CHN Finals

Course Description
This course focuses on the care of population groups and community as clients utilizing
concepts and principles in community health development.
It also describes problems, trends and issues in the Philippine and global health care systems
affecting community health nursing practice.
Learning Outcomes
1. Apply concepts and principles of community health
development in the care of communities & population groups.
2. Utilizes the nursing process in the care of communities and
population groups.
Learning Outcomes
3. Ensure a well-organized recording and reporting system.
4. Share leadership/relate effectively with others in work
situations related to nursing and health.
RLE Guide:
1. Provide opportunity to practice chn bag technique
2. Provide for actual care of individual, family, population group and community as a client
which requires competencies with emphasis on health promotion and disease prevention.
Overview of Community Health Nursing (Maglaya, 2009)
2 Major Fields of Nursing
• Hospital Nursing
• Community Health Nursing (CHN)
Definition of Community Health Nursing by Maglaya
Community health nursing is defined as the “Synthesis of nursing knowledge and practice and the
science and practice of public health, implemented via a systematic use of the nursing process and
other processes to promote health and prevent illness in the population groups
• The responsibility of the Nursing society is to guide individuals and families in choosing
possibilities in changing the health process which is accomplished by intersubjective
participation with people
(George in Maglaya, 2009)
Framework for Community Health Nursing
Macro Framework Components:
1. Health Care Delivery System (CHN Subsystem)

2. Client (Individual, Family, Population Group
and Community)
3. Health (Goal of the Health Care Delivery System)
3. Economic (Sociocultural, Political, and
environmental Factors)
Characteristics of Community Health Nursing
The Goals of Professional Practice are the following (Clark in Maglaya, 2009)
• Promotion of Health
• Prevention of Disease
“Community health nursing practice is comprehensive, general, continual, and not episodic” (Clark in
Maglaya, 2009)
Community health nursing includes different levels of clientele with the population as a whole as the
focus. (Maglaya, 2009)
• Individuals
• Families
• Population Groups
• Community
ROLES of PHN
Health Advocate
Health Educator
Health Care Provider
Community Organizer
Health Trainer
Researcher
Community Health Nursing as a

Field of Nursing Practice
The hallmark of community health nursing is that it is population- or aggregate-focused.
“There are different level of clientele—individuals, families, and population groups and the
practitioner recognizes the primacy of the population as a whole
The hallmark of community health nursing is that it is population-focused and that the primary client
is and recipient of care is a group of people in the community.
Community Health Nursing
3 important concept:
• Community - “client”
• Health - “goal”
• Nursing- “the means”
Community Health Nursing as a

Field of Nursing Practice
CHN is a synthesis of nursing and public health practice.
“Public health is generally regarded as a responsibility of government.”
“Public health is the science and art of preventing disease, prolonging life, and promoting health and
sufficiency through organized community effort…” (Hanlon and Pickett in Maglaya)
Three Core Functions of Public Health
Assessment – “the regular collection and analysis of health data.”
Policy Development – “involves advocacy and political action to develop policies in various levels of
decision making.”
Assurance – “making sure that health services are effective, available and accessible to the people”
Ten Essential Health Services of Public Health:

1. Monitoring Health Status to Identify Community Health Problems
2. Diagnosis and Investigating Health Problems and Hazards in the Community
3. Informing , Educating , and Empowering People About Health Issues
4. Mobilizing Community Partnerships to Identify and Solve Health Problems
5. Developing Policies and Plans that Support Individual, Family, and Community Efforts.
Ten Essential Health Services of Public Health:

6. Enforcing Laws and Regulations that Protect Health
and Safety
7. Linking People to Needed Personal Health Services
and Ensuring the Provision of Health Care
8. Ensuring Competent Public Health and Personal
Health Care Workforce.
9. Evaluating Effectiveness, Accessibility, and Quality of
Personal and Population-Based Health Services
10. Researching for New Insights and Innovative
Solutions to Health Problems.
Emphasis on CHN
• Prioritization of health services and activities focuses on the principle of the
“greatest good for the greatest number”
• Another guiding principle also includes the fair, equitable, and appropriate
distribution of health services. This is also known as the equity rule or
distributive justice.
Nursing Process and CHN
» Assessment – “the process of collecting, organizing and

analyzing data/information about the client.” (In Health
Assessment, this includes the Collecting, Organizing,
Validating, and Documenting of Data/Information).
• Qualitative Data – Represents the Client’s Perspective (Maglaya, 2009)
• Quantitative Data – Represents the Nurse’s Point of View (Maglaya, 2009)
Diagnosis – “the identification of the client’s wellness status or needs and problems based on an
analysis of the data/information gathered.” (Maglaya. 2009:35)
NANDA focuses on an individual level. Maglaya proposed the Typology of Nursing Problems in Family
Nursing and the three categories of Community Health Nursing Problems as Health Status Problems,
Health Resources Problems, and Health Related Problems
Planning – it the creation of a step by step process of attaining set of desired goals and outcomes
Objectives - formulated should be Specific, Measurable, Attainable, Realistic and Time-Bounded

