COMMUNITY HEALTH NURSING (ANA) PRINCIPLES OF COMMUNITY HEALTH

NURSING:
1. COMMUNITY NEEDS:
 Is a synthesis of nursing and public health
practice applied to promoting and preserving
the health of populations. The recognized need of individuals, families and
communities provides the basis for CHN
 It combines all the basic elements of practice.
professional, clinical nursing with public
health and community practice. 2. UNDERSTANDING:

 Is concerned with the health of the Knowledge and understanding of the objectives
population and communities. It meets with and policies of the agency facilitate goal
the collective needs of the community and achievement.
society.

 It identifies the problems of the community,

preserves, and improves health 3. FAMILY AS UNIT:
community health
 Refers to the health status of the members of CHN considers the family as the unit of service.
the community, to problems affecting their Its level of functioning is influenced by the
health and to the totality health care degree to which it can deal with its own
provided to the community. problems

AIMS OF COMMUNITY HEALTH

4. RESPECT VALUES, CUSTOMS AND
NURSING
BELIEFS:
• Health promotion
• Health maintenance
Respect for the values, customs and beliefs of
• Pprevention of illness
the clients contribute to the effectiveness of care
• Restoration of health
to the client.

PHILOSOPHY OF COMMUNITY
HEALTH NURSING 5. INTEGRATING EDUCATION AND
COUNSELING:
 Community based nursing is a philosophy of
care that is characterized by collaboration,
continuity of care, client and family CHN integrated health education and counseling
responsibility for self-care and preventive as vital parts of functions of a nurse.
health care.

 Community-based nursing focuses on an 6. COLLABORATIVE WORK

individual and is family – centered in
orientation Collaborative work relationships with the co-
workers and members of the health team
facilities accomplishments of goals.
PRINCIPLES OF COMMUNITY HEALTH
NURSING 7. PERIODIC AND CONTINUING
EVALUATION
 Health services should be realistic in terms
of available resources. Community is the
focus which is the unit of health care It provides the means for assessing the degree to
services.  which CHN goals and objectives are being
 Community participation is an integral part attained.
of the community health services.
 Individual and family members participation
8. CONTINUING STAFF EDUCATION
in decision making.
PROGRAM
Quality services to client and are essential to • "Poor environmental conditions are bad for
upgrade and maintain sound nursing practices in health and that good environmental
their setting. conditions reduce disease."
• This is one way to measure a person’s level
of health.
9. UTILIZATION OF LOCAL • This model views health as a constantly
RESOURCES changing state, with high level wellness and
death being on opposite ends of a graduated
Utilization of indigenous existing community scale, or continuum.
resources maximizing the success of the efforts • This continuum illustrates the dynamic state
of the community Health Nurses.  of health, as a person adapts to changes in
the internal and external environments to
maintain a state of well-being.
10. ACTIVE PARTICIPATION

Participation and involving of the individual, NURSING THEORY is defined as "a creative
family and community in planning and making and rigorous structure of ideas that project a
decisions for their health care needs, determine, tentative, purposeful, and systematic view of
to a large extent, the success of the CHN phenomena".
programs. 
Through systematic inquiry, whether in nursing
11. SUPERVISION OF NURSING research or practice, nurses can develop
SERVICES knowledge relevant to improving the care of
patients.
By qualified CHN personnel provides guidance
and direction to the work to be done. 
CLINICAL MODEL
12. ACCURATE RECORDING AND
REPORTING  The absence of signs and symptoms of
disease indicates health.
 Illness would be the presence of
Serve as the basis for evaluation of the progress
conspicuous signs and symptoms of disease.
of planned programs and activities and as a
 People who use this model of health to guide
guide for the future actions. their use of healthcare services may not seek
preventive health services, or they may wait
until they are very ill to seek care.
C. FEATURES OF CHN:
1. It is a specialty field of nursing. MODEL:
2. Its practice combines public health with
nursing.  Is a theoretical way of understanding a
3. It is population-based. concept or idea.
4. It emphasizes wellness and other than  represent different ways of approaching
disease or Illness. complex issues.
5. It includes interdisciplinary collaboration.  There are different models of health.
6. It amplifies the client's responsibility and
self-care. a. HEALTH BELIEF MODEL

