Theoretical

Foundations of
Community
Health Nursing
Practice
• The goal of theory is to improve nursing
practice.
• A theory is a group of related concepts that
propose action that guide practice.

• A systematic vision of reality; a set of

interrelated concepts that is useful for
Theory
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)
• A creative and rigorous structuring of ideas that
projects a tentative, purposeful, and systematic
view of phenomena. (Chinn & Kramer)

• A set of ideas, hunches, or hypotheses that

provides some degree of prediction and/or
explanation of the world. (Pryjmachuk)
•

Theory
• Theory organizes the relationships between the
complex events that occur in a nursing situation
so that we can assist human beings. Simply
stated, theory provides a way of thinking about
and looking at the world around us. (Torres)
 GENERAL SYSTEM THEORY
• First proposed by Ludwig von Bertalanffy (1901-1972) as General Systems theory.
• The general system theory is applicable to the different levels of the community
health nurse’s clientele: individuals, families, groups or aggregates, and
communities.
• General systems theory can be applied to nursing in how nurses care for their
patients. Nurses look at the whole picture with their patients, not just the one issue
at hand. They help patients in all aspects of their life and health, anyway they can.
• General system theory describes “ how to break whole things into parts and then
to learn how the parts work together in systems”. General system theory is known
by different names - systems theory, theory of open systems, systems model, and
family systems theory
Systems are usually complex and consist of several parts called subsystems.

Each system is a part of a larger system known as a super system, a collection of two or
more systems into a larger system.

A separation that differentiates one system from another is called boundary.

Boundaries that separate it from its environment as well as regulate its exchange of
matter energy, and information with its environment.

The family environment constitutes everything outside its boundaries that may affect it.
1. Is based on the belief that learning takes place
in a social context, that is, people learn from one
another and that learning is promoted by
modeling or observing other people.

2. It is anchored on the fact that persons are

thinking beings with self-regulatory capacities,
capable of making decisions and acting according
to expected consequences of their behavior.

Social Learning
Theory
The nurse applies this theory in different ways:

- By serving as a model

- By giving detailed verbal instructions

- By using print or multimedia strategies

 Attention
The nurse Retention
facilitates
learning
through: Reproduction

Motivation
 It was developed in the 1950s by a group of U.S. Public Health
Service social psychologists who wanted to explain why so few
people were participating in programs to prevent and detect
disease.

HBM is a good model for addressing problem behaviors that

evoke health concerns (e.g., high-risk sexual behavior and the
possibility of contracting HIV) (Croyle RT, 2005)
Health Belief
Model HBM is a popular model applied in nursing, especially in
issues focusing on patient compliance and preventive health
care practices.

The model postulates that health-seeking behaviour is

influenced by a person’s perception of a threat posed by a
health problem and the value associated with actions aimed at
reducing the threat.
 There are six
1.      Perceived
major concepts in
Susceptibility
HBM:

THE MAJOR 2.      Perceived

severity
3.      Perceived
benefits
CONCEPTS AND
DEFINITIONS OF
4.      Perceived 5.      Cues to
THE HEALTH barriers action
PROMOTION
MODEL 6.      Self-
efficacy
- Nancy Milio developed a framework for prevention that
includes concepts of community – oriented, population-
focused care.

- Milio stated that behavioural patterns of the

populations-and individuals who make up populations –
Milio’s Framework for
are a result of habitual selection from limited choices. Prevention
- She challenged the common notion that a main
determinant for unhealthful  behavioural choice is lack of
knowledge.

- Milio’s framework described a sometimes neglected

role of community health nursing to examine the
determinants of a community’s health and attempt to
influence those determinants through public policy.

- Provides a complement to the HBM and provides a

mechanism for directing attention upstream and
examining opportunities for nursing intervention at the
population level.
 Pender’s Health Promotion Model

- Health Promotion Model indicates preventative health measures and describes nurses’ critical function in helping
patients prevent illness by self-care and bold alternatives.

- The Health Promotion Model notes that each person has unique personal characteristics and experiences that affect
subsequent actions. The set of variables for behavioral specific knowledge and effect have important motivational
significance.

-These variables can be modified through nursing actions. Health-promoting behavior is the desired behavioral
outcome and is the endpoint in the Health Promotion Model.

