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Community Health Nursing 1 - Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR
Session # 3

LESSON TITLE: Theoretical Foundation of Community Materials:

Health Nursing
Pen, paper, index card, book, and class List
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can: Reference:
1. Integrate relevant principles and theory of social,
Famorca, Z. U., Nies, M. A., & McEwen, M.
physical, natural and health sciences and humanities in
(2013). Nursing Care of the Community. Elsevier
a given health and nursing situation in the community;
Gezondheidszorg.
and,
2. Compare the different theories in community health
nursing.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Discuss the duties of the nurse as mandated in section 28 of R.A No. 9173.
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MAIN LESSON (30 minutes)

When the nurses work on a complex community health problem, they need to think strategically. They need to know
where to focus their time, energy and programmatic resources. There are health problems that have existed for years with
other layers of foundational problems that may have existed for generations. The nurses should use organizational
resources in a focused manner, so that they will solve the problem and can’t create new problems along the way.
The nursing profession has advanced and with it so has the need to develop nursing theories that formalize the scientific
base of community health nursing. The richness of community health nursing comes from the challenge of
conceptualizing and implementing strategies that will enhance the health of the people.

There are several theoretical approaches that the community health nurse may apply in efforts to improve community
health.

1. General System Theory

⎯ It is applicable to the different levels of the community health nurses ’ clientele: individual, families, groups or
aggregates and communities.
⎯ It is viewed as an open system; the client is considered a set of interacting elements that exchange energy,
matter, or information with external environment to exist (Katz and Kahn 1966).
⎯ The family and the group are set of interrelated individuals. This concept is particularly useful when analyzing
interrelationships of the elements within the client as well as those of the client.
⎯ The family home and the community and its institution make up its immediate environment and are therefore
important aspects to be considered in the assessment of the family health status.
⎯ The nurse observes interpersonal relationships among the members and appraises the physical environmental
conditions in the home.
⎯ An interview with the family members may reveal how the family relates to the larger system-the community and
the structures in the community such as health agencies.
⎯ The family gets inputs of matter (e.g., food, water), energy (e.g., sunlight, and electricity), information (e.g., news
on community events, health teaching, which resources are taken from its environment.
⎯ The outputs refer to material products, energy and information that results from the family’s processing
(throughput) of inputs. The health practices and the health status are examples of outputs.
⎯ Feedbacks is information from the environment directed back to the system, which allows the system to make the
necessary adjustment for better functioning

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2. Social Learning Theory

⎯ It is based on the belief that learning takes place in a social context, that is, people learn from one another and
that learning is promoted by modeling or observing other people.
⎯ People can learn by observing the behavior of others.

3. The Health Belief Model

⎯ The health belief model provides the basis for much of the practice of health education and health promotion
today.
⎯ The individuals must know what to do and how to do it before they can take action.

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⎯ The information must be related in some way to the individual’s needs. One of the most widely used conceptual
frameworks in health behavior, the HBM, has been used to explain behavior change and maintenance of behavior
change and to guide health promotion intervention.

4. Milio’s Framework for Prevention

⎯ The framework provides that the health status existing in the population occurs due to too little or excess critical
health sustaining resources whereby people who are have enough and safe food, shelter, water and environment
are vulnerable to infectious diseases which too much food will lead to obesity.
⎯ Population behavior patterns also affect health since knowledge and perception is influenced by informal and
formal learning and also by experience (Milio, n.d).
⎯ Health is also influenced by organizational behavior which includes policy makers since they provide options
available to thus influencing selections made by individuals.
⎯ Milio proposed that health deficits often result from the imbalance between a population’s health needs and its
health- sustaining resources.
⎯ Personal and societal resources affect the range of health promoting or health damaging choices available to
individual.
✓ Personal resources include:
• Awareness
• Knowledge
• Beliefs
• Money
• Time
• The urgency of priorities
✓ Societal: community and national conditions strongly influence societal resources.
• Availability and cost of health services
• Environmental protection
• Safe shelter
• Penalties for failure to select the given options
• Rewards
⎯ Milio challenged health education’ assumption that knowledge of health generating behaviors implies an act in
accordance with that knowledge.
⎯ She proposed that most human beings professional or non-professional, provider or consumer make the easiest
choices available to them most of the time.
⎯ Health promoting choices must be more readily available and less costly than health damaging options for
individuals to gain health and for society to improve health status.

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5. Pender’s Health Promotion Model

⎯ Pender’s Health Promotion Model explores many biopsychosocial factors that influence individuals to pursue
health promotion activities
⎯ The HPM depicts the complex multidimensional factors which people interact as they work to achieve optimum
health. This model contains seven variables related to health behaviors as well as individual characteristics that
may influence them
⎯ Pender’s model does not include threats as a motivator as threat nay not be a motivating factor for clients in all
age groups.

