COMMUNITY HEALTH NURSING

ajpelongco RN,MN
 Community Health Nursing

• COMMUNITY – “communitas”
 Health

• “a state of complete physical, mental, and

social well-being and not merely the
absence of disease or infirmity” (1948)
• Has been modified to include economic,
socio-cultural, environmental and other
factors that affect or influence the
attainment and maintenance of a “ socially
and economically productive life.”
 NURSING

• Latin word “Nutrix” or Nutridus” - to

nourish or nourishing
• Basically the relationship between the
Nurse and the person in her or his care.
Community Health Nursing
• One of the 2 broad fields of Nursing in
terms of setting or place of practice
• Old; established one
• Public Health Nursing is just a part of
Community Health Nursing. PHN is
concerned with the services of the
government Nurses in the community
 Public Health
• -” science and art of preventing disease,
prolonging life, promoting health and efficiency
thru’ 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 diseases and
the development of social machinery to ensure
everyone a standard of living adequate for the
maintenance of health, so organizing these
benefits as to enable every citizen to realize his
birthright off birth and longevity” ( DR. C.E.
Winslow)
 Community Health Nursing

• - special field of nursing that combines the

skills of nursing, 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
the conditions in the social and physical
environment, rehabilitation of illness and
disability ( WHO Expert Committee of
Nursing )
 Community Health Nursing
• - a learned practice discipline with the ultimate
goal of contributing as individuals and in
collaboration with others to the promotion of the
client’s optimum level of functioning thru’
teaching and delivery of care ( Jacobson )
• - a service rendered by a professional nurse to
IFCs, population groups in health centers, clinics,
schools , workplace for the promtion of health,
preventionof illness, care of the sick at home and
rehabilitation (DR. Ruth B. Freeman)
 Community Health Nursing

• “Deals with the greater understanding of

man and his health-seeking and coping
behaviors and in-depth understanding of
behavioral science principles”
(Reinhardt and Quinn, 1976)
• A service rendered by a professional nurse
to IFCs, population groups in health
centers, clinics, schools, workplace for the
promotion of health, prevention of illness,
care of the sick at home and rehabilitation
(Dr. Ruth B. Freeman)
 Community Health Nursing
• A field of Nursing practice where services
are delivered outside of purely curative
institutions, but in community settings such
as:
- the home
- the school
- places of work
- health centers and clinics
 Community Health Nurse
• “Visiting Nurse”
• “Lady Health Visitor”
• “Public Health Nurse”
• “Community Health Nursing” and
• “Community Health Nurse” were first
used in 1960
Medicine shifted – disease to health; from
cure to health promotion & disease
prevention; from hospital to the community
Results : Community Medicine, Community
Dentistry, Community Pharmacy,
etc…Community Health Nursing came into
use in lieu of age-old Public Health Nursing
 Concepts
• The primary focus of community health nursing is
health promotion.
• Recognized needs of IFC provide the basis for
CHN
• Family is the unit of care/service
• Nursing process in community health nursing
changes based on the needs of the community.
• Contact with the client may continue over a long
period of time which includes all ages and all types
of health care
 Concepts
• CH nurses are generalists in terms of their
practice throughout life’s continuum – its
full range of health problems and needs
• CHN practice is extended to benefit not
only the individual, but the whole family
and community
• CHNurse provides care necessary to meet
the requirements of an individual all
throughout the life cycle
• Knowledge on different fields (biological
and social sciences, clinical nursing, and
community health organizations) is used.
 Basic Principles of CHN
1.The need of the community is the basis of
community health nursing.

2. The community health nurse must understand

fully the objectives and policies of the agency she
represents.

3. The family is the unit of service.

• CHN must be available to all regardless of
race, creed and socioeconomic status
• The CHN works as a member of the health
team
• There must be provision for periodic
evaluation of community health nursing
services
• Opportunities for continuing staff
education programs for nurses must be
provided by the community health
nursing agency and the CHN as well
• The CHN makes use of available
community health resources
• 9. The CHN taps the already existing
active organized groups in the community
There must be provision for educative
supervision in community health nursing

There should be accurate recording and

reporting in community health nursing
• Health teaching is the primary
responsibility of the community health
nurse
 Basic Principles of CHN
3. The community is the client/patient in
CHN, viewed either physically in the
geographic boundaries or time-space
dimension.
4. The basic purpose of CHN is to improve
community health through the selective
application of nursing and public health
measures within the framework of the
total health care system.
5. The goal of improving health is realized
through multidisciplinary effort.
6. The basis for the professional practice of
nursing and of CHN is the application of the
problem-solving method, which is referred to
as the “nursing process”.
7. The family is the basic unit of care in CHN.
An individual client/patient is viewed as a
member of a family which, in turn, is part of a
community.
8. The community health nurse works with and
not for the individual client/patient, family,
group, or community.
9. Two very important role of a community
health nurse are those of a health teacher and a
change agent.
10. The practice of CHN is affected by changes in
society in general and by changes and
developments in the health and related fields
in particular.
Basic Ethical Principles in Health
Principle Definition Example
Altruism Concern for Being present
the welfare of
others
Beneficence Doing good Providing
immunization
Nonmaleficence Avoiding Not
harm abandoning
client
 Principle Definition Example
Respect for Honoring self- Allowing client
autonomy determination, to refuse
i.e. right to treatment;
make one’s informed
own decision; consent;
respecting maintaining
privacy confidentiality
Veracity Truth-telling Communicating
authentically
and not lying
 Principle Definition Example
Fidelity Keeping Arriving on
promises time for home
visit

