UNIT 1: INTRODUCTION TO COMMUNITY HEALTH NURSING

Chapter 1: Fundamental Concepts of Community Health Nursing

• Community/ public health nursing is the synthesis of nursing practice and public health
practice.
• Major goal of CHN- preserve the health of the community and surrounding population
by focusing on health promotion and health maintenance of individual, family and
group within community.
- Thus CHN/ PHN is associated with health and identification of population at risks rather
than with an episodic response to patient demand.
• Mission of public health- is social justice that entitles all people to basic necessities,
such as adequate income and health protection, and accepts collective burdens to
make possible.
• Definition of health according to:
a. WHO- “a state of complete physical, mental and social well-being and not merely
the
absence of disease or infirmity.”
b. Murray- “a state of well-being in which the person is able to use purposeful,
adaptive responses and processes physically, mentally, emotionally, spiritually, and
socially.”
c. Pender- “actualization of inherent and acquired human potential through goal-
directed behavior, competent self-care, and satisfying relationship with others.”
d. Orem- a state of person that is characterized by soundness or wholeness of
developed human structures and of bodily and mental functioning.”
• Social- “of or relating to living together in organized groups or similar close
aggregates”
• Social health- connotes community vitality and is a result of positive interaction among
groups within the community with an emphasis on health promotion and illness
prevention.
• Community- is seen as a group or collection of locality-based individuals, interacting in
social units and sharing common interests, characteristics, values, and/ or goals.
• Definition of community according to:
a. Allender- “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.”
b. Lundy and Janes- “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 geographic boundary.”
c. Clark- “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.”
d. Shuster and Goeppinger- “a locality-based entity, composed of systems of
formal organizations reflecting society’s institutions, informal groups and
aggregates.”
• Maurer and Smith (2009)- two main types of communities:
a. Geopolotical communities- also called as territorial communities.
-are most traditionally recognized.
 - defined or formed by both natural and man-made boundaries and include barangays,
municipalities, cities, provinces, regions and nations.
b. Phenomenological communities- also called as functional communities.
- refer to relational, interactive groups, in which the place or setting is more abstract,
and people share a group perspective or identity based on culture, values, history,
interest and goals.
• Population- is typically used to denote a group of people having common personal or
environmental characteristics.
• Aggregates- are subgroups or subpopulations that have some common characteristics
or concerns.

• Determinants of Health
1. Income and social status- higher income and social status are linked to better health.
The greater the gap between the richest and poor health, the greater differences in
health.
2. Education- low education levels are linked with poor health, more stress and lower
self-confidence.
3. Physical environment- safe water and clean air, healthy workplaces, safe houses
communities and roads all contribute to good health.
4. Employment and working conditions- people in employment are healthier,
particularly those who have control over their working conditions.
5. Social support networks- greater support from families, friends and communities is
linked to better health.
6. Culture- customs and traditions, and the beliefs of the family and community all
affect health.
7. Genetics- inheritance plays a part in determining lifespan, healthiness and the
likelihood of developing illnesses.
9. Personal behavior and coping skills- balanced eating, keeping active, smoking,
drinking and how we deal with life’s stresses and challenges all affect health.
10. Health services- access and use of services that prevent and treat disease influences
health.
11. Gender- men and women suffer from different types of diseases at different ages.

Indicators of Health and Illness

• National Epidemiology Center of DOH, PSA and local health centers/ offices/
departments- provide morbidity, mortality and other health status related data.
• Local health centers/ offices/ departments- are responsible for collecting morbidity and
mortality data and forwarding the information to the higher lever of health, such as
Provincial Health office.
• Nurses should participate in investigative efforts to determine what is precipitating the
increased disease rate and work to remedy the identified threats or risks.
Definition and Focus of Public Health and Community Health
• Definition of public health according to:
a. C. E. Winslow- “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:
1. sanitation of the environment,
2. control communicable infections,
3. education of the individual in personal hygiene,
4. organization of medical and nursing services for the early diagnosis and
preventive treatment of disease, and
5. “development of the 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 of health and longevity.”
(Hanlon)
• Public health- key phrase definition: “through organized community effort”.
- connotes organized, legislated, and tax-supported efforts that serve all people through
health departments or related governmental agencies.
• 9 Essential public health functions according to WHO Regional Office for the Western
Pacific
1. Health situation monitoring and analysis
2. Epidemiological surveillance/ disease prevention and control
3. Development of policies and planning in public health
4. Strategic management of health systems and services for population health gain
5. Regulation and enforcement to protect public health
6. Human resources development and planning in public health
7. Health promotion, social participation and empowerment
8. Ensuring the quality of personal and population-based health service
9. Research, development, and implementation of innovative public health solution
• Community health- extends the realm of public health to include organized health
efforts at the community level through both government and private efforts

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.
- implemented after a problem has begun but before signs and symptoms appear and
targets populations who have risk factors (Keller).
3. Tertiary prevention- targets populations that have experienced disease or injury and
focuses on limitations of disability and rehabilitation.
 -AIM: reduce the effects of disease and injury and to restore individuals to their
optimum level of functioning.

