A.

COMMUNITY HEALTH NURSING AS A FIELD OF NURSING PRACTICE

 The hallmark of community health nursing is that it is population or aggregate-focused

I. CHN is a synthesis of nursing and public health practice
 1. Emphasis on the importance of the greatest good for the greatest number
 2. Assessing health needs planning, implementing and evaluating the impact of
health services on population groups.
3. Priority of health-promotive and disease preventive strategies over curative
interventions
4. Tools for measuring and analyzing community health problems; and analyzing
community health problems;
5. Application of principles of management and organization in the delivery of
health services to the community.
II. Basic concepts and principles of community health nursing
1. The family is the unit of care; the community is the patient and there are four levels of clientele in
community health nursing
2. The goal of improving community health is realized through multidisciplinary effort.
3. The community health nurse works with and not for the individual patient, family, group or
community. The latter are active partners, not passive recipients of care.
4. The practice of community health nursing is affected by changes in society in general and by
developments in the health field in particular.
5. Community health nursing is part of the community health system, which in turn is part of the larger
human services system.
III. Roles of the nurse in caring for communities and population groups.
IV. Brief history of community health/public health nursing practice in the Philippines

Community
• a group of people with common characteristics or interests living together within a territory or
geographical boundary
• place where people under usual conditions are found
• Derived from a Latin word “comunicas” which means a group of people.
• In recent nursing Literature, community has defines as “a collection of people who interact with
another and whose common interest or characteristics form the basis for a sense of unity or
belonging”.(Allender et al., 2009)
• A group of people who share something in common and interact with one another and may
share a geographic boundary (Lundy and Janes 2009)
• A group of people who share common interest , who interact with each other, and who
functions collectively within a defined social structure to address common concerns (Clark,
2008)
• “A locality based entity. Composed of systems of formal organizations reflecting society’s
institutions, informal groups and aggregates (Shuster and Goeppinger, 2008)
• Maurer and Smith (2009) further addressed the concept of community and identified four
defining attributes: (1) people (2) place, (3) interaction (4) common characteristics, interests, or
goals.
Maurer and Smith (2009) noted that there are two main types of communities: geopolitical
communities and phenomenological communities.
• Geopolitical communities are defined or formed by both natural and manmade
boundaries and include barangays, municipalities, cities, provinces, regions and nations.
It may also be called territorial communities.
• Phenomenological communities refer to the relational, interactive groups, in which the
place or setting is more abstract, and people share a group of perspective or identity
based on culture, values, history, interests and goals. Examples are schools, colleges,
and universities; churches, and mosques; and various groups and organizations.
• Population is typically used to denote a group of people having common personal and
environmental characteristics. It can also refer to all of the people in a defined
community.
 • Aggregates are subgroups or subpopulations that have some common characteristics or
concerns (Clark 2008)

Community Health Nursing Definition

• Maglaya - “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)
• Goal: “To raise the level of citizenry by helping communities and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential for high-level
wellness” ( Nisce, et al)

• WHO - 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 program for the promotion of
health, the improvement of the conditions in the social and physical environment, rehabilitation
of illness and disability ( WHO Expert Committee of Nursing)
 • Jacobson:
• A learned practice discipline with the ultimate goal of contributing as individuals and in
collaboration with others to the promotion of the client’s optimum level of functioning
thru’ teaching and delivery of care (Jacobson)
• “Nursing practice in a wide variety of community services and consumer advocate areas,
and in a variety of roles, at times including independent practice….community nursing is
certainly not confined to public health nursing agencies.
• Dr. Ruth B. Freeman - A service rendered by a professional nurse with communities, groups,
families, individuals at home, in health centers, in clinics, in schools, in places of work for the
promotion of health, prevention of illness, care of the sick at home and rehabilitation. (DR. Ruth
B. Freeman)
American Nurses Association (ANA) - The synthesis of nursing practice and public health
practice applied to promoting and preserving the health of population”.

Standards in CHN
I. Theory
• Applies theoretical concepts as basis for decisions in practice
II. Data Collection
• Gathers comprehensive, accurate data systematically
III. Diagnosis
• Analyzes collected data to determine the needs/ health problems of IFC
IV. Planning
• At each level of prevention, develops plans that specify nursing actions unique to needs
of clients
V. Intervention
• Guided by the plan, intervenes to promote, maintain or restore health, prevent illness
and institute rehabilitation
VI. Evaluation
• Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnoses and plan
VII. Quality Assurance and Professional Development
• Participates in peer review and other means of evaluation to assure quality of nursing
practice
• Assumes professional development
• Contributes to development of others
VIII. Interdisciplinary Collaboration
• Collaborates with other members of the health team, professionals and community
representatives in assessing, planning, implementing and evaluating programs for
community health
IX. Research
• Indulges in research to contribute to theory and practice in community health nursing
X. Community –based nursing
• Application of the nursing process in caring for individuals, families, and groups
where they live, work or go to school as they move through the health care
system. (McEwen and Pullis 2008)
• Community based nursing is setting-specific and the emphasis is on acute and
chronic care and includes practice areas such as home health nursing and
nursing in outpatient or ambulatory setting.
Difference between Community Health Nursing and Community-based nursing (Zotti et al,
1996)
• Community health nursing emphasizes preservation and protection of health while community
based nursing emphasizes managing acute or chronic conditions.
• In community health nursing, the primary client is the community; in community- based nursing,
the primary clients are the individual and the family.
• The services in community health nursing are both direct and indirect while community based
nursing are largely direct.

Distinguishing Features of Community health Nursing Practice

• In addition to its preventive approach to health, community health nursing is
characterized by its being population-or aggregate-focused, it’s developmental
nature, and the existence of a prepayment mechanism for consumers of
community health nursing services. Also, unlike nurses who work in hospital
settings, community health nurses care for different levels of clientele.
Population-focused approach and Community health Nursing Interventions
• Population-focused nursing concentrates on specific groups of people and focuses on health
promotion and disease prevention, regardless of geographical location (Baldwin et al, 1998)
1. Focuses on the entire population
2. Is based on assessment of the population’s health status
3. Considers the broad determinants of health
4. Emphasizes all levels of prevention and
5. Intervenes with communities, systems, individuals, and families.
• Community health nurses may be responsible for a specific subpopulation in the community
(e.g., a school nurse may be responsible for students enrolled in an elementary school),
• population-focused practice is concerned with many distinct and overlapping community sub-
populations. The goal of population-focused nursing is to promote healthy communities.
• Population- focused community health nurses would not have exclusive interest in one or two
sub-populations but would focus on the many sub-populations that make up the entire
community. A population focus involves concern for those who do and for those who do not,
receive health services.
Community health nursing practice requires the following types of data for scientific approach
and population focus: (1) the epidemiology, or body of knowledge, of a particular problem and
its solution and (2) information about the community

• Levels of Clientele of the Community health Nurse

• Community health nurses focus on the care of several levels of clientele: the individual,
the family, the group/aggregate, and the community as a whole in many settings,
including homes, clinics and schools.
• The Intervention Wheel
• The Public Health Intervention Model was initially proposed in the late 1990s by nurses
from the Minnesota Department of Health to describe the breadth and scope of public
health nursing practice. This model was later revised and termed Intervention Wheel,
 and it has become increasingly recognized as a framework for community and public
health nursing practice.
• The intervention Wheel contains 3 important elements
• It is population based
• It contains 3 levels of practice (community, systems and individual/family)
• It identifies and defines 17 public health interventions are directed at improving
population health