NCM 113j, Community

Health Nursing
(Population group, and
Community as client)
week 1
Prepared by:
Mary Ruth V. Enriquez, RN MAN
Elena M. Tierra, RN, MN
Shohadaa B. Mandangan RN MAN
 OVERVIEW OF PUBLIC HEALTH
NURSING IN THE PHILIPPINES
INTRODUCTION
 Community health nursing is one of the two major fields of nursing in the
Philippines; the other is hospital nursing.
 Generally use the terms: Community Health Nursing/Public Health Nursing,
and Community Health Nurse/ Public Health Nurse interchangeably.
 Those who work in Rural Health Units (RHUs) or Health Centers are
community health nurses and are officially called Public Health Nurses (PHNs).
 Occupational health nurses (Company Nurses) and School health nurses are
classified as Community Health Nurses.
 The Department of Health and public health system have evolved into what it is
now in response to the challenges of the times, so has Public Health Nursing
practice been influenced by the changing global and local health nursing been
influenced by the changing global and local health trends.
 Terms:
COMMUNITY:
a group of people with common characteristics or interests living
together within a territory or geographical boundary
 Is a group of people sharing common geographic boundaries and / or
common values and interests.
 HEALTH (WHO definition)
 Is
a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
 Community Health
 Part of paramedical and medical intervention approach which is
concerned on the health of the whole population
 Aims:
 Health promotion
 Disease prevention
 Management of factors affecting health
Public Health (Dr. C.E. Winslow, 1920)
 the “science and art of preventing disease, prolonging life and promoting health and
efficiency through organized community effort for the :
 sanitation of the environment
 control of communicable diseases
 education of the individual in personal hygiene
 The organization of medical and nursing services for the early diagnosis and preventive
treatment of disease
 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.E Winslow)
 Mission of CHN
 Health Promotion
 Health Protection
 Health Balance
 Disease prevention
 Social Justice
 Public Health Nursing
 The World Health Organization Expert Committee of Nursing defined,
 As a “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 programme for the promotion of health, the
improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability.”
 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)
 A service rendered by a professional nurse to IFCs
(individual, family & community), 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).
Community Health Nursing- service rendered by a nurse to different clientele:
 Individuals
 Families
 Population groups
 Communities
 school

Home

Health Center

clinic
Philosophy :
“The philosophy of CHN is based on the
worth and dignity of man.”(Dr. M.
Shetland)
 Basic Principles of CHN
 The community 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.
 In CHN, the client is considered as an ACTIVE partner NOT PASSIVE
recipient of care
 CHN practice is affected by developments in health technology, in particular,
changes in society, in general
 The goal of CHN is achieved through multi-sectoral efforts
 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
 Health Advocator, who speaks on behalf of the client
 Advocator, who act on behalf of the client
 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
Responsibilities of CHN
 be a part in developing an overall health plan, its implementation and
evaluation for communities
 provide quality nursing services to the three levels of clientele
 maintain coordination/linkages with other health team members,
NGO/government agencies in the provision of public health services
 conduct researches relevant to CHN services to improve provision of
health care
 provide opportunities for professional growth and continuing education
for staff development
 Features of CHN Practice:
In addition to its preventive approach to health, community health
nursing is characterized by
 Its being population- or aggregate-focused,
 Its developmental nature, and existence of a prepayment
mechanism for consumers of community health nursing services.
 Unlike nurses who work in the hospital settings, community health
nurses care for different levels of clientele.
Theoretical Models/Approaches
 1. The Health Belief Models
 2. Milo’s Framework for Prevention
 3. Nola Pender’s Health Promotion
 4. Lawrence Green’s Precede-Proceed Model
 5. Proceed –Policy Regulatory and Organizational Construct in
Educational and Environmental Development
The Health Belief Model
 Initially proposed in 1958
 HBM provides the basis for much of practice of health education and health
promotion today.
 HBM was developed by a group of social psychologists to explain why the
public failed to participate in screening for tuberculosis (Hochbaum, 1958).
 Hochbaum and his associates had the same questions that perplex many
health professionals today:
 Why do people who may have a disease reject health screening? Why do
individuals participate in screening if it may lead to the diagnosis of disease?
Conceptual Frameworks in Health
Behavior
 HBM, has been used to explain behavior change and maintenance of
behavior change to guide health promotion interventions (Janz et
al.,2002)
Key concepts and definitions of the Health Belief Model (Janz et al.,2002)
CONCEPT DEFINITION
Perceived Susceptibility One’s belief regarding the chance of getting a given condition.

Perceived Severity One’s belief regarding the seriousness of a 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

take action.