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 s home health, hospice care, and independent
nurse practice
-“the synthesis of nursing practice and public health practice applied to
promoting and
preserving health of the populations (ANA, 1980)
Public Health Nursing
- a component or subset of CHN
- the synthesis of public health and nursing practice
PHC according to FREEMAN (1963):
- Public Health Nursing may be defined as the 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. These skills are applied in concert
with those of other persons engaged in health care, through comprehensive nursing care of
families and other groups and through measures for evaluation or control of threats to health,
for health education of the public and for the mobilization of the public for health action.
PHC according to ANA (1996):
- “the practice of promoting and protecting the health of populations using
knowledge from
nursing, social and public health sciences”
- “population-focused, with the goals of the promoting health and preventing disease
and disability for all people through the creation of conditions in which people can be healthy.
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
- setting-specific, and the emphasis is on acute and chronic care and includes practice areas
such as home health nursing and nursing in outpatient or ambulatory setting.
CHN vs. Community-based Nursing
CHN – emphasizes preservation and protection of heath
- the primary client is the community
Community-based Nursing
- Emphasizes on managing acute and chronic
- the primary clients are the individual and the family
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
CHN practice requires the ff. types of data for scientific approach and population:
1. the epidemiology or body of knowledge of a particular problem and its solution
2. information about the community
Types of Sources
information
Demographic Vital Statistics; census
Groups at high risk Health statistics; disease statistics
Services/providers City directors, phone books, local/regional social workers, list of low
available income providers, CH nurse
Family – basic unit of care in CHN
Individual –focus in the clinic or health center
The Intervention Wheel
- proposed in the late 1990s by nurses from the Minnesota Department of Health to describe
the breadth and scope of public health nursing
practice; recognized as a framework for community and public health practice
- consist of 17 health interventions are grouped into 5 wedges
3 Important Elements:
1. It is population-based
2. It contains 3 levels of practice (Community, systens and individual/family)
3. It identifies and defines 12 public health interventions
Public Health Interventions and Definition (Keller et al., 2004)
• Surveillance – monitors health events
• Disease and other health event investigation – systematically gathers and analyzes data
regarding threats to the health of populations
• Outreach – locates populations of interests or populations at risk
• Screening – identifies indiduals with unrecognized health risk factors
• Case finding – identifies risk actors and connects them with resources
• Referral and follow-up – assists individuals and families, families, groups, organizations
ad communities to identify and access necessary resources
• Case management – optimizes self-care capabilities of individuals and families
• Delegated functions – direct care tasks that the nurse carries out
• Health teaching – communicates facts, ideas and skills that change knowledge, attitudes
values, behaviors and practice
• Counseling – establishes an interpersonal relationships; with the intention of increasing
or enhancing their capacity for self-care and coping
• Consultation – seeks information and generates optional solutions to perceived
problems
• Collaboration – commits two or more persons or an organization
• Coalition building – develops alliances among organizations
• Community organizing – helps community groups to identify common problems or goals
mobilizes resources and develop and implement strategies
• Advocacy – pleads someone’s cause or acts on someone’s behalf
• Social marketing – utilizes commercial marketing principles for programs
• Policy development and enforcement – place issues on decision makers’
agendas,
acquires plan of resolution
EMERGING FIELDS OF CHN IN THE PHILIPPINES
• 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. It aims
to:
1. Reduce the cost of health care for the countries indigent population by bringing
primary health care services to poor rural communities
2. Maximize employment opportunities for the ountries 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 Millenium
Development Goals (MDG) on maternal and child health, (DOLE, 2013)
MAIN PURPOSE OF ENTRPRENURSE
- To deliver home health care services
COMPETENCY STANDARDS IN CHN
1. Safe and Quality Nursing Care
-knowledge of health/illness status of the client, sound decision making ; safety, comfort,
privacy, administration of meds and health therapeutics and nursing process.
2. Management of resources and environment
- orgamization of workload; use of financial resurces for client care; mechanism to ensure
proper functioning of equipment and maintenance of a safe environment
3. Health Education
- assessement of client’s learning needs; development of health education plan and
learning
materials and implementation and evaluation of health education plan
4. Legal Responsibility
- adherence to the nursing laws as well as to national, local and organizational policies including
documentation of care given to clients.
5. Ethicomoral Responsibility
- respect for the rights of the client; responsibility and accountability for own decisions and
actions; and adherence to the international and national codes of ethics for nurses
6. Personal and Professional Development
- identification of own learning needs, pursuit of continuing education; involvement in
professional image; positive attitude towards change and criticism
7. Quality Improvement
- data gathering for quality improvement; participation in nursing rounds; identification and
reporting of solutions to identifies problems related to client care.
8. Research
- research-based formulation of solutions to problems in client care and dissemination and
application of research findings
9. Records Management
- accurate and updated documentation of client care while observing legal imperatives and
record keeping
10. Communication
- uses therapeutic communication techniques, identiies verbal and nonverbal cues, responds to
client needs,while using formal and informal channels of communication and appropriate
information technology
11. Collaboration and Teamwork
- establishment of collaborative relationship with colleagues and other members of health team

