Community Health Nursing II

Community Health Nursing:

According to David B. Clark:
“Synthesis of nursing knowledge and practice and the science and practice of public health,
implemented via a systematic use of the nursing process and other process to promote health and
prevent illness in population group”.
 Community health nursing is one of the two major fields of nursing in the Philippines
 The other is hospital nursing.
 Those who work in rural health units (RHUs) or health centers are community health nurses and
are officially called Public Health Nurses (PHNs).
 Occupational nurses (company nurses) and School health nurses are classified as community
health nurses.

According to American Nurses Association:

 Community health nursing practice promotes and preserves the health of populations by
integrating the skills and knowledge relevant to both nursing and public health.
 The practice is comprehensive and general, and is not limited to a particular age or diagnostic
group.
 It is continual, and it is not limited to episodic care.
 Community health nursing practice includes nursing directed to individuals, families; the
dominant responsibility is to the population as a whole.

Philosophy and Principles

Goal
 The ultimate goal of community health services is to raise the level of health of the citizenry.
 To this end, the goal of community health nursing is to help communities and families to cope
with the discontinuities in health and threats.
Objectives
 To participate in the development of an over-all health plan for the community and its
implementation and evaluation.
 To provide quality nursing services to individuals, families and communities utilizing as basis, the
standards set for community health nursing practice.
 To coordinate nursing services with various members of the health team, community leaders
and significant others GO and NGOs in achieving the aims of public health services within the
community.
 To participate in and/or conduct researches relevant to community health and community
health nursing services and disseminate their results for improvement of health care.
 To provide community health nursing personnel with opportunities for continuing education
and professional growth through staff development.
Important Points in Community Health Nursing:
 The goal of professional practice is the promotion and prevention of the health of populations;
 The nature of practice is comprehensive, general, continual and not episodic;
 The knowledge base comes from the nursing and public health;
 The different levels of clientele-individuals, families and groups;
 The practitioner's recognition of the primacy of the population as a whole

1
 Features of Community Health Nursing

Characteristics or Distinguishing Attributes of Community

Health Nursing
 greater control for both the nurse and the client in making decisions related to health care;
 collaboration between nurse and client as equals;
 recognition of the impact of different factors on health;
 Nurses greater awareness of their client's lives and situations.

The six basic elements of nursing practice incorporated in community health programs and services
are
◦ Promotion of healthful living
◦ Prevention of health problems
◦ Treatment of disorders
◦ Rehabilitation
◦ Evaluation
◦ Research
Major Roles
 The focus of nursing includes not only the individual, but also the family and the community,
meeting these multiple needs requires multiple roles such as:
 Care provider
 Educator
 Advocate
 Manager
 Collaborator
 Leader
 Researcher

Major Settings
Settings for community health nursing can be grouped into six categories:
 Homes
 Ambulatory care setting
 Schools
 Occupational health settings
 residential institutions
 The community at large
Community health nursing practice is not limited to a specific area, but can be practiced anywhere.

Clients of the Community Health Nurse

 Individual – Sick or well on a daily basis. These are the people who consult at the health center
and receive health services such as prenatal supervision, well-child follow-ups and morbidity
services.
 These also include clients with chronic illnesses such as diabetes mellitus and hypertension who
go to the health center for blood sugar and blood pressure monitoring.
 Individuals as clients are also seen during home follow-ups, school health consultation,
workplace visit-conference and other community-based activities such as case finding, screening,
health education class, nutrition campaign and promotion of healthy lifestyle.

2
  Family – The family is a very important social institution that performs two major functions:
Reproduction and Socialization. It is generally considered as the basic unit of care in community
health nursing.
 Population Group – or “aggregate” is a group of people who share common characteristics,
developmental stage or common exposure to particular environmental factors. These includes
children, men, women, farmers, factory workers, commercial workers, prisoners, military men
and elderly.
 Community – is a group of people sharing common geographic boundaries and/or common
values and interests.

Public Health (C.E. Winslow) – is a science and art of preventing disease, prolonging life and promoting
health and efficiency through organized community effort for
o Sanitation of the environment
o Control of communicable infections
o Education of the individual in personal hygiene
o Organization of medical and nursing services for the early diagnosis and preventive treatment of
disease
o Development of the social machinery to ensure everyone a standard of living adequate for the
maintenance of health, so organizing these benefits as to enable every citizen to realize his
birthright of health and longevity.

Public Health Nursing- a field of professional practice in nursing and in public health in which technical
nursing, interpersonal, analytical, and organizational skills are applied to problems of health as they
affect the community
o In the Philippines, PHN is seen as a subspecialty nursing practice generally delivered within
“official” or government agencies.

