group perspective or identify based on culture values,

COMMUNITY HEALTH NURSING 2 PRELIM

history, interests, and goals
Community Health Nurses
Health
➢ Community Health Nurses assists in the transition of
➢ Basic human right
the Philippine health care system from a disease
➢ Important prerequisite and consequence of
oriented-system to health-oriented system by
development
focusing on health promotion and disease prevention.
➢ By promoting health and preventing disease it
Community contributes to the country’s’ economic and social
development
➢ Social group determined by geographical boundaries
➢ Is a state of complete physical, mental, and social
and/or common values and interests (WHO,1998)
well. (WHO, 1958)
➢ Members interact with each other, functions within a
➢ Being and not merely the absence of disease or
particular social structure, exhibits and creates norms
infirmity.
and values and establishes social institutions.
➢ State of well being in which the person is able to use
➢ Collection of people who interact with one another
purposeful, adaptive response and processes
and whose common interest or characteristics form
physically, mentally, emotionally, spiritually, and
the basis for a sense of unity or belonging (Allender
socially. (Murray et. Al 2009)
et al. 2009)
➢ A quality of life, involving social, emotional, mental,
➢ A group of people who share something in common
spiritual, and biological fitness on the part of the
and interact with one another, who may exhibit a
individual, which results from adaptations to the
commitment with one another and may share a
environment. (Butler, 2001)
geographic boundary
➢ A group of people who share common interests, who Community Health Nursing
interact with each other, and who function
➢ Synthesis of nursing practice and public health
collectively within a defied social structure to address
practice applied to promoting and preserving the
common concerns
health of populations
➢ Four defining attributes by Maurer and Smith
➢ Emphasizes preservation and protection of health
▪ People
▪ Place ➢ Primary client is the community
➢ Services are both indirect and direct
▪ Interaction
▪ Common characteristics, interests, or goals
Public Health Nursing

Geopolitical Communities ➢ Field of professional practice in nursing and in public

health in which technical skills, interpersonal,
➢ defined or formed by both natural and man- made
analytical and organizational skills are applied to
boundaries and include barangays, municipalities
problems of health as they affect the community
cities, provinces, regions, and nations
➢ In the Philippines, it is seen as a subspecialty nursing
Phenomenological Communities practice generally delivered within official or
governmental agencies
➢ refer to relational, interactive groups, in which the
place or setting is more abstract, and people share a
Community-Based Nursing ➢ Practice is affected by changes in society in general,
and by development in the health field.
➢ Application of nursing process in caring for
➢ Community health nursing is a part of functions
individuals, families, and groups where they live,
within a large and complex system and any change in
work, school as they move through the health system.
this system affects it
➢ Primary clients are the individuals and the family
Levels of Clientele
Population – focused nursing
Individual
➢ Concentrates om specific groups of people and
focuses on health promotion and disease prevention. ➢ Sick or well on a daily basis
➢ Population focused practice focuses on the entire ➢ Problems of individual are intertwined with those of
population, based on assessment of the populations the other members of the family and community
health status, considers the broad determinants of ➢ Entry point in working with these clients
health, emphasizes all levels of prevention and
Family
intervenes with communities, systems, individuals
and families. ➢ Collection of people who are integrated, interacting
and interdependent
Characteristics of Community Health Nursing
➢ Family members interact with each other and the
➢ Promotion of health and prevention of disease are the action of one affects the other members
goals of professional practice
Population group
➢ Comprehensive, general, continual, and not episodic
➢ Practitioner recognizes the primacy of the population ➢ Who share common characteristics, developmental
as a whole stage or common exposure to particular environment
➢ Nurse and client collaborate equals factors, and consequently common health problems
➢ The nurse recognizes the impact of different factors issues and concerns
on health and has a greater awareness of his/her
clients lives and situations. Community

Principles in Community Health Nursing Practice ➢ Group of people sharing common geographic
boundaries and or common values and interests
➢ The family is the unit of care hence the community within a specific social system
health nurse considers the health needs of all the ➢ Webs of people shaped by relationships,
members of the family in providing nursing services interdependence, mutual interests, and patterns of
➢ The community as a whole is the locus of service and interaction
the patient
➢ The goal in improving community is realized through STANDARDS OF CARE
multidisciplinary approach. Assessment Collects comprehensive data
pertinent to the health status
➢ The community health nurse is deeply concerned
of populations
with increasing the capability of the four levels of
Population Diagnosis and Analyzes the assessment
clientele Priorities data to determine the
population diagnoses and
➢ The public health nurse works with and not for the
priorities
client who is an active partner
 Determinants of Health and Disease
Outcome Identification Identifies expected outcome
for plan based on diagnoses
and priorities Biology
Planning Strategies, action plans and
alternatives to attain ➢ individuals genetic make-up, family history and any
expected outcomes physical and mental health problems developed in the
Implementation Implements identified plan course of life, hereditary, aging, diet physical
by partnering with others
- Coordination activity, lifestyle ,vices and toxic or infectious agent
- Health Education
and promotion may produce illness or disability changing an
- Consultation individual’s biology.
- Regulatory
Activities
Behaviors
Evaluation Evaluates health status of
the population
➢ are the individual’s responses to internal stimuli and
Quality of Practice Systematically enhances
quality and effectiveness of external conditions.
nursing practice
Social Environment
Education Attains knowledge and
competency that reflects
current nursing and public ➢ includes interactions and relationships with family,
health practice friends, coworkers and others in the community
Professional Practice Evaluation of owns practice
Evaluation in relation to professional Physical Environment
practice standards and
guidelines, relevant statutes,
rules and regulations. ➢ Physical environment is what is experienced by the