HISTORY OF PUBLIC HEALTH AND PUBLIC HEALTH NURSING IN THE PHILIPPINES

1577 - Franciscan FriarJuan Clemente opened medical dispensary in Intramuros for the indigent
1690 – Dominican Father Juan de Pergero worked toward installing a water system in San Juan
del Monte and Manila
1805 – smallpox vaccination was introduced by Franciwsco de Balmis , the personal physician of
King Charles IV of Spain
1876 – first medicos titulares were appointed by the Spanish government
1888 - 2-year courses consisting of fundamental medical and dental subjects was first offered
in the University of Santo Tomas. Graduated were known as
“cirujanosministrantes” and serve as male nurses and sanitation inspectors
1901 – United States Philippines Commission, through Act 157, created the Board of Health of
the Philippine Islands with a Commisioner of the Public Health ,as its chief executive officer
(now the Departmnt of Health
Fajardo Act of 1912 – created sanitary divisions made up of one to four municipalities. Each
sanitary division had a president who had to be a physician
1915 - the Philippine General hospital began to extend public health nursing services in the
homes of patients by organizing a unit called Social and Home Care services
Asociacion Feminista Filipina (1905) – Lagota de Leche was the first center dedicated to the
service of the mothers and babies
1947 – the Department of Health was reorganized into bureaus: quarantine, hospitals that
took charge of the municipal and charity clinics and health with the sanitary divions under it.
1954 – Congress passed RA 1082 or the Rural Health Act that provided the creation of RHU in
every municipality
RA 1891 – enacted in 1957 amendd certain provisions in the Rural Health Act
- Created 8 categories of rural health units corresponding to the population size of the
municipalities
RA 7160 (Local Government Code) – enacted in 1991, amended that devolution of bsic health
services incuding health services, to ocal government units and the establishment of a local
health board in every province and city of municipality
Millennium Development Goals – adopted during the world summit in September 2000
FOURmula One (F1) for health, 2005 and Universal Health Care in 2010 – agenda launched in
1999
Universal Health Care – aims to achieve the health system goals of better health outcomes,
sustained health financing, and responsive health system that will provide equitable access to
health care
Chapter 2: THEORETICAL FOUNDATIONS OF COMMUNITY HEALTH NURSING PRACTICE
• Historical Perspectives on Nursing Theory
 Florence Nightingale was the first nurse to formulate a conceptual foundation for
nursing practice.
 She believed that clean water, clean linen, access to adequate sanitation and a
quiet environment would improve health outcomes.
 Other early nursing theories were extremely narrow and depicted health care
situations that involved only one nurse and one patient. Noticeably, the family and
other health care professionals were absent from the context of the theories.
 From 1980 onwards, several nursing theorists including, Dorothy Johnson, Sister
Callista Roy, Imogene King, Betty Neuman and Jean Watson have included
community perspectives in their definition of health.
• How Theory Provides Direction to Nursing
 The goal of theory is to improve nursing practice by acting as a guide.
• General Systems Theory
 The General Systems Theory is the basis, in part, of several nursing theories.
 It is applicable to the different levels of the community health nurse’s
clientele:
individuals, families, groups or aggregates and communities.
 The client is considered as a set of interacting elements that exchange energy,
matter or information with the external environment to exist (Katz and Kahn,
1966; von Bertalanffy, 1968)
 This theory is useful when analyzing interrelationships of the elements within the
client and the environment
 For example: the family has the basic structures that all open systems have.
 It has boundaries that separate it from its environment.
 Culture and the Family Code dictate the boundaries of the Filipino Family.
 The Family Environment constitutes everything outside its boundaries that may
affect it; the family home and the community and its institutions make up the
immediate environment and should be considered in the assessment of family
health status.
 The family gets inputs of matter (food, water), energy, and information from
the environment
 Outputs are material products, energy and information that result from the
family’s processing of inputs. Examples are health practices
and the health status of the family members.
 Feedback is the information from the environment directed back to the
system, it allows the system to make the necessary adjustments for better fxn
 (a) For example: a nurse’s feedback to a mother that her child
is underweight makes the mother more aware of her child’s
needs and allows her to take action.
 Subsystems are the components of a system that interact to accomplish their
own purpose. (Family members)
 Suprasystems are a bigger system composed of families who interrelate with
and affect one another. (Families)
• Social Learning Theory
 It is based on the belief that learning takes place in a social context; people learn
from one another and learning is promoted by modeling or observing other
people.
 It assumes that all personas are thinking beings that are capable of making
decisions and acting according to expected consequences of their behavior.
 The environment affects learning but learning outcomes depend on the
learner’s
individual characteristics.
 Application of the theory can be done by:
 Catching the person’s attention with different strategies
 Promoting retention of learning
 Providing opportunities for reproduction or imitation of the procedures
 Motivating the person by explaining the benefits possible by practicing the
behavior
• The Health Belief Model
 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.
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.
• Milio’s Framework for Prevention
 Milio (1976) proposed that health deficits often result from an imbalance between
a population’s health needs and its health sustaining resources.
 She stated that diseases associated with excess occurred in affluent societies
(obesity) and diseases that result from inadequacies in food, shelter and water
afflict the poor. Therefore, poor people in affluent societies experience the least
desirable combination of factors.
 Personal and societal resources affect the range of health promoting or health
damaging choices available to individuals. Personal resources include the
individual’s awareness, knowledge and health beliefs. Money and
time are also personal resources.
 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.
• Pender’s Health Promotion Model
 The model explores many biopsychosocial factors that influence individuals to
pursue health promotion activities.
Constructs/Variables of HPM
Individual Each person’s unique characteristics and
characteristics and experiences
experiences affect his or her actions. Their effect depends on the
behavior in 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 significant in behavior motivation. They are a
affect “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 The perceived benefits of a behavior are strong
of action motivators o 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 Barriers are perceived unavailability, inconvenience,
to action expense, difficulty or time regarding health behaviors
Perceived self- Self-efficacy is one’s belief that he or she is
efficacy capable of 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 The feelings associated with a behavior will likely affect
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 These are perceived options available, demand
influences 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
plan of action action initiates a behavioral event”. This
commitment will compel one into the behavior until
completed, unless a
competing demand or preference intervenes.
Immediate These are alternative behaviors that one considers as
competing possible optional behaviors immediately prior to
demands and engaging in the intended, planned behavior. One has
preferences little control over competing demands, but one has
great control over competing preferences
 Health promoting This is the goal or outcome of the HPM. The aim of
behavior health promoting behavior is the attainment of positive
health outcomes

