CAPITOL MEDICAL CENTER COLLEGES

College of Nursing

______________________________________________________________________________
Prof LENIE R. AGPALASIN

NCM 104 - COMMUNITY HEALTH NURSING 1

WEEK 1

LEARNING OBJECTIVES
1. Define health and community
2. Discuss the focus of public health
3. Explain the differences among community health nursing, public health nursing and community-
based nursing
4. Discuss the important characteristics of Public Health Nursing practice and basic concepts and
principles in CHN practice
5. Discuss the different roles, responsibilities and the major functions & activities of Community
Health Nurse
6. Apply the competency standards of nursing practice in the Philippines in community health
nursing practice.
7. Describe the standards of public health nursing practice
8. Outline the historical development of public health and public health nursing in the Philippines.

HEALTH (WHO)
• A state of complete physical, mental, and social well – being and not merely the absence of
disease or infirmity.
COMMUNITY
• 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, p 6)
• 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 geographic boundary. (Lundy and
Janes, 2009, p 16)
• 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 p 27)
• A locality-based entity, composed of systems of formal organizations reflecting society’s
institutions, informal groups and aggregates. (Shuster and Geoppinger, 2008, p 344)

MAURER & SMITH (2009) FURTHER ADDRESSED THE CONCEPT OF COMMUNITY & IDENTIFIED
FOUR DEFINING ATTRIBUTES
1. People
2. Place
3. Interaction
4. Common characteristics, interests, or goals

TWO MAIN TYPES OF COMMUNITIES (MAURER & SMITH 2009)

1. Geopolitical communities
 •Most traditionally recognized or imagined
•Defined or formed by both natural and man-made boundaries and include barangays,
municipalities, cities, provinces, regions, and nations
• Also called territorial communities
2. Phenomenological communities
• Refer to rational, 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: schools, colleges, and universities; churches, and mosques; and various
groups or organizations
• May also be described as functional communities

PUBLIC HEALTH (C.E WINSLOW)

The science and art of:
1. Preventing diseases
2. Prolonging life
3. Promoting health and efficiency through organized community effort for:
• Sanitation of the environment
• Control of communicable infections
• Education of the individual in personal hygiene
• Organization of medical and nursing services for the early diagnosis and preventive
treatment of disease
• Development of the social

KEY PHRASE OF PUBLIC HEALTH ----- “Through organize effort”

PUBLIC HEALTH NURSING

• Is a synthesis of public and nursing practice.
• FREEMAN (1963) - “Public health nursing may be defined as 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.”
• WHO (Expert Committee on Nursing) - “special field of nursing that combines skills of nursing,
public health and some phases of social assistance, and functions as a part of the total public
health program for the promotion of health, the improvement of conditions in the social and
physical environment, rehabilitation and the prevention of illness and disability.
• AMERICAN PUBLIC HEALTH ASSOCIATION COMMITTEE on Public Health Nursing (1996) -
Public health nursing is the practice of promoting and protecting the health of populations using
knowledge from nursing, social, and public health sciences.

American Public Health Association Committee on Public Health Nursing (1996) stated the
following:
Public health nursing practice is a systematic process by which:

1. The health and health care needs of a population are assessed in order to identify subpopulations,
families, and individuals who would benefit from health promotion or who are at risk of illness,
injury, disability or premature death.
 2. A plan for intervention is developed with the community to meet identified needs that takes into
action available resources, the range of activities that contribute to health and the prevention of
illness, injury, disability, and premature death.
3. The plan is implemented effectively, efficiently and equitably.
4. Evaluation are conducted to determine the extent to which the interventions have an impact on
the health status of individuals and the population.
5. The results of the process are used to influence and direct the current delivery of care,
deployment of health resources, and the development of local, regional, state and national health
policy and research to promote health and prevent disease.

