The Definition of Terms:

* Concept and Key Concept of CHN ( Community Health Nursing)

 Perceived susceptibility - One's belief regarding the chance of getting a disease.
 Perceived severity - One's belief regarding the seriousness of given condition
 Perceived benefits - One's belief in the ability of an advised action to reduce the health
risk or seriousness of a given condition
 Perceived barriers - One's belief regarding the tangible and psychological costs of an
advised action
 Cues to action - Strategies or conditions in one's environment that activate readiness to
act
 Self-efficacy - One's confidence in one's ability to act to reduce health risks.
* Three important components of CHN
1. The community as a client
2. Health as a goal
3. Nursing as the vehicle or means to achieve its aims
* Health
- Social
- Social Health
* Definition of CHN according to:
1. Lundy & Janes
2. Clark
3. Allender, Rector, & Warner
4. Shuster & Goepingger
* Public Health- The science and art of preventing disease, prolonging life and promoting health
through the organized efforts and informed choices of society, organizations, public and private,
communities and individuals.
* Community health nursing- The synthesis of nursing practice and public health practice
applied to promoting and preserving the health of populations.
* Public health nursing- Promoting and protecting the health of populations using knowledge
from nursing, social, and public health sciences.
* Community-based nursing
* Philosophy and principles of CHN
Philosophy:
 Individual’s right of being healthy
 Working together under a competent leader for the common good.
 The people in the community have the potential for continual development and are
capable of dealing with their own problems if educated and helped.
 Socialism
Principles:
 CHN is based on recognized needs of communities, families, groups, and individuals.
 The CH nurse must fully understand the objectives and policies of the agencies she
represents.
 In CHN, the family is the unit of service.
 CHN must be available to all.
 Health teaching is the primary responsibility of the Ch nurse.
 The CH nurse works as a member of the health team.
 There must be provision for periodic evaluation of CHN services.
 Opportunities for continuing staff education programs for nurses must be provided by the
agency.
 The CH nurse makes use of available community health resources.
 The CH nurse utilizes the already existing active organization in the community.
 There should be accurate recording and reporting in CHN.
* Characteristics and features of Community and Public Health Nurse
1. CPHN is developmental
2. CPHN is multidisciplinary
3. CPHN is ecology oriented
4. CPHN promotes social justice
5. CPHN values consumer involvement
6. CPHN uses prepayment mechanism
7. CPHN focuses on preventive severe
8. CPHN offers comprehensive care
* Health Belief Model
 It was initially proposed in 1958 by group of social psychologists Irwin M. Rosenstock,
Godfrey M. Hochbaum, Stephen Kegeles, and Howard Leventhal at the U.S. Public
Health.
  This was developed by the group of psychologists to explain why the public failed to
participate in the screening for tuberculosis. (Hochbaum,1958)
 It provides the basis for the practice of HEALTH EDUCATION and HEALTH
PROMOTION
 It is the one of the most widely used conceptual framework in health behavior to be able
to explain behavior change and maintenance of behavior change and to guide health
promotion interventions.
 It includes different key concepts - perceived susceptibility, perceived severity, perceived
benefits, perceived barriers, cues to action, self-efficacy.
Kurt Lewin's work lent itself to the model's core dimensions. He proposed that behavior
is based on current dynamics confronting an individual rather than prior experiences
The Health Belief Model assumes that the major dominant of preventive health behavior
is disease avoidance.
Disease avoidance includes:
 perceived susceptibility to disease "X"
 perceived seriousness of disease "X"
 modifying factors
 cues to action
 perceived benefits minus
 perceived barriers to preventive
 health action
 perceived threat of disease "X" likelihood of taking a
 recommended health action
How is HBM used by nurse?
 It assists clients in making necessary behavior modifications by making them conscious
of the need for such modifications
 It is used by the nurse to Determine client's Misperceptions That serve as barriers to
appropriate health act
Limitation of HBM
 It places the burden or pressure to action exclusively on the client it focuses on giving
 Interventions designed to modify the client’s perceptions it does not
 Acknowledge the health’s professional's responsibility to alter or reduce health care
barriers
* Milio’s Framework for Prevention
 This was proposed by Nancy Milio, a Public Health Nurse, and leader in public health
policy and education.
  A framework for prevention that includes concepts of community oriented, population-
focused care.
 Inclusion of economic, political and environmental health determinants.
 This provides a mechanism for directing attention upstream and examining opportunities
for nursing intervention at the population level.
 Made of six propositions that relate an individual's ability to improve healthful behavior
to a society's ability to provide accessible and socially affirming options for healthy
choices.
 She challenged the common notion that a main determinant for unhealthful behavioral
choice is lack of knowledge.
 According to Milio, the range of available health choices is critical in shaping a society's
overall health status & that policy decisions in governmental and private organizations
shape the range of choices available to individuals.
