DYNCM113:

COMMUNITY HEALTH NURSING II

(Population Groups and Community as Clients)

REGIE P. DE JESUS, MAN

Instructor, College of Health Sciences
 Module No. 1
REVIEW OF COMMUNITY HEALTH NURSING CONCEPTS

At the end of this module, you are expected to:

1. integrate relevant principles of social, physical, natural and health sciences and humanities
in the care of population groups and communities
2. explain the different theoretical models that serve as the foundation of community health
nursing practice
3. explain the difference of each health care system models
4. discuss the different fields in community health nursing in the Philippines

DEFINITION OF COMMUNITY HEALTH NURSING

o "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." (Maglaya, et al)

o Goal: "To raise the level of citizenry by helping communities and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential for
high-level wellness" (Nisce, et al)

o 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
(OLOF) thru' teaching and delivery of care (Jacobson)

o 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)

PHILOSOPHY OF CHN

§ “The philosophy of CHN is based on the worth and dignity of man.”(Dr. M. Shetland)

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 MISSION OF PUBLIC HEALTH
o Health Promotion
o Health Protection
o Health Balance
o Disease prevention
o Social Justice
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: individual, family, population group (those 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 PASSIVE recipient of
care
3. CHN practice is affected by developments in health technology, in particular, changes in
society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.

ROLES OF THE PUBLIC HEALTH NURSE

§ Clinician, who is a health care provider, taking care of the sick people at home or in the
RHU
§ Health Educator, who aims towards health promotion and illness prevention through
dissemination of correct information; educating people
§ Facilitator, who establishes multi-sectoral linkages by referral system
§ Supervisor, who monitors and supervises the performance of midwives
§ Health Advocator, who speaks on behalf of the client
§ Advocator, who act on behalf of the client
§ Collaborator, who working with other health team member
§ Change Agent, who motivates changes in health behavior to promote and maintain health
§ Recorder/Reporter/Statistician
§ Prepares and submits required reports and records
§ Maintain adequate, accurate, and complete recording and reporting
§ Reviews, validates, consolidates, analyzes, and interprets all records and reports
§ Prepares statistical data/chart and other data presentation
§ Researcher
§ Participates in the conduct of survey studies and researches on nursing and health-
related subjects
§ Coordinates with government and non-government organization in the
implementation of studies/research

NOTE: In the event that the Municipal Health Officer (MHO) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of the
MHO’s responsibilities.

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THEORETICAL MODELS OR APPROACHES IN CHN
a. Health Belief Model (HBM)-
• Initially proposed in 1958
• the model provides the basis for much of the practice of health education and
promotion today.
• This model found that information alone is rarely enough to motivate people to act
for their health. Individuals must know what to do and how to do it before they can
take action.
• 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)
• The model postulates that health-seeking behaviour 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.

Concept Definition
Perceived susceptibility One’s belief regarding the chance of getting a given
condition
Perceived severity One’s belief in the seriousness of a given condition
Perceived benefits One’s belief in the ability of an advised action to reduce
the health risk or seriousness of a given condition
Perceived barriers One’s belief regarding the tangible and psychological
costs of an advised action
Cues to an action Strategies or conditions in one’s environment that activate
readiness to take action
Self-efficacy One’s confidence in one’s ability to take action to reduce
health risks
• The model’s concepts all relate to the client’s perceptions

• For example: The cue to action in the prevention of dengue fever may be provided
through an information campaign. This makes the people in a barangay aware of the
disease and that everyone is susceptible to the possibly fatal disease. The HBM
would be used by the nurse to help clients in making behavior modifications to
avoid dengue.

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 b. Milio’s Framework for Prevention
• Nancy Milio (1976) proposed that health deficits often result from an imbalance
between a population’s health needs and its health sustaining resources.
• Milio asserted that health deficits occur when there is an imbalance between a
community’s health needs, and its health-sustaining resources (e.g. individual’s
awareness, knowledge and health beliefs, money and time)
• She challenged the common notion that a main determinant for unhealthful
behavioural choice is lack of knowledge.
o Milio’s Propositions
§ 1. Population health results from deprivation and/excess of critical
health resources.
• Example: Individuals / families living in poverty have poorer
health status compared with middle & upper class

§ 2. Behaviors of populations result from selection from limited choices

• Example: Positive and negative lifestyle choices ( e.g.,
smoking, alcohol use, safe sex practices, regular exercise,
diet/nutrition, seatbelt use) are strongly dependent on culture,
socioeconomic status, and educational level

§ 3. Organizational decisions & policies (GO & NGO) dictate many of

the options available to individuals/populations & influence choices
• Example: Health insurance coverage and availability are
largely determined and financed by private companies (e.g.
Medicare and Medicaid) and employers (e.g. private
insurance); the source and funding of insurance very strongly
influence health provider choices and services.

