CHN

• Community


  A group of people with common characteristics or interests living together within a territory or geographical boundary
• Community


  • Has one or more roles that define its identity within society
  • Has a set of goals - provides a sense of direction
  • Is organized within a set of formal/informal beliefs, values, expectations and behaviors that defines the boundary of the community
  • The boundary may be explicit (physical) or implicit (defined by the shared characteristics of its members)
  • Has ownership of its members
  • There is some form of communication between members
  • Has skills and resources that are shared between the members
  • Balance the needs of the community with the needs of its members
  • Often has clubs, teams, groups etc. within the community
• Community Health


  Part of paramedical and medical intervention/approach which is concerned on the health of the whole population
• Health

  "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" - WHO
• Health


  "Health is a state of ENOUGH physical, mental and social well-being OF AN INDIVIDUAL TO PARTICIPATE ACTIVELY and PRODUCTIVELY IN THE SOCIAL and ECONOMIC LIFE OF THE COMMUNITY IN WHICH HE LIVES IN" - PHC
• Public Health


  Aims to help individuals achieve their birthright of health and longevity
• Organized community efforts for public health

  1. Sanitation of the environment

  2. Controlling communicable infections

  3. Educating individuals in personal hygiene

  4. Organizing medical services for early diagnosis and treatment

  5. Developing social mechanisms for a healthy standard of living
• Roles of the Public Health Nurse

  • Clinician
  • Health Educator
  • Facilitator
  • Supervisor
  • Health Advocator
  • Collaborator
• Community Health Nursing Process

  • Systematic, scientific, ongoing interpersonal process
  • Views nurses and clients as a system influencing each other
  • Both parties are affected by behavioral factors
• Nature/Concept of Community Health Nursing Process

  • Provides a framework blending art and science
  • Series of planned steps for meeting needs and solving problems
  • Requires cognitive, technical, and interpersonal skills
  • Goal-oriented, humanistic, and systematic individualized care
  • Addresses community health problems at all levels, aiming to prevent illness
  • Dynamic, continuous, intellectual activity for effective patient care
  • Responds timely to client's needs, aiming to improve or maintain health
• Characteristics of Community Health Nursing Process

  • Deliberative (Weidenbach, 1964): Purposeful, rational, and careful, requiring independent thinking and decision-making
  • Adaptable (Lewis, 1988): Dynamic nature allows adjustment to individual needs and flexibility in application
  • Cyclical (Henlay, 1986): Involves continual progression of actions including interaction, data collection, analysis, intervention, and evaluation
  • Client-focused (Hooper, 1986): Aimed at helping clients achieve and maintain health directly or indirectly
  • Interactive (Yura and Walsh, 1973): Involves ongoing interpersonal communication between nurses and clients, fostering understanding and effective use of the process
  • Need-oriented (Steps, 1976): Anticipates needs and prevents problems, essential for protecting, promoting, and restoring community health
• First Level Assessment (1)

  1. The process whereby existing and potential health conditions or problems of the family are determined

  2. It relates what health problems exist and will exist
• Categories of First Level Assessment

  • Wellness State
  • Health Threats
  • Health Deficits
  • Foreseeable Crisis
• Wellness Condition


  • Potential or readiness for transitioning to a higher level of wellness
  • Nursing judgment based on client's current performance, competencies, clinical data, or expressed desire for improvement in health promotion areas
• Examples of Wellness Condition

  • Potential for enhanced capability in healthy lifestyle, health maintenance/management, parenting, breastfeeding, spiritual well-being
  • Readiness for enhanced capability in the same areas as potential for enhanced capability
• Health Threats


  Conditions conducive to disease, accidents, or failure to maintain wellness
• Examples of Health Threats

  • Presence of risk factors for specific diseases
  • Cross-infection threat from communicable diseases
  • Family size exceeds available resources
  • Accident hazards
  • Faulty/unhealthy nutritional habits or feeding practices
  • Stress-provoking factors
  • Poor home/environmental conditions
  • Unhealthy lifestyle habits
  • Lack of immunization or inadequate status, family disunity, inappropriate role assumptions
  • Personal health history contributes to health deficits, and inherent personal characteristics like poor impulse control
• Health Deficits


  Instances of failing to maintain health
• Examples of Health Deficits

  • Illness states, whether diagnosed or undiagnosed
  • Failure to thrive or develop at a normal rate
  • Disabilities, whether congenital or from illness, transient or permanent
• Presence of Stress Points/Foreseeable Crisis Situations

  Anticipated periods of high demand on individuals or families, affecting adjustment and resources
• Examples of Stress Points/Foreseeable Crisis Situations

