CHN LEC

• Community


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

  • Has one or more roles that define its identity within society
  • Has a set of goals - provides a sense of direction
  • Is organised 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 it's 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 (WHO definition)

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

  "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 WHIHC HE LIVES IN"
• Principles of Health


  • The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition
  • The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States
  • The achievement of any State in the promotion and protection of health is of value to all
  • Unequal development in different countries in the promotion of health and control of diseases, especially communicable disease, is a common danger
  • Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development
  • The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health
  • Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people
  • Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures
• Community Health Nursing


  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
• Goal of Community Health Nursing

  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
• Characteristics of Community Health Nursing

  • It is a specialty field of nursing
  • Its practice combines public health with nursing
  • It is population-based
  • It emphasizes wellness and other than disease or Illness
  • It includes interdisciplinary collaboration
  • It amplifies the client's responsibility and self-care
• Functions of Community Health Nursing

  1. Identification of community culture and resources that lead as a key factor in the community health care delivery system

  2. Evaluate community health conditions, health risks, and problems to identify the health-care demands of the people

  3. Plan and implementation of comprehensive community health interventions, care, services, and programs

  4. Develop health policy at the local community level to drive policies/agreements at the state and national levels for collaborative endeavors and actions
• Nursing


  Both profession & a vocation. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
• Basic Concepts and Principles of Community Health Nursing

  • The FAMILY is the unit of care, the community is the patient and there are four levels of clientele in CHN
  • The goal of improving community health is realized through multidisciplinary effort
  • The community health nurse works WITH and not for the individual patient, family, group or community. The latter are active partners, not passive recipients of care
  • The practice of CHN is affected by changes in society in general and by developments in the health field in particular
  • CHN is part of the community health system which in turn is part of the larger human services system
• Basic Principles of Community Health Nursing

  • The community is the patient in CHN, the family is the unit of care and there are four 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
  • In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
  • CHN practice is affected by developments in health technology, in particular, changes in society, in general
  • The goal of CHN is achieved through multi-sectoral efforts
  • CHN is a part of health care system and the larger human services system
• Philosophy of Community Health Nursing


  "The philosophy of CHN is based on the worth and dignity of man."
• Responsibilities of Community Health Nursing

  • be a part in developing an overall health plan, its implementation and evaluation for communities
  • provide quality nursing services to the three levels of clientele
  • maintain coordination/linkages with other health team members, NGO/government agencies in the provision of public health services
  • conduct researches relevant to CHN services to improve provision of health care
  • provide opportunities for professional growth and continuing education for staff development
• Standards in Community Health Nursing

  • Theory: Applies theoretical concepts as basis for decisions in practice
  • Data Collection: Gathers comprehensive, accurate data systematically
  • Diagnosis: Analyzes collected data to determine the needs/ health problems of IFC
  • Planning: At each level of prevention, develops plans that specify nursing actions unique to needs of clients
  • Intervention: Guided by the plan, intervenes to promote, maintain or restore health, prevent illness and institute rehabilitation
  • Evaluation: Evaluates responses of clients to interventions to note progress toward goal achievement, revise data base, diagnoses and plan
  • Quality Assurance and Professional Development: Participates in peer review and other means of evaluation to assure quality of nursing practice, Assumes professional development, Contributes to development of others
  • Interdisciplinary Collaboration: Collaborates with other members of the health team, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health
  • Research: Indulges in research to contribute to theory and practice in community health nursing
• Home visit


  A family-nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities
• Bag technique


  A tool by which the nurse, during her visit will enable her to perform a nursing procedure with ease and deftness, to save time and effort with the end view of rendering effective nursing care to clients
• Public health bag


  An essential and indispensable equipment of a public health nurse which she has to carry along during her home visits, contains basic medication and articles which are necessary for giving care
• BP apparatus and stethoscope are carried separately and are never placed in the bag
• Family Health Teaching Plan - HOME VISIT