Self-efficacy One’s confidence in one’s ability to take action to reduce health risks.
Milio’s Framework for Prevention
Milio, N. (1976) A framework for prevention: Changing health-damaging to
health-generating life patterns. AJPH, 66(5), 435-439.

 Nancy Milio outlined Six propositions relating to health promotion and

 disease prevention.
 Milio asserted that health deficits occur when there is an imbalance between a
community’s health needs, and its health-sustaining resources.
 All human beings make health choices that are the easiest for them to make, most of
the time.
 Central thesis is that if we wish to support health promoting patterns, then we must
focus on the central problem of how to make health-damaging choices more difficult
when health-promoting behaviors are realistically and easily available.
 Application of Milio’s Framework in Public health Nursing (Milio, 1976)
Milio’s Proposition Population Health Examples
Summary

Population health deficits’ result Individuals and families living in poverty have poorer health status compared with middle- and upper-class
from deprivation and/or excess of individuals and families.
critical health resources

Behavior of populations result from Positive and negative lifestyle choices (e.g., smoking, alcohol use, safe sex practices, regular exercise,
selection from limited choices; these diet/nutrition, seatbelt use) are strongly dependent on culture, socioeconomic status, and educational level.
arise from actual and perceived
options available as well as beliefs
and expectations resulting from
socialization, education, and
experience.

Organizational decisions and
policies ( both governmental and
nongovernmental) dictate many of
the options available to individuals
and populations and influence
choices.
Health insurance coverage and availability are largely determined and financed by the government through
the National Health Insurance Corporation ( PhilHealth) and private insurance (out-of-pocket expense by
patients or provided by employers); the source and funding of insurance influences health provider choices
and services.
 Milio’s Framework
Milio’s Proposition Summary
Individual choices related to health promotion or health
damaging behaviors are influenced by efforts to maximize
valued resources.
Alteration in patterns of behavior resulting from decision
making of a significant number of people in a population can
result in social change.
Without concurrent availability of alternative health-promoting
options for investment of personal resources, health education
will be largely ineffective in changing behavior patterns.
Population Health Examples
Choices and behaviors of individuals are strongly influenced by
desires, values, and beliefs. For example, the use of illegal drugs
by adolescents is often dependent on peer pressure and the need
for acceptance, love, and belonging.
Some behaviors such as tobacco use have become difficult to
maintain in many settings or situations in response to
organizational and public policy mandates.
Addressing persistent health problems(e.g. hypertension) is
hindered because most people are very aware of what causes the
problem, but are reluctant to make lifestyle changes to prevent or
reverse the condition. Often, “new” information ( e.g., a new
diet) or resources ( e.g., a new medication) can assist in attracting
attention and directing positive behavior changes.
Nola Pender’s Health Promotion Model (HPM)
 Developed in the 1980s, revised in 1996
 Explores many biopsychosocial factors that influence individuals to
pursue health promotion activities.
 HPM depicts the complex multidimensional factors with which
people interact as they work to achieve optimum health.
Pender’s Health Promotion Model (HPM)(Pender et
al.,2006)

Individual characteristics and experiences
Prior related behavior
Each person’s unique characteristics and experiences
affect his her actions. Their effect depends on the
behavior in question.
Prior behaviors influence subsequent behavior through
perceived self-efficacy, benefits, barriers, and affects
related to that activity. Habit is also a strong indicator of
future behavior.

Personal factors Personal factors that may influence behavior are

biological factors such as age, body mass index,
strength, and agility; psychological factors include self-
esteem, self-motivation, and perceived health status;
sociocultural factors include race, ethnicity,
acculturation, education, and socioeconomic status.
Pender’s HPM
Behavior- specific cognition and affect
Perceived benefits of action
Perceived barriers of action
In the PHM, these variables are considered to be very
significant in behavior motivation. They are a “core” for
intervention because they may be modified through
nursing actions. Assessment of the effectiveness of
interventions is accomplished by measuring the change in
these variables.
The perceived benefits of a behavior are strong
motivators of that behavior. These motivate behavior
through intrinsic and extrinsic benefits. Intrinsic benefits
include increased energy and decreased appetite.
Extrinsic benefits include social rewards such as
compliments and monetary rewards.
Barriers are perceived unavailability, inconvenience,
expense, difficulty otr time regarding health behaviors.
Pender’s HPM
Perceived self-efficacy Self-efficacy is one’s belief that he or sheis capable of
carrying out a health behavior. If one has high self-
efficacy regarding a behavior, one is more likely to engage
in that behavior than if one has low self-efficacy.