  • Marriage
  • Pregnancy, labor, postpartum period
  • Parenthood
  • Birth of a new family member or lodger
  • Abortion
  • School entrance
  • Adolescence
  • Divorce or separation
  • Menopause
  • Job loss
  • Hospitalization of a family member
  • Death of a family member
  • Resettlement in a new community
  • Illegitimacy
• Second Level Assessment (2)

  1. Determine if the family recognizes the condition/problem

  2. If recognized, determine actions taken

  3. Identify other problems in implementing interventions

  4. Assess impact on other family members
• Inability to recognize the condition or problem

  • Lack of or inadequate knowledge
  • Denial stemming from fear of consequences
  • Attitude/philosophy in life that hinders recognition or acceptance of a problem
• Inability to make decisions regarding appropriate health actions

  • Failure to comprehend the nature/magnitude of the problem/condition
  • Feeling of confusion, helplessness, or resignation due to perceived severity of the situation
  • Lack of knowledge/insight about alternative courses of action
  • Inability to choose from a list of alternatives
  • Conflicting opinions among family/significant others regarding the action to take
  • Lack of knowledge about community resources for care
  • Fear of consequences
  • Negative attitude towards the health condition interfering with decision-making
  • Inaccessibility of appropriate care resources due to physical or economic constraints
  • Lack of trust/confidence in health personnel or agencies
  • Misconceptions or erroneous information about proposed courses of action
• Inability to provide adequate nursing care

  • Lack of knowledge about the disease/health condition
  • Lack of knowledge about child development and care
  • Uncertainty about the nature or extent of nursing care needed
  • Absence of necessary facilities, equipment, and supplies for care
  • Inadequate knowledge or skill in carrying out necessary interventions or treatments
  • Insufficient family resources
  • Unexpressed feelings of significant persons hindering their capacity to provide care
  • Philosophy or attitude that hinders caring for vulnerable family members
  • Member's preoccupation with personal concerns/interests
  • Exhaustion of family supportive capacity due to prolonged illness or disabilities
  • Altered role performance
• Inability to provide a conducive home environment


  • Inadequate family resources, including financial constraints and limited physical resources
  • Failure to recognize long-term benefits of investing in home environment improvement
  • Lack of knowledge about hygiene, sanitation, and preventive measures
  • Lack of skills to carry out measures for improving the home environment
  • Ineffective communication patterns within the family
  • Lack of supportive relationships among family members
  • Negative attitudes or philosophies not conducive to health maintenance and personal development
  • Lack of competencies in relating to each other for mutual growth and maturation
• Failure to utilize community resources

  • Lack of knowledge about available resources
  • Perceiving no benefits from healthcare/services
  • Lack of trust/confidence in agencies or personnel
  • Previous unpleasant experiences with health workers
  • Fear of consequences
  • Unavailability or inaccessibility of required care/services due to cost constraints, physical barriers, or lack of family resources
  • Feeling of alienation or lack of support from the community
  • Negative attitudes hindering effective utilization of community resources for health care
• First Level Assessment (3)

  1. Presence of Health Threats

  2. Presence of Health Deficits

  3. Presence of Foreseeable Crisis
• Prioritizing Health Problems


  • Decide the score for each of the criteria
  • Divide the score by the highest possible score and multiply the respective weight
  • Add up the score for all criteria. The highest score is five (5), which is equivalent to the total weight
  • The higher the score of the given problem must be prioritized
  • With the given or available score, we need to rank the problem
• Association


  A group of people who come together to promote a common cause or interest, often with a specific goal or mission in mind. Membership is often more formal and may require an application process, background check, or other criteria.
• Club


  A group of people who share a common interest or activity and come together for social or recreational purposes. Membership is often informal and may be obtained by expressing interest and paying any required fees.
• Needs of the members

  The individual interests and requirements of members, such as personal growth, fulfillment, or financial stability. May be balanced with the needs of the community as a whole.
• Needs of the community


  The collective interests and requirements of a community, such as safety, security, or social connections. May be balanced with the needs of individual members.
• Skills and resources


  The knowledge, abilities, and tools that members bring to a community. May be shared or pooled to benefit the community as a whole.
• Communication


  The exchange of information and ideas among members of a community. May be formal or informal, and may take place through meetings, social media, or other channels.
• Ownership


  The sense of belonging and responsibility that members have for their community. May be reflected in membership fees, volunteer work, or other contributions.
• Implicit boundary


  A less tangible or visible barrier that defines the limits of a community. Examples include shared values, beliefs, or characteristics that are not easily observable.
• Explicit boundary


  A physical or visible barrier that defines the limits of a community. Examples include walls, fences, or membership cards.
• Beliefs, values, expectations, and behaviors

  The formal or informal rules that define the culture and identity of a community. May be explicit or implicit, and may be based on shared characteristics, traditions, or goals.
• Goals


  A set of objectives that provide direction and purpose for a community. May be formal or informal, and may be shared by all members or only a subset.