NCM 113

CHN 2
MODULE 1
CHN CONCEPTS

MARIA CORAZON LOURDES C.LUCIN, RN,MAN,LPT

SUBJECT INSTRUCTOR

[Pick the date]

Course Title: COMMUNITY HEALTH NURSING II

Course No.: NCM 113

Course Description: This course deals with concepts, principles, theories

and techniques in the provision of care in terms of health promotion, disease
prevention, restoration and maintenance and rehabilitation at the population
groups and community level. It includes the study of the Philippine Health Care
Delivery System, national health situation and the global context of public
health. The learners are expected to provide safe, appropriate and holistic
nursing care to population groups and community as clients utilizing the
universal values of love and peace and the nursing process.

At the end of this module, the learners will be able to:

1. Apply knowledge of physical, social, natural, health sciences and

humanities in the care of population groups and community.
2. Provide safe, appropriate and holistic care to population groups and
community utilizing the community organization process.
3. Apply guidelines and principles of evidence-based practices in the
delivery of care to population groups and community.
4. Practice nursing in the community setting in accordance with laws, legal,
ethical, and moral principles.
5. Communicate effectively in speaking, writing, and presenting using
culturally appropriate language in the community setting.
6. Document care of population groups and community accurately and
comprehensively.
7. Work effectively and develop love and peace in collaboration with the
inter-, intra-, and multidisciplinary and multicultural teams in the care of
population groups and community.
8. Practice beginning management and leadership skills using systems
approach in the delivery of care to population groups and community.
9. Conduct research with an experienced researcher in the care of
population groups and community.
10.Engage in lifelong learning with a passion to keep current with national
and global development in the care of population groups and
community.
11.Demonstrate responsible citizenship and pride of being a Filipino
embracing love and peace.
12.Apply techno-intelligent care systems and processes to perform safe and
efficient nursing activities for population groups and community.
13.Adopt the universal values of love and peace and the nursing core
values in the care to population groups and community.
14.Apply entrepreneurial skills in the delivery of nursing care to population
groups and community.

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INTRODUCTION TO THE COURSE:

Community health nursing is simply the application of

the nursing process in the care of client in the community
setting. This means that essential to understanding its
practice is the mastery of the nursing process itself.

Dr. Araceli Maglaya, author and a pioneer in the

development of the family data base used in the community
setting, defined Community Health Nursing as “ 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”. The goal of which according
to Nisce, et.al. is to “ to raise the level of health of the
citizenry by helping communities and families to cope with the
discontinues in and threats to health in such a way as to
maximize their potential for high-level wellness.

This module will help you understand the concepts,

principles, theories and techniques in the care of population
groups and community utilizing community organizing
strategies toward health promotion, disease prevention,
restoration and maintenance, and rehabilitation and
community development. It is expected then that as BSN III
students, you are to provide safe, appropriate and holistic
nursing care to individual and family as clients in community
setting utilizing the nursing process.

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Community Health Nursing Concepts
(Definition, Philosophy and Principles and Features of
CHN)

DEFINITION OF TERMS

PUBLIC HEALTH

 THE SCIENCE AND ART OF PREVENTING DISEASE, PROLONGING LIFE,

PROMOTING HEALTH and efficiency through organized community effort
for the sanitation of the environment, control of communicable diseases,
the education of individuals in personal hygiene, the organization of
medical and nursing services for the early diagnosis and preventive
treatment of disease and the development of the social machinery to
ensure everyone a standards 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. – Dr. CE
Winslow

 The ART OF APPLYING SCIENCE in the context of politics so as to reduce

inequalities in health while ensuring the best health for the greatest
number. – WHO

PUBLIC HEALTH NURSING

 The practice of nursing in national and local government health

departments (which include health centers and rural health units), and
public schools. It is COMMUNITY HEALTH NURSING PRACTICED IN THE
PUBLIC SECTOR. – Standards of Public Health Nursing in the
Philippines, 2005

 SPECIAL FIELD OF NURSING THAT COMBINES THE SKILLS OF NURISNG,

PUBLIC HEALTH, AND SOME PHASES OF SOCIAL ASSISTANCE AND
FUNCTIONS AS PART OF THE TOTAL PUBLIC HEALTH PROGRAM for the
promotion of health, the improvement of conditions in the social and

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 physical environment, rehabilitation, and the prevention of illness and
disability. – WHO Expert Committee on Nursing

COMMUNITY HEALTH NURSING

 Service rendered by a professional nurse with communities, groups,

families, individuals at home, in health centers, in clinics, in schools, in
places of work for the promotion of health, prevention of illness, care of
the sick at home and rehabilitation. – Ruth B. Freeman

 Nursing practice in a wide variety of community services and consumer

advocate areas, and in a variety of roles, at times including independent
practice… Community nursing is certainly not confined to public health
nursing agencies. – Jacobson, 1975

 The utilization of the NURSING PROCES in the DIFFERENT LEVELS OF

CLIENTELE-INDIVIDUALS, FAMILES, POPULATION GROUPS AND
COMMUNITIES, concerned with the PROMOTION OF HEALTH,
PREVENTION OF DISEASE AND DISABILITY AND REHABILITATION. – Dr.
Araceli Maglaya, et al.