  • Health Problem - Identified health condition that was presented during home visit
  • Goal of Care - Goal of care should be SMART
  • Nursing Intervention - Independent nursing action mainly will focus on how to answer the health problem through health teachings and actions that are appropriate and evidence-based
  • Resources - Materials needed in conducting health teachings during home visit
  • Expected Outcome - Assumption after providing health teaching
• Dr. C.E Winslow: 'Public Health is directed towards assisting every citizen to realize his birth rights and longevity.'
• Public Health


  The science and art of preventing disease, prolonging life and efficiency through organized community effort for:

  • The sanitation of the environment
  • The control of communicable infections
  • The education of the individual in personal hygiene
  • The organization of medical and nursing services for the early diagnosis and preventive treatment of disease
  • The development of a social machinery to ensure every one a standard of living, adequate for maintenance of health to enable every citizen to realize his birth right of health and longevity
• Roles of the PUBLIC HEALTH NURSE

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

  A systematic, scientific, dynamic, on-going interpersonal process in which the nurses and the clients are viewed as a system with each affecting one and another and both being affected by the factors within the behavior
• Key concepts of the community health nursing process

  • The nursing process provides a framework for the practice of nursing. It involves both art and science.
  • The nursing process refers to a series of planned steps and actions directed at meeting the needs and solving the problems of patients.
  • The nursing process is a deliberative problem-solving approach that requires cognitive, technical, and interpersonal skills and is directed to meeting the needs of the patient.
  • The nursing process is a goal-oriented humanistic and systemic plan of individualized care that is both effective and efficient.
  • The nursing process is a problem-solving process that addresses community health problems at all aggregate levels and aims to prevent illness.
  • The nursing process is a deliberate intellectual activity whereby the practice of nursing is approached in a dynamic, systematic manner to patient care in a dynamic, continuous method to assist the patient to achieve and maintain health.
  • The nursing process is dynamic and continuous. It provides blueprint care and responds to the client's needs in a timely and reasonable manner to improve or maintain the client's level of health.
• Importance or Implications of Community Health Nursing process

  • The nursing process helps to identify the client's health care needs, determine priorities, establish goals and expected outcomes of care establish and communicate a client-centered plan of care, and provide nursing interventions designed to meet client outcomes and goals.
  • The nursing process involves scientific reasoning. The nurse makes inferences about the meaning of a client's functional state of health. The nursing makes the process is simply one variation of scientific reasoning that allows nurses to organize, systemize, and conceptualize nursing practice. It is a general approach to the client system of individuals, families, groups, or communities.
  • The nursing process approach allows nurses to differentiate their practice from that of physicians and other health care professionals. When nurses think critically, the client becomes an active participant and the ultimate outcomes are a comprehensive, individualized approach to care.
  • The nursing process forms the basis for nursing judgments in the form of diagnosis, nursing care plan, implementation, and evaluation. Conceptual frameworks such as pain management or theoretical models give a basis for determining the information to be collected, diagnostic areas to be considered and nursing goals and therapies.
• Characteristics of Community Health Nursing process

  • The process is deliberative (purposefully, rationally, and care throughout the care. This requires judgment. The situation demands independent thinking and difficult decision making).
  • The process is adaptable (This dynamic nature enables the community health nurse to adjust appropriately to each situation to be flexible in applying the process to the individual needs. The nurse adapts individual service to each community client).
  • The process is cyclical (The actions are in constant progression. The nurse in any given situation engages continual interaction, data collection, analysis, intervention, and evaluation. Steps are repeated over and over in the nurse-client relationship continuously).
  • Client-focused (Nurses use this process to help clients, directly or indirectly to achieve and maintain health).
  • The process is interactive (Nurses and clients are engaged in the process of ongoing interpersonal communication. Giving and receiving accurate information is necessary to promote understanding between nurse and client and foster effective use of the nursing process. The client-nurse relationship can and should be a partnership called ''peer practice'').
  • Need- oriented (Application of this nursing process in community health to the anticipation of needs and prevention of problems assumes additional significance. This focus is needed if we are to realize the goals of community health to protect promote and restore people's health).
• Typology of Nursing Problem

  • Presence of Wellness Condition
  • Health Threats
  • Health Deficits
  • Anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources
  • Inability to recognize the presence of the condition or problem
• Wellness Condition