(SMART) to facilitate Evaluation. These objectives facilitate evaluation.
“Desired outcomes could be in the terms of health, knowledge, attitudes and practices and the
ability to cope with problems
» Implementation – this is characterized by doing the specific

interventions in the nursing care plan in partnership with
the clients and other members of the health team through
empowering of the client.
• CHN Interventions should be directed to improve the standards of living and quality of life of
the community by improving the health status and improving the capability of the
community to manage its own health described as community competence.
•
•

» Evaluation – this is characterized by the identification of the
attainment of the goals and outcomes. This is relevant to
determine the change or termination of nursing
interventions.
Focus of Evaluation in individual :
• Quality of Life
• Functional Status
• Patient Satisfaction
• Compliance Measures
• Impact of Educational Interventions
Focus of evaluation in the family
is determining the capability of the family to perform the family health tasks to maintain
wellness or to address specific health problems in the family –
• health deficits
• health threats
• foreseeable crisis/stresspoints.
Focus of evaluation in the community
Evaluation of Projects and Programs:
• Inputs – the important resources of the program
Ex.: Iron and Vitamin A, for a Nutrition Program
• Processes – the important activities of the program
• Outputs – are the specific products or services after an activity
• Effects – are the results of the use of Project Outputs
• Impact – the outcome of the program effects; a broader statement of attainment of a long-
ranged program objective
Focus of evaluation in the community
Evaluation of Projects and Programs:
• Inputs: Iron and Vitamin A, for a Nutrition Program
• Processes – Administration of Iron and Vit. A to malnourished children, Food fortification

program
• Outputs – Successful full implementation of the Micronutrient program of DOH in schools &
H.C.
• Effects – Decrease number of malnourished children
• Impact – A healthier community, less absenteeism among elementary and pre-school

children
Tools for measuring and analyzing community health problems
The data gathering methods concerns are the accuracy, validity, reliability, and adequacy of the
assessment data.
Combinations of methods and sources provide cross-checks and data validation.
Methods in Assessing Community
Observation – gathering information through observing. This method includes the use of sensory
capacities-sight, hearing, smell and touch
Records Review – gathering of information which are stored. It is done by reviewing existing records
and reports which may be in the forms of electronic databases or written
Interviews – It is considered to be “the most common and widely used method of data collection.” It
is accomplished by asking questions to the participants in a systematic manner
Focus Group Discussion (FGD) – It is a qualitative research technique with a considerable number of
participants selected based on the variables being observed.
Basic Concepts and Principles of Community Health Nursing by A. Maglaya
A. The family is the unit of care; the community is the patient and there are four levels of clientele
in CHN
1. Individual – CHN considers the individual sick or well to be the entry point in the different
levels of client.
2. Family – collection of people who are integrated, interacting and interdependent in a

systems approach were one family member affects the other family members.
3. Population Group
– a group of people who share a common characteristics, developmental stage or common exposure
to particular environmental factors, and consequently common health problems, issues and
concerns.
4. Community - group of people sharing common geographic boundaries and/or common values
and interest within a specific social system.
• health system
• family system
• economic system
• educational system
• religious system
Community
“webs of people shaped by relationships, interdependence, mutual interests and patterns of

interaction” (Behringer and Richards)
Characteristics of Community
1. From the General Systems Theory, all communities are considered the same.
2. Each community is considered to be unique – because it functions within a

specific sociocultural, political, economic and environmental context
3. Community vary in community dynamics – this includes citizen participation,

power and decision making structures and community collaboration efforts.
4. A Community is considered to be an organism – a community has its own

developmental stages facilitated by catalysts from within and outside the
community
5. Community as a client/Community as a partner – The community is considered to be a partner in

health with the people at the core of the assessment
6. The core of the assessment of the community is the people and it includes:
a. People Variables (Core of the Assessment)
Demographics
Values
Beliefs
History
6. The core of the assessment of the community is the people and it includes:
a. People Variables (Core of the Assessment)
b. Community Variables (8 subsystems of community)
– Physical Environment
– Education
– Safety and Transportation
– Politics and Government
– Health and Social Services
B. The goal of improving community health is realized through multidisciplinary effort.

• CHN works with other health workers in multi-sectoral linkages to solve the different aspects
of the health problem.
• CHNs, together with other health care workers participate in the planning, implementation,
monitoring and evaluation of health programs.
C. The community health nurse works with and not for the individual patient, family, group or
community.
• Community as a client – The community is considered to be a partner in health with the

