COMMUNITY HEALTH NURSING REVIEW NOTES  Health Advocator,who speaks on behalf of the client
COMMUNITY HEALTH NURSING  Advocator,who act on behalf of the client
Community is a group of people with common characteristics or
interests living together within a territory or geographical boundary.
Community Health is part of paramedical and medical
intervention/approach which is concerned on the health of the
whole population.
Different Definitions of Community Health Nursing
 “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)
 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)
 A service rendered by a professional nurse to IFCs, population
groups in health centers, clinics, schools , workplace for the
promotion of health, prevention of illness, care of the sick at
home and rehabilitation (DR. Ruth B. Freeman)
Public Health
 “Public Health is directed towards assisting every citizen to
realize his birth rights and longevity.” “The science and art of
preventing disease, prolonging life and efficiency through
organized community effort for:
1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for the early
diagnosis and preventive treatment of disease
5. The development of a social machinery to ensure every one a
standard of living, adequate for maintenance of health to
enable every citizen to realize his birth right of health and
longevity (Dr. C.EWinslow)
Mission of CHN
 Health Promotion
 Health Protection
 Health Balance
 Disease prevention
 Social Justice
Philosophy of CHN
 “The philosophy of CHN is based on the worth and dignity of
man.”(Dr. M. Shetland)
Basic Principles of CHN
1. Thecommunity is the patient in CHN, the family is the unit of
care and there are four levels of clientele: individual, family,
population group (those who share common characteristics,
developmental stages and common exposure to health
problems – e.g. children, elderly), and the community.
2. In CHN, the client is considered as anACTIVE partner 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.
Roles of the PUBLIC HEALTH NURSE
 Clinician,who is a health care provider, taking care of the sick
people at home or in the RHU
 Health Educator,who aims towards health promotion and
illness prevention through dissemination of correct
information; educating people
 Facilitator,who establishes multi-sectoral linkages by referral
system
 Supervisor,who monitors and supervises the performance of
midwives
 Collaborator,who working with other health team member
*In the event that the Municipal Health Officer (MHO) is unable to
perform his duties/functions or is not available, the Public Health
Nurse will take charge of the MHO’s responsibilities.
Other Specific Responsibilities of a Nurse, spelled by the
implementing rules and Regulations of RA 7164 (Philippine
Nursing Act of 1991) includes:
 Supervision and care of women during pregnancy, labor and
puerperium
 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of a physician
 Provision of first aid measures and emergency care
 Recommending herbal and symptomatic meds…etc.
In the care of the families:
 Provision of primary health care services
 Developmental/Utilization of family nursing care plan in the
provision of care
In the care of the communities:
 Community organizing mobilization, community development
and people empowerment
 Case finding and epidemiological investigation
 Program planning, implementation and evaluation
 Influencing executive and legislative individuals or bodies
concerning health and development
PRIMARY HEALTH CARE
Overview
 May 1977 -30th World Health Assembly decided that the main
health target of the government and WHO is theattainment of a
level of health that would permit them to lead a socially and
economically productive life by the year 2000.
 September 6-12, 1978 – First International Conference on PHC
in Alma Ata, Russia (USSR) The Alma Ata Declaration stated
that PHC was the key to attain the “health for all” goal
 October 19, 1979 – Letter of Instruction (LOI) 949, the legal
basis of PHC was signed by Pres. Ferdinand E. Marcos, which
adopted PHC as an approach towards the design, development
and implementation of programs focusing on health
development at community level.
Rationale for Adopting Primary Health Care
 Magnitude of Health Problems
 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other development
activities
Definition of Primary Health Care
 An essential health care made universally accessible to
individuals and families in the community by means acceptable
to them, through their full participation and at cost that the
community can afford at every stage of development.
 A practical approach to making health benefits within the reach
of all people.
 An approach to health development, which is carried out
through a set of activities and whose ultimate aim is the
continuous improvement and maintenance of health status
Goal of Primary Health Care
 HEALTH FOR ALL FILIPINOS by the year 2000 AND
HEALTH IN THE HANDS OF THE PEOPLE by the year
2020.
 An improved state of health and quality of life for all people
attained throughSELF RELIANCE.
Key Strategy to Achieve the Goal:
 Partnership with and Empowerment of the people– permeate as
the core strategy in the effective provision of essential health
services that are community based, accessible, acceptable, and
sustainable, at a cost, which the community and the
government can afford.