 The goal of community of community health nursing is to raise the level

of health of the citizenry by helping communities and families cope with
the discontinuities in and threats to health in such a way as to maximize
their potential for high-level wellness. – Nisce, Reyala, et. al.

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 Memory Aid: HUMANISTIC
Humanistic values of the nursing profession upheld
Unique and distinct component of health care
Multiple factors of health considered
Active participation of clients encouraged
Nurse considers availability of resources
Interdependence among health team members
practiced
Scientific and up-to-date
Tasks of community health nurse vary with time and
place
Independence or self-reliance of the people is the end
goal

PHILOSOPHY OF COMMUNITY HEALTH NURSING PRACTICE

A philosophy is defined as “a system of beliefs that provides a basis for

and guides action.” A philosophy provides the direction and describes the
whats, the whys and the hows of activities within a profession.

CHN practice is guided by the following beliefs:

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BASIC PRINCIPLES OF CHN

1. The COMMUNITY is the PATIENT in CHN; the FAMILY IS THE UNIT OF

CARE; and there are FOUR LEVELS OF CLIENTELE: the INDIVIDUAL, the
FAMILY, the POPULATION GROUP (sub-units of the population 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 an ACTIVE PARTNER, not a passive

recipient of care.

3. CHN practice is AFFECTED BY DEVELOPMENTS IN HEALTH TECHNOLOGY,

in particular and CHANGES IN SOCIETY, in general.

4. The goal of CHN is achieved through MULTI-SECTORAL EFFORTS.

 Write a short reflective journal entry about a personal or observed

experience that relates to the following:
o Community as a patient
o Client involvement
o Influence of technology/societal changes
o Multisectoral collaboration
 Output should be 2-3 paragraph reflection. Be ready for sharing it to the
class.

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THEORETICAL MODELS/APPROACHES

Health Belief Model

1) The Health Belief Model (HBM) is one of the first theories of health behavior.
2) 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.
3) 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)
4) The health belief model proposes that a person's health-related behavior
depends on the person's perception of four critical areas:
1. the severity of a potential illness,
2. the person's susceptibility to that illness,
3. the benefits of taking a preventive action, and

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 4. the barriers to taking that action.
5) HBM is a popular model applied in nursing, especially in issues focusing on
patient compliance and preventive health care practices.
6) The model postulates that health-seeking behavior 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 major concepts in HBM:
1. Perceived Susceptibility
2. Perceived severity
3. Perceived benefits
4. Perceived costs
5. Motivation
6. Enabling or modifying factors

1. Perceived Susceptibility: refers to a person’s perception that a health

problem is personally relevant or that a diagnosis of illness is accurate.
2. Perceived severity: even when one recognizes personal susceptibility,
action will not occur unless the individual perceives the severity to be
high enough to have serious organic or social complications.
3. Perceived benefits: refers to the patient’s belief that a given treatment
will cure the illness or help to prevent it.
4. Perceived Costs: refers to the complexity, duration, and accessibility
and accessibility of the treatment.
5. Motivation: includes the desire to comply with a treatment and the
belief that people should do what.
6. Modifying factors: include personality variables, patient satisfaction,
and socio-demographic factors.

Source: http://currentnursing.com/nursing_theory/health_belief_model.html

A Framework for Prevention by Nancy Milio, PhD, RN

- It is a paradox that health professionals, in their efforts to improve

people’s health-related practices, seem to expect more of the ordinary
consumer than they do of themselves. Almost all patient and consumer
health education assume, explicitly, that if people know what is most
healthful, they will do it.
- Most human beings, professional or nonprofessional, provider or
consumer, make the easiest choices available to them most of the time,
and not necessarily because of what they know is most healthful. Thus, if
it is agreed that health-promoting life patterns are a good thing, then the

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 focus for changing behavior should be on the problem of how to make
health-generating choices easier, and how to make health-damaging
choices more difficult.