people at the core of the assessment. This includes 2 elements:
1. The community as a partner
2. The use of the nursing process.
D. The practice of community health nursing is affected by changes in society in general and by
developments in the health field in particular.
Identified Prerequisites of Health in Maglaya are:
• Peace
• Food and Shelter
• Clean Water
• Education
• Adequate Economic Resources
• “There is a strong link between a society’s health and its economic development determined
by its social and political structures and processes.
• “Poor health is a consequence and cause of poverty and under development.
• “By promoting health and preventing disease, CHN’s, therefore, contribute to the country’s
economic and social development.”
E. CHN is part of the community health system, which in turn is part of the larger human services
system.
• Community Health Nursing is a subsystem of the Health Care Delivery System.
• The Health Care Delivery System influences and is influenced by community health
The Roles and Functions of CHN
defined by (RA 9173) and standards that are developed by PNA, OHNAP & and the League of
Philippine Government Nurses and agencies such as the DepED
CLIENT ORIENTED ROLES
• Caregiver
• Educator
• Counselor
• Referral
• Resource
• Role Model
• Case Manager
DELIVERY ORIENTED ROLES
• Coordinator
• Collaborator
• Liaison
Health Care Delivery System
– it is identified as the “totality of societal services and activities designed to protect or restore the
health of individuals, families, groups, and communities”.
Preventive health care are the focused activities of the government owned health centers and
curative care are the focused activities of both government and private hospitals.
The Philippine Health Care Delivery System
The Department of Health (DOH)
Millennium Development Goals (MDG)
National Objectives for Health (NOH)
Local Health Care System

(Devolution of Health Care Services)
(RA) 7160
• Provincial, district and municipal hospitals were under the provincial government
and the Rural Health Units (RHU) and the Barangay Health Stations (BHS) to the
municipal government.
• The decentralization of the health care leadership resulted in the improvement and
deterioration of health care delivery because some local government units (LGU) have the
capability to support their own health care and needs while others are not.
Community Health and Development Concepts, Principles and Strategies

PRIMARY HEALTH CARE

Development – because it views the community as moving
progressively towards socio-economic prosperity
with the ultimate goal of self-reliance.
Principles OF PHC
1. Equitable distribution
2. Focus on prevention
3. Multi-sectoral approach
4. Scope of technology
5. Feasibilty
Elements of Primary Health Care

• Health Care Delivery System
– it is identified as the “totality of societal services and activities designed to protect or restore the
health of individuals, families, groups, and communities”.
Preventive health care are the focused activities of the government owned health centers and
curative care are the focused activities of both government and private hospitals.
• The Philippine Health Care Delivery System
• The Department of Health (DOH)
– Referral system
• Levels of Health Care and Referral System (Cuevas, 2007 p. 32)
– Primary Level of Care
– Secondary Level of Care
– Tertiary Level of Care
• Primary Level of Care
• devolved to the cities and municipalities
• health care provided by health center physicians, PHN, RHM, BHW, traditional healers and
others at the barangay health stations and RHU
• is usually the first contact between the community members and the other levels of health
facility
• Secondary Level of Care
 given by physicians with basic health trainings
 given in health facilities privately owned or government operated such as infirmaries,

municipal and district hospitals, and OPD of provincial hospitals
 this serves as a referral center for the primary health facilities
 capable of performing minor surgeries and simple laboratory exams
• Tertiary Level of Care
• rendered by specialists in health facilities including medical centers as well as regional and
provincial hospitals, and specialized hospitals
• serves as a referral center for the secondary care facilities
• complicated cases and intensive care requires tertiary care
• Levels of Health Care and Referral System (Cuevas)
• Millennium Development Goals (MDG)
• National Objectives for Health (NOH)
• Local Health Care System

(Devolution of Health Care Services)
• Health Promotion
Concept of Health Promotion (Ottawa Charter, Nov. 1986)
• Health Promotion (Ottawa Charter)
• Health Promotion Model by Pender
• Health Promotion Model by Bandura
• Social cognitive theory is viewed that people learn by watching others.
• In psychology, it explains personality in terms of how a person thinks about and responds to
one's social environment.
• For example, in the 1960s Albert Bandura argued that when people see someone else
awarded for behaviour, they tend to behave the same way to attain an award.
• People are also more likely to imitate those with whom they identify.
• Health Promotion Model by Bandura
PRECEDE has four phases:
• Phase 1: Identifying the ultimate desired result.
• Phase 2: Identifying and setting priorities among health or community issues and their
behavioral and environmental determinants that stand in the way of achieving that result, or
conditions that have to be attained to achieve that result; and identifying the behaviors,
lifestyles, and/or environmental factors that affect those issues or conditions.
• Phase 3: Identifying the predisposing, enabling, and reinforcing factors that can affect the
behaviors, attitudes, and environmental factors given priority in Phase 2.
• Phase 4: Identifying the administrative and policy factors that influence what can be
implemented.
PROCEED has four phases: the actual implementation of the intervention and the careful evaluation
of it
– the ultimate desired outcome of the process.
• Phase 5: Implementation – the design and actual conducting of the intervention.
• Phase 6: Process evaluation. Are you actually doing the things you planned to do?
• Phase 7: Impact evaluation. Is the intervention having the desired impact on the target
population?
• Phase 8: Outcome evaluation. Is the intervention leading to the outcome (the desired result)
that was envisioned in Phase 1
• How do you use PRECEDE/PROCEED?
• In Phase 1, social diagnosis, you ask the community what it wants and needs to improve its
quality of life.
• In Phase 2, epidemiological diagnosis, you identify the health or other issues that most
clearly influence the outcome the community seeks.
• In these two phases, you create the objectives for your intervention.
• How do you use PRECEDE/PROCEED? (cont.)
• In Phase 3, behavioral and environmental diagnosis, you identify the behaviors and lifestyles
and/or environmental factors that must be changed to affect the health or other issues
identified in Phase 2, and determine which of them are most likely to be changeable.
• In Phase 4, educational and organizational diagnosis, you identify the predisposing, enabling,
and reinforcing factors that act as supports for or barriers to changing the behaviors and
environmental factors you identified in Phase 3.
• In these two phases, you plan the intervention.
• In Phase 5, administrative and policy diagnosis, you identify (and adjust where necessary)
the internal administrative issues and internal and external policy issues that can affect the
successful conduct of the intervention.
• Those administrative and policy concerns include generating the funding and other
resources for the intervention.
• In Phase 6, implementation, you carry out the intervention.