• Based from these definitions, public health nurses synthesize their knowledge of nursing and
public health to promote the health of communities. Nursing knowledge helps on the
understanding of problem solving and creative empowerment, of human beings and their
responses to health and illness, and of relationships between people and their environment

THE UNIQUENESS OF COMMUNITY HEALTH NURSING PRACTICE

AMERICAN NURSES ASSOCIATION (1980)

The American Nurse Association (1980) uses the term community health nursing and gives the following
definition:
• “The practice is general and comprehensive. It is not limited to a particular age group or diagnosis
and is continuing, not episodic. The dominant responsibility is to the population as a whole;
nursing directed to individuals, families, or groups contributes to the health of total population.
Health promotion, health maintenance, health education and management, coordination, and
continuity of care are utilized in a holistic approach to the management of the health care of
individuals, families and groups in a community”.
• “Community health nursing is a synthesis of nursing practice and public health practice applied
to promoting and preserving the health of populations.

ACCORDING TO PHILIPPINE DEPARTMENT OF HEALTH:

• “Community Health Nursing is a unique blend of nursing and public health practice woven into a
human service that, properly developed and applied has a tremendous impact on human well-
being.”
• Its responsibilities expand to the care and supervision of individuals and families in their homes,
in places of work, in schools and clinics”.

Two Major sources:

1. Public Health – as it addresses itself to the health of the public with the ultimate goal of a healthy,
vital community;
2. Nursing one of the helping professions, join forces in a practice aimed at promoting and protecting
the general health of the community. This practice emphasizes various levels of prevention, identifies
public health problems, mobilizes the community resources including human resources in an effort of
intervention to prevent, eliminate and/or control these public health problems which inhibits each
citizen of the community enjoyment of optional health and an adequate standard of life.
COMMUNITY HEALTH NURSING
• “Nursing for the community’s health”
• Community health nurses address both the personal and the environmental aspects of health and
deal with community factors which either inhibit or facilitate healthy living.
• Personal health involves the biophysical and spiritual aspects of individual, family and group
functioning, whereas environmental health deals with people’s surroundings – settings such as
homes, schools, workplaces, recreational facilities.

“The word client or consumer rather than patient are used in community health nursing
because they reflect a wellness orientation”

COMMUNITY – BASED NURSING

Refers to application of the nursing process in caring for individuals, families and groups
where they live, work or go to school or as they move through the health care system.

Important Characteristics of Public Health Nursing Practice:

• Autonomy
• Continuity of care
• Collaboration
• Interactivity
• Accountability
• Intimacy with reality of client’s situations

Community Health Nursing

• 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

Community Health Nursing

• Priority of health promotive and disease preventive strategies over curative interventions
• Application of principles of management and organization in the delivery of health services to the
community.
• Tools for measuring and analyzing community health problems;

BASIC CONCEPTS & PRINCIPLES IN CHN PRACTICE

• The family is the unit of care, hence the community health nurse consider the health needs of all
members of the family in providing nursing services.
• The community as a whole is the locus of service and the patient;
• The goal in improving community health is realized through multidisciplinary approach.
• The community health nurse is deeply concerned with the increasing capability of her four levels
of clientele – individual, family, population groups and community to deal with its own
recognized needs and health problems
• The public health nurse works with and not for the client who is an active partner
• Practice is affected by changes in society in general; and by development in the health field in
particular;
 • Community health nursing is a part of functions within a large and complex system and any change
in this system affects it

BASIC ETHICAL PRINCIPLES IN RENDERING SERVICE AND CARE TO THE CLIENT

1. Respect for persons/autonomy – protecting the clients’ rights as they are given the right for
self-governance, to deliberate and decide what is the best solution to their recognized needs
and problems
2. Beneficence/utility – do good for everyone, maximize possible benefits/community resources
and minimize possible harms;
3. Non-maleficence – applying “primum non nocere” – at first do no harm
4. Justice – treat everyone equally regardless of their race, creed or socioeconomic status, give
what is due corresponding to the needs and problems of the people
5. Inviolability of life – maintain the dignity of the individual as we give respect for human life.

