WEEK 1

COMMUNITY HEALTH NURSING

- Global or umbrella term;

- Broader and more general specialty area that encompasses subspecialties that include public health
nursing, school nursing, occupational health nursing, and other developing fields of practice, such as
home health, hospice care, and independent nurse practice

COMMUNITY HEALTH NURSING: AN OVERVIEW

COMMUNITY
- A group of people with common characteristics or interests, living together within a territory or
geographical boundary
HEALTH
- a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity.
- the state of being free from illness or injury.
- well-being, healthiness, fitness, good condition, good shape, fine fettle
- Place where people under usual conditions are found
NURSING
- Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness

COMMUNITY HEALTH
- Part of paramedical and medical intervention/ approach which is concerned on the health of the
whole population.

COMMUNITY HEALTH NURSING

- Foundation of nursing profession

Ruth B. Freeman
- Service rendered by a professional nurse with the communities, groups, families, individuals at
home, in health centers, in clinics, in schools, in place of work for the promotion of health,
prevention of illness, care of the sick at home and rehabilitation.
Goal:
“To raise the level of health of the citizenry

PUBLIC HEALTH
Winslow
- Science and art of Promoting Health, Preventing Disease, and Prolonging life,
- to enable every citizen to realize his birthright to health and longevity

WHO
- Art of applying Science in the Context of Politics so as to Reduce Inequalities in Health (best health
for the greatest number)

PUBLIC HEALTH NURSING

- Community Health Nursing Practiced in the Public Sector

WHOECN (WHO Expert Committee on 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

NLGN
 Practice of nursing in the local or national health departments and public schools

COMMUNITY-BASED NURSING
- application of the nursing process in caring for individuals, families and group where they live, work
go to go school or they move through the health care system

POPULATION-FOCUSED NURSING
- concentrates on specific groups of people and focuses on health promotion and disease prevention,
regardless of geographical location (Baldwin et al., 1998)

Focused practice:
1. focuses on the entire population
2. is based on assessment of the populations’ health status
3. considers the broad determinants of health
4. emphasizes all levels of prevention
5. intervenes with communities, systems, individuals and families
Goal: promote healthy communities

TYPES OF DATA FOR SCIENTIFIC APPROACH AND POPULATION

- The epidemiology or body of knowledge of a particular problem and its solution
- Information about the community

THE INTERVENTION WHEEL

17 PUBLIC HEALTH INTERVENTIONS

 Surveillance
 Disease and other health event investigation
 Outreach
 Screening
 Case finding
 Referral and follow-up
 Case management
 Delegated functions
 Health teaching
 Counseling
 Consultation
 Collaboration
 Coalition building
 Community organizing
 Advocacy
 Social marketing
 Policy development and enforcement
DETERMINANTS OF HEALTH
 Income and social status
 Education
 Physical environment
 Employment and working conditions
 Social support networks
 Culture
 Genetics
 Personal behavior and coping skills
 Health services
 Gender

FOCUS OF PUBLIC HEALTH AND COMMUNITY HEALTH

- “Public health is the science and art of (1) preventing disease, (2) prolonging life, and (3)
promoting health and efficiency through organized community effort for:
 sanitation of the environment,
 control 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 machinery to ensure everyone a standard of living adequate for
the maintenance of health,

HEALTH PROMOTION AND LEVELS OF PREVENTION

 Health promotion- activities enhance resources directed at improving well-being.
 Disease prevention- activities protect people from disease and effects of disease.

Leavell and Clark’s Three Levels of Prevention

1. Primary prevention- relates to activities directed at preventing a problem before it occurs by
altering susceptibility or reducing exposure for susceptible individuals.
2. Secondary prevention- early detection and prompt intervention during the period of early
disease pathogenesis.
3. Tertiary prevention- targets populations that have experienced disease or injury and focuses
on limitations of disability and rehabilitation.