Collegiality and Establishes partnerships senses, what is smelled, seen, touched, heard
Professional Relationships while interacting with and tasted. If there are poisonous or infectious
representatives of the
population, organizations substances in the environment it has a negative
and health and human influence on health while sanitary environment with
services professionals, and
contributes to the areas to create and play is good influence to health
professional development of
peers, students, colleagues Policies and Interventions
and others
Collaboration Collaborate with partners in ➢ Policies and interventions can have a profound effect
providing for and promoting
on health of individuals, groups, and
the health of the population
communities. Positive effects such as policies
Ethics Integrates ethical provisions
in all areas of practice against smoking in public areas and enhanced health
Research Integrates findings in care promote health.
practice
Resource utilization Considers of safety, cost Income and Social Status-higher
population effectiveness, impact on
practice and in the planning ➢ income and social status are linked to better health.
and delivery of nursing and
public health programs, The greater the gap between the richest and poorest
policies and services people, the greater the differences in health.
Leadership Provides leadership in
nursing and public health
Education ➢ Theory is like a map of a territory is does not give the
full terrain (full picture) instead it picks out those
➢ low education levels are linked with poor health,
parts that are important for its given purpose
more stress and lower self-confidence.
General Systems Theory
Employment and working conditions
➢ Viewed as an open system
➢ people in employment are healthier particularly those
➢ Client exchange energy, matter or information with
who have control over their working conditions
the external environment (Katz and Kahn, 1966)

Culture ➢ Individual is a set of several dimensions physical,

psychological, social and spiritual that are
➢ customs and traditions and the beliefs of the family interdependent and interrelated.
and community all affect health ➢ Family and group are set of interrelated individuals
➢ Geographic community is composed of a set of
Personal behavior and Coping skills
families.
➢ balance eating, keeping active, smoking, ➢ Useful for nurses in analyzing interrelationships of
drinking, and how we deal with life's stresses the elements within the client as well as those of the
and challenges all affect health. client and environment.

Health Services

➢ access and use of services that prevent and treat

disease influences health.

Gender

➢ men and women suffer from different types of

diseases at different ages.

Theories

➢ The complexity of community health problems

makes it impossible for a nurse to make a substantial
improvement in health. ➢ Learning takes place in a social context; people learn
➢ The nurses need to think strategically to know where from one another by modeling or observing other
to focus on people
➢ The nurse needs to build strong relationships with ➢ Persons are thinking beings with self-regulatory
community partners capacities, capable of making decisions and acting to
➢ Nurses need to advocate for their constituencies in a expected consequences of their behavior.
scientifically, responsible, logical, and persuasive ➢ The environment affects learning, but learning
manner outcomes depends on the learners individual
➢ The goal of theory is to improve nursing practice characteristics
➢ Theory-based practice guides data collection and
interpretation in a clear and organized manner to
easily diagnosed and address health problems
Social Learning Theory

➢ In practice this model focuses the nurse’s energies on

interventions designed to modify the client’s distorted
perceptions, without acknowledging the health
professional’s responsibility to reduce or alter health
care barriers other than patients’ perspectives.
➢ Nurses need to examine the root causes of health
opportunities and behaviors in the community
causing inaction or inappropriate health action

Milio’s Framework for Prevention

➢ Noted that available health choices is critical in

Health Belief Model
shaping a society’s overall health status
➢ Information alone is rarely enough to motivate one to ➢ Policy decisions in governmental and private
act organizations shape the range of choices available to
➢ Information must be related in some way to individuals
individual’s needs ➢ National-level policy making is the best way to
➢ Individuals must know what to do and how to do it impact health rather than concentrating efforts on
before they can take action. imparting information in an effort to change
➢ Determinant of preventive health behavior is disease individual patterns of behavior
avoidance ➢ Health deficits often result from an imbalance
between health needs and health sustaining resources.
➢ Diseases associated with excess (obesity and
alcoholism) afflict affluent societies, and the diseases
that result from inadequate or unsafe food, shelter
and the water afflict the poor.
Application Of Milio’s Framework In Public Health Nursing ➢ Pender’s health promotion model defines health as “a
positive dynamic state not merely the absence of
disease.” Health promotion is directed at increasing a
client’s level of well-being. It describes the multi-
dimensional nature of people as they interact within
the environment to pursue health.