  Potential or Readiness - a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on client's performance, current competencies, or performance, clinical data or explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance.
• Examples of Wellness Condition

  • Potential for Enhanced Capability for: Healthy lifestyle, Healthy maintenance/health management, Parenting, Breastfeeding, Spiritual well-being
  • Readiness for Enhanced Capability for: Healthy lifestyle, Health maintenance/health management, Parenting, Breastfeeding, Spiritual well-being
• Examples of Health Threats

  • Presence of risk factors of specific diseases, Threat of cross infection from communicable disease case, Family size beyond what family resources can adequately provide, Accident hazards, Faulty/unhealthful nutritional/eating habits or feeding techniques/practices, Stress Provoking Factors, Poor Home/Environmental Condition/Sanitation, Unhealthy Lifestyle and Personal Habits/Practices, Unsanitary Food Handling and Preparation, Inherent Personal Characteristics, Health History, Inappropriate Role Assumption, Lack of Immunization/Inadequate Immunization Status, Family Disunity
• Examples of Health Deficits

  • Illness states, Failure to thrive/develop according to normal rate, Disability-whether congenital or arising from illness; transient/temporary or permanent
• Examples of anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources

  • Marriage, Pregnancy, labor, puerperium, Parenthood, Additional member, Abortion, Entrance at school, Adolescence, Divorce or separation, Menopause, Loss of job, Hospitalization of a family member, Death of a member, Resettlement in a new community, Illegitimacy
• Examples of Inability to recognize the presence of the condition or problem

  • Lack of or inadequate knowledge, Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, Attitude/Philosophy in life, which hinders recognition/acceptance of a problem, Inability to make decisions
• Leg amputation secondary to diabetes, blindness from measles, lameness from polio

  Examples of anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources
• Examples of anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources

  • Marriage
  • Pregnancy, labor, puerperium
  • Parenthood
  • Additional member-e.g. newborn, lodger
  • Abortion
  • Entrance at school
  • Adolescence
  • Divorce or separation
  • Menopause
  • Loss of job
  • Hospitalization of a family member
  • Death of a member
  • Resettlement in a new community
  • Illegitimacy
• Inability to recognize the presence of the condition or problem

  Due to:

  Lack of or inadequate knowledge

  Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically:

  Social-stigma, loss of respect of peer/significant others

  Economic/cost implications

  Physical consequences

  Emotional/psychological issues/concerns

  Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
• Inability to make decisions with respect to taking appropriate health action


  Due to:

  Failure to comprehend the nature/magnitude of the problem/condition

  Salience of the problem/condition

  Feeling of confusion, helplessness and/or resignation brought about by perceive magnitude/severity of the situation or problem, i.e. failure to breakdown problems into manageable units of attack

  Lack of/inadequate knowledge/insight as to alternative courses of action open to them

  Inability to decide which action to take from among a list of alternatives

  Conflicting opinions among family members/significant regarding action to take

  Lack of/inadequate knowledge of community resources for care

  Fear of consequences of action, specifically:

  Social consequences

  Economic consequences

  Physical consequences

  Emotional/psychological consequences

  Negative attitude towards the health condition or problem-by negative attitude is meant one that interferes with rational decision-making

  Inaccessibility of appropriate resources for care, specifically:

  Physical Inaccessibility: constraints or economic/financial inaccessibility

  Lack of trust/confidence in the health personnel/agency

  Misconceptions or erroneous information about proposed course(s) of action
• Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family


  Due to:

  Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management)

  Lack of/inadequate knowledge about child development and care

  Lack of/inadequate knowledge of the nature or extent of nursing care needed

  Lack of the necessary facilities, equipment and supplies of care

  Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of care (i.e. complex therapeutic regimen or healthy lifestyle program)

  Inadequate family resources of care specifically:

  Absence of responsible member

  Financial constraints

  Limitation of luck/lack of physical resources

  Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which his/her capacities to provide care

  Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member

  Member's preoccupation with on concerns/interests

  Prolonged disease or disabilities, which exhaust supportive capacity of family members

  Altered role performance, specify:

  Role denials or ambivalence

  Role strain

  Role dissatisfaction

  Role conflict

  Role confusion

  Role overload