disease.
● Perceived barriers and benefits
○ A person evaluates if the barrier is high compared to
the benefit of a certain action. So upon evaluation the
person knows that the barrier is high and the benefit
is low, he or she is unlikely to take action.
● Cues to actions
○ This includes pieces of advice from friends or family
members, doctors recommendations, media
campaign, which serves as avenues and increases the
likelihood for one to take positive health actions.
○ The more cues seen by the person, the likelihood of
positive behavior towards preventive actions
increases.
● Likelihood of taking recommended preventive health action.
● The variables mentioned affect the likelihood of taking
recommended preventive health action, which is the endpoint
of this health belief model.
● The health belief model depicts the complex multi-dimensional
factors with which people interact as they work to achieve
optimum health.
2. Nancy Milio’s Framework for Prevention
● Milio outlined the relationship of an individual’s ability to have
healthful behavior and the society’s ability to provide accessible
and affirming options for healthy choices.
● Based on Milio’s framework, preventive behavior or individual
choice related to health promotion or health damaging
behavior, are influenced by socioeconomic status, culture,
educational status, accessibility of health options such as health
insurance coverage. In practical translation, the source and
funds of insurance influences the choice of health services and
health experts.
● Example:
○ A person who doesn’t have health insurance will not
go to a private hospital which is expensive.
● If any alteration of pattern is noted, like the increase in the
degree of smoking behavior among teenagers in the
community, this calls for policy making mandates.
● Example:
○ The creation of anti-tobacco policy.
● Another example that translates Milio’s promotive model is
realizing that addressing chronic or persistent health problem is
sometimes challenging.
● Example:
○ Chronic condition hypertension - clients with
hypertension are very aware of the cause and effect
of the problem already, but are reluctant to make
lifestyle change to prevent or reverse the condition.
○ According to Milio, once these clients are given new
information, this might attract their attention and can
possibly direct changes in their behavior in the
promotion of their health.
6 Propositions
1. Population health results from deprivation and or excess of
critical health resources.
2. Behaviors of populations result from selection from limited
choices; these arise from actual and perceived options available
as well as beliefs and expectations resulting from socialization,
education and experience.
3. Organization decisions and policies (both governmental and
non-governmental) dictate many of the options available to
individuals and populations and influence choices.
4. The choice making of individuals at a given point in time
concerning potentially health-promoting or health-damaging
selections is affected by their effort to maximize valued
resources.
5. Social change may be thought of as changes in patterns of
behavior resulting from shifts in the choice-making of
significant numbers of people within a population.
 6. Health education, as the process of teaching and learning
health-supporting information can have little significantly
extensive impact on behavior patterns, that is, on personal
choice-making of groups of people, without the easy availability
of new, or newly-perceived alternative health promoting
options for investing personal resources.
Separate Milio’s Framework PPT
Milio’s Proposition Summary Population Health Examples
Population health deficits’ result Individuals and families living in
from deprivation and/or excess of poverty have poorer health status
critical health resources compared with the middle; and
upper- class individuals and
families
Behaviors of populations result Positive and negative lifestyle
from selection from limited choices (e.g. smoking, alcohol
choices; these arise from actual use, safe sex practices, regular
and perceived options available exercise, diet, seatbelt use) are
as well as beliefs and strongly dependent on culture,
expectations resulting from socioeconomic status, and
socialization, education, and educational level.
experience.
Organizational decisions and Health Insurance coverage and
policies (both governmental and availability are largely determined
nongovernmental) dictate many and financed by the government
of the options through the National Health
Insurance Corporation
(Philhealth) and private
insurance; the source and funding
of insurance influences health
provider choices & services
Individual choices related to Choices and behaviors of
health promotion or health individuals are strongly
damaging behaviors are influenced by desires, values, and
influenced by efforts to maximize beliefs. For example, the use of
values resources illegal drugs by adolescents is
often dependent on peer
pressure and the need for
acceptance, love and belonging.
Alteration in patterns of behavior Some behaviors such as tobacco
resulting from decision making of use have become difficult to
significant number of people in a maintain in many settings or
population can result in social situations in response to
change organizational & public policy
mandates
Without concurrent availability of Addressing persistent health
alternative health-promoting problems (e.g. hypertension) is
options for investment of hindered because most people
personal choices, health are very aware of what causes
education will largely ineffective the problem, bur re reluctant to
in changing behavior patterns. make lifestyle changes to prevent
or reverse the condition. Often
“new” information (e.g. new diet)
or resources (e.g. new
medication) can assist in
attracting attention and directing
positive behavior changes.
Nola Pender’s Health Promotion Model
● The model knows that each person has unique personal
characteristics and experiences that affect subsequent
promotive action.
● The set of variables per behavior, specific knowledge, and
affect have important motivational significance. These variables
can be modified through nursing actions.
● Health promoting behavior is the desired behavioral outcome
and is the endpoint in the health promotion model.
● These health promoting behaviors should result in improved
health, enhanced functioning ability, and better quality of life.
● This model is also based on the idea that human beings are
rational and will seek their advantage in health. Before
commiting to a plan of action, which will result in a health
promoting behavior, the person thinks first and considers
perception on benefits, barriers, and other concerns like
efficacy of the action before he or she commits.
Precede - Proceed Model of Health Promotion by Lawrence Green
PRECEDE stands for:
● Predisposing
● Reinforcing
● Enabling in
● Educational
● Diagnosis Evaluation
○ All of these are used for community diagnosis.
PROCEED stands for:
● Policy
● Regulatory
● Organizational
● Constructs in
● Educational and
● Environmental
● Development
○ A model for implementing and evaluating health
programs based on PRECEDE
● The framework itself presents that health and good quality of
life, which is the endpoint/target of this model, is in itself a
constellation of factors that add up to a healthy life of the
individuals and community.
● This framework assumes that a far-reaching diagnosis should
come first before the public health intervention.
● Prior to intervention should be an assessment and a
formulation of diagnosis.
● Health and other issues must be looked at in the context of the
community’s demands.
● To make it more workable, experts turned this model into
phases: The Role of the Community Health Nurses
● To assist in the transition of the Philippine healthcare system
from a disease-oriented system to a health-oriented system.

