Central Philippine University

COLLEGE OF NURSING
The First Nursing School in the Philippines, 1906
AY 2021 – 2022
First Semester
Lecture Notes
COMMUNITY HEALTH NURSING 2 (NCM 3115)

Module 1: Community Health Nursing Concepts

A. Definition

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:

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.

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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.

B. 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) by: social psychologists Irwin M. Rosenstock, Godfrey M.

 The health belief model is a theoretical model that can be used to guide health promotion and disease
prevention.

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 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 of Prevention

 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 5th 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.

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 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.

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.