D. THEORETICAL  is a theoretical way of understanding a

MODEL/APPROACHES concept or idea.
 represent different ways of approaching
• Florence Nightingale’s environmental theory complex issues.
focuses on preventive care for populations  There are different models of health.
• was the first nurse to formulate a conceptual  Initially proposed in 1958, the model
foundation for nursing practice. provides the basis for much of the practice
• name the Lady with the Lamp of health education and promotion today.
• She suggested that disease was more  This model found that information alone is
prevalent in poor environments and that rarely enough to motivate people to act for
health could be promoted by providing their health. Individuals must know what to
adequate ventilation, pure water, quiet, do and how to do it before they can take
warmth, light and cleanliness action
 OTHER COMMON HEALTH BELIEFS
ARE PUT TO THE TEST:
FOUR CORE COMPONENTS:
1. PERCEIVED SUSCEPTIBILITY
 Sugar makes kids hyperactive.
 This refers to a person's subjective
 Going out in the cold with wet hair
perception of the risk of acquiring an illness will make you sick
or disease.  Reading in dim light or sitting close
to the TV will hurt your eyes
 Perceived susceptibility to the threat refers
to one's belief about the probability of them
experiencing the threat.
4. PERCEIVED BARRIERS

For example:   Refers to a person's feelings on the obstacles

to performing a recommended health action.
Individuals who do not think they will get the
flu are less likely to get a yearly flu shot. People
COMMON BARRIERS
who think they are unlikely to get skin cancer
are less likely to wear sunscreen or limit sun 1. Lack of time
exposure. 2. Lack of resources/equipment. e.g. facilities
and equipment
3. Technology interoperability challenges.
2. PERCEIVED SEVERITY 4. Financial risk and unpredictable revenue
streams.
 Refers to the magnitude and significance of 5. Shifting policies and regulations.
the threat, while perceived susceptibility to 6. Lack of motivation and/or energy.
the threat refers to one's belief about the 7. Difficulty collecting and reporting patient
probability of them experiencing the threat. information

Example:
5. SELF-EFFICACY
 If you are young and in love, you are
unlikely to avoid kissing your sweetheart on  refers to an individual’s perception of his or
the mouth just because they have the her competence to successfully perform a
sniffles, and you might get their cold. behavior.
 On the other hand, you probably would stop
kissing if it might give you a more serious
 Self-efficacy was added to the health belief
illness.
model in an attempt to better explain
individual differences in health behaviors
3. PERCEIVED BENEFIT
MILIO FRAMEWORK FOR PREVENTION
 Refers to the perception of the positive
consequences that are caused by a specific  Nancy Milio, PhD, RN, was a public health
action. nurse who formulated a framework for
prevention, which aimed to explain the
 In behavioral medicine, the term perceived connection between the individual’s state of
benefit is frequently used to explain an health and that of the community.
individual's motives of performing a
behavior and adopting an intervention or  Milio formulated propositions in an attempt
treatment. to explain the interrelation of a person’s
choices as they corresponded to the
Example: resources available in the community.
 If you believe that getting regular exercise
 She develops a
and eating a healthy diet can prevent heart
framework for prevention that includes
disease, that belief increases the perceived
concepts of:
benefits of those behaviors.
 community – oriented,
population- focused care.
  She started studying health-promoting
 She challenged the common notion that a behavior in the mid-1970s and first
main determinant for unhealthful published the Health Promotion Model in
behavioural choice is lack of knowledge. 1982.
 Pender's health promotion model defines
 She described a sometimes-neglected role of health as “a positive dynamic state not
community health nursing to examine the merely the absence of disease.” Health
determinants of a community’s health and promotion is directed at increasing a client's
attempt to influence those determinants level of well-being.
through public policy.  It describes the multi-dimensional nature of
persons as they interact within the
 This theory is broader than the Health Belief environment to pursue health.
Model, it includes economic, political, and
environmental health determinants rather
than just the individual’s perceptions. Among the many models of health related to
quality of life, Nola Pender : Health Promotion
behavior model helps identify factors
 This theory encourages the nurse to influenced the decisions and actions of
understand health behaviors in the context of individuals that were made to prevent disease
their societal milieu. and promote a healthy lifestyle.