 The model depicts complex multidimensional factors which people interact with as
they work to achieve optimum health.
• The Transtheoretical Model
 This model combines several theories of intervention.
 It is based on the assumption that behavior change takes place over time, and
progresses through stages
 Each stage is stable and is open to change; Meaning one may stop in one stage,
progress to the next stage or return to a previous stage.

Core constructs of the TTM

Stages of change
Precontemplation Individual has no intention to take action
toward behavior change in the next 6
months. May be in this phase due to a lack of
information about the consequences of the
behavior or due to failure on previous
attempts at change.
Contemplation The individual has some intention to take
action toward behavior change in the next 6
months. Weighing pros and cons to change.
Preparation The individual intends to take action within
the next month, and has taken steps toward
behavior change. Has a plan of action.
Action The individual has changed overt behavior for
less than 6 months. Has changed behavior
sufficiently to reduce risk of disease
Maintenance The individual has changed overt behavior for
more than 6 months. Strives to prevent
relapse. The phases may last months to
years.
Decisional balance
Pros The benefits of behavior change
Cons The costs of behavior change

 Change is difficult. People may resist change for many reasons. Change may be
unpleasant, require giving up pleasure, be painful, stressful, etc.
• PRECEDE-PROCEED Model
 It provides a model for community assessment, health education planning, and
evaluation.
 PRECEDE, which stands for predisposing, reinforcing and enabling constructs in
educational diagnosis and evaluation is used for community diagnosis.
 PROCEED, stands for policy, regulatory, and organizational constructs in education
and environmental development, is a model for implementing and evaluating
health programs based on PRECEDE.
 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
 CHAPTER 3: PRIMARY HEALTH CARE

