NCM 3115

Module 1. Community Health Nursing Concepts B. PHILOSOPHY and PRINCIPLES (CHN SERVICE
IN THE PHILIPPINES p.17)

A. DEFINITION  The philosophy of Community Health Nursing is

based on the worth and dignity of a man. (According
- A field of nursing practice where services are to Dr. Margaret Shetland)
delivered outside of purely curative institutions - According to Margaret Shetland, the
(ex. hospital), but in the community settings philosophy of CHN is based on the worth and
such as home, the school, places of work, health dignity of man.
centers, and clinics. Basic Principles:
- The scope of services provided covers the whole
range of health promotive, preventive, curative 1. The community is the patient in CHN, the
and rehabilitative nursing services, with bias family is the unit of care and there are four
towards priority given to health promotion and levels of clientele: individual, family, population
disease prevention especially for the group (Ex: children, elderly and pregnant
underserved and high-risk individuals, families, women) and the community.
population groups and areas of the community. 2. In CHN, the client is considered as ACTIVE
- CHN is composed of three words: partner and NOT PASSIVE recipient of care.
o Community 3. CHN practice is affected by developments in
o Health health technology, in particular, changes in
o Nursing society, in general.
4. The goal of CHN is achieved through multi-
sectoral efforts.
COMMUNITY 5. CHN is a part of health care system and the
larger human services system.
- Community comes from the Latin word
Comunicas which means “a group of people”
 While the following principles of CHN were adapted
- A group of people with common characteristics
from those formulated by Mary S. Gardner and by
or interests living together withing a territory or
Leahy, Cobb and Jones. (CHN service in the
geographical boundary
Philippines p.17)
- Place where people under usual conditions are
1. CHN is based on recognized needs of
found
communities, families’ groups and individuals.
- The community is the object or focus of care in
2. The CH nurse must understand fully the
CHN, with the family as the unit of service
objectives and policies of the agency she
- Draws the concept about the client (community)
represents.
- Within the community there is:
3. In CHN, the family is the unit of service
o Population groups or aggregates
4. CHN must be available to all regardless of race,
o Family
creed and socio-economic status.
o Individual
5. Health teaching is a primary responsibility of the
CH nurse.
HEALTH 6. The CH nurse works as a member of the health
team.
- Draws the basic concept which is the goal 7. There must be provision for periodic evaluation
- Goal of community nursing is to keep the of CH nursing service.
community in good health. That’s why there are 8. Opportunities for continuing staff education
activities (strategies), like: programs for nurses must be provided by the
o Health promotion CHN agency. The CHN also has a responsibility
o Disease prevention for her/his own professional growth.
o Curative 9. The community health nurse makes use of
o Rehabilitative available community health records.
10. The CHN utilizes the already existing active
organized groups in the community.
NURSING 11. There must be provision for educative
- Draws the basic concept which is the means – supervision in the CH nursing.
the means to an end 12. There should be accurate recording and
- Nursing is the means where in we can achieve reporting in CHN.
the goal, which is health for our client, which is
the community
 3) MILIO’S FRAMEWORK OF PREVENTION
C. FEATURES OF CHN (MAGLAYA p.2) - The basic treatise is that behavioral patterns of
populations and individuals who make up
1. Goal – the goal is promotion and prevention of populations are a result of habitual selection
the health of the population from limited choices.
2. The nature of practice of CHN – - She challenged the common notion that a main
comprehensive, general, continual, and not determinant for unhealthful behavioral choice is
episodic lack of knowledge.
3. Knowledge-base – the knowledge is based on - Governmental and institutional policies, she said
nursing and public health set the range of options for personal choice
4. Clientele – IFPC (Individual, Family, making.
Population, Community) - It neglected the role of community health
5. Practitioners’ recognition – the primacy of the nursing, examining the determinants of
population as a whole is being recognized community health and attempting to influence
those determinants through public policy.
CHARACTERISTICS OFA COMMUNITY HEALTH
NURSE 4) NOLA PENDER’S HEALTH PROMOTION