4 LEVELS OF PREVENTION:
CONCLUSION:
1) PRIMORDIAL PREVENTION  Community health care setting is the
best avenue in promoting health and
 Primordial prevention is a term that is preventing illnesses.
seldom used in clinical care.  Using Pender’s Health Promotion
 Is defined as preventing the risk factor.
Model, community programs may be
 Refers to avoiding the development of
risk factors in the first place. focused on activities that can improve
people’s well-being.
2) PRIMARY PREVENTION  Health promotion and disease prevention
can more easily be carried out in the
 Is about treating risk factors to prevent community than programs that aim to
cardiovascular disease cure disease conditions.

3) SECONDARY PREVENTION
LAWRENCE GREEN (PROCEED-
 Screening to identify diseases in the PROCEED MODEL)
earliest. Stages, before the onset of signs  Is a comprehensive structure for assessing
and symptoms, through measures such. health needs for designing, implementing,
As mammography and regular blood and evaluating health promotion and other
pressure testing public health programs to meet those needs.

4) TERTIARY PREVENTION  Is a community-oriented, participatory

model for creating successful community
 Consists of rehabilitation and efforts to health promotion interventions
prevent disease progression after an
injury or event has occurred. PRECEDE-PROCEED MODEL
 was developed for use in public health.
NOLA PENDER: HEALTH PROMOTION  Its basic principles, however, is the transfer
MODEL of community issues
 The model not just for health intervention,
 Nola J. Pender (1941– present) is a nursing
but for community intervention in general.
theorist who developed the Health
 The model provides a structure that supports
Promotion Model in 1982.
the planning and implementation of health
 She is also an author and a professor
promotion or disease prevention programs.
emeritus of nursing at the University of
Michigan.
PRECEDE-PROCEED should be a  you identify the health or other issues that
participatory process, involving all stakeholders most clearly influence the outcome the
– those affected by the issue or condition in community seeks
question – from the beginning.
 Health is, by its very nature, a community In these two phases you create the objectives for
issue.  your intervention.

 It is influenced by community
attitudes, shaped by the community PHASE 3: BEHAVIORAL AND
environment ENVIRONMENTAL DIAGNOSIS
 (Physical, social, political, and
economic), and colored by  you identify the behaviors and lifestyle and
community history. or environmental factors that must be
changed to affect the health or other issues
identified in phase 2
 Health is an integral part of a larger context,
probably most clearly defined as quality of
life, and it’s within that context that it must PHASE 4: EDUCATIONAL AND
be considered.  ORGANIZATIONAL DIAGNOSIS
 It is only one of many factors that make life
better or worse for individuals and the  You identify the predisposing, enabling and
community. reinforcing factors that act as supports for or
barriers to changing the behaviors and
environmental factors you identified in
PRECEED AND PROCEED ACRONYMS: phase 3
Predisposing In these phases you plan the intervention
Reinforcing
Enabling
Construct in PHASE 5: ADMINISTRATIVE AND
Educational environmental POLICY DIAGNOSIS
Diagnosis and  You identify the internal administrative
Evaluation issues and internal and external

 Policy issues that can affect the successful

PROCEED:
conduct of the intervention
 Process follows with implementation process
and impact and outcome evaluation
PROCEED HAS 4 PHASES:

Policy
Regulatory and PHASE 6: IMPLEMENTATION
Organizational
Constructs in PHASE 7: PROCESS EVALUATION
Educational and PHASE 8: IMPACT EVALUATION
Environmental
Development PHASE 9: OUTCOME EVALUATION

