Community Health Nursing 2 is focused on the care of the population. This lesson introduces the overview of Community Health Nursing 2.

1. OVERVIEW

2. INTENDED LEARNING OUTCOMES

3. INTENDED LEARNING OUTCOMES
LESSON 2:
After the lesson, the students will be able to:
1. Determine the significant characteristics of each
type of field in CHN.
2. Compare and contrast the different
specializations in CHN.
3. Appraise each field of CHN inorder to consider
among the choices of specialization especially,
when working as a Community/Public Health
Nurse in the future.

4. Topic Outline for Prelim Coverage
Community Health Nursing Overview
Definition
-Philosophy and Principles
A. Features of CHN
B. Theoretical Models/ Approaches
1. Health Belief Model (HBM)
2. Milio’s Framework for Prevention
3. Nola Pender’s Health Promotion
4. Lawrence Green’s PRECEDE- PROCEED MODEL (PRECEDE-
Predisposing, Enabling Constructs in Educational Diagnosis
and Evaluation)
5.(PROCEED- Policy, Regulatory and Organizational Constructs
in Educational and Environmental Development)

5. Different Fields
1. School Health Nursing
2. Occupational Health Nursing
3. Community Mental Health
Nursing

6. ▪ “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.”

7. • “Community health refers to the HEALTH Status of the members of the
community, to the problems affecting their health and to the totality
of health care provided to the community”.. WHO (1971)
▪ “Public health is the science and art of preventing diseases,
prolonging life and promoting health and efficiency through
organized community efforts for the sanitation of environment the
control of diseases, the education of individuals in personal hygiene,
the organization of medical and nursing services for early diagnosis
and preventive treatment of diseases and the development of social
machinery to ensure for every individual a standard of living
adequate for maintenance of health, so organizing these benefits as
to enable every citizen to realize the birth right of health and
longevity”

8. ▪

9. • “Community health Nursing is a unique
blend/mix of nursing and community health,
woven into a service which when properly
developed and implemented can have a
tremendous impact on
▪human health.”

10. ▪

11. 1. Topromote and preserve health.
2. To restore health when it is impaired.
3. Tominimize suffering and distress.
4. Topromote quality of living.
5. Todevelop self care abilities.

12. • Toincrease the competency of individuals, families, groups and community
to deal with their own health and nursing needs.
• Tostrengthen community resources.
• Tocontrol environment and develop resistance to environmental
conditions.
• Toprevent and control communicable and non communicable
diseases.
• Toprovide specific services to mothers, children, workers, elderly, eligible
couples and handicaps etc.
• Toconduct research and training programs.
• Tosupervise, guide and help health personnel in carrying out their
functions.

13. 1. The community has a defined geographical boundaries which has the
beginning and the end.
2. The community is composed of people who live together in the defined
boundaries of the community.
3. The community people have common psychological characteristics i.e.,
there is similarity in language, life style, customs and traditions etc.
4. The people in the community interact with each other and have free
communication.
5. The community has organized social structure and system and common
organization which carry various functions

14. 1. It provides space for housing, shelter, socialization and
recreation.
2. It provides means and facilities for livelihood.
3. Community provides opportunity for employment.
4. It takes care off socialization and education of its members.
5. It provides safety and security for its members by enforcement
of norms and legislation formulated by the society.
6. It provides opportunities for people participation and
communication.

15. The objective of community health is to provide need based
comprehensive services which include the following:
1. Promotion and protection of health
▪ i.e. PRIMARY LEVEL PREVENTION.
2. Early diagnosis and treatment and control of further spread of
disease i.e. SECONDARY LEVEL PREVENTION.
3. Control of disability and rehabilitation ie. TERTIARY LEVEL
OF PREVENTION.
❖ The major emphasis is on primary level prevention with the
active involvement of people (as majority of the health problems
are preventable by simple measures).

16. In community health the whole community is a client and the
services are focused and hence it is important to:
1. Know the community (COMMUNITY
IDENTIFICATION).
2. Identify the health needs of the community (COMMUNITY
DIAGNOSIS).
3. Understand underlying factors affecting health problems.
4. Plan and implement comprehensive services.

17. • Principles or precepts are rules for practice or
action.
• These are the guidelines or directives derived
from concepts, theory and philosophy of
community health and nursing.

18. NEED OF PRINCIPLES
• Ensuring relevant, safe, and correct practices to meet
the health needs of the individuals, families, groups
and community.
• More important in changing socio-economic
conditions of the people. More knowledgeable of
what is wrong or right, and are more demanding.
• Knowledge on working principles and apply them in
their daily activities regardless of their position and
training.