• In Phase 7, process evaluation, you evaluate the process of the intervention – i.e., you
determine whether the intervention is proceeding according to plan, and adjust accordingly.
• In Phase 8, impact evaluation, you evaluate whether the intervention is having the intended
impact on the behavioral and environmental factors it’s aimed at, and adjust accordingly.
• In Phase 9, outcome evaluation, you evaluate whether the intervention’s effects are in turn
producing the outcome(s) the community identified in Phase 1, and adjust accordingly.
• Community Organizing Towards Community Participation in Health
• Community Organizing – it is described as a social developmental methodology used to

develop self-reliant and self-sustaining communities with the people as the center.
• Community Participation – Identified as a fundamental process to achieve health and

sustainable development changing the conditions within the community and behaviors of
the people in it.
History of Community Organizing
Community Organizing as part of PHC:
• May 1977 – (WHO) Main health target/goal of all governments & WHO shall be “Health for
all by year 2000” which will permit them to become socially and economically productive.
• September 1978 – Alma Ata Declaration USSR): Achieve the goal of world health thru
Primary Health Care which represents a global idea how to achieve world health.
• 1979 – WHO launched global strategy for PHC
October 1979 – Marcos mandated the Ministry of Health to adopt PHC
– organized communities are composed of political, spiritual and social groups.
– COPAR is inspired by the process of community organizing as practiced by the Basic

Ecclesiastical Community (BEC) which is implemented by the Catholic church.
– BEC practices home visits, community teaching, assemblies and they help to form
groups that can serve as leaders in helping the community to address their needs,
whether spiritual, educational or environmental needs.
Community Organizing as part of
Community Health Development (CHD)
• Community Health Development is both a means and an end towards achieving health as
total well being and not just the absence of disease. CHD is based on the Primary Health
Care (PHC) philosophy and approach. The module on CHD Principles and Practices includes
the definition of PHC as defined in the Alma Ata Declaration in 1978.
A most recent review of the PHC as a philosophy and strategy to attain health for all, emphasizes
these concepts of health care: (WHO, 2002)
1. Health care is not just about doctors and drugs; it is about people acting for their own well-
being
2. Health care is not just the obligation of governments; it is the responsibility of society as a
whole
3. Health care is not just fighting disease; it is about dealing with the constant changes in social
systems and institutional structures
4. Health care is not just about delivering and using services; it addresses all factors affecting
health status
• COPAR
Community Development as end goal of Community Organizing:
Community Development (CD) is the end goal of community organizing and all other efforts
towards uplifting the status of the poor and marginalized.
Only when the participation of the basic sector or stakeholders is elicited can development be
meaningful and sustained by the basic sectors themselves.
“Community development” will have to be defined and visualized by the community members and
their participation is important in the attainment of this vision.
Community development entails a process of assessment of current situation, the identification of

needs, deciding on appropriate courses of actions or responses, mobilization of resources to
address these needs, and monitoring and evaluation by the people.
• COPAR – Community Organizing Participatory Action Research
Evolution of Community Health Development Strategy
• Primary Health Care
(Health)
• Primary Health Care
Elements at Varied
Levels and Scope
of Partnerships
• Community Participation
• Gender and Health
• Strengthened
Partnership Building
and Community Organizing
Community Health
Development
Community Organizing and the Nursing Profession:
• One of the roles of Public Health Nurses is Community Organizer and as such, nurses work
with the local government in facilitating Community Health through Community Organizing.
• The nursing curriculum includes Community Development and COPAR as stated in the
CHED’s Instructional standards for Nursing Education. Student nurses with their clinical
instructor act as facilitator of CO in selected barangays following the COPAR process.
• In this way, the Schools of Nursing act as one of the NGO’s who reach out and help in the
implementation of the WHO in achieving health for all especially to those who are in the
remote areas.
• Community Organizing Process
• It “is a process whereby the community members develop the capability to assess their
health problems, plan and implement actions to solve these problems, put up and sustain
organizational structures which will support and monitor implementation of health
initiatives by the people.” (Maglaya)
• Phases of CO by Maglaya
A. Preparatory Phase
B. Organizational Phase
C. Education and Training Phase
D. Inter-sectoral Collaboration Phase
E. Phase out
A. Preparatory Phase – activities includes area selection, community profiling, entry in the
community, and integration with the people.
1. Area Selection:
• Is the community in need assistance?
• Is there need of the community to work together?
• Are there concerned groups or organization?
3. Entry: Integration
• Recognize the role and position of local authorities.
• Adapt a lifestyle in keeping with that of the community.
• Choose a modest dwelling
• Avoid raising expectations. Be clear with your objectives and limitations.
• Make house calls and seek out people where they usually gather.
• Participate in some social activities.
B. Organizational Phase – activities are directed towards creating a people’s organization
1. Social Preparation – the nurse deepens and strengthens her ties with the people.
2. Spotting and Developing Potential Leaders – the potential leaders are chosen
• The leaders should be able to identify and understand with the community
the problems
• The Potential Leaders should have deep concern and understanding of the
conditions of the community and is willing to work for the desired change.
3. Core Group Formation – consists of the identified potential leaders that will form the people’s
organization.
• The core groups forms their members in their respective sectors of the
community and the nurse helps facilitate the development of the skills in
the core group members.
– Democratic and Collective Leadership
– Planning and Assuming Tasks
– Handling and Resolving Group Conflicts
– Critical Thinking and Decision-Making Process
4. Setting Up the Community Organization
The nurse facilitates the formulation of a health committee that initially includes the identification of
prospective community health workers (CHWs).
D. Inter-sectoral Collaboration Phase
The nurse facilitates and coordinates the assistance and support from external sources from the
community
E. Phase-Out
The community assumes greater responsibility in managing their own health and the nurse prepares
for the turnover of the work to the community.
• COPAR process & its related concepts
PAR - PARTICIPATORY ACTION RESEARCH
Definition:
An investigation of the problems and issues concerning the life and environment of
the under privileged in the society by way of a research collaboration with the under privileged,
whose representatives participate in the actual research process as equal partners.
PARTICIPATION is the core element of participatory action research. It is an active process