A Set of Propositions:

1. The health status of populations is the result of deprivation and/or

excess of critical health-sustaining resources. – Health sustaining
resources include the seminal ones (e.g., food) or the synergistic ones
(e.g., basic education, health services).
2. Behavior patterns of populations are a result of habitual selection from
limited choices, and these habits of choice are related to: (a) actual and
perceived options available; (b) beliefs and expectations developed and
refined over time by socialization, formal learning, and immediate
experience. – This is a point at which new health information and
knowledge may influence individual choice-making under certain
conditions.
3. Organizational behavior (decisions or policy-choices made by
governmental/nongovernmental, national/non-national; non-profit/for-
profit, formal/non-formal organizations) sets the range of options
available to individuals for their personal choice-making. –
Organizational decisions directly affect the options available to people
and/or their awareness of those options and/or the ease with which they
may make daily, habitual, selections.
4. The choice-making of individuals at a given point in time concerning
potentially health-promoting or health damaging selections is affected
by their effort to maximize valued resources. Choice is therefore related
to the type and amount of:
1. their personal resources: their awareness, knowledge, beliefs and
skills; those of family, friends, and of other primary (small, face-to-
face) groups; available money and time; convenience concerning
distance, travel, transportation; the urgency of other priorities;
and
2. societal (community and national) resources: the availability of
health-sustaining services and resources in terms of cost, distance
or location, type, comprehensiveness, program outreach
components (e.g., food, housing, income maintenance,
environmental protection, health services); alternatives to formal
services; penalties or losses incurred, or rewards given, for
selection or failure to select given options.
5. Social change may be thought of as changes in patterns of behavior
resulting from shifts in the choice-making of significant numbers of
people within a population. – People must be aware of the new options

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 and of what they can gain from selecting them relative to their former
choices.
6. Health education, as the process of teaching and learning health-
supporting information can have little significantly extensive impact on
behavior patterns, that is, on personal choice-making of groups of
people, without the easy availability of new, or newly-perceived
alternative health promoting options for investing personal resources.

Source: https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.66.5.435

Pender's Health Promotion Model

- The Health Promotion Model was designed by Nola J. Pender to be a

“complementary counterpart to models of health protection.” It defines
health as a positive dynamic state rather than simply the absence of
disease.
- 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.
- Pender’s model focuses on three areas: individual characteristics and
experiences, behavior-specific cognitions and affect, and behavioral
outcomes. The theory notes that each person has unique personal
characteristics and experiences that affect subsequent actions. The set of
variables for behavior specific knowledge and affect have important
motivational significance. The variables can be modified through nursing
actions.
- Health promoting behavior is the desired behavioral outcome, which makes
it the end point in the Health Promotion Model. These behaviors should
result in improved health, enhanced functional ability and better quality of
life at all stages of development.

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.

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 There are thirteen theoretical statements that come from the model. They
provide a basis for investigative work on health behaviors. The statements are:

1. Prior behavior and inherited and acquired characteristics influence beliefs,

affect, and enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which they anticipate
deriving personally valued benefits.
3. Perceived barriers can constrain commitment to action, a mediator of
behavior as well as actual behavior.
4. Perceived competence or self-efficacy to execute a given behavior
increases the likelihood of commitment to action and actual performance
of the behavior.
5. Greater perceived self-efficacy results in fewer perceived barriers to a
specific health behavior.
6. Positive affect toward a behavior results in greater perceived self-efficacy,
which can in turn, result in increased positive affect.
7. When positive emotions or affect are associated with a behavior, the
probability of commitment and action is increased.
8. Persons are more likely to commit to and engage in health-promoting
behaviors when significant others model the behavior, expect the
behavior to occur, and provide assistance and support to enable the
behavior.
9. Families, peers, and health care providers are important sources of
interpersonal influence that can increase or decrease commitment to and
engagement in health-promoting behavior.
10.Situational influences in the external environment can increase or
decrease commitment to or participation in health-promoting behavior.
11.The greater the commitments to a specific plan of action, the more likely
health-promoting behaviors are to be maintained over time.
12.Commitment to a plan of action is less likely to result in the desired
behavior when competing demands over which persons have little control
require immediate attention.
13.Persons can modify cognitions, affect, and the interpersonal and physical
environment to create incentives for health actions.

Source: https://www.nursing-theory.org/theories-and-models/pender-health-
promotion-model.php

PRECEDE-PROCEED MODEL

 The acronym PRECEDE stands for predisposing, reinforcing, and enabling

constructs in educational/environmental diagnosis and evaluation. The
acronym PROCEED stands for policy, regulatory, and organizational

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 constructs in educational and environmental development. The model
was initially called PRECEDE (predisposing, reinforcing, and enabling
constructs in educational diagnosis and evaluation) and remained
popular under that name throughout the 1980s.
 In the 1980s the movement for health promotion grew very strong; in
response, the model evolved and a number of health promotion
functions were added. As a result, it came to be known as PRECEDE-
PROCEED.
 In the 1990s the role of socioenvironmental approaches was
strengthened even further, and the model emphasized the ecological
approach.

The eight phases of the PRECEDE-PROCEED model provide guidance in

planning any health program.