These are the essential ethical principles that the public health nurse considers as he is
guided by the philosophy: “community health nursing is based on the worth and dignity
of man”.

PHILOSOPHY OF COMMUNITY HEALTH NURSING IS BASED ON THE WORTH AND

DIGNITY OF MAN (Margaret Shetland)

THE COMMUNITY HEALTH NURSE

ROLES OF THE COMMUNITY HEALTH NURSE

1. CASE MANAGER
Assisting clients to make decisions about appropriate health care services and to achieve service
delivery integration and coordination which are among the important roles of the community health
nurse.
2. ADVOCATE
Clients in the community health nursing setting frequently are unable to negotiate for change in the
health care system. The nurse seeks to promote an understanding of health problems, lobby for
beneficial public policy and stimulate supportive community action for health
3. TEACHER
Application of teaching – learning principles to facilitate behavioral changes among clients
is a basic intervention strategy in community health.
4. PARTNER & COLLABORATOR
The aim of partnership and collaboration is to get people to work together in order to
address problems or concerns that affect them.
The community health nurse establishes and maintains valuable working relationships
with people such as people’s organization, health organizations, educational institutions,
socio-civic organization, sectoral groups and the like.
Through health education, communities and health professional bodies can become
geared up to demand for change and begin to effect the transformation in public policy
that will address social and environmental inequalities and therefore improve health.
5. HEALTH PLANNER/PROGRAMMER
• Identifies needs, priorities and problems of individuals, families and communities
• Formulates nursing component of health plans. In doctor less area, she is responsible for the
formulation of the municipal health plan
• Interprets and implements the nursing plan, program policies, memoranda and circulars for the
concerned staff/personnel
• Provides technical assistance to rural health midwives in health matters.

6. MANAGER/SUPERVISOR
• Formulates individual, family, and aggregates centered care plan
• Interprets and implements program policies, memoranda and circulars
• Organizes work force, resources, equipments and supplies and delivery of health care at local
levels.
• Provides technical and administrative support to Rural Health Midwife (RHM). Conducts
regular supervisory visits and meetings to different RHMs and give feedback on
accomplishments/performances
7. COMMUNITY ORGANIZER
• Responsible for motivating and enhancing community participation in terms of planning,
organizing, implementing, and evaluating health programs/services
• Initiates and participates in community development activities.
8. HEALTH EDUCATOR/TRAINER
• Identifies and interprets training needs of RHMs, Barangay Health Workers/Volunteers
(BHW/BHV) and Hilots
• Formulates appropriate training program designs
• Provides and arranges training and learning experiences of nursing and midwife affiliates
• Conducts trainings for health personnel
• Acts as resource speaker on health and health related services as the need arises
• Participates in the development and distribution of Information Education and
Communication (IEC) materials
9. CASE FINDER
• Because of the nurse proximity to families and aggregates in the community, case finding
has been a strategic role for many years.
• Example: at risk children are identified and followed periodically as they developed
10. EPIDEMIOLOGIST
• The nurse uses the epidemiological method to study disease and health among population
groups and to deal with community-wide health problems.
• Collecting data on health problem and care is an important epidemiological role. Reasons
why people do and do not use health care are important elements in planning health
services.
11. RECORDER/REPORTER/STATISTICIAN
• Prepares and submit required records and reports
• Review, validates, consolidates, analyzes, and interprets all records and reports
• Maintains adequate, accurate and complete recording and reporting
12. COMMUNITY LEADER
The CHN, being a leader, a role model and respected in the community is in a better
position to empower others.
Empowerment is giving your influence to others for purpose of personal and organization
growth.
MAJOR FUNCTIONS & ACTIVITIES OF THE COMMUNITY HEALTH NURSE