COMPETENCY STANDARDS IN CHN

 Safe and Quality Nursing Care
 Management of resources and environment
 Health Education
 Legal Responsibility
 Ethicomoral Responsibility
 Personal and Professional Development
 Quality Improvement
 Research
 Records Management
 Communication
 Collaboration and Teamwork

BASIC PRINCIPLES OF CHN

1. The community is the client in CHN, the family is the unit of care and there are four levels of
clientele.
a) Individual
b) Family
c) Sub-groups/ Population aggregates
d) Community
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care.
▪ Philosophy of CHN
WORTH and DIGNITY of MAN
 Dr. Shetland
3. CHN practice is affected by on-going changes in public health system such as:
a) Shift in demographic and epidemiologic trends in diseases
b) New technologies
c) Existing and emerging environmental hazards
d) Health reforms

MISSION OF CHN
1. Health Promotion
2. Health Protection
3. Health Balance
4. Disease Prevention
5. Social Justice

CONCEPT OF CHN
1. Primary focus – promotion of health
2. Clientele
3. Community health workers are generalist
4. Long term/ lifetime service
5. Knowledge based is comprehensive
6. Use of Nursing process
WEEK 2

THE COMMUNITY HEALTH NURSE

✔ Conducts a continuing and comprehensive practice that is preventive, promotive, curative, and
rehabilitative using the nursing process as its primary tool.

ROLES AND FUNCTIONS OF THE COMMUNITY HEALTH NURSE

1. CLINICIAN
2. ADVOCATE
3. COLLABORATOR
4. CONSULTANT
5. COUNSELOR
6. EDUCATOR
7. RESEARCHER
8. CASE MANAGER

ACTIVITIES OF THE COMMUNITY HEALTH NURSE

1. HOME VISIT
2. BAG TECHNIQUE
HOME VISIT
✔ Is a professional face to face contact made by a nurse to the patient or the family in order to provide
necessary health care activities and further attain an objective of the agency

PRINCIPLES OF HOME VISIT

1. It must have a purpose or objective

2. Use of all available information
3. Needs
4. Involve the client
5. Flexible

PURPOSE OF HOME VISIT

1. To render nursing care
2. To assess family’s living condition
3. To educate the public
4. To establish relationship between the public and the health agency
5. To utilize community services

THREE PHASES IN HOME VISITATION

1. Preparatory Phase – review existing records or referral data before doing home visit. Notify the family of
your intention to do home visit. Introduce yourself and explain the purpose.
2. Home Visit Phase – actual visit to the patient. Conduct assessment, planning, and health teaching.
Perform nursing intervention for conditions which will require your nursing skills.
3. Post Visit Phase – record the data in the chart. Plan for your next visit with the family. Referral to other
health professionals must be done if warranted by the situation.
BAG TECHNIQUE

✔ A tool by which the nurse , during her visit will enable her to perform a nursing procedure with ease
and deftness

PUBLIC HEALTH BAG

 ✔ Is an essential and indispensable equipment of a PH Nurse which she has to carry along during her
home visit
PRINCIPLE WITH THE USE OF THE BAG

 The use of the bag technique should minimize, if not totally prevent, the spread of infection

 It should save time and effort in the performance of nursing procedures

 It should not overshadow the concern for the patient

 It shows the effectiveness of total care given to individual or family

CONSIDERTIONS IN THE USE OF THE BAG

 It should contain all necessary articles and equipment

 The bag and its content should be clean as often as possible
 It should be protected from contact with any article in the home of the patient
 The arrangement of the bag contents should be convenient.
 When used in a communicable case, the PHN bags should be thoroughly cleaned and disinfected before
keeping and re-using

CONTENTS OF THE PHN BAG

✔ THERMOMETERS IN CASE (ORAL AND ANAL)
✔ SYRINGES (g 23 AND 25)
✔ ALCOHOL LAMP
✔ SPUTUM CUP
✔ MEDICINE DROPPER
✔ POVIDONE IODINE
✔ SPIRIT OF AMMONIA
✔ ACETIC ACID
✔ 70% ALCOHOL
✔ HYDROGEN PEROXIDE
✔ OPTHALMIC OINTMENT
✔ ZEPHIRAN SOLUTION AND BENEDICT SOLUTION
✔ TAPE MEASURE
✔ HYPODERMIC NEEDLES g 19, 22, 23, 25
✔ PAPER LINING
✔ PLASTIC/ LINEN LINING
✔ EXTRA PAPER FOR MAKING WASTE BAG
✔ APRON AND HAND TOWEL
✔ WEIGHING SCALE
✔ SOAP IN A SOAP DISH
✔ 2 PAIRS OF SCISSORS (SURGICSL AND BANDAGE)
✔ 2 PAIRS OF FORCEPS (CURVED AND STRAIGHT)
✔ STERILE DRESSING
✔ COTTON BALLS (DRY AND WITH ALCOHOL)
✔ MICROPORE PLASTER
✔ 1 PAIR OF STERILE GLOVES
✔ CORD CLAMP
✔ 2 TEST TUBES
✔ TEST TUBE HOLDERS
❖SPHYGMOMANOMETER AND STETHOSCOPE ARE CARRIED SEPARATELY
❖ UMBRELLA
PROCEDURE: BAG TECHNIQUE https://youtu.be/BVLSKqIxIAQ
STEPS RATIONALE