1) The first phase is social assessment. An assessment of community

perceptions provides a starting point for identifying quality of life
concerns, and methods such as asset mapping, social reconnaissance,
nominal group process, the Delphi method, focus groups, central location
intercept interviews, and surveys may be employed. Asset mapping is an
assessment of the strengths, capacities, and skills of individuals and the
existing resources in a community. In social reconnaissance, a point of entry
into the community is chosen and local players are identified; this is
followed by preparation of research and briefing materials and identification
of leaders and representatives. This is followed in turn by field interviews
and then analysis, reporting, and follow-up. In the nominal group process,
community participants are recruited and are asked to reflect on a single
question. The responses are collected and then ranked in importance by the
participants to establish a priority list. In the Delphi method, a panel of
experts is recruited and sent a questionnaire. Subsequent mailings of
the questionnaire aim at deriving consensus and the choices are narrowed
at each iteration. Focus group discussions are small group discussions on a
given topic moderated by a facilitator. Central location intercept interviews
are conducted at shopping malls, churches, and other places where
target population members can be found. These interviews typically
include structured, close-ended questions. Surveys also consist of asking
questions of the target population and can be done by mail, e-mail, online,
or other means.
2) The second phase is epidemiological assessment, and it includes
identifying the specific health problems that are contributing to or
interacting with the quality of life concerns identified in the social
assessment. This phase also identifies the causative factors in the three
categories of genetics, behavior, and environment. Epidemiology
assessment consists of two parts—descriptive and analytical—and attempts

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 to gather information on both these aspects. In descriptive epidemiology,
facts regarding the time, place, and population attributes of the health
problem are collected through mortality (death), morbidity (illness), and
disability rates. Analytical epidemiology examines the determinants of
health. In this model analytical work translates into identifying
behaviors and environments. Behaviors are of three types: proximal, or
direct, actions affecting health; actions influencing the health of others;
and distal actions affecting the organizational or policy environment. To
diagnose behaviors that need to be targeted, the behavioral factors
are rated in terms of importance and changeability. Behavioral
objectives are developed for those behaviors that are judged to be more
changeable and more important. To diagnose environments, environmental
factors are rated in terms of importance and changeability. Environmental
objectives also are determined by focusing on the more changeable and
more important ones listed.
3) The third phase is educational and ecological assessment. In this
phase, factors are classified into the hallmark categories of this model as
predisposing, enabling, or reinforcing factors. Predisposing factors are
antecedents to behavioral change that provide motivation for the behavior
(for example, knowledge, beliefs, attitudes, values, perceptions). Enabling
factors are antecedents to behavioral or environmental change that allow a
motivation or environmental policy to be realized (for example, availability
of resources, accessibility, laws, legislations, and skills). Reinforcing factors
follow a behavior and provide continuing reward for sustaining the
behavior (for example, family, peers, teachers, employers, health
providers, community leaders, or decision makers). In this phase the
factors are identified and sorted, priorities are determined, and once
again priorities within categories are identified using the criteria of
changeability and importance.
4) The fourth phase is administrative and policy assessment and
intervention alignment. In this phase the program components are
aligned with priorities, resources needed to run the program are
identified, barriers that may influence the program are addressed, and
policies needed to run the program are developed. In aligning priority
determinants with program components, ecological levels are first matched
with program components, followed by mapping specific interventions, and
finally pooling previous interventions to patch any gaps. This phase
assesses aspects such as time, personnel, and budget.
5) The fifth phase is implementation. In this phase several factors may
hinder or augment the impact of the program. These factors pertain to the
program (such as resources and goals), the implementing organization
(such as employee attributes, organizational goals, and organizational
climate), the political milieu, and the environment (such as timing and
other organizations).

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6) The sixth phase is process evaluation. In this phase, the first evaluation is
whether the intervention has been implemented in the manner in which
it was planned. For example, if 10 activities were planned, have all of
them been implemented, and to what extent have they been implemented?
Second, the reception of the program at the site where it has been
implemented is evaluated. Third, the attitudes of the recipients of the
program are considered. How satisfied have they been with the program?
What did they like and what did they dislike about the program? Fourth, the
response of the person implementing the program is determined. What
difficulties did he or she face while implementing the program? What things
were easy to do? Finally, the competencies of the personnel involved are
assessed. For example, if health education work was done, was it done by a
certified health education specialist or someone else?
7) The seventh phase is impact evaluation. Impact evaluation assesses the
immediate effect of the program on its target behaviors or environments
and their predisposing, enabling, and reinforcing antecedents. For example,
a program designed to combat obesity in a community would measure
physical activity and consumption of fruits and vegetables.
8) The final phase is outcome evaluation. In this phase, changes in health
status (such as mortality, morbidity, and disability indicators) and quality of
life concerns (such as perceived quality of life and unemployment) are
measured. The PRECEDE-PROCEED model has been used in a variety of
applications in health promotion and health education programming. The
PRECEDE-PROCEED model is by far the most popular and most researched
model in the field of health promotion and health education.

Source: http://medsab.ac.ir/uploads/1_(4)_46099.pdf

Make a matrix of the different theories /approaches

used in Community Health Nursing. Fill-up the format found below.