I. ADMINISTRATION & MANAGEMENT

A. Planning & Programming

• Participate in the formulation of the city health plan. Develop the nursing service
component of the plan.
- Collect , process and analyze data needed for planning.
- Make data projection.
- Identify nursing needs, problems and requirement.
- Establish priorities.
• Formulate program for implementing nursing plan.
- Set time frame for activities.
- Modify plans based on need and requirements for nursing inputs.
- Discuss nursing programs with community leaders organized groups and health
related agencies.
B. Oversee the Nursing Inputs into the different programs
• Determine needs of nursing personnel for training/development or for administrative
support.
• Interpret needs of nursing personnel for administrative support.
C. Monitoring
• Monitor status of implementation of nursing inputs.
- Provide feedback to community and health related groups/agencies of nursing inputs in
programs.
- Provide feedback in the implementation of results of studies research in nursing services.
- Redirect nursing programs as required.
• Maintain/Review records and reports on nursing services.
- Process reports.
- Verify data if required.
- Identify strengths and weaknesses in the delivery of health services.
- Submit reports on nursing services periodically.
D. Evaluation
• Assess periodically strategies and activities as to their effectiveness and appropriates.
-Utilize monitoring tools in collecting data at specified periods.
- Make recommendations.
• Assess extent objectives of nursing inputs are attained.
-Review objectives in relation to outputs of nursing component.
- Study strategies/alternative chosen for implementation in relation to objectives.
- Make recommendations.
- Discuss finding and recommendations.

E. Coordination
• Identify groups in the community through which nursing programs/services can be
implemented.
- Utilize various methods in identifying groups/health related agencies which provide
community services.
-Establish and maintain updated directory.
 • Coordinate nursing inputs with other health programs elements.
-Identify the inter-relationship of nursing inputs with the inputs of other health
discipline and related agencies.
-Define working relationship that could promote coordination.
-Promote effective working relationship of groups and within the group.
-Monitor group activities.
• Identify groups in the community through which nursing programs/services can be
implemented.
- Utilize various methods in identifying groups/health related agencies which provide
community services.
-Establish and maintain updated directory.
F. Resources
1. Staff
• Review needs/requirements for staff to implement nursing component in the health
programs.
-Determine the job requirements of the programs for nursing inputs.
- Review present staffing pattern and capabilities.
- Study other resources which can be utilized to extend existing staff.
-Interpret and discuss needs.
• Plan for adequate implementation of nursing inputs in terms of existing staff.
-Look at quality/quantity of expected outputs from nursing.
- Plan for the effective utilization of nursing manpower.
2. Physical Facilities
• Determine programs needs for physical facilities to implement the nursing components.
- Look at details required of present facilities and geographic location which influence
effective delivery of nursing inputs.
- Assess needs for new physical facilities modifying of present facilities.
- Discuss with physical charge and make recommendations.
• Interpret needs for essential working and sanitation facilities for nursing personnel.
-Determine minimum requirements for delivery of safe nursing services.
- Make recommendations.
-Discuss with physician in charge and community leaders.
G. Logistics
• Determine needs and requirements of programs for logistics supports of instruments for
delivery of nursing services.
- Look at quantity and quality of supplies, materials, equipments and instruments for
delivery in charge.
- Identify anticipated requirements.
- Discuss with physician in charge.
• Implement the accepted system, for maintenance and replenishments of stock levels in
health centers.
- Utilize the logistic system.
• Assess and monitor states of supplies/equipment.
- Check monthly reports on logistics of health center.
- Verify information by comparing report with management.
- Discuss findings with staff, physician in charge.
II. TECHNICAL
A. Patient/Family Health
• Determine nursing needs/requirements.
-Perform physical examination and home selected laboratory procedures.
- Relate findings with community and home environment.
- Assess family health needs in relation to patient health needs.
- Interpret findings to patient/family.
• Provide/arrange for nursing services.
-Plan care.
- Identify objectives to patient/family.
- Set priorities.
- Assess effectiveness of nursing care.
- Teach or guide patient/family in health promotion, disease or accident prevention and
rehabilitation.
- Refer cases needing further care to the head of the health department or to other
health facility.
- Follow-up of priority cases.
B. Disaster Emergency
• Plan with staff the nursing inputs for disaster/emergency situation.
- Identify needs and requirement for nursing services.
- Determine man power needs and logistics supports for delivery of nursing inputs.
- Contribute to the plan by identifying nursing inputs.
• Identify nursing inputs of community/health-related agencies organization.
- Participate in the planning of nursing inputs
- Assure the coordination of nursing inputs with other agencies.
• Participate in implementing plan.
- Assist in the implementation of the plan.
- Monitor implementation of nursing inputs in the plan.
C. Epidemiology
• Maintain surveillance of occurrence of symptoms of notifiable disease.
- Study utilization of medicines and relate to health problems.
- Identify age groups/areas affected.
- Conduct investigation to define problems.
- Reports findings to physician.
- reports notifiable disease.
• Participate in conducting epidermiological invetigation.
- Assist in processing data.
D. Environmental Sanitation
• Relate aspects of environmental situation of the family/community to the planned nursing
inputs of health programs.
- Include environmental element of the community in supervisory visits.
• Coordinate the nursing inputs with environmental santitation activities.
- Plan the education contribution of nursing to coincide with programs environmental
sanitation activities.
- Refer problems identified to sanitarian.
 III. SUPPORTIVE