SEPTEMBER 6-12, 1978 - first International Conference for PHC at Alma Ata, USSr, Russia
L.O.I. 949 - legal basis for PHC in the Philippines
- signed by Pres. Ferdinand Marcos
- THEME : Health in the Hands of the People by 2020
Definition - the essential care made universally accessible to individuals and families in the
community through their full preparation.
Universal Goal - Health For All by the Year 2000
- this is achieved through community and individual self-reliance

5 KEY ELEMENTS :
1. Reducing exclusion and social disparities in health (universal coverage).
2. Organizing health services around people’s needs and expectations (health
service reforms).
3. Integrating health into all sectors (public policy reforms).
4. Pursuing collaborative models of policy dialogue (leadership reforms).
5. Increasing stakeholder participation.

8 Essential Health Services

E - Education for health
L - Locally endemic disease control
E - Expanded program for immunization
M - Maternal and child health including responsible parenthood
E - Essential drugs
N - Nutrition
T - Treatment of communicable and noncommunicable diseases
S - Safe water and sanitation

KEY PRINCIPLES
1. 4 A’s :
A. Accessibility - distance/travel time required to get to a health care facility/services.
- the home must be w/in 30 min. from the Brgy. health stations
B. Affordability - consideration of the individual, family, community and government can
afford the services
- the out-of-pocket expense determines the affordability of health care.
- in the the Philippines, government insurance is covered through PhilHealth
C. Acceptability - health care services are compatible with the culture and traditions of the
population.
D. Availability - is a question whether the health service are offered in health care facilities
or is provided on a regular and organized manner.
Examples :
* Botika ng Bayan and Botika ng Bayan - ensures the availability and accessibility of
affordable essential drugs. It sells low-priced generic home remedies, OTC and common
antibiotics.
* Ligtas sa Tigdas ang Pinas - mass door-to-door measles immunization campaign.
- target age : 9 months to below 8 y.o.
2. Support mechanism - there are 3 major resources:
1. People
2. Government
3. Private Sectors (e.g. NGO, church…)

3. Multisectoral approach
• Intrasectoral linkages (Two - way referral sys.) — communication, cooperation
and collaboration within the health sectors.
• Intersectoral Linkages - between the health sector and other sectors like education,
agriculture and local gvn. officials.

4. Community participation - a process in which people identify the problems and needs and
assumes responsibilities themselves to plan, manage, and control.

5. Equitable distribution of health resources

2 DOH programs to ensure equitable distribution:
• Doctor to the Barrio (DTTB) Program
- the deployment of doctors to municipalities that are w/o doctors.
- deployed to unserved, economically depressed 5th or 6th class municipalities for 2 years.
• Registered Nurses Health Enhancement and Local Service (RN HEALS)
- training and program for unemployed nurse
- deployed to unserved, economically depressed municipalities for 1 year.

6. Appropriate technology - health technology includes:

- tools
- drugs
- methods
- procedures and technique
- people’s technology
- indigenous technology

Criteria for Appropriate health technology

• Safety
• Effectiveness
• Affordability
• Simplicity
• Acceptability
• Feasibility and Reliability
• Ecological effects
• Potential to contribute to individual and community development

R.A. 8423 - Traditional and Alternative Medicine Act of 1997 (Juan Flavier)

Medicinal Plants Use/indication Preparation

Lagundi Asthma, cough and colds, fever, dysentry, Decoction
pain Wash affected site with
Skin disease (scabies, ulcer, eczema), wounds decoction
Yerba Buena Headache, stomachache Decoction
Cough and colds Infusion
Rheumatism, Asthritis Massage sap
Sambong Antiedema/antiurolithiasis Decoction
Tsaang Gubat Diarrhea Decoction
Stomachache
Niyog-niyogan Antielminthic Seeds are used
Bayabas Washing wounds Decoction
Diarrhea, gargle, toothache
Akapulko Antifugal Poultrice
Ulasimang Lowers blood uric acid (rheumatism and Decoction
Bato/ Pansit- gout) Eaten raw
pansitan
Bawang Hypertension, lowers blood cholesterol Eaten raw/fried
Toothache Apply on part
Ampalaya Diabetes mellitus (mild non-insulin- Decoction
dependent) Steamed
Medicinal Plant Preparation
1. DECOCTION - boiling the plant material in water for 20 min.
2. INFUSION - plant material is soaked in hot water for 10 - 15 minutes.
3. POULTRICE - directly apply plant material on the affected part, usually in bruises, wounds
and rashes.
4. TINCTURE - mix the plant material in alcohol.
Alternative health care modalities
Term Definition
Acupressure - application of pressure on acupuncture pts. w/o puncturing the skin
Acupuncture - uses special needles to puncture and stimulate specific part of the body
Aromatherapy - combines essential aromatic oils to then applied to the body
Nutritional -“nutritional healing”, this improves health by enhancing the nutritional
therapy value to reduce the risk of the disease
Pranic Healing - follows the principle of balancing energy
Reflexology - application of pressure on the body’s reflex joints to enhance body’s natural
healing.