Theoretical Model / Definition Major Concepts

Author

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DIFFERENT FIELDS

A. School Nursing
The primary role of the school nurse is to support student learning and
ensure that educational potential is not hampered by unmet health needs.
School nurses are the front liners in the provision of health and nutrition
programs in the school.
It is based on the philosophy that the academic performances of the
pupils and the instructional outcomes are also determined by the quality of
health of the school population and the community where they come from.
School nursing is a type of public health nursing that focuses on the
promotion of health and wellness of the pupils/students, teaching and non-
teaching personnel of the schools.

Duties and Responsibilities of the School Nurse:

- Health advocacy
- Health and nutrition assessment including other screening procedures such
as vision and hearing
- Supervision of the health and safety of the school plant
- Treatment of common ailments and attending to emergency cases
- Referrals and follow-up of pupils and personnel
- Home visits
- Community outreach like attending community assemblies and organizing
school community health councils
- Recording and reporting of accomplishments
- Monitoring and evaluation of programs and projects

Functions of the School Nurse

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1. School Health and Nutrition Survey
This shall be done initially to provide data for evaluation and for planning
purposes. The survey shall include among others the current health and
nutritional status of school children, situation on health facilities as well as
actual status of health education activities undertaken by the teachers and
health personnel.
2. Putting up a Functional School Clinic
RA 124 mandates that all schools are to provide school clinics for the
treatment of minor ailments and attendance to emergency cases. The
school nurses encourage the provision of this facility.
3. Health Assessment
Health assessment aims to discover the signs of illness and physical
defects in order to correct them check on the health habits of pupils and
prevent the progress of those which cannot be corrected.
Health assessment should include:
a. Interviewing for information gathering
b. Nutritional assessment- height and weight measurements
c. Vision-acuity test/hearing test
d. Four methods of physical examination(inspection, percussion,
palpation, auscultation)
e. Taking of vital signs
f. Appraisal of the general physical and mental condition
g. Recording of findings

Take Note:
Every school child should be examined once a year and as the need
arises like during epidemics.
4. Standard Vision Testing for School Children
Vision is a very important sensory skill that affects a child’s learning and
general development. The student’s visual status must be 20/20 for him to
perform his visual task demand clearly and comfortably at far and near
distances.
5. Ear Examination
The main responsibility of the school nurse with respect to auditory
health services is to detect hearing difficulties as early as possible.
Treatment, referral, health counseling and follow through program for
correcting the defect should be a part of the total plan.
6. Height and Weight Measurement and Nutritional Status Determination
It offers the most acceptable parameter and is the simplest way to
determine the nutritional status of school children.
In the DepEd, weight-for-age and height-for-age indicators for children
below 10 years are used while Body Mass Index (BMI) is used for children 10
years and above. This is done at the beginning and end of the school year.

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 Appropriate school feeding programs with rice, milk or fortified noodles
are given to children with below normal nutritional status for 120 feeding
days to overcome nutritional deficiencies. Deworming is a pre-requisite
before feeding, parental consent is a must before deworming is done.
7. Medical Referrals
Whenever necessary, the school nurse may recommend that a student
with an existing condition be referred for further assessment and
intervention by the appropriate professional/agency.
8. Attendance to Emergency Cases
It is incumbent upon the nurses to attend to emergency cases while they
are in school. However, majority of the nurses are assigned to several
schools. In their absences, the school authorities and the clinic teacher have
the responsibility of attending and referring them promptly. Parents must
be informed of the occurrence of the emergency as soon as possible.
9. Student Health Counseling
School nurses welcome the opportunity to help concerned parents and
guardians of students in any form of individual health counseling.
10.Health and Nutrition Education Activities
The school nurse takes every opportunity to talk on health related topics
both in formal and informal settings. She should be willing to use her ability,
knowledge and background to influence the school and community in a
healthy and positive way.
11.Organization of School-Community Health and Nutrition Councils
The school nurse shall initiate/encourage the organization/reactivation of
School-Community Health Council, the membership of which shall come
from both school and community project during their term.
12.Communicable Disease Control
Prevention and control of communicable disease is a responsibility
shared by parents, school personnel, community and the Department of
Health. If a child is suffering from a recognized contagious or infectious
disease, he/she should be referred and sent home and not be permitted to
return until the school authorities are satisfied that any contagious an
infectious disease does not exist.
13.Establishment of Data Bank on School Health and Nutrition Activities
Accurate and up-to-date health records are essential in helping monitor
the health of students while they are in schools. Findings are recorded in
the health examination card and reviewed and updated annually.
14.School Plant Inspection for Healthy Environment
The school plant shall be inspected in order to provide a healthful
environment and safety in schools. Particular attention shall focus on the
provision and maintenance of toilets, school clinics, water supplies,
sanitation of school canteen, and safety and nutritional value of foods being
served.
15.Rapid Classroom Inspection