Objectives of Primary Health Care
 Improvement in the level of health care of the community
 Favorable population growth structure
 Reduction in the prevalence of preventable, communicable and
other disease.
 Reduction in morbidity and mortality rates especially among
infants and children.
 Extension of essential health services with priority given to the
underserved sectors.
 Improvement in Basic Sanitation
 Development of the capability of the community aimed at self-
reliance.
 Maximizing the contribution of the other sectors for the social
and economic development of the community.
Mission
 To strengthen the health care system by increasing
opportunities and supporting the conditions wherein people
will manage their own health care.
Two Levels of Primary Health Care Workers
1. Barangay Health Workers– trained community health workers
or health auxiliary volunteers or traditional birth attendants or
healers.
2. Intermediate level health workers-include the Public Health
Nurse, Rural Sanitary Inspector and midwives.
Principles of Primary Health Care
1. 4 A’s = Accessibility, Availability, Affordability &
Acceptability, Appropriateness of health services.
 The health services should be present where the supposed
recipients are. They should make use of the available
resources within the community, wherein the focus would
be more on health promotion and prevention of illness.
2. Community Participation (COPAR)
 The heart and soul of PHC
3.People are the center, object and subject of development.
 Thus, the success of any undertaking that aims at serving
the people is dependent on people’s participation at all
levels of decision-making; planning, implementing,
monitoring and evaluating. Any undertaking must also be
based on the people’s needs and problems (PCF, 1990)
o Part of the people’s participation is the partnership
between the community and the agencies found in
the community; social mobilization and
decentralization.
o In general, health work should start from where the
people are and building on what they have. Example:
Scheduling of Barangay Health Workers in the
health center
Barriers of Community Involvement
 Lack of motivation
 Attitude
 Resistance to change
 Dependence on the part of community people
 Lack of managerial skills
4. Self-reliance
 Through community participation and cohesiveness of
people’s organization they can generate support for health
care through social mobilization, networking and
mobilization of local resources. Leadership and
management skills should be develop among these
people. Existence of sustained health care facilities
managed by the people is some of the major indicators
that the community is leading to self reliance.
5. Partnership between the community and the health agencies in
the provision of quality of life.
 Providing linkages between the government and the
nongovernment organization and people’s organization.
6. Social Mobilization
 It enhances people participation or governance, support
system provided by the Government, networking and
developing secondary leaders.
7. Decentralization
 This ensures empowerment and that empowerment can
only be facilitated if the administrative structure provides
local level political structures with more substantive
responsibilities for development initiators. This also
facilities proper allocation of budgetary resources.
Elements of Primary Health Care
1. Education for Health
 Is one of the potent methodologies for information
dissemination. It promotes the partnership of both the
family members and health workers in the promotion of
health as well as prevention of illness.
2. Locally Endemic Disease Control
 The control of endemic disease focuses on the prevention
of its occurrence to reduce morbidity rate. Example
Malaria Control and Schistosomiasis Control
3. Expanded Program on Immunization
 This program exists to control the occurrence of
preventable illnesses especially of children below 6 years
old. Immunizations on poliomyelitis, measles, tetanus,
diphtheria and other preventable disease are given for free
by the government and ongoing program of the DOH
4. Maternal and Child Health and Family Planning
 The mother and child are the most delicate members of the
community. So the protection of the mother and child to
illness and other risks would ensure good health for the
community. The goal of Family Planning includes
spacing of children and responsible parenthood.
5. Environmental Sanitation and Promotion of Safe Water
Supply
 Environmental Sanitation is defined as the study of all
factors in the man’s environment, which exercise or may
exercise deleterious effect on his well-being and survival.
Water is a basic need for life and one factor in man’s
environment. Water is necessary for the maintenance of
healthy lifestyle. Safe Water and Sanitation is necessary
for basic promotion of health.
6. Nutrition and Promotion of Adequate Food Supply
 One basic need of the family is food. And if food is
properly prepared then one may be assured healthy
family. There are many food resources found in the