- Health-promoting behaviors should result in improved health, enhanced functional ability, and better quality of life
at all development stages. The final behavioral demand is also influenced by the immediate competing demand and
preferences, which can derail intended health-promoting actions.
 Health promotion is defined as behavior motivated by the
desire to increase well-being and actualize human health
potential. It is an approach to wellness.

Major Individual characteristics and experiences - (prior related

behavior and personal factors).
Concepts of
the Health Behavior-specific cognitions and affect (perceived benefits of
action, perceived barriers to action, perceived self-efficacy,
Promotion activity-related affect, interpersonal influences, and situational
influences).
Model
Behavioral outcomes (commitment to a plan of action,
immediate competing demands and preferences, and health-
promoting behavior).
 Personal biological factors. Include variables
such as age, gender, body mass index, pubertal
status, aerobic capacity, strength, agility, or
balance.

Sub-concepts Personal psychological factors. Include

of the Health variables such as self-esteem, self-motivation,
personal competence, perceived health status, and
Promotion definition of health.

Model Personal socio-cultural factors. Include

variables such as race, ethnicity, acculturation,
education, and socioeconomic status.
Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action

Anticipated, imagined, or real blocks and personal costs of understanding a given behavior.

Perceived Self-Efficacy

The judgment of personal capability to organize and execute a health-promoting behavior. Perceived self-efficacy influences perceived barriers to
action, so higher efficacy results in lowered perceptions of barriers to the behavior’s performance.

Activity-Related Affect

Subjective positive or negative feeling occurs before, during, and following behavior based on the stimulus properties of the behavior itself.

Activity-related affect influences perceived self-efficacy, which means the more positive the subjective feeling, the greater its efficacy. In turn,
increased feelings of efficacy can generate a further positive affect.
• Interpersonal Influences
• Cognition concerning behaviors, beliefs, or attitudes of others. Interpersonal influences include norms (expectations of
significant others), social support (instrumental and emotional encouragement), and modeling (vicarious learning through
observing others engaged in a particular behavior). Primary sources of interpersonal influences are families, peers, and
healthcare providers.
• Situational Influences
• Personal perceptions and cognitions of any given situation or context can facilitate or impede behavior. Include perceptions
of options available, demand characteristics, and aesthetic features of the environment in which given health-promoting is
proposed to take place. Situational influences may have direct or indirect influences on health behavior.
• Commitment to Plan of Action
• The concept of intention and identification of a planned strategy leads to the implementation of health behavior.
• Immediate Competing Demands and Preferences
• Competing demands are those alternative behaviors over which individuals have low control because of environmental
contingencies such as work or family care responsibilities. Competing preferences are alternative behaviors over which
individuals exert relatively high control, such as choice of ice cream or apple for a snack.
• Health-Promoting Behavior
• A health-promoting behavior is an endpoint or action-outcome directed toward attaining positive health outcomes such as
optimal wellbeing, personal fulfillment, and productive living.
 The TTM is based on the assumption that behavior change takes place over time,
progressing through a sequence of stages.
Change is difficult, even for the most motivated individuals.

People resist change for many reasons. Change may:

1. Be unpleasant

2. Require giving up pleasure

Transtheoretical 3. Be painful
Model
4. Be stressful

5. Jeopardize social relationships

6. Not seem important anymore

7. Require change in self-image

 The Stages of Change Model, also called the Transtheoretical Model, explains an
individual's readiness to change their behavior. It describes the process of behavior
change as occurring in stages. These stages include:

Pre-contemplation: There is no intention of taking action.

Stages of Change
Contemplation: There are intentions to take action and a plan to do so in the near
future.

Model Preparation: There is intention to take action and some steps have been taken.
(Transtheoretical
Model) Action: Behavior has been changed for a short period of time.

Maintenance: Behavior has been changed and continues to be maintained for the

long-term.

Termination: There is no desire to return to prior negative behaviors.

 Developed by Dr. Lawrence W. Green

PRECEDE-PROCEED Model provides a model for community assessment, health

education planning, and evaluation.

PRECEDE- PRECEDE stands for predisposing, reinforcing, and enabling constructs in

PROCEED educational diagnosis and evaluation.

Model PROCEED, is an 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 refer to people’s characteristics that motivate

them toward health-related behavior.
The PRECEDE-PROCEED model 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 provides the structure for planning a targeted and focused public
health program.

PROCEED provides the structure for implementing and evaluating the public
health program.