22. 1. The recognized need of individuals, families and
communities.
2. Knowledge and understanding of the objectives
and policies of the agency facilities goal
achievement.
3. CHN considers the family as the unit of service.
4. Respect for the values, customs and beliefs

23. 5. CHN integrated health education and counseling as vital parts
of functions.
6. Collaborative work relationships with the co-workers and
members of the health team facilities accomplishments of
goals.
7. Periodic and continuing evaluation provides the means for
assessing the degree to which CHN goals and objectives are
being attained.
8. Continuing staff education programs, quality services to client
and are essential to upgrade and maintain sound nursing
practices in their setting.

24. 9. Utilization of indigenous and existing community resources
maximizing the success of the efforts of the Community Health
Nurses.
10.Active participation of the individual, family and community in
planning and making decisions for their health care needs,
determine, to a large extent, the success of the CHN programs.
11.Supervision of nursing services by qualified by CHN personnel
provides guidance and direction to the work to be done.
12.Accurate recording and reporting serve as the basis for evaluation
of the progress of planned programs and activities and as a guide
for the future actions.
13.Develop the community to become self-reliant.

26. Philosophy
set or system of beliefs that provides a basis and
guide for action
includes general beliefs, concepts, attitudes,
ethical considerations and guidelines, as well
as values that explain the way a life is lived, or
the manner in which an organization is run or
how a profession is practiced.

27. Theoretical Framework
refers to the basic structure of ideas, concepts, beliefs and
principles proposed or followed as the basic conduct of the
particular profession.

28. Being aware of the philosophy and theoretical
framework for practice of a profession makes the
action of practitioners well-directed, purposive and
systematic, and consequently productive and
effective.

29. 1. Nursing is a unique and distinct component of health care.
2. CHN subscribes to the philosophy of interdependence among
the health professions.
3. As a special field of nursing practice, CHN shares the humanistic beliefs
and values of the nursing profession.
4. CHN believes in the primacy of health as a goal and as essential
element that affects the quality of life of individuals, families, groups
and communities.
5. The goal of nursing is independence and self-reliance in health care for
the client/ patient- be it an individual, a family, a group or the whole
community.
PHILOSOPHY FOR COMMUNITY HEALTH NURSING PRACTICE

30. PHILOSOPHY FOR COMMUNITY HEALTH NURSING PRACTICE
6. Nursing, in general, and CHN in particular, recognizes the relationship
of non-health interventions in the solution of health problems.
7. To achieve the goal of community health, the nurse works with, not for,
individual clients/patients, families, specific population groups and the
community at large.
8. Nursing goals and standards of care should consider constraints
imposed by client, health agency and community resources.
9. CHN practice is not a body or set of the same repeating tasks.
10.Nurses have the responsibility to keep their knowledge and skills
current and up-to-date according to developments in nursing, public
health and other related sciences.

33. Theoretical models/ approaches

34. Health belief model
First developed in the 1950s by Social Psychologists Hochbaum,
Rosenstock and Kegels working in the US Public Health Services who
wanted to explain why so few people were participating in programs to
prevent and detect disease.
The model was developed in response to the failure of a free
Tuberculosis (TB) health screening program.
Useful for explaining the behaviors and actions taken by people to
prevent illness and injury.
It postulates the readiness to act on behalf of a person’s own health .

36. Major components/ concepts
There are six major concepts in HBM:
1. Perceived susceptibility to the condition in question
2. Perceived severity/ seriousness of the condition in question
3. Perceived benefits to taking action
4. Barriers to taking action
5. Cues to action
6. Self- efficacy

39. Milio’s Framework for Prevention
Nancy Milio a nurse and leader in public health policy and public
health education developed a framework for prevention that
includes concepts of community-oriented, population focused
care.(1976,1981).
For these 3 general categories of nursing intervention have also
been put forward, they are
1. education directed toward voluntary change in the attitude and
behavior of the subjects
2. engineering directed at managing risk-related variables
3. enforcement directed at mandatory regulation to achieve better
health.

42. Nola Pender’s Health Promotion
First published in the 1980s
Envisioned as a framework for exploring health- related behaviors within
a nursing and behavioral science context
Includes three general areas of concern to health- promoting behavior
1. Individual characteristics and experiences
2. Behavior specific cognitions and affect
3. Behavioral outcomes

44. The Precede and Proceed
Models
First published by Lawrence Green in 1974.
The PROCEED model works in tandem with the PRECEDE model as
the community health nurse proceeds to plan, implement, and evaluate
health education programs.
The entire PRECEDE – PROCEED model includes eight phases in the
formulation and evaluation of health educational programs.
A hallmark of the model is the emphasis on the desired outcome.

45. Precede Phases
1. Social
2. Epidemiologic
3. Educational/ ecological assessments
4. Administrative and policy assessment and intervention alignment
5. Implementation

46. Proceed Phases
1. Process evaluation
2. Impact evaluation
3. Outcome evaluation

49. The framework provides direction and guidelines
to the community health nurse in terms of who or
to whom she/he is giving care, who should receive
care in the face of limited time and resources, the
objectives of her/his actions and intervention
measures, and the how of providing care and
delivering nursing services.

