Community Health Nursing
member of the health team.
"Service rendered by a professional nurse to
communities, groups, families, and individuals at
home, in health centers, in clinics, in schools, and
in places of work for the promotion of health,
prevention of illness, care of the sick at home,
and rehabilitation. "-Ruth B. Freeman
"The utilization of the nursing process in the
different levels of clientele - individuals,
population groups and communities, concerned
with the promotion of health, prevention of
disease and disability and rehabilitation."
Maglaya, et al.
GOAL!! "Raise the level of the 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.
PHILOSOPHY OF CHN
The following are Community Health Nursing
principles that were adapted from those
formulated by Mary S. Gardner and by Leahy,
Cobb, and Jones:
(1) Community Health Nursing is based on
recognized needs of communities, families,
groups, and individuals.
(2) The community health nurse must fully
understand the objectives and policies of the
agency she represents.
(3) In community health nursing, the family is
the unit of service.
(4) Community Health Nursing must be available
to all regardless of race, creed, and
socioeconomic status.
(5) Health teaching is a primary responsibility of
the community health nurse.
(6) The community health nurse works as a
(7). There must be a provision for periodic
evaluation of Community Health Nursing Service.
(8) Opportunities for continuing staff education
programs for nurses must be provided by the
community health nursing agency. The
community health nurse also has a responsibility
for his/her professional growth.
(9) The community health nurse makes use of
available community health resources.
(10) The community health nurse utilizes the
already existing organized groups in the
community.
(11) There must be provision for educative
supervision in Community Health Nursing.
(12) There should be accurate recording and
reporting in community Health Nursing.
FEATURES OF CHN
It is a specialty field of nursing.
Its practice combines public health with nursing.
It is population-based.
It emphasizes wellness and other than disease or
illness.
It includes inter-disciplinary collaboration.
It amplifies the client's responsibility and self-
care.
PRINCIPLES OF CHN
Philosophy of CHN Community Health Nursing is
a philosophy of care that is characterized by
collaboration, continuity of care, client and
family responsibility of self-care, and preventive
health care (Hunt, 2005). Community-based
nursing focuses on an individual and is a family-
centered in orientation.
The community is the patient in CHN, the Family risk sexual behavior and the possibility of
is the unit of care and there are four levels of contracting HIV) (Croyle RT, 2005)
clientele: Individual, Family, Population Group
HBM is a popular model applied in nursing,
(those who share common characteristics,
especially in issues focusing on patient
developmental stages, and common exposure to
compliance and preventive health care practices.
health problems---e. children, elderly,) and the
community. The model postulates that health-seeking
behavior is influenced by a person's perception
of a threat posed by a health problem and the
THEORY value associated with actions aimed at reducing
the threat.
-The goal of theory is to improve nursing
practice.
- A theory is a group of related concepts that THEORETICAL PROPOSITIONS OF THE HEALTH
propose action that guide practice. BELIEF MODEL: (Photo)
- A systematic vision of reality; a set of
interrelated concepts that is useful for prediction
and control. (Woods and Catanzaro)
- A conceptual system or framework invented for
some purpose; and as the purpose varies, so too
must the structure and complexity of the system.
(Dickoff and James)
The nurse applies this theory in different ways:
 By serving as a model
 By giving detailed verbal instructions
 By using print or multimedia strategies.

The nurse facilitates learning through: Milo's Framework for Prevention:

 Attention - Complements the health belief model.

 Retention - Emphasizes change at the community level.
 Reproduction
 Motivation - Identifies the relationship between health
deficits and availability of health-promoting
resources.
Health Belief Model: - Theorizes that behavior changes within a large
It was developed in the 1950s by a group of U.S. number of people can ultimately lead to social
Public Health Service social psychologists who change.
wanted to explain why so few people were
participating in programs to prevent and detect
disease. Pender's Health Promotion Model:

HBM is a good model for addressing problem Does not consider health risk as a factor that
behaviors that evoke health concerns (e.g., high- provokes change.
• Examines factors that affect individual actions
to promote and protect health.
o Personal factors (biological,
psychological, sociocultural),
behaviors, abilities, self- efficacy
o Feelings, benefits, barriers, and
characteristics associated with the
action.
o Attitudes of others, and competing
demands and preferences.
Determinants of health are factors that influence
the client's health. These can include nutrition,
stress, education, the environment, finances, and
social status/ sigma (prejudice).
Health indicators (mortality rates, disease
prevalence, levels of physical activity, obesity,
tobacco or other substance use) describe the
health status of a community and serve as targets
for the improvement of a community's health.
PRECEDE- PROCEED Model
Developed by Or. Lawrence W. Green
Precede-Proceed Model provides a model for
community assessment, health education
planning, and evaluation.
PRECEDE stands for predisposing, reinforcing,
and enabling constructs in educational diagnosis
and evaluation.
PROCEED, is the acronym for policy, regulatory,
and organizational constructs in educational and
environmental development- is a model for
implementing and evaluating health programs
based on PRECEDE.
In this model, predisposing factors refers to
people’s characteristics that motivate them
toward health-related behavior.
PROCEED- (Policy, Regulatory, and
Organizational Constructs in Educational and
Environmental
Development)
Provides the structure for implementing and
evaluating the public health program.
It involves the identification of desired outcomes
and program implementation:
- Implementation: Design
intervention, assess the availability
of resources, and implement
programs.
- Process Evaluation: Determine if
the 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.
ROLES AND ACTIVITIES OF A COMMUNITY
HEALTH NURSE
NURSE Clinician, who is a health-care provider,
taking care of sick people at home or in the RHU.
Health Educator, who aims towards
health promotion and illness prevention through Services with Visiting
dissemination of correct information; educating Psychiatrists.
people.
CHARACTERISTICS OF A HEALTHY
Facilitator, who establishes multi-sectoral COMMUNITY:
linkages by referral system. A healthy community has the characteristics of:

Supervisor, who monitors and - The members are aware of their

supervises the performance of midwives.
Different Fields of CHN
1. School Health Nursing
o School nursing is a specialized
nursing practice that advances the
well-being, academic success, and
lifelong achievement and health of
students. Keeping children healthy,
safe, and ready to learn should be a
top priority for both healthcare
and educational systems.
own health and biologic status.
- Members give credit to the
governing authority; the natural
and biological resources are open
for everybody.
- Has a strong and reliable
governing body,
- People work together to attain
independence.
THE KEY COMPONENTS OF SUSTAINABLE
COMMUNITIES

o School nurses lead in developing

policies, programs, and procedures
for the provision of school health
services at an individual or district
level (NASN, 2016a), relying on
student-centered, evidence-based
practice and performance data to
inform care (Robert Wood Johnson
Foundation, 2009).

2. Community Mental Health Nursing

Are specialized Nurses who
provide holistic nursing
services for people with mental
health issues in a community
setting. We provide caring and  Clinician Role/ Direct care provider
confidential supports for our  Educator role
clients, using the recovery  Advocate role
model for care.  Managerial Role
The services provided by the  Collaborator role
Community Mental Health  Leader role
Nursing Program include  Research Role
Treatment Planning,
Medication Management.
Assessment, Counseling,
Family Support, Education,
Group Support, Facilitate
PHN Functions and Activities
Management:
1. Plans and organizes the nursing service of the
health unit.
2. Participates in the preparation of the
municipal health plan.
3. Participates in the implementation of
municipal health plans.
4. Implements the nursing service plan
5. Monitors and evaluates the implementation of
the nursing service plan.
6. Initiates changes for the improvement of
services.
7. Manages the RHU in the absence of the rural
health physician.
PH Functions and Activities
Training Participants in meeting the training
needs of midwives, student affiliates and other
trainee:
1. Prioritizes the identified needs of rural health
midwives that can be addressed by training.
2. Organizes a staff development program for
RHMs.
3. Conducts a staff education program or
coaching session
4, Evaluates effects of training on work
performance.
 Supervises the RHMS
 Monitors and evaluates midwives’
performance in the implementation of
public health programs.
 Maintain records and reports.
 Provision of Health and Nursing Care
Provides health and nursing care to
individuals, families, and communities.
1. Identifies health needs and problems of
individuals, families, and communities.
2. Formulates individual, family and community
nursing/health care plan.
3. Coordinates with individual groups and
agencies for resource assistance in
implementing the health care plan
PH Functions and Activities
Coordination
1. Identifies persons, groups, organizations,
other agencies and
communities whose resources are available
within and outside the
community and which can be tapped in the
implementation of individual, family and
community health care.
• 2. Refers patient to other health personnel,
health facilities and government agency.
What is Epidemiology?
“Study of the causes, distribution, determinants
and deterrent of diseases, injuries and other
related condition in human population'-
Onwasigwe (2004)
Frequencies and types of illnesses and injuries in
a group of people and with factors that influence
their distribution.
USES OF EPIDEMIOLOGY
* Studying the history of diseases in population
in terms of profile, time & trends.
* Determining the most common causes of death,
diseases and disability.
* Community diagnosis in terms of morbidity,
and mortality rates and ratio
* Determining the effective control method of
disease when known.
* Provision of data for proper planning and
evaluation of health services.
* Identifying deficiencies in ongoing programs *
Identifying the priority areas for medical
research.
DEMOGRAPHY
* The science in which deals with the study of the
human population's size, composition and
distribution.
* The science of population helps the nurse find
reasons or rationale why or how a particular
population or group is influenced by a variety of
factors resulting in vulnerability to ill health.
SOURCES OF DEMOGRAPHIC DATA
* Census
* Sample Surveys
* Registration System
Census- defined as an official and periodic
enumeration of population.
Population Size:
* The nurse determines the population size not
because she simply wants to know how large or
small the population is. Knowing the population
size of a place will allows the nurse to make
comparisons about the population changes over
time.
* It also helps her rationalize the types of health
programs or interventions which are going to be
provided for the community.
POPULATION SIZE:
Rate of Natural Increase: (RNI) is a measure of
how fast the population is increasing due only to
the births and deaths.
The formula is RNI= BR- DR
the 2nd method of measuring the population size
is to determine the increase in the population
using data obtained during two census period.
Absolute increase per year
• Measures the number of people that are added
to the population per year.
Formula: Al per year =
Where:
Pt= population size at a later time
Po= population size at an earlier time
t= number of years between time 0 and time t
Relative increase
• The actual difference between the two census
counts expressed in percent relative to the
population size made during the earlier census.
Relative increase =
Where:
Pt= population size at a later time
Po= population size at an earlier time
Life Expectancy of the Philippines
United Nations Population Division. World
Population Prospects: 2022 Revision or derived
from male and female life expectancy at birth
from sources such as:
(1) Census reports and other statistical
publications from national statistical offices,
(2) Eurostat: Demographic Statistics,
(3) United Nations Statistical Division.
Population and Vital Statistics Report for various
years
(4) U.S. Census Bureau: International Database,
and
(5) Secretariat of the Pacific Community:
Statistics and Demography
LIFE expectancy OF FiLIPINOS As of Year 2021 –
69
PHILIPPINE HEALTH SITUATION
The Philippines is an archipelago in the South-
East Asia Region, with a population of 104.9
million as of 2017.
Year Population Urban Pop
2023 117,337,368 47.1 %
It is the thirteenth most populous country in the
world.
The majority of Filipinos are Christian Malays
(92.2%), with Roman Catholics constituting
87.4% of the Christian population.
Muslim minority groups, comprising 5.6%, are
concentrated in Mindanao.