➢ Personal Factors
▪ Personal factors are categorized as
biological, psychological, and socio-cultural.
▪ Personal biological factors. Include age,
gender, body mass index, pubertal status,
aerobic capacity, strength, agility, or
balance.
▪ Personal psychological factors. Include
self-esteem, self-motivation, personal
competence, perceived health status, and
definition of health.

Heath Promotional Model ▪ Personal socio-cultural factors. Include

race, ethnicity, acculturation, education, and
➢ Health Promotion Model notes that each person has socioeconomic status.
unique personal characteristics and experiences that ➢ Interpersonal Influences
affect subsequent actions. ▪ Behaviors, beliefs, or attitudes of others.
➢ The set of variables for behavioral specific ▪ Interpersonal influences include norms
knowledge and effect have important motivational (expectations of significant others), social
significance. support (instrumental and emotional
➢ Health-promoting behavior is the desired behavioral encouragement), and modeling (vicarious
outcome and is the endpoint in the Health Promotion learning through observing others engaged
Model in a particular behavior).
 ▪ Primary sources of interpersonal influences control because of environmental
are families, peers, and healthcare providers. contingencies such as work or family care
➢ Situational Influences responsibilities.
▪ Personal perceptions and cognitions of any ▪ Competing preferences are alternative
given situation or context can facilitate or behaviors over which individuals exert
impede behavior. relatively high control, such as choice of ice
▪ Include perceptions of options available, cream or apple for a snack.
demand characteristics, and aesthetic
Health Promoting Behavior
features of the environment in which given
health-promoting is proposed to take place. ➢ A health-promoting behavior is an endpoint or
▪ Situational influences may have direct or action-outcome directed toward attaining positive
indirect influences on health behavior. health outcomes such as optimal wellbeing, personal
➢ Prior Related Behavior fulfillment, and productive living.
▪ Perceived Benefits of Action ➢ Persons are more likely to commit to and engage in
❖ Anticipated positive outcomes that health-promoting behaviors when significant others
will occur from health behavior. model the behavior, expect the behavior to occur, and
▪ Perceived Barriers to Action provide assistance and support to enable the behavior.
❖ Anticipated, imagined, or real ➢ Families, peers, and health care providers are
blocks and personal costs of important sources of interpersonal influence that can
understanding a given behavior. increase or decrease commitment to and engagement
▪ Perceived Self-Efficacy in health-promoting behavior.
❖ The judgment of personal ➢ Situational influences in the external environment can
capability to organize and execute a increase or decrease commitment to or participation
health-promoting behavior. in health-promoting behavior.
▪ Activity-Related Affect ➢ The greater the commitments to a specific plan of
❖ Subjective positive or negative action, the more likely health-promoting behaviors
feelings occur before, during, and will be maintained over time.
following behavior based on the ➢ Commitment to a plan of action is less likely to result
stimulus properties of the behavior in the desired behavior when competing demands
itself. over which persons have little control require
❖ Activity-related affect influences immediate attention.
perceived self-efficacy, which ➢ Commitment to a plan of action is less likely to result
means the more positive the in the desired behavior when other actions are more
subjective feeling, the greater its attractive and preferred over the target behavior.
efficacy ➢ Persons can modify cognitions, affect, and the
➢ Commitment to Plan of Action interpersonal and physical environment to create
▪ The concept of intention and identification incentives for healthy actions
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
The Transtheoretical Model ➢ Enabling factor
▪ refer to conditions in people and the
➢ Based on the assumption that behavior change takes
environment that facilitate or impede health
place over time, progressing through sequence of
related behavior
stages
➢ Reinforcing factor
➢ Each stages is both stable and open to change , one
▪ refer to feedback given by support persons
may stop in one stage, progress to the next stage , or
or groups resulting from the performance of
return to the previous stage
the health related behavior
➢ Change is difficult even for the most motivated of
➢ PROCEED stands for policy, regulatory, and
individuals.
organizational constructs in educational and
➢ People resist change …. change may be…
environmental development
▪ Unpleasant (exercising)
➢ Model for implementing and evaluating health
▪ Require giving up pleasure (eating desserts
programs based on PRECEDE
or fruits)
▪ Painful (insulin injections)
▪ Stressful (eating new foods)
▪ Jeopardize social relationship
▪ Not seem important
▪ Require change in self-image (from couch
potato to athlete)

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 used for community diagnosis.
➢ Predisposing factor
▪ refer to people’s characteristics that motivate
them toward health-related behavior