communities but because of faulty preparation and lack of
knowledge regarding proper food planning, Malnutrition
is one of the problems that we have in the country.
7. Treatment of Communicable Diseases and Common Illness
 The diseases spread through direct contact pose a great risk
to those who can be infected. Tuberculosis is one of the
communicable diseases continuously occupies the top ten
causes of death. Most communicable diseases are also
preventable. The Government focuses on the prevention,
control and treatment of these illnesses.
8. Supply of Essential Drugs
 This focuses on the information campaign on the
utilization and acquisition of drugs.
 In response to this campaign, the GENERIC ACT of the
Philippines is enacted. It includes the following drugs:
Cotrimoxazole, Paracetamol, Amoxycillin, Oresol,
Nifedipine, Rifampicin, INH (isoniazid) and
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
Major Strategies of Primary Health Care
1. Elevating Health to a Comprehensive and Sustained National
Effort.
 Attaining Health for all Filipino will require expanding
participation in health and health related programs
whether as service provider or beneficiary. Empowerment
to parents, families and communities to make decisions of
their health is really the desired outcome.
 Advocacy must be directed to National and Local policy
making to elicit support and commitment to major health
concerns through legislations, budgetary and logistical
considerations.
2. Promoting and Supporting Community Managed Health Care
  The health in the hands of the people brings the  Soap in soap dish
government closest to the people. It necessitates a process  Thermometers in case [one oral and rectal]
of capacity building of communities and organization to  2 pairs of scissors [1 surgical and 1 bandage]
plan, implement and evaluate health programs at their  2 pairs of forceps [ curved and straight]
levels.  Syringes [5 ml and 2 ml]
3. Increasing Efficiencies in the Health Sector  Hypodermic needles g. 19, 22, 23, 25
 Using appropriate technology will make services and  Sterile dressings [OS, C.B]
resources required for their delivery, effective, affordable,  Sterile Cord Tie
accessible and culturally acceptable. The development of  Adhesive Plaster
human resources must correspond to the actual needs of
 Dressing [OS, cotton ball]
the nation and the policies it upholds such as PHC. The
 Alcohol lamp
DOH will continue to support and assist both public and
private institutions particularly in faculty development,  Tape Measure
enhancement of relevant curricula and development of  Baby’s scale
standard teaching materials.  1 pair of rubber gloves
4. Advancing Essential National Health Research  2 test tubes
 Essential National Health Research (ENHR) is an  Test tube holder
integrated strategy for organizing and managing research  Medicines
using intersectoral, multi-disciplinary and scientific o betadine
approach to health programming and delivery. o 70% alcohol
o ophthalmic ointment (antibiotic)
Four Cornerstones/Pillars in Primary Health Care o zephiran solution
1. Active Community Participation o hydrogen peroxide
2. Intra and Inter-sectoral Linkages o spirit of ammonia
3. Use of Appropriate Technology o acetic acid
4. Support mechanism made available o benedict’s solution
Note: Blood Pressure Apparatus and Stethoscope are carried
separately.
Bag technique-a tool making use of public health bag through Steps/Procedures
which the nurse, during his/her home visit, can perform nursing
Actions Rationale
procedures with ease and deftness, saving time and effort with the
1. Upon arriving at the client’s To protect the bag from
end in view of rendering effective nursing care.
home, place the bag on the table contamination.
Public health bag – is an essential and indispensable equipment of
or any flat surface lined with
the public health nurse which he/she has to carry along when he/she
paper lining, clean side out
goes out home visiting. It contains basic medications and articles
(folded part touching the table).
which are necessary for giving care.
Put the bag’s handles or strap
beneath the bag.
Rationale: To render effective nursing care to clients and /or
members of the family during home visit.
Principles
1. The use of the bag technique should minimize if not totally
prevent the spread of infection from individuals to families, 2. Ask for a basin of water and a To be used for
hence, to the community. glass of water if faucet is not handwashing.
2. Bag technique should save time and effort on the part of the available. Place these outside the To protect the work field
nurse in the performance of nursing procedures. work area. from being wet.
3. Bag technique should not overshadow concern for the patient
rather should show the effectiveness of total care given to an
individual or family.
4. Bag technique can be performed in a variety of ways 3. Open the bag, take the To make a non-
depending upon agency policies, actual home situation, etc., as linen/plastic lining and spread contaminated work field