PRIMARY CARE
- includes health promotion, disease prevention, health maintenance, counseling, patient
education and diagnosis and treatment of acute and chronic illness in different health settings
(American Association of Family Medicine)
- refers to the first contact of a person with a professional
- a model of nursing care that emphasizes continuity of care
- nursing care is directed towards meeting all the patient’s need.

PHC PC

Focus of client family and community individual

Focus of care promotive and preventive curative
Decision-making process community-centered health worker driven
Outcome self-reliance reliance on health workers
Setting for services rural-based satellite clinics; mostly urban places; hospital,
community health centers clinics
Goal development and preventive absence of disease
care
 CHAPTER 4
Community Organizing: Ensuring Health in the Hands of the People
DEFINITION OF COMMUNITY ORGANIZING:
Community organizing as a process consists of steps or activities that instill and reinforce
the people’s self-confidence on their own collective strengths and capabilities (Manalili,
1990). It is the development of the community’s collective capacities to solve its own
problems and aspire for development through its own efforts.
Community organizing is a continuous process of educating the community to develop its
capacity to assess and analyze the situation (which usually involves the process of
consciousness raising), plan and implement interventions (mobilization), and evaluate them.

Community Organizing is a process of educating and mobilizing members of the

community to enable them to resolve community problems. It is a means to build the
community’s capacity to work for the common good in general and health
goals.

Community organizing and community health nursing practice have common goals:
People empowerment, development of self-reliant community, and improved quality of life.
As a result, they become the health care professionals’ partners in health
care delivery and overall community development.

Community development means improvement access to resource (including health resources)

that will enable the people to improve their standards of living and overall quality life.
The emphases of community organizing in primary health care are the following:
1. People from the community working together to solve their own problems.
2. Internal organizational consolidation as a prerequisite to external expansion
3. Social movement first before technical change
4. Health reforms occurring within the context of broader social transformation.

Community development is the end goal of community organizing and all efforts towards
uplifting the status of the poor and marginalized.

Community development – entails a process of assessment of the current situation, the

identification of needs, deciding on appropriate courses of actions or response, mobilization of
resources to address these needs, and monitoring and evaluation by the people.

Community organizing is a value-based process, tracing its roots to three basic values: human
rights, social justice, and social responsibility (LOCOA, 2005).

1. Human rights – are based on the worth and dignity inherent to all human beings: the
right to life, the right to development as persons and as a community, and the freedom
to make decisions for oneself.
 2. Social justice- entails fairness in the distribution of resources to satisfy basic needs and
to maintain dignity as human beings.
3. Social responsibility- is an offshoot of the ethical principle of solidarity, which points to
people being part of one community and is reflected in concern for one another.

CORE PRINCIPLES IN COMMUNITY ORGANIZING:

Anchored on the basic values of human rights, social justice, and social responsibility, the
following are the core principles and grounds for the practice of community organizing.

COMMUNITY ORGANIZING IS PEOPLE-CENTERD:

The basic premise of any community organizing endeavor is that the people are the means
and ends of development, and community empowerment is the process and the outcome
(Felix, 1998). It is people-centered (Brown, 1985) in the sense that the process of critical inquiry
is informed by and responds to experiences and needs of the marginalized sectors/people.

Community organizing is not meant for person-to-person interaction, with only a few who
will benefits from any undertakings and activities.

Community organizing is a people-centered strategy, with emphasis on the development of

human resources necessitating education. The educational processes are interactive,
empowering both the learners (the members of the community) and the teacher (the nurse),
leading to decision making that plays a part in human development (Brown, 1985).

Community organizing is participative:

The participation of the community in the entire process-assessment, planning,

implementation, and evaluation-should be ensured. The community is considered as the prime
mover and determinant, rather than beneficiaries and recipients, of development efforts,
including health care.
For people empowerment, community participation is a critical condition for success (Reid,
2000). In community participation decision making and responsibility are in the hands of
ordinary people, not just the elite. Distinction is not made among different groups and different
personalities (Reid, 2000).