MODEL (Nursing Theorists and their work 5th
1. Greater control for both the nurse and the client edition p.624)
in making decisions related to health care - Nola J. Pender graduated her BSN course in
2. Collaboration between nurse and client as equals 1964 at Michigan State University, earned her
3. Recognition of the impact of different factors on M.A. In Human Growth and Development in the
health same university.
4. Nurses’ greater awareness of their clients lives - She finished her Ph. D. in psychology and
and situations education in 1969 at Northwestern University.
- Pender’s Health Promotion Model focuses on
CHARACTERISTICS OF A COMMUNITY HEALTH three areas: Individual characteristics and
NURSING experiences, behavior-specific cognitions and
affect, and behavioral outcomes.
 It is a specialty field of nursing. - The theory notes that each person has unique
 Its practice combines public health with nursing. personal characteristics and experiences that
 It is population based. affect subsequent actions.
 It emphasizes on wellness and other than disease
or Illness. 5) LAWRENCE GREEN’S PRECEDE-PROCEED
 It includes inter-disciplinary collaboration. MODEL
 It amplifies client's responsibility and self-care. - PRECEDE = Predisposing, Reinforcing, and
Enabling Constructs in Educational Diagnosis
and Evaluation
D. THEORETICAL MODELS/APPROACHES
- Is a cost-benefit evaluation framework which
helps program planners, policy makers and other
1) NIGHTINGALE’S ENVIRONMENTAL evaluators, analyze situations and design health
THEORY programs efficiently. It is a comprehensive
- External influences and conditions can prevent, structure for assessing health needs for
suppress, or contribute to disease or death. designing, implementing and evaluating health
- Her goal was to help patient retain her own promotion and other public health programs to
vitality by meeting her basic needs through meet those needs.
control of her environment. - It involves assessing the following community
factors:
2) HEALTH BELIEF MODEL (HBM) By: Social o Social assessment – Determine the
Psychologists: Irwin M. Rosenstock, Godfrey M. social problems and needs of a given
- The health belief model is a theoretical model population and identify desired results.
that can be used to guide health promotion and o Epidemiological assessment – Identify
disease prevention. the health determinants of the identified
- It used to explain and predict individual changes problems and set priorities and goals.
in health behaviors. o Ecological assessment – Analyze
- People will not change their behaviors unless behavioral and environmental
they believe that they are at risk. determinants that predispose, reinforce,
- Example: those who do not think that they are at and enable the behaviors and lifestyles
risk of acquiring HIV from unprotected sexual are identified.
intercourse are unlikely to use condom. o Match appropriate interventions –
identify administrative and policy
factors that influence implementation
and match appropriate interventions that
 encourage desired and expected
changes.
o Implementation of interventions
- PROCEED = 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 behavior or an increase
in identified positive behavior.

E. DIFFERENT FIELDS (MAGLAYA p.3-4)

1) SCHOOL HEALTH NURSING

- School health nursing is primarily determined by
the characteristics of their clientele, which is
their age, developmental stage and their
common health problems and concerns.
- School health nursing aims at promoting the
health of school children and preventing health
problems that would hinder their learning and
performance of their developmental tasks.

2) OCCUPATIONAL HEALTH NURSING

- Occupational health nursing is nursing in the
work place; it is community health nursing
focused on people in their places of work.
- Occupational health nursing is the specialty
practice that provides for and delivers health
care services to workers and worker population.
- The practice focuses on promotion, protection,
and restoration of worker's health within the
context of a safe and healthy work environment.
- The foundation of occupational health nursing
practice is research-based with an emphasis on
optimizing health, preventing illness and injury,
and reducing health hazards.
- Occupational health nursing is “aimed at
assisting workers in all occupations to cope with
actual and potential stresses in relation to their
work and work environment.

3) COMMUNITY MENTAL HEALTH

NURSING
- Is the application of specialized knowledge to
population communities to promote and
maintain mental health, rehabilitate population
at risk.
- The psychiatric nurse must possess knowledge
about community resources.