long as principles of avoiding transfer of infection is carried over work field or area. The paper or area.
out. lining, clean side out (folded part
out).
Special Considerations in the Use of the Bag
1. The bag should contain all necessary articles, supplies and
equipment which may be used to answer emergency needs.
2. The bag and its contents should be cleaned as often as possible, 4. Take out hand towel, soap dish To prepare for
supplies replaced and ready for use at any time. and apron and the place them at handwashing.
3. The bag and its contents should be well protected from contact one corner of the work area
with any article in the home of the patients. Consider the bag (within the confines of the
and it’s contents clean and /or sterile while any article linen/plastic lining).
belonging to the patient as dirty and contaminated. 5. Do handwashing. Wipe, dry Handwashing prevents
4. The arrangement of the contents of the bag should be the one with towel. Leave the plastic possible infection from
most convenient to the user to facilitate the efficiency and wrappers of the towel in a soap one care provider to the
avoid confusion. dish in the bag. client.
5. Hand washing is done as frequently as the situation calls for, 6. Put on apron right side out and To protect the nurses’
helps in minimizing or avoiding contamination of the bag and wrong side with crease touching uniform. Keeping the
its contents. the body, sliding the head into the crease creates aesthetic
6. The bag when used for a communicable case should be neck strap. Neatly tie the straps at appearance.
thoroughly cleaned and disinfected before keeping and re- the back.
using. 7. Put out things most needed for To make them readily
the specific case (e.g.) accessible.
Contents of the Bag thermometer, kidney basin, cotton
 Paper lining ball, waste paper bag) and place
 Extra paper for making bag for waste materials (paper bag) at one corner of the work area.
 Plastic linen/lining 8. Place waste paper bag outside To prevent contamination
 Apron of work area. of clean area.
 Hand towel in plastic bag
 9. Close the bag. To give comfort and 6. prioritization of health problems
security, maintain 7. development of a health plan
personal hygiene and 8. validation and feedback
hasten recovery.
10. Proceed to the specific To prevent contamination Evaluation Phase
nursing care or treatment. of bag and contents. Biostatistics
11. After completing nursing care To protect caregiver and  DEMOGRAPHY – study of population size, composition and
or treatment, clean and alcoholize prevent spread of spatial distribution as affected by births, deaths and migration.
the things used. infection to others.  Sources: Census– complete enumeration of the population
12. Do handwashing again. 2 Ways of Assigning People
13. Open the bag and put back all 1. De Jure– People were assigned to the place where assigned to
articles in their proper places. the place they usually live regardless of where they are at the
14. Remove apron folding away time of census.
from the body, with soiled 2. De Facto– People were assigned to the place where they are
sidefolded inwards, and the clean physically present at are at the time of census regardless, of
side out. Place it in the bag. their usual place of residence.
15. Fold the linen/plastic lining, Components
clean; place it in the bag and 1. Population size
close the bag. 2. Population composition
16. Make post-visit conference on To be used as reference o Age Distribution
matters relevant to health care, for future visit. o Sex Ratio
taking anecdotal notes o Population Pyramid
preparatory to final reporting. o Median age– age below which 50% of the population falls
and above which 50% of the population falls. The lower
the median age, the younger the population (high fertility,
high death rates).
17. Make appointment for the For follow-up care. o Age – Dependency Ratio– used as an index of age-induced
next visit (either home or clinic), economic drain on human resources
taking note of the date, time and o Other characteristics:
purpose. 7.
o occupational groups
o economic groups
After Care o educational attainment
1. Before keeping all articles in the bag, clean and alcoholize o ethnic group
them. 8. Population Distribution
2. Get the bag from the table, fold the paper lining ( and insert), o Urban-Rural– shows the proportion of people living in
and place in between the flaps and cover the bag. urban compared to the rural areas
o Crowding Index– indicates the ease by which a
Evaluation and Documentation communicable disease can be transmitted from 1 host to
1. Record all relevant findings about the client and members of another susceptible host.
the family. o Population Density– determines congestion of the place
2. Take note of environmental factors which affect the Vital Statistics
clients/family health.  The application of statistical measures to vital events (births,
3. Include quality of nurse-patient relationship. deaths and common illnesses) that is utilized to gauge the
4. Assess effectiveness of nursing care provided. levels of health, illness and health services of a community.