whereby the expected beneficiaries of research are the main actors in the entire research process,
they act as researchers and facilitators.
OBJECTIVES OF PAR:
1. Encourages consciousness of their problems and develop competence for changing their
situation.
2. Help in organization-building by harnessing both human and material resources in

responding to community needs.
3. Enhances the knowledge of the researchers and the community on the social reality
before them.
• PARTICIPATORY ACTION RESEARCH PROCESS
I. Preparatory Phase
II. Operational Phase-data gathering
III. Collective data synthesis and analysis
IV. Dissemination and research utilization
• Community Organizing Participatory Action Research (COPAR)
Definition:
COPAR is a social development approach that aims to transform the apathetic,

individualistic and voiceless poor into dynamic, participatory and politically responsive community.
COPAR is a collective, participatory, transformative, liberative, sustained and

systematic process of building people’s organizations by mobilizing and enhancing the capabilities
and resources of the people for the resolution of their issues and concerns towards effecting change
in their existing oppressive and exploitative conditions -
1994 National Rural Conference
COPAR is a process by which a community identifies its needs and objectives,

develops confidence to take action in respect to them and in doing so, extends and develops
cooperative and collaborative attitudes and practices in the community (Ross 1967)
COPAR is a continuous and sustained process of educating the people to understand

and develop their critical awareness of their existing condition, working with the people collectively
and efficiently on their immediate and long-term problems, and mobilizing the people to develop
their capability and readiness to respond and take action on their immediate needs towards solving
their long-term problems
(CO: A manual of experience, PCPD)
• Phases of Community Organizing Participatory Action Research (COPAR)
1. Pre-Entry Phase
2. Entry Phase
3. Organization and Capability Building Phase
4. Sustenance and Strengthening Phase
5. Termination & Phase-Out
• Three major focus of nursing action or

processes in the community:
1. Client
2. Health Care Unit
3. Political Leaders/Decision Makers.
• Concept of a sustainable community health development
3 Important Approach
• Community-Based Approach – empowers the people to address their health needs and
problems
• Integrated Approach – considers various dimensions of health and development including

changing lifestyle, changing environment, and reorienting health care
• Comprehensive Approach – addresses the root of the problem and addresses the social
determinants of health
• Capacity-building strategies
• Health Education – “Health education is one of the strategies of health promotion and a
major function and intervention of a CHN.”
• Competency-Based Training for Community Health Workers – “the competency-based

framework involves the mastery of a cluster of related knowledge, skills, and attitudes
critical to performance of one’s role or responsibilities measured against well-accepted
standards.” (Sullivan)
• Supervision of Lower Level Health Workers – Supervision is a developmental and enabling

process ensuring that the needed work is done effectively and efficiently. (Morrissey)
• Partnership Building and Collaboration
Networking - relationship among organizations that consists of exchanging information about each
other’s goal and objectives, services or facilities.
Linkage-Building – creation of partnership with other organization