A. Community organization
• Participate in informing community about services and community inputs in health care.
- Determine what community can contribute.
- Explain the contribution and needs for nursing.
- encourage group/community participation.
• Organize groups to assist and support the implemetation of nursing programs.
- Establish communication lines with groups among groups.
- Plan with groups’ specific contribution, the time froms and resources needs.
- Identify outputs.
- Monitor/Coordinate group activities.
B. Health education
• Assure that health education intagrated in all nursing inputs gear on health education
to health problems of family/community obtain appropriates information materials.
C. Staff Development and Training of Manpower
• Relate findings of supervisory visits to training requirement .
- Identify competencies headed by nursing personnel in implementing new programs.
- Interpret the needs.
• Plan for ways of meetings, training development needs of nursing personnel.
- Relate needs to type of training/development program needs utilize varied methods in
developing capabilities of staff.
- Recommend for special training of staff.
• Conduct/participate in training development program.
- Conduct orientation and on the job training.
- Assist personnels in re-entry and utilizing knoledge/skills gained in the work situation.
- share new techniques with nursing staff.
D. Research Development
• Identify areas in health and/or nursing services needing investigation and research.
- Review the monitored information of nursing services.
- Select areas whom research is feasible and would have an impact in the delivery of
nursing services.
- Participate in the selction of the reasearch areas in which nursing a component.
• Participate in the implementation of studies/research.
- Look at planned activities to fit in the research activities.
- Oversee/monitor nursing inputs in the research activities.
• Participate in the documentation of the findings and in the designation and utilization
of such to concerned groups.
- Oversee the processing of data.

COMPETENCY STANDARDS IN COMMUNITY HEALTH NURSING

1. Safe & quality nursing care
2. Management of resources and environment
3. Health education
4. Legal responsibility
5. Ethico moral responsibility
6. Personal & professional development
7. Quality improvement
8. Research
9. Records management
10. Communication
11. Collaboration & teamwork

STANDARDS OF PUBLIC HEALTH NURSING PRACTICE

STANDARDS OF CARE
REFERENCE

1. COMMUNITY HEALTH NURSING: An Approach to Families and Population Group -

Erlinda David, Maria Jesusa Lourdes Rodolfo, Virginia Serraon-Claudio, Adela Jamorabo-
Ruiz
2. NURSING CARE OF THE COMMUNITY: A comprehensive text on community and public
health nursing in the Philippines – Zenaida U. Famorca, Mary A. Nies, Melanie Mcewen

"Every day may not be wonderful, but there is something wonderful in

every day."