Theoretical Models/ Approaches

Health Belief Model (HBM)

Origin of the Health Belief Model
 The health belief model was created in the 1950s by social scientists who wanted to understand
why few people responded to a campaign for tuberculosis (TB) screening.
 It is a theoretical model that can be used to guide health promotion and disease prevention
programs.
 It is used to explain and predict individual changes in health behaviors.
Key elements of the Health Belief Model
 individual beliefs about health conditions, which predict individual health-related behaviors.
 key factors that influence health behaviors as an individual's perceived threat to sickness or
disease (perceived susceptibility),
 belief of consequence (perceived severity)
 potential positive benefits of action (perceived benefits)
 perceived barriers to action, exposure to factors that prompt action (cues to action)
 confidence in ability to succeed (self-efficacy).
Health Belief Model as Nursing Tool
 The health belief model is a great tool for nurses, offering them a theoretical framework for
helping their patients prevent chronic disease or, if disease is present, improve quality of life.

3
  to clarify patients' perceptions of risk and why they behave in a way that is harmful; this enables
nurses to apply strategies that influence patients to make healthy lifestyle changes.

Milio’s Framework for Prevention

 Nancy Rosalie Milio, Ph.D., FAPHA, FAAN, is Professor Emeritus of Nursing and Professor
Emeritus of Health Policy and Administration, School of Public Health, University of North
Carolina at Chapel Hill
 She is a leader in public health policy and education, who originated the notion of healthy public
policy which addresses the effects of all areas of public policy on health and has been adopted
internationally
 She developed a framework for prevention that includes concepts of community – oriented,
population- focused care.
 She stated that behavioral patterns of the populations-and individuals who make up populations
– are a result of habitual selection from limited choices.
 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.
Nola Pender’s Health Promotion
 is a nursing theorist, author, and academic.
 She is a professor emerita of nursing at the University of Michigan.
 She created the Health Promotion Model. She has been designated a Living Legend of the
American Academy of Nursing.
 Designed to be a “complementary counterpart to models of health protection.”
 Health promotion is directed at increasing a patient’s level of well-being.
 The health promotion model describes the multidimensional nature of persons as they interact
within their environment to pursue health.
 This model focuses on three areas: individual characteristics and experiences, behavior-specific
cognitions and affect, and behavioral outcomes.
The Health Promotion Model makes four assumptions:
1. Individuals seek to actively regulate their own behavior.
2. Individuals, in all their biopsychosocial complexity, interact with the environment, progressively
transforming the environment as well as being transformed over time.
3. Health professionals, such as nurses, constitute a part of the interpersonal environment, which
exerts influence on people through their life span.
4. Self-initiated reconfiguration of the person-environment interactive patterns is essential to
changing behavior.

Lawrence Green’s PRECEDE-PROCEED MODEL

 Dr. Green received his B.S. in 1962 from the University of California-Berkeley.
 Ford Foundation project associate and a commissioned officer of the US Public Health Service
with the University of California Family Planning Research and Development Project in Dhaka,
East Pakistan (now Bangladesh), serving from 1963 through 1965. He returned to Berkeley,
where he earned his M.P.H.
PRECEDE=Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis and Evaluation
PROCEED= Policy, Regulatory and Organizational Constructs in Educational and Environmental
Development

4
.
 The PRECEDE–PROCEED model is a cost–benefit evaluation framework proposed in 1974 that
can help health program planners, policy makers and other evaluators, analyze situations and
design health programs efficiently.
 It provides a comprehensive structure for assessing health and quality of life needs, and for
designing, implementing and evaluating health promotion and other public health programs to
meet those needs.
 One purpose and guiding principle of the PRECEDE–PROCEED model is to direct initial attention
to outcomes, rather than inputs.
 It guides planners through a process that starts with desired outcomes and then works
backwards in the causal chain to identify a mix of strategies for achieving those objectives.
 A fundamental assumption of the model is the active participation of its intended audience —
that is, that the participants ("consumers") will take an active part in defining their own
problems, establishing their goals and developing their solutions.

Different Fields in Community Health Nursing

Community health nursing is a specialized field of nursing practice. Its basic knowledge and skills are
anchored on nursing theories and important concepts from the science of public health such as:
 emphasis on the importance of the “greatest good for the greatest number”;
 assessing health needs, planning, implementing and evaluating the impact of health services on
population groups;

 priority of health-promotive and disease-preventive strategies over curative interventions;

 tools for measuring and analyzing community health problems;
 Application of principles of management and organization in the delivery of health services to
the community.
Occupational health nursing
 Occupational health nursing is nursing in the work place; it is community health nursing focused
on people in their places of work.
 Occupational health nursing is the specialty practice that provides for and delivers health care
services to workers and worker population.
 The practice focuses on promotion, protection, and restoration of worker's health within the
context of a safe and healthy work environment.
 The foundation of occupational health nursing practice is research-based with an emphasis on
optimizing health, preventing illness and injury, and reducing health hazards.
 Occupational health nursing is “aimed at assisting workers in all occupations to cope with actual
and potential stresses in relation to their work and work environment
School Health Nursing
 School health nursing is primarily determined by the characteristics of their clientele, which is
their age, developmental stage and their common health problems and concerns.
 School health nursing aims at promoting the health of school children and preventing health
problems that would hinder their learning and performance of their developmental tasks.
Mental Health Nursing
 Mental health nursing deals with patient with mental disorders.