Multi-sectoral collaboration - health and illness are multi-causal and could addressed only by an
integrated effort, the CHN works with other health workers in multi-sectoral linkages to solve the
different aspects of the health problem.
Interdisciplinary collaboration - CHNs, together with other health care workers participate in the
planning, implementation, monitoring and evaluation of health programs.
Advocacy - nurses uphold the client’s autonomy to make their own decisions.
Family Health Nursing
Objectives:
1. Identify key concepts and principles of a family
2. Utilize the Nursing Process in caring for a family
3. Design a family nursing care plan and teaching plan from assessment findings of an actual
family, to be presented on day 4
Definition of family
The family is an open and developing system of interacting personalities with structure and
process created in relationships among the individual members regulated by resources and
existing within a larger community. (Smith & Maurer, 1995)
Basic unit in society, and is shaped by all forces surround it.
-Values, beliefs, and customs of society influence the role and function of the family (invades
every aspect of the life of the family)
Is a unit of interacting persons bound by ties of blood, marriage or adoption.
Constitute a single household, interacts with each other in their respective familial roles and
create and maintain a common culture.
Two or more people who live in the same household (usually), share a common emotional bond,
and perform certain interrelated social tasks (Spradly & Allender, 1996)
People may have different definitions of family depending on the context on which they
understand it.
Types of family
According to structure
Nuclear - a father, a mother with child/children living together but apart from both sets of parents
and other relatives.
Extended - composed of two or more nuclear families economically and socially related to each
other. Multigenerational, including married brothers and sisters, and the families.
Types of family
Blended - combination of two families with children from both families and sometimes children of
the newly married couple. It is also a remarriage with children from previous marriage.
Compound - one man/woman with several spouses
Communal - more than one monogamous couple sharing resources
Types of family
Foster - substitute family for children whose parents are unable to care for them
Single-parent - divorced or separated, unmarried or widowed male or female with at least one
child.
Cohabiting - unmarried couple living together
Dyad - husband and wife or other couple living alone without children
Types of family
Gay/ Lesbian - homosexual couple living together with or without children
No – Kin - a group of at least two people sharing a relationship and exchange support who have no
legal or blood tie to each other
Types of family
According to authority
Patriarchal - full authority on the father or any male member of the family e.g. eldest son,
grandfather
Matriarchal - full authority of the mother or any female member of the family, e.g. eldest sister,
grandmother
Matricentric - the mother decides/takes charge in absence of the father (e.g. father is working
overseas)
Types of family
According to authority
Patricentric - the father decides/ takes charge in absence of the mother
Egalitarian - husband and wife exercise a more or less amount of authority, father and mother
decides
Laissez-faire – full autonomy

Democratic - everybody is involve in decision making
Types of family
According to function
Family of procreation
- refers to the family you yourself created
Family of orientation
– refers to the family where you came from
Types of family
According to locality
Matrilocal - live near the domicile of the parents of the wife
Patrilocal - family resides / stays with / near domicile of the parents of the husband
THE FILIPINO FAMILY and its CHARACTERISTICS
There is a great degree of equality between husband and wife
Children not only have to respect their parents and obey them, but also have to learn to repress
their repressive tendencies
The older siblings have something of authority of their parents.
Universal functions of the family:
1. Reproduction
2. Status placement
3. Biological and emotional maintenance of the young and dependent members
4. Socialization and care of the children
5. Social control
THE FAMILY AS A UNIT OF CARE
RATIONALE FOR CONSIDERING THE FAMILY AS A UNIT OF CARE:
The family is considered the natural and fundamental unit of society
The family as a group generates, prevents, tolerates and corrects health problems within its
membership
THE FAMILY AS A UNIT OF CARE
RATIONALE FOR CONSIDERING THE FAMILY AS A UNIT OF CARE:
The health problems of the family members are interlocking
The family is the most frequent focus of health decisions and action in personal care
The family is an effective and available channel for much of the effort of the health worker
THE FAMILY AS THE CLIENT
CHARACTERISTICS OF A FAMILY AS A CLIENT
1. The family is a product of time and place-
A family is different from other family who lives in another location in many ways.
A family who lived in the past is different from another family who lives at present in many ways.
2. The family develops its own lifestyle
Develop its own patterns of behavior and its own style in life.
Develops their own power system which either be:
Balance-the parents and children have their own areas of decisions and control.
Strongly Bias-one member gains dominance over the others.
3. The family operates as a group
A family is a unit in which the action of any member may set of a whole series of reaction within a
group, and entity whose inner strength may be its greatest single supportive factor when one of its
members is stricken with illness or death.
4. The family accommodates the needs of the individual members.
An individual is unique human being who needs to assert his or herself in a way that allows him to
grow and develop.
Sometimes, individual needs and group needs seem to find a natural balance;
a. The need for self-expression does not over shadow consideration for others.
b. Power is equitably distributed.
c. Independence is permitted to flourish.
5. The family relates to the community
Family develops a stance with respect to the community:
The relationship between the families is wholesome and reciprocal; the family utilizes the
community resources and in turn, contributes to the improvement of the community.
There are families who feel a sense of isolation from the community.
Families who maintain proud, “We keep to ourselves” attitude.