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6. The Transtheoretical Model

⎯ The TTM combines several theories of intervention
⎯ It is based on the assumption that behavior change takes place over time, progressing through a sequence of
stages.
⎯ It also assumes that each of the stages is both stable and open to change
⎯ One may stop in one stage progress to the next stage or return to the previous stage
⎯ Change is difficult even for the most motivated of individuals. People resist change for many reasons:
✓ Be unpleasant
✓ Require giving up pleasure
✓ Be painful
✓ Be stressful
✓ Jeopardize social relationships
✓ Not seem important any more
✓ Require change of self-image

7. PRECEDE-PROCEED Model
⎯ It provides a model for community assessment, health education, planning, and evaluation.
⎯ PRECEDE stands for:
✓ P- predisposing
✓ R-reinforcing
✓ E- enabling
✓ C-construct
✓ E- educational
✓ D diagnosis
✓ E- Evaluation
⎯ PROCEED
✓ P- policy
✓ R- regulatory
✓ O- organizational
✓ C-construct
✓ E-educational
✓ D- developmental
⎯ Predisposing factors refer to a people’s characteristic that motivate them towards health –related behavior

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CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 20 minutes for this activity:

Multiple Choice

1. In preparing to review different theories, nurse Bobby reviews basic information to assist in understanding the material.
Theories are defined as:
A. Statements that describe concepts or connect concepts
B. Mental formulations of objects or events
C. Aspects of reality than can be consciously sensed
D. Concepts or propositions that project a systematic view of phenomena
ANSWER: _ D_
RATIO:___ ___________________________________________________________________________________________ In
order to help the reader understand the content, nurse Bobby examines the fundamentals. Concepts or claims that
present a systematic picture of occurrences are referred to as theories. __________________________________
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2. Kristy, a community health nurse is working with a variety of clients and decides to use a Systems theory approach to
assist them to meet their health care needs. In using the Systems theory, nurse Kristy focuses on the:
A. Client’s interaction with the environment
B. Hierarchy of the client’s human needs
C. Client’s attitudes toward health behaviors
D. Response of the client to the process of growth and development
ANSWER: _ A _

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RATIO:____ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _______ The

nurse patient or client should examine the client's contact with the environment fi rst, and in my opinion, the ideal response
would be how the client interacts with the environment.
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3. When assessing the external variables that influence a client’s health beliefs and practices, nurse Mindy must consider
his:
A. Educational background
B. Religious practices
C. Income status
D. Reaction to the heart disease
ANSWER: _ C _
RATIO:___ ___________________________________________________________________________________________ Nurse
Mindy must take his clients' or patients' income status into account when evaluating the external factors that affect
a client's health beliefs and practices. This will help and comprehend what actually the health care goals and
reasons are. __________________________________________________________________________________________
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4. In the Health Belief Model, nurse Chiara recognizes that the focus is placed on the:
A. Functioning of the individual in all dimensions
B. Relation of perceptions and compliance with therapy
C. Relation of perceptions and compliance with therapy
D. Multidimensional nature of clients and their interaction with the environment
ANSWER: _ B C _
RATIO:___ ___________________________________________________________________________________________
BONUS ______________________________________________________________________________________________
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5. Which of the following is the most basic type of health promotion activity? (Select all that apply).
A. A billboard promoting abstinence to prevent sexually transmitted diseases and unplanned pregnancies
B. A wellness assessment program
C. An environment control program about pesticide uses
D. A nurse who models healthy lifestyle behaviors
E. A school of nursing that holds a blood pressure fair
ANSWER: _ A,E _
RATIO:___ ___________________________________________________________________________________________ The
options a and e are the best and most fundamental types of health promotion activities since they will help gather
information and explain what a nursing school is to others. ______________________________________________
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6. Nurse Marco is providing health education about injury and poisoning prevention to a group of young mothers at a
health fair. What type of prevention is the nurse conducting?
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Limited prevention
ANSWER: _ A _
RATIO:___ ___________________________________________________________________________________________
this strategy emphasizes avoiding illness before it occurs. ______________________________________________
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7. Pender’s health promotion model would benefit which of the following clients? (Select all that apply)
A. An active 23-year-old who does not smoke or drink alcohol
B. A 49-year-old client who exercises four times a week
C. A 35-year-old who has yearly breast exams and other routine health screenings

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D. An overweight 27-year-old who engages in risky behaviors

ANSWER: _ A B _
RATIO:___ ___________________________________________________________________________________________
Pender's health promotion model describes health as "a positive dynamic state not only the absence of disease
and it refers to it as option a and b." ____________________________________________________________________
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8. Client Clint reports that he believes he will "never lick the habit" of smoking because he has trie d before and failed.
Using the Transtheoretical model (TTM), what stage of health behavior is the client functioning in?
A. Preparation stage

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B. Contemplation stage
C. Termination stage
D. Action stage
ANSWER: _ A _
RATIO:___ ___________________________________________________________________________________________ The
stage of preparation comprises behavioral and intentional criteria. People who are in this stage have attempted to
take action in the past year without success and plan to do so in the coming month. ______________________
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9. Honey, a public health nurse compares the rate of teenage pregnancy in various areas of the city. Which of the core
functions of public health is being implemented?
A. Assurance
B.Assessment
C.Prevention
D.Policy development
ANSWER: _ B _
RATIO:___ ___________________________________________________________________________________________
Honey is collecting information that indicates evaluating clients or anyone in any city where they encounter
teenage pregnancy. ___________________________________________________________________________________
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10. Nurse Glynnis performs activities to meet the primary goals of public health. Which of the following is nurse Glynnis
most likely to complete?
A. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication
B.Finding home care for a 70-year-old client recuperating from a hip replacement
C.Conducting an infant car seat safety check
D.Contacting a local hospice to admit a terminally ill 60-year-old woman
ANSWER: _ C _
RATIO:___ ___________________________________________________________________________________________
Option c is the example of the primary goals of public health ____________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION)

The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

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6. ANSWER: _ _

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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

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AL Activity: Muddiest Point:

In today’s session, what was least clear to you?
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