COMMUNITY DIAGNOSIS Types of Vital Statistics

 A process by which the nurse collects data about the Fertility Rate
community in order to identify factors which may influence the 1. Crude Birth Rate
deaths and illnesses of the population, to formulate a
community health nursing diagnosis and develop and
Total ¿ of livebirths ∈a givencalendar year
implement community health nursing interventions and Estimated popula
strategies.
2 Types: 2. General Fertility Rate
Comprehensive Community Problem-Oriented
Total ¿ of livebirths ∈a givencalendar year ¿
Diagnosis Community Diagnosis Total number of r
 aims to obtain general  type of assessment
information about the responds to a particular
community need Mortality Rate

1. Crude Death Rate

STEPS:
Preparatory Phase
Total ¿ of deaths∈a given calendar year
Estimated populatio
1. site selection
2. preparation of the community
3. statement of the objectives 2. Infant Mortality Rate
4. determine the data to be collected
5. identify methods and instruments for data collection Total ¿ of deathbelow 1 yr ∈a given calendar year
Estimated
6. finalize sampling design and methods
7. make a timetable
3. Maternal Mortality Rate
Implementation Phase
1. data collection
2. data organization/collation Total ¿ of deathamong all maternal cases∈a given calendar y
3. data presentation
4. data analysis
5. identification of health problems
Morbidity Rate  Hepatitis B
1. Prevalence Rate
Target Setting
Total ¿ of new∧old cases∈a givencalendar year  Infants 0-12¿months x 100
Estimated population as of July
 Pregnant 1 ofPartum
and Post the same calendar year
Women
 School Entrants/ Grade 1 / 7 years old

2. Incidence Rate Objectives of EPI

 To reduce morbidity and mortality rates among infants and
Total ¿ of new cases∈a givencalendar year ¿ from six childhood immunizable xdisease
children 100
Estimated population as of July 1 of the same calendar year
Elements of EPI
 Target Setting
3. Attack Rate  Cold chain Logistic Management- Vaccine distribution through
cold chain is designed to ensure that the vaccines were
Total ¿ of person who are exposed ¿ the disease ¿ under proper environmental condition
maintained x 100until the time
Estimated population as of July 1 of the same calendar year
of administration.
 Information, Education and Communication (IEC)
 Assessment and evaluation of Over-all performance of the
EPIDEMIOLOGY program
 the study of distribution of disease or physiologic condition  Surveillance and research studies
among human population s and the factors affecting such
distribution
 the study of the occurrence and distribution of health
conditions such as disease, death, deformities or disabilities on
human populations

1. Patterns of disease occurrence

Epidemic
 A situation when there is ahigh incidence of new cases of a
specific disease in excess of the expected.
 when the proportion of the susceptible are high compared to
the proportion of the immunes
Epidemic potential
 anarea becomes vulnerable to a disease upsurge due to causal
factors such as climatic changes, ecologic changes, or socio-
economic changes
Endemic
 habitual presence of a diseasein a given geographic location
accounting for the low number of both immunes and
susceptibles.E.g. Malaria is a disease endemic at Palawan.
 Thecausative factor of the disease is constantly available or
present to the area.

Sporadic
 disease occursevery now and then affecting only a small
number of people relative to the total population
 intermittent
Pandemic
 global occurrence of a disease

Steps in Epidemiological Investigation:

1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained
5. Role of the Nurse
 Case Finding
 Health Teaching
 Counseling
 Follow up visit

Expanded Program on Immunization

Principles of EPI
 Epidemiological situation
 Mass approach
 Basic Health Service

The 7 immunizable diseases

 Tuberculosis
 Diptheria
 Pertussis
 Measles
 Poliomyelitis
 Tetanus