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 Rapid classroom inspection is done as a routine procedure when
frequent and regular visits can be made to a school during the year, in
addition to the individual health assessment. The pupils or students are
instructed to line up showing their hands, arms, hair, eyes, nose, throat,
ears, neck, chest, feet and legs. Careful observations should be done while
doing the procedure.
16.Home Visitation
Home visitation is necessary in the effective implementation of the total
school program particularly the Integrated School Health and Nutrition
Program (ISHNP).
Home visitation is a social, educational, and preventive work and should
not be regarded as remedial or curative.
The following are some cases needing home visitation:
- pupils whose parents are afraid of some medical procedures
- pupils who get re-infected because of home conditions
- pupils suffering from communicable diseases
- pupils who are absent frequently because of sickness
- pupils who are malnourished

Legal Bases of the School Health Program

 PD 603 Child and Youth Welfare Code
 PD No. 491 s. 1974 – Designated July as Nutrition Month for the
purpose of creating greater awareness among the people on the
importance of nutrition
 RA 856 s. 1975 – Code of Sanitation of the Philippines

B. Occupational health nursing

Occupational health nursing is an autonomous practice requiring

independent decisions and creative solutions to complex occupational and
environmental health and safety problems.

Occupational health nurses are assuming innovative roles and increasing

responsibilities as they respond to a changing and more complex work
environment. The complexity of providing in effective occupational health
services has been compounded in recent years by a constantly changing social,
economic, and political climate, by the many challenges precipitated by health
care reform and managed care, and by rapid and multiple technological
advances.

Functions of Public Health Nurse as an Occupational Health Nurse (Referenced

from PD 856, Chapter VII – Industrial Hygiene of the Sanitation Code of the
Philippines)

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 1. Work with the occupational Health team to lead the sanitary and
industrial hygiene of all industrial establishments including hospitals to
determine their compliance with the sanitation code and its
implementing rules and regulations.
2. Recommends to Local Health Authority the issuance of license/business
permits and suspensions or revocation of the same for any violation of
the condition upon which said licenses or permits had been issued,
pursuant to existing rules and regulations.
3. Coordinates with other government agencies relative to the
implementation of the implementing rules and regulations.
4. Attends to complaints of all establishments in the area of assignment
related to industrial hygiene and recommends appropriate measures for
immediate compliance.
5. Participates to provide, install and maintains in good condition all control
facilities and protective barriers for potential and actual hazards.
6. Informs all affected workers regarding the nature of hazards and the
reasons for the control measures and protective equipment.
7. Makes a periodic testing for physical examination of the workers and
other health examinations related to worker’s exposure to potential or
actual hazards in the workplace.
8. Provides control measures to reduce noise, dust, health and other
hazards.
9. Ensure strict compliance on the regular use and proper maintenance of
Personal Protective Equipment (PPE).
10.Provide employees/workers an occupational health services and
facilities.
11.Refers or elevates to higher authority all unsolved issues in relation to
occupational and environmental health problems.
12.Prepares and submit yearly reports to the Local and National
Government.

C. Community Mental Health Nursing

The first mental health act legislation in the history of the Philippines has
been officially signed into law and was enacted as the Republic Act no. 11036
on 21 June 2018. It provides a rights-based mental health bill and a
comprehensive framework for the implementation of optimal mental healthcare
in the Philippines.
Some sections of the Implementing Rules and Regulations (IRR) of Republic
Act 11036 or otherwise known as “The Mental Health Act” is discussed here.

Section 16 Mental Health Services at the Community Level

CHN 2 Module Part 1 Page 19

 Responsive primary mental health services shall be developed and
integrated as part of the basic health services at the appropriate level of
care, particularly at the city, municipal, and barangay levels. The
standards of mental health services shall be determined by the DOH in
consultation with stakeholders based on current evidences.
Mental health services at the community level that encompass
wellness promotion, prevention, treatment, and rehabilitation shall be
inclusive and responsive to the needs of the vulnerable population.
These services must also actively link peer supports, education,
livelihood and employment, social services, and other community
support services.
Every local government unit (LGU) and academic institution shall
create their own program in accordance with the general guidelines set
by the Philippine Council for Mental Health, created under this Act, in
coordination with other stakeholders. LGU’s and academic institutions
shall coordinate with all concerned government agencies and the private
sector for the implementation of the program.
The Department of Health, in collaboration with related
associations/organizations engaged in mental health services at the
community level, shall provide further guidance and technical assistance
on the design, implementation and evaluation of mental health
programs for the LGUs, academic institutions and workplaces within two
years after the effectivity of the IRR.

Section 17 Community-based Mental Health Care Facilities

The national government through the DOH shall fund the establishment
and assist in the operation of community-based mental health care facilities in
the provinces, cities and cluster of municipalities in the entire country based on
the needs of the population, to provide appropriate mental health care
services, and enhance the rights-based approach to mental health care.