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 § 4. Individual choice related to health-promoting or health-damaging
behaviors is influenced by efforts to maximize valued resources
• Example: Choices and behaviors of individuals are strongly
influenced by desires, values and beliefs. For example, the use
of barrier protection during sex by adolescents is often
dependent on peer pressure and the need for acceptance, love
and belonging.

§ 5. Alteration in patterns of behavior resulting from decision making of

significant number of people in a population can result in social
change.
• Example: Some behaviors such as tobacco use have become
difficult to maintain in many settings or situations in response
to organizational and public policy mandates.

§ 6. Without concurrent availability of alternative health-promoting

options for investment of personal resources, health education will be
largely ineffective in changing behavior patterns.
• Example: Addressing persistent health problems (e.g.
overweight/obesity) is hindered because most people are very
aware of what causes the problem, but are reluctant to make
reluctant lifestyle changes to prevent or reverse the condition.
Often "new" information (e.g., a new diet) or resources (e.g., a
new medication) can assist in attracting attention and directing
positive behavior changes.

• She proposed that most human beings make the easiest choices available to them most
of the time.
• Health promoting choices must be more readily available and less costly than health
damaging options for individuals to gain health.
• This theory is broader than the HBM, it includes economic, political and
environmental health determinants rather than just the individual’s perceptions.
• This theory encourages the nurse to understand health behaviors in the context of their
societal milieu.

c. Nola Pender’s Health Promotion Model

• The model explores many biopsychosocial factors that influence individuals to pursue
health promotion activities.
• The model depicts complex multidimensional factors which people interact with as
they work to achieve optimum health.

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 Constructs/Variables of HPM
Individual Each person’s unique characteristics and experiences affect
characteristics and his or her actions. Their effect depends on the behavior in
experiences question
Prior related Prior behaviors influence subsequent behavior through
behavior perceived self-efficacy, benefits, barriers and affects related
to that activity. Habit is also a strong indicator of future
behavior.
Behavior specific In the HPM, these variables are considered to be very
cognitions an affect significant in behavior motivation. They are a “core” for
intervention because they may be modified through nursing
actions assessment of the effectiveness of interventions is
accomplished by measuring the change in these variables.
Perceived benefits of The perceived benefits of a behavior are strong motivators o
action that behavior. These motivate the behavior through intrinsic
and extrinsic benefits. Intrinsic benefits include increased
energy and decreased appetite. Extrinsic benefits include
social rewards such as compliments and monetary rewards.
Perceived barriers to Barriers are perceived unavailability, inconvenience,
action expense, difficulty or time regarding health behaviors
Perceived self- Self-efficacy is one’s belief that he or she is capable of
efficacy carrying out a health behavior. If one has high self-efficacy
regarding a behavior, one I more likely to engage in that
behavior than if one has low self-efficacy.
Activity related affect The feelings associated with a behavior will likely affect
whether an individual will repeat or maintain the behavior
Interpersonal I the HPM, these are feelings or thoughts regarding the
influences beliefs or attitudes of others. Primary influences are family,
peers, and health care providers.
Situational influences These are perceived options available, demand
characteristics, and aesthetic features of the environment
where the behavior will take place.
For example, a lovely day will increase the probability of
one taking a walk; the fire code will prevent one from
smoking indoors.
Commitment to a Pender states that “commitment to a plan of action initiates
plan of action a behavioral event”. This commitment will compel one into
the behavior until completed, unless a competing demand or
preference intervenes.
Immediate competing These are alternative behaviors that one considers as
demands and possible optional behaviors immediately prior to engaging
preferences in the intended, planned behavior. One has little control
over competing demands, but one has great control over
competing preferences

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 Health promoting This is the goal or outcome of the HPM. The aim of health
behavior promoting behavior is the attainment of positive health
outcomes

Pender's Health Promotion Model

d. Lawrence Green’s PRECEDE-PROCEED MODEL

• It is a comprehensive structure for assessing health needs for designing,
implementing, and evaluating health promotion and other public health programs to
meet those needs
• It provides a model for community assessment, health education planning, and
evaluation.

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 • PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in
Educational Diagnosis and Evaluation. It involves assessing the following
community factors:
o Social assessment: Determine the social problems and needs of a given
population and identify desired results.
o Epidemiological assessment: Identify the health determinants of the
identified problems and set priorities and goals.
o Ecological assessment: Analyze behavioral and environmental determinants
that predispose, reinforce, and enable the behaviors and lifestyles are
identified.
o Identify administrative and policy factors that influence implementation
and match appropriate interventions that encourage desired and expected
changes.
o Implementation of interventions.

• PROCEED stands for Policy, Regulatory, and Organizational Constructs in

Educational and Environmental Development. It involves the identification of desired
outcomes and program implementation:
o Implementation: Design intervention, assess availability of resources, and
implement program.
o Process Evaluation: Determine if program is reaching the targeted
population and achieving desired goals.
o Impact Evaluation: Evaluate the change in behavior.
o Outcome Evaluation: Identify if there is a decrease in the incidence or
prevalence of the identified negative behavior or an increase in identified
positive behavior.