Practical Implications of Community Health Nursing

● Represents a profession that responds to all categories of
demands of the people .
● The opportunity for nurses to learn and develop partnership
skills with all stakeholders and key actors in their community.

Separate PRECEDE and PROCEED PPT

How Do You Use PRECEDE/PROCEED MODEL?

● In Phase 1, Social diagnosis, you ask the community what it
wants and needs to improve its quality of life.
● In Phase 2, Epidemiological diagnosis, you identify the health or
other issues that most clearly influence the outcome the
community seeks.
● In these two phases, you create the objectives for your
intervention.
● In Phase 3, Behavioral and environmental diagnosis, you
identify the behaviors and lifestyles and/or environmental
factors that must be changed to affect the health or other
issues identified in Phase 2, and determine which of them are
most likely to be changeable.
● In Phase 4, Educational and organizational diagnosis, you
identify the predisposing, enabling, and reinforcing factors that
act as supports for or barriers to changing the behaviors and
environmental factors you identified in Phase 3.
● In these two phases, you plan the intervention.
● In Phase 5, Administrative and policy diagnosis, you identify
(and adjust where necessary) the internal administrative issues
and internal and external policy issues that can affect the
successful conduct of the intervention.
● Those administrative and policy concerns include generating
the funding and other resources for the intervention.
● In Phase 6, implementation, you carry out the intervention.
● In Phase 7, Process evaluation, you evaluate the process of the
intervention – i.e., you determine whether the intervention is
proceeding according to plan, and adjust accordingly.
● In Phase 8, Impact evaluation, you evaluate whether the
intervention is having the intended impact on the behavioral
and environmental factors it’s aimed at, and adjust accordingly.
● In Phase 9, Outcome evaluation, you evaluate whether the
intervention’s effects are in turn producing the outcome(s) the
community identified in Phase 1, and adjust accordingly