Activity-related affect The feelings associated with a behavior will likely affect
whether an individual will repeat or maintain the behavior.

Interpersonal influences In the HPM, these are feelings or thoughts regarding the
beliefs or attitudes of others. Primary influences are
family, peers, and health care providers.

Situational influences These are perceived option available, demand

characteristics, and aesthetic features of the environment
where the behavior will take place , for example, a lovely
day will increase the probability of the one taking awalk;
the fire code will prevent one from smoking indoors.
Pender’s HPM
Commitment to a plan of action
Immediate competing demands and preferences
Health-promotion behavior
Pender states that “commitment to a plan of action
initiates a behavioral event” (pender et al.,2006, p56).
This commitment will compel one into the behavior
until completed, unless a competing demand or
preference intervenes.
These are alternative behavior that one considers as
possible optional behaviors immediately prior to
engaging in the intended, planned behavior. One has
little control over competing demands, but one has great
control over competing preferences.
This is the goal or outcome of the HPM. The aim of
health-promoting behavior is the attainment of positive
health outcomes.
 Lawrence Green’s Precede-Proceed Model
 Developed by Dr.Lawrence W. Green and colleagues
 Provide for community assessment, health education planning, and
evaluation.
 PRECEDE: which stands for PREDIPOSING, REINFORCING and
enabling Constructs in educational Diagnosis and Evaluation, is used for
community diagnosis.
 PROCEED: an ACRONYM for POLICY, REGULATORY, and
ORGANIZATIONAL CONSTRUCT in EDUCATIONAL and
ENVIRONMENTAL DEVELOPMENT, is a model for implementing and
evaluating health programs based on PRECEDE.
Precede Proceed Model
 Predisposing factors refers to people’s characteristics that motivate
them toward health –related behavior.
 Enabling factors refers to conditions in people and the environment that
facilitate or impede health-related behavior.
 Reinforcing factors refer to feedback given by support persons or
groups resulting from the performance of the health related behavior.
QUIZ
 a) “PUBLIC HEALTH SERVICES ARE GIVEN FREE OF
CHARGE’’ IS THIS STATEMENT TRUE OR FALSE?ay indirectly
for public health services.
 b) The statement maybe true or false;depending on the specific
service required.
 c) The statement maybe true or false;depending on policies of
the government concerned.
 2. According to C.E. Winslow, which of the following is the
goal of Public Health?

a) For people to attain their birthrights and

longevity.
b) For promotion of health and prevention of
diseases
c) For people to have access to basic health
services.
d) For people to be organized in their health
efforts
 3. Which is the primary goal of community health
nursing?
a)To support and supplement the efforts of the medical
profession in the promotion of health and prevention of diseases.

b)To enhance the capacity of individuals,families and community to cope

with their health needs

c)To increase the productivity of the people by providing them with services
that will increase their level of health

d)To contribute to national development thru promotion family welfare

focusing particularly on mother and children.
 4. Tertiary prevention is needed in which stage of the
natural history of disease?

a) Pre-pathogenesis
b) Pathogenesis
c) Predromial
d) Terminal
 5. The philosophy of CHN is based on the worth of dignity of
men

a) Dr. M. Shetland
b) Dr. Freeman
c) WHO
d) DOH
 6. Other specific responsibilities of the nurse is spelled by the
implementing rules and regulations of RA 7164

a) Philippine Nurse Act of 1991

b) Nursing Law
c) Public Health Nurse Law
d) Community Law
7.-9.Enumeration: Give the three roles
of a public health nurse (3pts.)
 10. This is initially proposed in 1958, provides the basis for
practice of health education and health promotion of today.

a) Health Belief Model

b) Nilos Framework For Prevention Model
c) Nola Penders Health Promotion Model
d) Proceed Model
 11. The use of ICT for health (WHO 2012)

a) E-Health
b) EMR
c) Information Technology
d) WHA
 12. According to Margaret Shetland the philosophy of public
health nusring is based on which of the following:

a) Health and longevity of birth rights

b) The mandate of the state to protect the birth
rights of its citizens
c) Public Health Nursing as specialization field of
nursing
d) The worth of dignity of men


11. The region IV hospital is as classified as what level of facility.

a) Primary

b) Secondary

c) Intermediate
d) Tertiary
 14. The Delos Reyes couple have a six-year old child entering
school for the first time. The Delos Reyes family has a:

a) Health Threat
b) Health Deficit
c) Foreseeable Crisis
d) Stress Point
15.-16. Differentiate Public Health Nurse and
Community Health Nurse (2pts.)
17.-20. What is a healthy community?
(4pts.)