PRECEED HAS 5 PHASES:

WHY USE PRECEDE/ PROCEED?
 preceed/proceed is participatory, thus
PHASE 1: SOCIAL DIAGNOSIS assuring community involvement
 community involvement leads to
 you ask the community what it wants and community buy-in
needs to improve its quality of life  it incorporates a multi-level evaluation,
which means you have the chance to
PHASE 2: EPIDEMIOLOGICAL  constantly monitor and adjust your
DIAGNOSIS evaluation.
 the model allows leeway to adapt the content  Conducting research and working with
and method of the intervention to your community organizations and health
particular needs and circumstances. educators
 Working with executives to lower costs of
disability claims or other related costs.

E. DIFFERENT FIELD OF CHN

1. SCHOOL HEALTH NURSING COMMUNITY MENTAL HEALTH
NURSING
 Is defined as a specialized practice of
 Or often called psychiatric nursing
professional nursing that promotes the
 Is the application of specialized knowledge to
well-being of the students. populations and communities to promote
and maintain mental health, and to
THE AREA RESPONSIBILITIES OF rehabilitate populations at risk that continue
SCHOOL NURSE: to have residual effects of mental illness.
 Community mental health nurses are
 Tracking and Preventing Communicable specialized nurses who provide
Diseases. ... holistic nursing services to people
 Managing Chronic Conditions. with mental health issues in the
 Handling Acute Injury and Illness. community setting.
 Health Screenings and the Development of  The nurse can help you with things like
Education/Prevention Programs. breastfeeding and feeding your child sleep
 Serving as a Health Liaison. and settling, making sure your child is
growing, learning, and developing well.
 They provide caring and confidential
supports for clients during the recovery
period.
2. OCCUPATIONAL HEALTH NURSING
MATERNAL AND CHILD HEALTH
 Is a specialty nursing practice that provides
NURSING
and delivers health and safety programs and
services to workers, worker populations, and  Is a nursing specialty that deals with the
community groups.  care of women throughout their
pregnancy and childbirth and the care of
 The key components of occupational health
nursing involve prevention of illness and their newborn children.
injury in the workplace, health and wellness,  This specialty includes obstetric nursing,
protection, and education of employees to perinatal nursing, and pediatric nursing.
maintain the highest level of well-being of  The maternal and child health nurse will
workforce and work-related environmental usually visit at key ages and stages from
hazards in the community. birth to three and a half years
 It is one of the inherent qualities of public
health nurse
COMMON ROLES AND
RESPONSIBILITIES OF OCCUPATIONAL
NURSE: LEVELS OF CLIENTELE:
 Observation of workers doing their job tasks
to assess health status
 Development of innovative health and safety INDIVIDUAL- particular person
programs
FAMILY- basic unit in society traditionally
 Management of work-related diseases
 Disaster and emergency planning consisting of parents and children and is the
 Environmental health planning focus of care (CHN)
 Assistance with rehabilitation COMMNUITY- group of families; placed
 Coordination of employee treatments and
where people with usual conditions are found.
referrals
 Emergency care to injured employees who CHN directs its services to the community
are on-the-clock because the client is the community
 Counseling employees and families when
injured
POPULATION GROUPS- vulnerable groups
with common health needs  Human beings have certain basic needs
 There is a sustainable use of available
resources for all.
A. TYPES OF COMMUNITIES:

1. RURAL COMMUNITY 3. THE ENVIRONMENT PROMOTES

SOCIAL HARMONY AND ACTIVELY
INVOLVES EVERYONE.
 An area or countryside is a geographically
located outside towns and cities.
 Rural areas are usually large, open areas  The community participates in identifying
with few houses and sparsely local solutions to local problems.
 populated, as opposed to urban areas.  Community members have access to varied
 An area which is under development and not interaction and communication.
fully civilized based on geographical
conditions. 4. THE HEALTH SERVICES ARE
 Rural communities are placed where the ACCESSIBLE AND APPROPRIATE.
houses are spread very far apart.