Families who are entirely passive taking the benefits from the community without either
contributing to it or demanding changes to it.
6. The family has a growth cycle
Families pass through predictable development stages (Duvall & Miller, 1990)
Initial Data Base for Family Nursing Practice by A. Maglaya

A. Family Structure Characteristics and Dynamics
Members of the household and relationship to the head of the family.
Demographic data-age, sex, civil status, position in the family
Place of residence of each member-whether living with the family or elsewhere
Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended
Dominant family members in terms of decision making especially on matters of health care
General family relationship/dynamics-presence of any obvious/readily observable conflict between

members; characteristics, communication/interaction patterns among members.
B. Socio-economic and Cultural Characteristics
Income and expenses
Occupation, place of work and income of each working member
Adequacy to meet basic necessities (food, clothing, shelter)
Who makes decision about money and how it is spent
Educational Attainment of each Member
Ethnic Background and Religious Affiliation
Significant others-role (s) they play in family’s life
Relationship of the family to larger community-nature and extent of participation of the family in
community activities
C. Home Environment
Housing
Adequacy of living space
Sleeping in arrangement
Presence of breathing or resting sites of vector of diseases (e.g. mosquitoes, roaches, flies, rodents,
etc.)
Presence of accident hazard
Food storage and cooking facilities
Water supply-source, ownership, pot ability

Toilet facilities-type, ownership, sanitary condition
Garbage/refuse disposal-type, sanitary condition
Drainage System-type, sanitary condition
Kind of Neighborhood, e.g. congested, slum etc.
Social and Health facilities available
Communication and transportation facilities available
D. Health Status of Each Family Member
Medical Nursing history indicating current or past significant illnesses or beliefs and practices
conducive to health and illness
Nutritional assessment (especially for vulnerable or at risk members)
Anthropometric data: measures of nutritional status of children-weight, height, mid-upper arm

circumference; risk assessment measures for obesity : body mass index(BMI=weight in kgs. divided
by height in meters2), waist circumference (WC: greater than 90 cm. in men and greater than 80
cm. in women), waist hip ration (WHR=waist circumference in cm. divided by hip circumference in
cm. Central obesity: WHR is equal to or greater than 1.0 cm in men and 0.85 in women)
dietary history specifying quality and quantity of food or nutrient per day
Eating/ feeding habits/ practices
Developmental assessment of infant, toddlers and preschoolers- e.g. Metro Manila Developmental
Screening Test (MMDST).
Risk factor assessment indicating presence of major and contributing modifiable risk factors for
specific lifestyle diseases-e.g. hypertension, physical inactivity, sedentary lifestyle, cigarette/ tobacco
smoking, elevated blood lipids/ cholesterol, obesity, diabetes mellitus, inadequate fiber intake,
stress, alcohol drinking, and other substance abuse.
Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical

practitioners )
Results of laboratory/diagnostic and other screening procedures supportive of assessment findings.
E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention.
Immunization status of family members
Healthy lifestyle practices. Specify.
Adequacy of:
Rest and sleep
Exercise/activities
Use of protective measure-e.g. adequate footwear in parasite-infested areas; use of bed nets and
protective clothing in malaria and filariasis endemic areas.
Relaxation and other stress management activities

Use of promotive-preventive health services
A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

1. First Level Assessment
I. Presence of Wellness Condition -stated as 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.
A. Potential for Enhanced Capability for:
Healthy lifestyle-e.g. nutrition/diet, exercise/activity
Healthy maintenance/health management
Parenting
Breastfeeding
Spiritual well-being-process of client’s developing/unfolding of mystery through harmonious

interconnectedness that comes from inner strength/sacred source/God (NANDA 2001)
Others. Specify.
A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE by A. Maglaya

B. Readiness for Enhanced Capability for:
Healthy lifestyle
Health maintenance/health management
Parenting
Breastfeeding
Spiritual well-being
Others. Specify

II. Presence of Health Threats-conditions that are conducive to disease and accident, or may result
to failure to maintain wellness or realize health potential. Examples of this are the following:
A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards specify.
Broken chairs
Pointed /sharp objects, poisons and medicines improperly kept
Fire hazards
Fall hazards
Others specify.

E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices. Specify.
Inadequate food intake both in quality and quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding techniques
F. Stress Provoking Factors. Specify.
Strained marital relationship
Strained parent-sibling relationship
Interpersonal conflicts between family members
Care-giving burden

G. Poor Home/Environmental Condition/Sanitation. Specify.
Inadequate living space
Lack of food storage facilities
Polluted water supply
Presence of breeding or resting sights of vectors of diseases
Improper garbage/refuse disposal
Unsanitary waste disposal
Improper drainage system
Poor lighting and ventilation

Noise pollution
Air pollution
H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
Alcohol drinking
Cigarette/tobacco smoking
Walking barefooted or inadequate footwear
Eating raw meat or fish
Personal abuse
Sexual promiscuity hygiene
Self medication/substance scuity
Engaging in dangerous sports
Inadequate rest or sleep
Lack of /inadequate exercise/physical activity
Lack of/relaxation activities
Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis endemic
areas).