• Predisposing factors: people’s characteristics that motivate them toward health-

related behavior.
• Enabling factors: conditions in people and the environment that facilitate or impede
health related behavior.
• Reinforcing factors: feedback given by support persons or groups resulting from the
performance of health-related behavior

• PRECEDE-PROCEED invites participation from community members, and has the

potential to increase community ownership of the program

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 Green’s PRECEDE-PROCEED MODEL

FIELDS OF CHN IN THE PHILIPPINES

• SCHOOL HEALTH NURSING - the application of nursing theories and principles in the
care of the school population
o Focus: Promotion of health and wellness of students and teachers
o Primary Role of CHN: to ensures that educational potential is not hampered by
unmet health needs
o Health and Nutrition Center (HNC) of the Department of Education has 2
Divisions:
§ 1. Health Division
§ 2. Nutrition Division
o Functions of the School Nurse:
§ 1. School Health and Nutrition survey
§ 2. Putting up a functional school clinic
§ 3. Health assessment
§ 4. Standard vision testing
§ 5. Ear examination
§ 6. Height and weight measurement and nutritional status determination

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 § 7. Medical referrals
§ 8. Attendance to emergency cases
§ 9. Student health counselling
§ 10. Health and nutrition education activities
§ 11. Organization of school-community health and nutrition councils
§ 12. Communicable disease control
§ 13. Establishment of data bank on school health and nutrition activities
§ 14. School plant inspection for health environment

• OCCUPATIONAL HEALTH NURSING – the application of nursing principles and

procedures in conserving the health workers in all occupations
o Mission: To assure that every man and woman in the country is safe and in healthful
working conditions
o R.A. 1054 is also known as the Occupational Health Act
o Based on R.A. 1054, an occupational nurse must be employed when there are 30 to
100 employees and the workplace is more than 1 km. away from the nearest health
center
o Occupational hazards: Physical, chemical, biological, mechanical, psychosocial

• COMMUNITY MENTAL HEALTH NURSING

o RA No. 11036 also known as The Mental Health Act
o a unique clinical process which includes an integration of concepts from nursing,
mental health, social psychology, community networks, and basic sciences
§ example of programs
• Provision of mental health and psychosocial support (MHPSS)
during personal and community wide disasters
• Provision of services for mental, neurologic and substance use
disorders at the primary level from assessment, treatment and
management to referral; and provision of psychotropic drugs which
are provided for free.

• HOME HEALTH CARE – this practice involves providing nursing care nursing care to
individuals and families in their own places of residence mainly to minimize the effects of
illness and disability.

• HOSPICE HOME CARE – homecare rendered to the terminally ill. Palliative care is
particularly important

ENTREPRENURSE
• A project initiated by the Department of Labor and Employment (DOLE), in collaboration
with the Board of Nursing of the Philippines, Department of Health, Philippines Nurses
Association and other stakeholders to promote nurse entrepreneurship by introducing a home
health care industry in the Philippines.
• The main purpose is to deliver home health care services

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 • It further aims to:
1. Reduce the cost of health care for the country’s indigent population by bringing
primary health care services to poor rural communities
2. Maximize employment opportunities for the country’s unemployed nurses
3. Utilize the countries unemployed human resources for health for the delivery of
public health services and the achievement of the country’s Millennium
Development Goals (MDG) on maternal and child health consistent with
FOURmula One Plus (DOLE, 2013)

Forms of Nurse Entrepreneurship

1. Hospice, domiciliary and healthcare facility manage
2. Public health advocacy and home health care services
3. Outsourcing public health delivery for LGUs, and other government institutions
4. Medical transcription services and healthcare training management
5. Emergency medical services and tourism health services
6. Wellness and fitness management or private companies
7. Outsourcing health services for private establishments per labor code requirement
8. medical mission management for private companies and LGUs
9. Periodic physical examination of workers for private companies

Write T if the statement is correct and F if it is incorrect. Explain your answer in 2 to 3

sentences only.
____ 1. The nature of CHN practice utilizes knowledge derived from biological, social sciences,
ecology, clinical nursing and community health organizations
Explanation:

____ 2. Community Health Nurses use the nursing process used in the clinical area
Explanation:

____ 3. CHN practice is continuous and episodic

Explanation:

____ 4. CHN requires collaboration between the nurse and the client as equals
Explanation:

____ 5. CHN allows the nurse to possess greater awareness of their clients’ lives and situations
Explanation:

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 ____ 6. Contact with the family may continue over a long period of time which includes all ages
and all types of health care.
Explanation:

____ 7. The community health nurse makes use of available community health resources.
Explanation:

____ 8. The community health nurse utilizes the already existing active organized groups in the
community
Explanation:

____ 9. There must be provision for educative supervision in Community Health Nursing
Explanation:

____ 10. There should be accurate recording and reporting in the Community Health Nursing
Explanation:

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