 Access to health care is the timely use of

2. URBAN COMMUNITY personal health services to achieve
 the best health outcomes.
 An area which refers to towns, cities, and  Coverage: facilitates entry into the health
suburbs. care system
 An urban area includes the city itself, as
well as the surrounding areas.
 They are well- developed community with 5. THERE IS AN UNDERSTANDING OF
high density population THE LOCAL HEALTH AND
including infrastructures ENVIRONMENT ISSUES.
 These are areas where people live in very
close proximity, and there is almost always  This involves examining and evaluating the
something going on or noise of some kind. effects of chemicals made by humans on
human health or wildlife and how the
ecological systems impact the spread of
illnesses.
3. SUBURBANS COMMUNITY  A number of specific environmental issues
can impede human health and wellness.
 The suburban areas that are the mix of the
urban and rural.
 Suburban’s are usually located near to 6. A COMMUNITY SHOULD HAVE
some major urban areas that build up around ENOUGH SECURITY AND SAFETY
or outside of city and less congested with FOR ALL PEOPLE
low or medium density
 A community should be free from any
criminality
B. CHARACTERISTICS OF A HEALTHY
COMMUNITY:

1. THE PHYSICAL ENVIRONMENT IS C. COMPONENTS OF A COMMUNITY

CLEAN AND SAFE. 
1. THE ENVIRONMENT
 An environment that has clean air, clean
water, and clean energy.  term for any naturally occurring group of
 Basically, it is a healthy and safe different organisms inhabiting a
environment. common environment, interacting with
each other, especially through food
2. THE ENVIRONMENT MEETS relationships, and relatively independent
EVERYONE'S BASIC NEEDS. of other groups.
2. THE PEOPLE  Quality of life plays a very important role in
the social development. it is effective for
 Is any group of people within a larger each of the individuals in the family.
society united through a common location,
interest, or characteristic.  If all the members of the family will have
 They are the members of a community at the good quality of life then the family can live
heart of healthy communities. happy and prosperous life.
 They include all who live, learn, work, play,
and pray in communities.
 Community members may have a formal D. FACTORS AFFECTING HEALTH OF
leadership role in a community organization, THE COMMUNITY:
or friends and neighbors may recognize
them as the person who gets things done. 1. Characteristics of the population
2. Location of the community
3. THE ECONOMY 3. Social systems within the community

 Community economy focus on creating and

developing nourishing livelihood
opportunities, building on local resources 1. CHARACTERISTICS OF THE
and capacities, increasing community POPULATION
control and ownership, enhancing the health
of the environment, and encouraging
a. POPULATION DENSITY:
community resilience.
 Community economic development
encourages a way of improving social  Refers to the size of any population in
conditions in a sustainable way to overcome relation to some unit of space.
to meet their needs.

4. CULTURE. Formula:
Population Density = Number of People
 Culture refers to the shared values, Land Area in square km
beliefs and norms of a specific group of b. NATALITY
people.
 Culture, therefore, influences the manner
we learn, live and behave.  Refers to the rate of reproduction or birth
per unit time.
 The number of births during a given period
5. HEALTH in the population.

 Community health is a public concern with Formula:

healthcare practices within a community.
Natality = number of births in year x 1000
 A healthy community benefits every person Mid-year population
in it and community health is one means of
achieving a healthy community
c. MORTALITY:

6. QUALITY OF LIFE
 The number of deaths in a population during
a given time or place
 The community quality of life approach
focuses on the perceptions of community
Formula:
members of what makes life good or not
good for them. Mortality = # of deaths x 100
# of infections
 Quality of Life directs attention to how these
factors affect individual lives and to whether
basic human needs are being met within a d. POPULATION GROWTH:
community
 Refers to change in the size of a
population which can be either  Populations rarely grow smoothly up to
 Positive or negative over time, the carrying capacity and then remain
depending on the balance of births and there. Instead, fluctuations in population
deaths. numbers, abundance, or density from
one time step to the next are the norm
To calculate the Population Growth (PG) we
find the difference (subtract) between the initial 2. LOCATION OF THE COMMUNITY:
population and the population at Time 1, then
 These are also called communities of place.
 Communities is a place situated in a given
geographical area (e.g. a country, village,
town, or neighborhoods) or in virtual space
through communication platforms

3. SOCIAL SYSTEM WITHIN THE

COMMUNITY:

 Community as a social system means

that members of the same community are
functionally related with each other.
o This means they have their own
role to play and love to work
o All the part are linked with each
other, and they make an
integrated whole

divide by the initial population and multiply by

100 ROLES AND ACTIVITIES OF
COMMUNITY HEALTH NURSE:

e. AGE DISTRIBUTION: Community-based nursing applies to all nurses

who practice outside the hospital.

 The frequency of different ages or age

groups in a given population.
7 MAJOR ROLES OF COMMUNITY
HEALTH NURSES:
It can be calculated by dividing the population
0-14 years and 65 years and older by the
1. Care giver “clinician role”
population that is in the 15–64-year age group.
 Uses the nursing process to provide direct
nursing intervention to individuals, families,
Formula: or population groups
 helps to manage physical needs, prevent
illness, and treat health conditions. To do
this, they need to observe and monitor the
patient, recording any relevant information
to aid in treatment decision-making.

Example: A community has 41,650 children 2. EDUCATOR

under age 14 and 6,800 persons aged 65 and
over. The total population is 85,000.  Facilitates learning for positive health
behavior change
 identifies and interprets training needs of the
RHM's, BHW's on promotion and disease
f. POPULATION FLUCTUATIONS: prevention
 conduct pre consultation conference for  The ability to inspire, influence and
clinic clients motivate nursing staff and other health care
 acts as a resource speaker on health-related workers to work together to achieve their
services highest potential and collective
 conducts pre-marital counseling organizational goals.

3. ADVOCATE
7. RESEARCHER
 Speaks or acts on behalf of clients who
cannot do so for themselves
 CHN engage in systematic investigation,
 a nurse who works on behalf of patients to
maintain quality of care and protect patients' collection, and analysis of data for solving
rights. They intervene when there is a care problems and enhancing community health
concern, and following the proper channels, practice
work to resolve any patient care issues.  participate in the conduct of survey studeis
Realistically, every nurse is an advocate and research on nursing and health related
 We must influence support systems so we  coordinates with government and non-
are able to provide safe and effective care
government organization in the
for patients, which is a top priority in our
work implementation of studies/research

4. MANAGER ROLE
COMMON ROLE AND ACTIVITIES OF A
COMMUNITY NURSE IN THE HEALTH
 Speaks or acts on behalf of clients who
CENTER
cannot do so for themselves
 The nurse serves as a manager when:
1. assist doctors with examination and
medical procedure
 Overseeing client care as a case 2. Attend to and perform deliveries
manager 3. Administering medications
 Supervising ancillary staff, Running 4. Setting up intravenous drips and monitoring
clinics, ongoing care
 Conducting community health needs 5. basic care-such as checking temp, blood
assessment projects pressure and breathing.
6. Supervision of the work of the health
 Identifies needs, prioritize problem of an personnel in the center
individual, families and community 7. Cleaning and dressing wounds.
 Interprets and implements nursing plan,
interprets program policies

A Community Health Nurse should be...

5. COLLABORATOR  Client-oriented
 Delivery-oriented
 Community health nurses seldom practice in  Population-oriented
isolation. They must work with many
people, including:- the clients, nutritionist
etc

6. LEADERSHIP ROLE

 CHN are becoming increasingly active in

the leadership role, the leadership role
focuses on affecting change; thus the nurse
becomes an agent of change
 As leaders, CHN seek to initiate changes
that positively affect people’s health