J. Inherent Personal Characteristics-e.g. poor impulse control
K. Health History, which may Participate/Induce the Occurrence of Health Deficit, e.g. previous
history of difficult labor.
L. Inappropriate Role Assumption- e.g. child assuming mother’s role, father not assuming his role.
M. Lack of Immunization/Inadequate Immunization Status Specially of Children
N. Family Disunity-e.g.
Self-oriented behavior of member(s)
Unresolved conflicts of member(s)

Intolerable disagreement
O. Others. Specify

III. Presence of health deficits -instances of failure in health maintenance.
Examples include:
A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner.
B. Failure to thrive/develop according to normal rate
C. Disability-whether congenital or arising from illness; transient/temporary (e.g. aphasia or

temporary paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness
from measles, lameness from polio)
Second Level Assessment
I. Inability to recognize the presence of the condition or problem due to:
A. Lack of or inadequate knowledge
B. 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
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
D. Others. Specify
II. Inability to make decisions with respect to taking appropriate health action due to:
Failure to comprehend the nature/magnitude of the problem/condition
Low 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 others 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.
In accessibility of appropriate resources for care, specifically:
Physical Inaccessibility
Costs constraints or economic/financial inaccessibility
Lack of trust/confidence in the health personnel/agency
Misconceptions or erroneous information about proposed course(s) of action
Others specify.
III. 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:
1. Absence of responsible member
2. Financial constraints
3. 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 disability, which exhaust supportive capacity of family members.
Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
Role confusion
Role overload
Others. Specify.
IV. Inability to provide a home environment conducive to health maintenance and personal
development due to:
Inadequate family resources specifically:
Financial constraints/limited financial resources
Limited physical resources-e.i. lack of space to construct facility
Failure to see benefits (specifically long term ones) of investments in home environment
improvement
Lack of/inadequate knowledge of importance of hygiene and sanitation
Lack of/inadequate knowledge of preventive measures
Lack of skill in carrying out measures to improve home environment
Ineffective communication pattern within the family
Lack of supportive relationship among family members
Negative attitudes/philosophy in life which is not conducive to health maintenance and personal
development
Lack of/inadequate competencies in relating to each other for mutual growth and maturation (e.g.
reduced ability to meet the physical and psychological needs of other members as a result of
families’ preoccupation with current problem or condition.
Others: specify

V. Failure to utilize community resources for health care due to:
Lack of/inadequate knowledge of community resources for health care
Failure to perceive the benefits of health care/services
Lack of trust/confidence in the agency/personnel
Previous unpleasant experience with health worker
Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically :
Physical/psychological consequences
Financial consequences
Social consequences
- Unavailability of required care/services
V. Failure to utilize community resources for health care due to:
Inaccessibility of required services due to:
1. Cost constrains
2. Physical inaccessibility
Lack of or inadequate family resources, specifically
Manpower resources, e.g. baby sitter
Financial resources, cost of medicines prescribe
Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness, AIDS,
etc.
Negative attitude/ philosophy in life which hinders effective/maximum utilization of community

resources for health care
Others, specify
Problem Identification
Sample Problem Ranking

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Course Description

1. Apply concepts and principles of community health

development in the care of communities & population groups.

2. Utilizes the nursing process in the care of communities and

3. Ensure a well-organized recording and reporting system.

4. Share leadership/relate effectively with others in work

situations related to nursing and health.

1. Provide opportunity to practice chn bag technique

Overview of Community Health Nursing (Maglaya, 2009)

2 Major Fields of Nursing

• Community Health Nursing (CHN)

Definition of Community Health Nursing by Maglaya

(George in Maglaya, 2009)

Framework for Community Health Nursing

Macro Framework Components:

1. Health Care Delivery System (CHN Subsystem)

3. Health (Goal of the Health Care Delivery System)

3. Economic (Sociocultural, Political, and

Characteristics of Community Health Nursing

Community Health Nursing as a

The hallmark of community health nursing is that it is population- or aggregate-focused.

Community Health Nursing

• Nursing- “the means”

Community Health Nursing as a

CHN is a synthesis of nursing and public health practice.

“Public health is generally regarded as a responsibility of government.”

Three Core Functions of Public Health

Assessment – “the regular collection and analysis of health data.”

Ten Essential Health Services of Public Health:

1. Monitoring Health Status to Identify Community Health Problems

2. Diagnosis and Investigating Health Problems and Hazards in the Community

3. Informing , Educating , and Empowering People About Health Issues

4. Mobilizing Community Partnerships to Identify and Solve Health Problems

Ten Essential Health Services of Public Health:

6. Enforcing Laws and Regulations that Protect Health

7. Linking People to Needed Personal Health Services

and Ensuring the Provision of Health Care

8. Ensuring Competent Public Health and Personal

Health Care Workforce.

9. Evaluating Effectiveness, Accessibility, and Quality of

Personal and Population-Based Health Services

10. Researching for New Insights and Innovative

Solutions to Health Problems.

Nursing Process and CHN

» Assessment – “the process of collecting, organizing and

• Qualitative Data – Represents the Client’s Perspective (Maglaya, 2009)

• Quantitative Data – Represents the Nurse’s Point of View (Maglaya, 2009)

Nursing Process and CHN

Nursing Process and CHN

Objectives - formulated should be Specific, Measurable, Attainable, Realistic and Time-Bounded

Nursing Process and CHN

» Implementation – this is characterized by doing the specific

Nursing Process and CHN

Focus of Evaluation in individual :

• Impact of Educational Interventions

Focus of evaluation in the family

Focus of evaluation in the community

Evaluation of Projects and Programs:

• Inputs – the important resources of the program