1. Upon arrival at the patient’s home, place the To protect the bag from getting contaminated.
bag on the table lined with a clean paper. The
clean side must be out and the folded part,
touching the table

2. Ask for a basin of water or a glass of drinking To be used for hand washing
if tap water is not available or you can use the
sink.

3. Open the bag and take out the towel and soap To prepare for hand washing

4. Wash hands using soap and water. Wipe to To prevent infection from the care provider to
dry. the client

5. Take out the apron from the bag and put it on To protect the nurses uniform
with the right side out

6. Put out all the necessary articles needed for To have them readily accessible
the specific care.

7. Close the bag and put it in one corner of the To prevent contamination
working area

8. Proceed in performing the necessary nursing To give comfort and security and hasten recovery
care and treatment

9. After giving treatment, clean all things that To protect the caregiver and prevent infection
were used and perform handwashing

10. Open the bag and return all things that were
used in their proper places after cleaning them.

11. Remove apron, folding it away from the

person, the soiled side in and the clean side out.
Place it in the bag.

12. Fold the lining, place it inside the bag and

close the bag.

13. Take the record and have a talk with the For reference in the next visit.
Mother. Write down all the necessary data that
were gathered, observations, nursing care and
treatment rendered. Give instructions for care of
patients in the absence of the nurse.

14. Make appointment for the next visit (ether For follow-up care
home or clinic) taking note of the date and time.

STEPS IN HOME VISIT

1. Knock on the door
2. Greet the patient and introduce self
3. State the purpose of visit
4. Observe the patient and determine the health needs
5. Put the bag in a convenient place then proceed to perform the bag technique
6. Perform the nursing care needed and give health teaching
7. Record all important data, observations and care rendered
8. Make an appointment for a return visit
WEEK 3

COMMUNITY ORGANIZING
- A process whereby people come together and identify common problem and act on these.
- People work together to get things done
- Goal: increase individual and community control over their health conditions (self-reliant)
- Empowerment
o Building the capability of people for future community action
o People decides for themselves
o Heart of community organizing
PRINCIPLE IN CO
1. Active Participation
2. Inclusiveness
3. Wholeness and Generativity
4. Critical Perspective

ROLES OF A NURSE IN CO
1. Facilitator
2. Trainor – trainee
3. Confidence builder
4. Linkage builder
5. Health advocate
6. Co-maker
7. Technical consultant
8. Documenter

THE CO Process (Cuevas – UP DOH)

1. Community Analysis
2. Design and initiation
3. Implementation
4. Program maintenance-consolidation
5. Dissemination-reassessment
WEEK 4:
Community Organizing Participatory Action Research (COPAR)

• Social development approach that aims to transform the apathetic, individualistic, and voiceless poor
into dynamic, participatory and politically responsive community

The COPAR Process (Jimenez)

1. Pre entry
a. Site selection
Depressed
Oppressed
Poor
Exploited
b. Identification of community
c. PSI (preliminary social investigation)
Ocular visit
Ocular survey
d. Networking with LGU’s, NGO’s, and other departments.

2. Entry
a. Courtesy call
Respect
Present intentions
Safety and security
b. Integration
c. Deepening/Continuing social investigation
d. Choosing potential leaders
Poor
Respective member
Change agent
e. Core group formation
SALT (Self Awareness and Leadership Training)

3. Community Diagnosis
a. Selection of research team
b. Reflection/ Investigation on their own health condition
c. Deeper understanding of the reality
d. Data gathering tools is needed
e. Data collection/ gathering
f. Prioritization of community needs/ problems for action

4. Organizational
a. Doing a PLAN
b. Election of officers
c. Seminars and trainings
d. Team building

5. Action
a. Mobilization
b. Ground working
c. Organization and training of community health workers

6. Sustainance and strengthening

a. Formulation of MVG
b. Registration to SEC
c. Income generating programs/ livelihood assistance program
d. Registration to DTI

7. Turn over
a. To promote self-reliance
WEEK 5