For the purpose of this IRR, a community-based mental health care

facility refers to a mental health facility outside of a mental hospital.

Examples of community-based mental health care facilities include, but

are not limited to, community mental health centers: outpatient care centers,
halfway houses, crisis centers, drop-in centers, and other facilities offering
services to help address the distinct needs and unique characteristics of the
population, including well-being enhancement programs.

Each community-based mental health care facility shall, in addition to

adequate room, office or clinic, have a complement of mental health
professionals, allied professionals, support staff, trained barangay health
workers ( BHWs), volunteer family members of patients or service users, basic

CHN 2 Module Part 1 Page 20

equipment and supplies, and adequate stock of medicines appropriate at that
level.

The DOH shall develop guidelines is the establishment of community-

based mental health care facilities.

https://www.officialgazette.gov.ph/downloads/2019/01jan/20190122-IRR-RA-
11036-RRD.pdf

Make a matrix of the different fields of nursing. Fill-up the format found below.

Field of nursing Role Duties and responsibilities

towards the community

Concept of the Community

CHN 2 Module Part 1 Page 21

- The definitions of community are also numerous and variable. Baldwin, et
al. (1998) outline the evolution of the definition of community by examining
definitions that appeared in community health nursing texts. They
determined that, before 1996, definitions of community focused on
geographical boundaries, combined with social attributes of people.
- In recent nursing literature, community has been defined as “ a collection of
people who interact with one another and whose common interests or
characteristics form the basis for a sense of unity or belonging” ( Allender et
al, 2009); “ a group of people who share something in common and interact
with one another, who may exhibit a commitment with one another and
may share a geographical boundary” ( Lundy and Janes, 2009); “ a group of
people who share common interests, who interact with each other, and who
function collectively within a defined social structure to address common
concerns” ( Clark, 2008); and “ a locality-based entity, composed of
systems of formal organizations reflecting society’s institutions, informal
groups and aggregates” ( Shuster and Goeppinger, 2008).
- Maurer and Smith ( 2009) further addressed the concept of community and
identified four defining attributes: (1) people, (2) place, (3) interaction, and
(4) common characteristics, interests, or goals. Combining ideas and
concepts, in this text, community is seen as a group or collection of locally-
based individuals, interacting in social units and sharing common interests,
characteristics, values, and/or goals.
- Maurer and Smith (2009) noted that there are two (2) main types of
communities: geopolitical communities and phenomenological communities.
Geopolitical communities are most traditionally recognized or imagined
when considering the term community. Geopolitical communities are
defined or formed by both natural and manmade boundaries and include
barangays, municipalities, cities, provinces, regions and nations. Other
commonly recognized geopolitical communities are congressional districts
and neighborhoods. Geopolitical communities may also be called territorial
communities. Phenomenological communities, on the other hand, refer to
relational, interactive groups, in which the place or setting is more abstract,
and people share a group perspective or identity based on culture, values,
history, interests and goals. Examples of phenomenological communities
include schools, colleges, and universities; churches, and mosques; and
various groups or organizations. These communities may also be described
as functional communities.
- Population and aggregate are related terms that are often used in public
health and community health nursing. Population is typically used to denote
a group of people having common personal or environmental
characteristics. It can also refer to all of the people in a defined community.
Aggregates are subgroups or subpopulations that have some common
characteristics or concerns. These common characteristics or concerns may
make the members of an aggregate vulnerable to similar health problems.

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 Examples of aggregates are age groups or groups undergoing similar
physiologic processes like pregnancy and menopause.

Characteristics of a Healthy Community

All systems of a community need to function effectively and work together

to maintain the health of the community. Characteristics of a healthy
community include:

 A shared sense of being a community based on history and values.

Despite the presence of subgroups, members of the community have a
feeling of belonging and that they make up one community. Recognition
and respect for these subgroups make this possible.
 A general feeling of empowerment and control over matters that affect
the community as a whole.
 Existing structures that allow subgroups within the community to
participate in decision making in community matters.
 The ability to cope with change, solve problems, and manage conflicts
within the community through acceptable means.
 Open channels of communication and cooperation among the members
of the community.
 Equitable and efficient use of community resources, with the view
towards sustaining natural resources.

A healthy community is, in fact, the context of health promotion defined in

the Ottawa Charter ( WHO, 1986) as “ the process of enabling people to
increase control over, and to improve, their health.” Further, the Charter
states, “ To reach a state of complete physical, mental ands social well-being,
an individual or group must be able to identify and to realize aspirations, to
satisfy needs, and to change or cope with the environment. Health is,
therefore, seen as a resource for everyday life, not the objective of living.
Health is a positive concept emphasizing social and personal resources, as well
as physical capacities. Therefore, health promotion is not just the responsibility
of the health sector but goes beyond healthy lifestyles to well-being.”