Community organizing is democratic:

Community organizing should empower the disadvantage population. It is a process that

allows the majority of people to recognize and critically analyze their difficulties and articulate
their aspiration. Hence, their decision must reflect the will of the whole, more so the will of the
common people, than that of the leaders and the elite.
 Conflicts are inevitable in group dynamics. They are to be expected in organizing work. Thus,
the organizer and community leaders require skills to effectively process and manage these
conflicts.
Effort must be exerted to achieve a consensus. This requires a participative and consultative
approach.

Community organizing is developmental:

Community organizing should be directed towards changing current undesirable conditions.

The organizer desires changes for the betterment of the community and believes that the
community shares these aspirations and that these changes can be achieved.
Beyond health or economic improvement, community organizing seeks authentic human
development.

Community organizing is process-oriented:

The community organizing goals of empowerment and development are achieved through a
process of change.
Community organizing is dynamic. With the evolving community situation, monitoring and
periodic review of plans are necessary. Through efforts of community members to identify and
deal with other problems leads to sustenance of the community organizing efforts.

PHASES OF COMMUNITY ORGANIZING:

Pre-entry:
Pre-entry involves preparation one the part of the organizer and choosing a community for
partnership.
• Preparation includes knowing the goals of the community organizing activity or
experience. It also necessary to delineate criteria or guidelines for site selection.
• Making a list of sources of information and possible facility resources, both government
and private, is recommended.
• For the novice organizers, preparation includes a study or review of the basic concepts
of community organizing.
• Proper selection of possible barriers, threats, strengths, and opportunities at this stage
is an important determinant of the overall outcome of community organizing.
Communities may be identified through different means:
✓ Initial data gathered through an ocular survey
✓ Review of records of a health facility
✓ Review of the barangay/municipality profile
✓ Referrals from other communities or institutions or through a series of meetings
✓ Consultation from the local government units (LGUs) or private institutions.
✓ An ocular survey done at this stage.
✓ Courtesy call to the Mayor
Entry into the community:

Entry into the community formalizes the start of the organizing process. This is the stage
where the organizer gets to know the community and the community likewise gets to know the
organizer.
▪ An important point to remember this phase is to make courtesy call to local formal
leaders (barangay chairperson, council members)
▪ Equally crucial but often overlooked is a visit to informal leaders recognized in the
community, like elders, local health workers, traditional healers, church leaders, and
local neighborhood association leaders.

Considerations in the entry phase:

The community organizer’s responsibility to clearly introduce themselves

and their
institution to the community.
A clear explanation of the vision and mission, goals, programs, and activities must be
given in all initial meetings and contacts with the community.
Preparation for the initial visit includes gathering basic information on socioeconomic
conditions, traditions including religious practices, overall physical environment, general
health resources.
the community organizer must keep in mind that the goal of the process is to build up
the confidence and capacities of people.
Manalili describe two strategies for gaining entry into a community:
1. Padrino – a patron, usually barangay or some other local government official. The
padrino, in an effort to boost the organizer’s image, tends to preset
the intended project output, thereby creating false hopes.
2. Bongga – as the easiest way to catch the attention and gain the “approval” of
the community. This strategy exploits the people’s weaknesses and
usually involves doles-out, such free medicines.
 CHAPTER 5
HEALTH PROMOTION, RISK REDUCTION AND CAPACITY BUILDING STRATEGIES
HEALTH PROMOTION - Green and Kreuter (1991)- any combination of health education and
related organizational, economic and environmental supports for
behavior of individual, groups or communities conducive to health
- Parse (1990)- Behavior that is motivated by the desire to increase
wellbeing and to reach the best possible health potential

HEALTH PROTECTION- Parse (1990) behaviors in which one engages with the specific intent to
prevent disease, detect disease in the early stages or to maximize
health within constraints of disease
HEALTH RISK- The probability that a specific event will occur in a given time frame
Risk Assessment- conducted to determine health risks to individuals, groups and
populations. A systematic way of distinguishing the risks posed by potentially harmful
exposures
Steps of risk assessment- Hazard Identification, risk description, exposure assessment
and risk estimation.