Milio’s Framework for Prevention
 Most human beings, professional or non-professional, provider or consumer, make the
easiest choices available to them most of the time.
 Health-promoting choices must be done readily available and less costly than health-
damaging options for individuals to gain health and for society to improve health status.
 Milio believed that national level policy-making was the best to favorably impact the
health of most people rather than concentrating efforts on imparting information in an
effort to change individual patterns of behavior.
 Individual's health and lifestyle choices are influenced by resources, availability, cost,
and convenience more than knowledge obtained in education.
MILIO'S SIX PROPOSITIONS
1. Population health deficits results from deprivation and/or excess of critical health
sustaining resources
2. Behaviors of populations result from selection from limited choices that arise from actual
and perceived options available as well as beliefs and Expectations developed from
socialization, education and experience.
3. Organizational decisions and policies (both governmental and nongovernmental) sets the
range of options available to individuals and populations and influence choices.
4. Individual choices related to health promotion or health damaging behaviors are
influenced by efforts to maximized valued resources.
5. Alteration in patterns of behavior resulting from decision making or a significant number
of people in a population can result in social change.
6. Without concurrent availability of alternative health promoting options for investments of
personal resources, health education will be largely ineffective in changing behavior
patterns.
* Nola Pender’s Health Promotion Model
NOLA J. PENDER Living legend of the American Academy of Nursing
 A nursing theorist who developed the Health Promotion Model.
 An author and a professor emeritus of nursing at the University of Michigan.
 Started studying health promoting behavior in the mid 1970s and first published the
Health Promotion Model in 1982.
THE HEALTH PROMOTION MODEL
 Originally published in 1982 and later improved in 1996 and 2002.
 It explores many biopsychosocial factors that influence individuals to pursue health
promotion activities.
 Does not include threat as a motivator, as threat may not be a motivating factor for clients
in all age groups.
 Was designed to be a "complementary counterpart to models of health protection."
Purpose: To help nurses know and understand the major determinants of health behaviors as a
foundation for behavioral counseling to promote well being and healthy lifestyles.
Defines health as "a positive dynamic state not merely the absence of disease". It describes the
multi dimensional nature of persons as they interact within the environment to pursue health.
Health Promotion- It is an approach to wellness
Health Protection- Focuses on illness prevention
The health promotion model focuses in the following areas:
INDIVIDUAL CHARACTERISTIC AND EXPERIENCES
 Prior related behavior- Prior behaviors influence subsequent behavior through perceived
self- efficacy, benefits, barriers, and affects related to that activity. Strong indicator:
Habit
 Personal factor- Biological Factors: Age, body mass index, strength, and agility.
Psychological Factors: Self esteem, self motivation, and perceived health status.
Sociocultural Factors: Race, ethnicity, acculturation, education, and socioeconomic
status.
BEHAVIOR-SPECIFIC COGNITIONS AND AFFECT
 Perceived benefits of action- Strong motivators of the behavior. These motivate behavior
through intrinsic and extrinsic benefits
 Perceived barriers to action- Perceived unavailability, inconvenience, expense, difficulty,
or time regarding health behaviors.
 Perceived self-efficacy- One's belief that he or she is capable of carrying out a health
behavior.
BEHAVIORAL OUTCOME
  Health-promoting behavior- This is the goal of the Health Promotion Model. To attain
positive health outcomes.
 Immediate competing demands and preferences- Alternate behaviors that one considers
as possible optional behaviors immediately prior to engaging in the intended, planned
behavior.
 Commitment to a plan of action- Initiates a behavioral event. This commitment will
compel one into the behavior until completed, unless a competing demand or preference
intervenes.
* The Transtheoritical Model
* Precede-Proceed Model
 provides a model for community assessment, health education planning and evaluation
Behind PRECEDE-PROCEED lie some assumptions about the prevention of illness and
promotion of health, and by extension, about community as well. These include:
 PRECEDE-PROCEED model should be a participatory process.
 Health is, by its very nature, a community issue.
 Health is an integral part of a larger context, probably most clearly defined as the quality
of life, and it's within that context that must be considered.
 Health is more than physical well being, or the absence of disease, illness, or injury.
PREDISPOSING
REINFORCING
ENABLING
CONSTRUCTS IN
EDUCATIONAL
DIAGNOSIS AND
EVALUATION
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
ECOLOGICAL ASSESSMENT- Analyze behavioral and environmental determinants that
predispose, reinforce, and enable the behaviors and lifestyles to be identified.
POLICY
REGULATORY AND
ORGANIZATIONAL
CONSTRUCTS IN
EDUCATIONAL AND
ENVIRONMENTAL
DEVELOPMENT
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 negative behavior or an increase in identified positive behavior
* Theory of Reasoned Action