The country has an adult literacy rate of 96.5%.
The Philippines is currently one of Asia's fastest-
growing economies, with a gross domestic
product growth of 6.7% at the end of 2017.
- Categorized as a newly industrialized country,
it is transitioning from one based on agriculture
to one based more on services and
manufacturing.
- Filipinos tend to live longer now than in
previous decades, with life expectancy at birth
increasing from 62.2 years in 1980 to 69.1 years
in 2016.
DOH. WHO celebrate public health milestones in
PH; commit to achieving Health for All' Filipinos
April 7, 2023
PHILIPPINE HEALTH SITUATION 2023
The World Health Day, which is celebrated every
April 7th annually, provides an opportunity to
focus on a health problem or issue that deserves
special attention. This year, 2023, the World
Health Organization (WHO) and its members,
together with the Department of Health, observe
WHO's 75th anniversary.
Looking back over the past 75 years, smallpox
has been globally eradicated, and many other
infectious diseases have been reduced. Since
2000, the average life expectancy of a Filipino
has risen by to 72 years in 2020 according to the
World Bank.
- More recently, in 2019, the Universal Health
Care (UHC) Act was adopted into law as Republic
Act No. 11223.
- Part of the provision of the law states that all
Filipino citizens shall be automatically enrolled
in the National Health Insurance Program and
prescribes complementary reforms in the health
system, including measures to ensure access to
essential health services, promote the well-being
of families and communities and protect them
against financial and health crises.
- According to the Philippine Statistics
Authority's 2022 Pace of Progress on the
Sustainable Development Goals (SDG), the
country is on track to achieve the SDG target on
health coverage.
17 Sustainability Goals
Health Service Delivery System
- Health service delivery Health is a basic human
right guaranteed by the Philippine Constitution
of 1987.
- This is provided in the Philippines through a
dual health delivery system composed of the
public and private sectors.
Health Service Delivery System (PUBLIC)
- The public sector is largely financed through a
tax- based budgeting system, where government
facilities deliver health services under the
national and local governments.
- The Department of Health (DOH) supervises
the government-corporate hospitals, specialty,
and regional hospitals.
- The Department of National Defense runs the
military hospitals. - At the local level, the
provincial governments manage and operate
district and provincial hospitals.
- Municipal governments provide primary care,
including preventive and promotive health
services and other public health programs
through the rural health units, health centers,
and barangay health stations.
- Highly urbanized and independent cities
provide both hospital services and primary care
services.
Health Service Delivery System (PRIVATE)
- The private sector, consisting of for-profit and
nonprofit healthcare providers, is largely market
oriented, where health care is generally paid for
through user fees at the point of service
HEALTH FINANCING

- Total health expenditure (THE) has

consistently increased since 2005.

- Government health expenditure has increased

significantly in nominal terms, but it has been
eclipsed by private sector funding sources, which
have grown rapidly with the economy.