Justice Treating people Providing

fairly nursing service
to all, regardless
of ability to pay
 GOAL OF CHN
To elevate the level health of the multitude.
PHILOSOPHY OF CHN

Worth and dignity of MAN

 Setting of CHN
• Home
• Clinic
• School
• Work place
• Health center
• Market
• Mall
• Rice field and more…
 PRIORITIES

• 1. High-risked I, F, G, C
• 2. Underserved I, F, G, C
 Objective of CHN

Achieve the highest level of community

health by developing & enhancing the
capabilities of I, F, G, C to take care of
their own health & effectively cope with
health problems. (OLOF)
Levels of Prevention
Methodology for Providing Care

Partnership with Clients using:

• Nursing Process ( Assessment,
Intervention, Evaluation)
• Collaboration & Cooperation with
health team & intersectoral teams
CHN as a synthesis of nursing &
Public Health
 Types of Clientele
• 1. INDIVIDUALS
• 2. FAMILIES
• 3. COMMUNITIES
• 4. POPULATION GROUPS
- Aggregate of people who share common
characteristics, developmental stage or common
exposure to particular environmental factors thus
resulting in common health problems ( Clark,
1995) e.g. children . elderly, women, workers etc.
 Types of Clientele

1. INDIVIDUAL – CHNurse provide care

to specific patient/clients in various
conditions of health and illness; from the
healthy/well to the dying; and all age groups
from birth to senescence
 Types of Clientele

2. FAMILY – two or more individuals

joined or related by ties of blood, marriage
or adoption and who constitute a single
household, interact with each other in their
respective familial roles and who create and
maintain a common culture
 Types of Families
• 1. Nuclear
• 2. Extended
• 3. Three generational
• 4. Dyad
• 5. Single- Parent
• 6. Step- Parent
• 7. Blended or reconstituted
 Types of Families

• 8. Single adult living alone

• 9. Cohabiting/ Living –in
• 10. No- kin
• 11. Compound
• 12. Gay
• 14. Commune
 Types of Clientele

3. GROUP – CHNurse focuses their

activities to certain population groups with
common unique health needs; are at risk of
developing or have already developed
certain defined health problems. (e.g.
pregnant women, infants, pre-school age
children, school children, workers in
industrial establishments
 Types of Clientele

4. COMMUNITY – CHNurse delivers

nursing services addressed to community-
wide health problems, in cooperation and
coordination with other members of the
health team as well as relevant intersectoral
teams
 THE COMMUNITY HEALTH
NURSE

• Qualifications
1.Bachelor of Science in Nursing
2.Registered Nurse of the
Philippines
 ROLES OF THE CHNurse

• Planner/Programmer
1. Identifies needs, priorities, and problems of individuals,
families, and communities
2. Formulates municipal health plan in the absence of a
medical doctor
3. Interprets and implements nursing plan, program policies,
memoranda, and circular for the concerned staff personnel
4. Provides technical assistance to rural health midwives in
health matters
 ROLES OF THE CHNurse
• Provider of Nursing Care
1.Provides direct nursing care to sick or
disabled in the home, clinic, school, or
workplace
2.Develops the family’s capability to
take care of the sick, disabled, or
dependent member
 ROLES OF THE CHNurse
• Manager/Supervisor
1. Formulates individual, family, group, and
community-centered plan
2. Interprets and implements programs, policies,
memoranda, and circulars
3. Organizes work force, resources, equipments, and
supplies at local level
4. Provides technical and administrative support to
Rural Health Midwives (RHM)
5. Conducts regular supervisory visits and meetings
to different RHMs and gives feedback on
accomplishments
 ROLES OF THE CHNurse
• Community Organizer
1. Motivates and enhances community participation
in terms of planning, organizing, implementing,
and evaluating health services

1. Initiates and participates in community

development activities
 ROLES OF THE CHNurse
• Coordinator of Services
1.Coordinates with individuals, families, and
groups for health related services provided
by various members of the health team
2.Coordinates nursing program with other
health programs like environmental
sanitation, health education, dental health,
and mental health
 ROLES OF THE CHNurse
• Trainer/Health Educator
1. Identifies and interprets training needs of the
RHMs, Barangay Health Workers (BHW), and
hilots
2. Conducts training for RHMs and hilots on
promotion and disease prevention
3. Conducts pre and post-consultation conferences
for clinic clients; acts as a resource speaker on
health and health-related services
4. Initiates the use of tri-media (radio/TV, cinema
plugs, and print ads) for health education purposes
5. Conducts pre-marital counseling
 ROLES OF THE CHNurse

• Health Monitor
Detects deviation from health of individuals,
families, groups, and communities through
contacts/visits with them
 ROLES OF THE CHNurse

• Role Model
Provides good example of healthful living to the
members of the community
 ROLES OF THE CHNurse

• Change Agent
Motivates changes in health behavior in
individuals, families, groups, and communities
that also include lifestyle in order to promote and
maintain health
 ROLES OF THE CHNurse

• Recorder/Reporter/Statistician
1.Prepares and submits required reports and
records
2.Maintain adequate, accurate, and complete
recording and reporting
3.Reviews, validates, consolidates, analyzes,
and interprets all records and reports
4. Prepares statistical data/chart and other data
presentation
 ROLES OF THE CHNurse

• Researcher
1.Participates in the conduct of survey
studies and researches on nursing and
health-related subjects
2.Coordinates with government and non-
government organization in the
implementation of studies/research
Theoretical Framework of CHN
 How do we compare Clinical Nursing
from a Community Health Nursing?

Clinical Nursing

Community Health Nursing