Risk factor- an exposure that is associated with a disease

3 Criteria for establishing a risk factor
1. The frequency of the disease varies by category or amount of factor.
2. The risk factor must precede the onset of the disease.
3. The association of concern must not be due to any source of error.
Two types of Risks Factors
- Modifiable Risk Factors- individual has some control
- Non- Modifiable Risk Factors- little or no control.( Ex. genetic makeup, gender, age)
Risk Reduction – a proactive process in which individuals participate in behaviors that
enable them to react to actual or potential threats to their health
Risk communication- process through which public receives information regarding
possible threats to health

To improve the nutritional status of the population, nutrition and education is essential. The 10
Nutritional Guidelines for Filipinos were developed to facilitate dissemination simple and
practical messages to encourage healthy diet and lifestyle.
1. Eat variety of foods everyday
2. Breast feed infants exclusively from birth to 4-6 months and give appropriate foods
while continuing breastfeeding
3. Maintain children’s normal growth through proper diet and monitor their growth
regularly
4. Consume fish, lean meat, poultry or dried beans
5. Eat more vegetables, fruits and root crops
6. Eat foods cooked in edible/cooking oil daily
 7. Consume milk and milk products and other calcium rich foods such as small fish and
dark leafy vegetables everyday
8. Use iodized salt but avoid intake of excessive intake of salty foods
9. Eat clean and safe food
10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid
drinking alcoholic beverages

Sleep is essential component of chronic disease prevention and health promotion.

How much sleep do you really need?
AGE SLEEP NEEDS
Newborn (1-2 months) 10.5-18 hours
Infants (3-11 months) 9-12 hours during night and 30-minute to 2
our naps 1-4 times a day
Toddlers (1-3 years) 12-14 hours
Preschoolers (3-5 years) 11-13 hours
School-aged children (5-12 years) 10-11 hours
Teens (11-17 years) 8.5-9.25 hours
Adults 9 hours
Older Adults 9 hours

Sleep Hygiene (National Sleep Foundation 2010)

1. Avoid caffeine and nicotine close to bedtime
2. Avoid alcohol as it can cause sleep disruptions
3. Retire and get up at the same time everyday
4. Exercise regularly but finish all exercise and vigorous activity at least 3 hours before
bedtime
5. Establish a regular relaxing bedtime routine (a warm bath, reading a book)
6. Create a dark, quiet, cool sleep environment
7. As much as circumstances allow, have comfortable beddings
8. Use the bed for sleep only. Do not read, listen to music or watch TV in bed
9. Avoid large meals before bedtime
Smoking Cessation is an important step in achieving optimum health. The American Cancer
society recommends the following Steps to Quit Smoking:
1. Make decision to quit.
2. Set a date to quit and choose a plan
3. Deal with withdrawal through. Avoid temptation
4. Staying off tobacco is a lifelong process. Remind yourself of the reasons why you quit
Alcohol Consumption
Health authorities have defined moderation as not more than 2 drinks a day for the average
sized man and not more than 1 drink a day for the average size woman
Heavy Drinking- consuming more than 2 drinks/day on average for men and more than
1 drink per day for women
 Binge drinking- drinking 5 or more drinks on a single occasion for men / 4 or more
drinks on a single occasion for women
Excessive Drinking- can take the form of heavy drinking/ binge drinking/ both.
Organized by the WHO, the 1st International Conference on Health Promotion was held at
Ottawa, Canada on November 17-21, 1986. It calls for a commitment to health promotion to
achieve the goal of Health for All by the year 2000 and beyond.
-The charter defines health promotion as the process of enabling people to increase
control over and improve their health. It is not just the responsibility of the health sector but
goes beyond healthy lifestyles to well-being.
3 basic strategies for Health Promotion
1. Advocacy for health to provide for the conditions and resources essential for health
2. Enabling all people to attain their full health potential
3. Mediating among the different sectors of society to achieve health
5 priority action areas provides support for these 3 strategies:
1. Build Healthy Public Policy
2. Create Supportive Environments
3. Develop Personal Skills
4. Reorient Health Services
5. Moving into the Future

HEALTH EDUCATION- a process of changing people’s knowledge, skills and attitudes for
health
promotion and risk reduction.
-The nurse participate in health education by empowering people
so that they are able to achieve optimum health and prevent
disease by bringing out lifestyle changes and reducing exposure to
health risk in the environment
Basic principles that guide the Effective Nurse Educator (based onKnowles Theory on
adult learning)
1. Message – send a clear/understandable message to the learner. Consider factors
that may affect learner’s ability to receive and retain info.
2. Format- strategy must match the objectives
3. Environment –conducive environment for learning, therapeutic and supportive
relationship with the learner
4. Experience – organize positive and meaningful learning experience
5. Participation- engage learner in participatory learning by involving then in the
discussion, solicit feedback
6. Evaluation- use tools such as quizzes, individual conferences and return
demonstration.
31