Factors Affecting Health of the Community

People

- Population variables that affect the health of the community include size,
density, composition, rate of growth or decline, cultural characteristics,
mobility, social class, and educational level
- Population size and density influence the number and size of healthcare
institutions. This explains the concentration of healthcare institutions in
urban areas.

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- Negative effects of overcrowding include: easy spread of communicable
diseases; increased stress among members of the community; rapid
degradation of housing facilities, and water, air and soil pollution.
- Health needs of communities vary because of differences in population
composition by age, sex, occupation, level of education, and other
variables.
- Rapid population growth usually results from migration of a large number of
people into a community, as can be seen in migration from rural areas to
the city. This results in increased demand for services that existing
healthcare institutions may find hard to cope with. A rapid decline in
population kay result from disturbances brought about by circumstances
like disasters, political instability, or economic changes. Rapid population
decline usually means a decrease in economic activity in the community
and lower government revenue. In turn, this results in a decrease in
resources accessible to the community.
- Feeling of belongingness and participation in community action are more
readily achieved in a culturally homogenous population , facilitating
cohesive action in dealing with a health threat in the community.
- People move from one place to another for various reasons, such as to start
a family, to take a new job, or to join another family member. The feeling of
belongingness and participation in community action are less likely when a
large segment of the community is composed of new or transient residents.

Location

- The health of the community is affected by both natural and man-made

variables related location. Natural factors consist of geographic features,
climate, flora and fauna. Community boundaries, whether the community is
rural or urban, the presence of open spaces, the quality of the soil, air and
water, and the location of health facilities are influenced by human
decisions and behavior.
- The Philippines has a tropical and maritime climate. Temperature, humidity,
and rainfall are the most important elements in the weather and climate of
the country. The country has a relatively high humidity due to the high
ambient temperature and the fact that the Philippines is surrounded by
bodies of water. Based on rainfall distribution, the Philippines has two
seasons: the rainy season ( June-November) and the dry season ( December
– May). Climate change, however, has brought about temperature spikes.
- Rural areas are characterized by wide-open spaces and low population
density, but inequities in resources and economic opportunities hinder rural
development. Health facilities and health workers are concentrated mainly
in urban areas. Also, poverty is more prevalent in rural areas, with almost
80% of the poor in the country residing in rural areas.

Social system

CHN 2 Module Part 1 Page 24

- Is the patterned series of interrelationships existing between individuals,
groups, and institutions and forming coherent whole.
- Social components that affect health include the family, economic,
educational, communication, political, legal, religious, recreational, and
health systems.
- As in other systems, the composite parts of the social system of the
community affect and interact with one another. During this interactions,
patterns and communication transpire, which forms the basis of
organizations.
- Because of the multifactorial nature of health, all the components of the
social system of a community influence its health. In providing care to a
community, the nurse has to take into account the totality of its social
system.

Roles of the Public Health Nurse

 Clinician or health care provider – utilizes the nursing process in the care
of the client in the home setting through home visits and in public health
care facilities; conducts referral of patients to appropriate levels of care
when necessary. (Ex.: The PHN conducts follow-up home visits to
families with children who are taking antibiotics for pneumonia.)
 Health Educator – utilizes teaching skills to improve the health
knowledge, skills, and attitudes of the individual, family and the
community, and conducts health information campaigns to various
groups for the purpose of health promotion and disease prevention. (Ex.:
The PHN conducts a lecture on the different vaccines covered in the EPI
and its importance to children at the health center.)
 Coordinator and collaborator – establishes linkages and collaborative
relationships with other health professionals, government agencies, the
private sector, non-government organizations and people’s organizations
to address health problems. (Ex.: The PHN taps a local NGO for a joint
sponsorship of a one-day free circumcision program during summer.)
 Supervisor – monitors and supervises the performance of midwives and
other auxiliary health workers; also initiates the formulation of staff
development and training programs for midwives and other auxiliary
health workers as part of their training function as supervisors. (Ex.: The
PHN assigns midwives under her supervision to attend a provincial
training on updates regarding IMCI.)
 Leader and Change agent – influences people to participate in the
overall process of community development. (Ex.: The PHN initiates a
community-wide clean-up of the water systems in the area.)
 Manager – organizes the nursing service component of the local health
agency or local government unit. (Ex.: Nursing service plan component
of the overall municipal health plan.) Also as program manager, the PHN

CHN 2 Module Part 1 Page 25

 is responsible for the delivery of the package of services provided by the
health program to the target clientele. (Ex.: The PHN is assigned as the
program manager of the National Tuberculosis Program.)
 Researcher – participates in the conduct of research and utilizes
research findings in practice. (Ex.: The PHN conducts disease
surveillance or the continuous collection and analysis of date on
dengue.)
 Others

ASSIGNMENT:

Choose one public health law (e.g., RA 11223 - Universal Health Care
Act). Analyze its impact on community nursing practice. Reflect on the role
of nurses in policy implementation.

CHN 2 Module Part 1 Page 26