50. The use and application of the philosophy and
theoretical framework for CHN practice would
bolster nursing as a profession, making a distinction
between professional nursing care and the care
provided by people and auxiliary health workers.

51. Different Fields
▪ School Health Nursing
▪ Occupational Health Nursing
▪ Community Mental Health Nursing

52. School health nursing
▪ A specialized practice of professional nursing that advances the well-
being, academic success and lifelong achievement of students.
▪ A school nurse works primarily with the students who attend the nurse’s
assigned schools, as well as with the families of those schoolchildren,
members of school staff and administration, health care providers and
other helping professionals within the school and community.

53. Standards of practice for school nurse
▪ Develop school health policies and procedures
▪ Evaluate their own nursing practice
▪ Keep up with nursing knowledge
▪ Interact with the interprofessional health care team
▪ Ensure confidentiality in providing health care
▪ Consult with others to give complete care
▪ Use research findings in practice.
▪ Ensure the safety of children, including when delegating care to other school
personnel
▪ Have good communication skills
▪ Manage a school health program effectively
▪ Teach others about wellness

54. Roles and functions of school nurses
▪ Direct caregiver
▪ Health Educator
▪ Case Manager
▪ Consultant
▪ Counselor
▪ Community Outreach
▪ Researcher

55. Occupational health nursing
▪ Utilizes an interdisciplinary approach to advocate for the employee’s right
to have cost-effective, prevention- oriented health and safety programs.
▪ OBJECTIVES OF OCCUPATIONAL HEALTH:
1. To maintain and promote the physical, mental and social well being of the
workers.
2. To prevent occupational diseases and injuries.
3. To adapt the work place and work environment to the needs of the
workers i.e application of ergonomics principle.
4. It should be preventive rather than curative.

56. FUNCTIONS OF OCCUPATIONAL HEALTH
SERVICE
1. Pre-employment medical examination.
2. First Aid and emergency service.
3. Supervision of the work environment for the control of dangerous
substances in the work environment.
4. Special periodic medical examination particularly for the workers in
dangerous operations.
5. Health education for disseminating information on specific hazards and
risks in the work environment.
6. Special examination and surveillance of health of women and children

57. 7. Advising the employer or management for improving working conditions,
and placement of hazards.
8. Monitoring of working environment for assessment and control of hazards.
9. Supervision over sanitation, hygiene and canteen facilities.
10. Liaison and cooperation with the safety committees
11. Maintenance of medical records for medical check-up and follow-up for
maintaining health standards and also for evaluation.
12. To carry out other parallel activities such as nutrition program, family
planning, social services recreation etc., Concerning the health and welfare of
the workers.
FUNCTIONS OF OCCUPATIONAL HEALTH
SERVICE

58. Community mental health nursing
▪ Application of specialized knowledge to population communities
▪ To promote and maintain mental health,
▪ To rehabilitate population at risk.
▪ Psychiatric nurse must possess knowledge about community resources.

59. Goals
▪ Provide prevention activities to population for the purpose of promoting mental
health.
▪ Provide prompt interventions
▪ Provide corrective learning experiences
▪ Help individuals develop a sense of self worth and independence.
▪ Anticipate emotional problems
▪ Identify and change social and psychological factors that influence human
interactions
▪ Develop innovative approach to primary preventive activities
▪ Provide mental health education and how to assess the mental health. e.g..
SIGECAPS

60. roles
▪ Provide basic care to patients
▪ Conducting therapies and health education to pts n family
▪ Training of professionals and non professionals and PHCs about mental
health
▪ Supervise MPWs in mental health care delivery.
▪ Assist psychiatrists in research activties.
▪ Social skill training
▪ Anxiety management and relaxation
▪ Assertive training
▪ Bereavement counselling
▪ Group meetings
▪ Community outreach work services
▪ Child care services
▪ Adult care and elderly care services

61. Now, let’s have an activity, I want you
to read first this parable. Then
proceed on answering the Guide
Questions found on the next pages…

63. Guide Question No. 1:
A. How will you relate the
parable to the
Community Health
Nursing (CHN)?
B. What is/are the
implication/s of the
parable to the role of
Public Health Nurse?
Guide Question No. 2:
The reading materials, the
lecture-discussions on the
different theoretical
frameworks and the parable
provide you thoughts on
what is Community Health
Nursing all about and it
gives you ideas on the
totality of CHN. Hence…
A. What is your own
philosophy in CHN?
B. Illustrate your
philosophy in a diagram
using Collage Making.
NOTE: SAVE THE FILE USING THIS
FORMAT: Ediza, R. - Parable