 Unique and distinct component

of health care
COMMUNITY HEALTH NURSING
 The term community health  Multiple factors of health
nursing is synonymous with considered
public health nursing.  Active participation of clients
Community health nursing encouraged
relies heavily on the systematic  Nurse considers availability of
process of designing and resources
delivering health services and  Interdependence among health
nursing care to improve the team members practiced
health of the entire community.  Scientific and up-to-date
 Community health nursing is a  Tasks of CHN vary with time
specialty in nursing. According and place
to the American Nursing  Independence or self-reliance
Association (ANA), public health of the people is the end goal
nursing is the practice of  Connectedness of health and
promoting and protecting the development regarded
health of populations using
knowledge from nursing, social Goals and Objectives
and public health sciences  The primary goal of community
(Waldorf, 1999). health nursing is to help a
 Community health nursing community protect and
involves the identification of preserve the health of its
high-risk aggregates in the members, while the secondary
community, and the goal is to promote self-care
development of appropriate among individuals and families.
and workable policies and In the health-care reform
interventions to ensure environment, the community
accessible services for all health nurse will probably
groups of the population. continue to care for individuals
and families, particularly high-
PHILOSOPHY risk clients and those with
 “The philosophy of CHN is communicable diseases.
based on the worth and dignity
on the worth and dignity of GOALS OF CHN
man.”(Dr. M. Shetland).  To promote health and
 A philosophy is defined as a efficiency.
system of beliefs that provides  Prevention and control diseases
a basis for a guides action. A and disabilities.
philosophy provides the  Need based health care to
direction and describes the prolong life.
whats, the whys, and the hows
of activities within a profession.

CHN Practice is guided by the following

beliefs:
 Humanistic values of the
nursing profession upheld
 OBJECTIVES OF CHN 1923
 Provide antenatal, intranatal  Zamboanga General Hospital
and postnatal, care to ensure School of Nursing & Baguio
safe pregnancy and delivery. General Hospital were
 Immunization established; other government
 Provide under five children care schools of nursing were
 Health education organized several years after.
 To improve the ability of the 1928
community to deal with their  1st Nursing convention was
own health problem held
 To strengthen the community 1940
resources  Manila Health Department was
 To prevent and control created.
communicable and non- 1941
communicable diseases  Dr. Mariano Icasiano became
 To provide specialized services the first city health officer;
 To conduct research Office of Nursing was created
through the effort of Vicenta
HISTORICAL DEVELOPMENT OF Ponce (chief nurse) and Rosario
CHN IN THE PHILIPPINES Ordiz (assistant chief nurse)
1901 Dec. 8, 1941
 Act # 157 (Board of Health of  Victims of World War II were
the Philippines); Act # 309 treated by the nurses of Manila.
(Provincial and Municipal July 1942
Boards of Health) were created.  Nursing Office was created; Dr.
1905 Eusebio Aguilar helped in the
 Board of Health was abolished; release of 31 Filipino nurses in
functions were transferred to Bilibid Prison as prisoners of
the Bureau of Health. war by the Japanese.
1912 Feb. 1946
 Act # 2156 or Fajardo Act  Number of nurses decreased
created the Sanitary Divisions, from 556 – 308.
the forerunners of present 1948
MHOs; male nurses performs  First training center of the
the functions of doctors Bureau of Health was organized
1919 by the Pasay City Health
 Act # 2808 (Nurses Law was Department. Trinidad Gomez,
created) – Carmen del Rosario, Marcela Gabatin, Costancia
1st Filipino Nurse supervisor Tuazon, Ms. Bugarin, Ms.
under Bureau of Health Ramos, and Zenaida Nisce
Oct. 22, 1922 composed the training staff.
 Filipino Nurses Organization 1950
(Philippine Nurses’  Rural Health Demonstration
Organization) was organized. and Training Center was
created.

1953
  The first 81 rural health units through Department Order #
were organized. 29.

1957 May 24, 1999

 RA 1891 amended some  EO # 102, which redirects the
sections of RA 1082 and functions and operations of
created the eight categories of DOH, was signed by former
rural health unit causing an President Joseph Estrada.
increase in the demand for the
community health personnel. Basic Principles of CHN
1958-1965  The community is the patient in
 Division of Nursing was CHN, the family is the unit of
abolished (RA 977) and care and there are four levels
Reorganization Act (EO 288) of clientele: individual, family,
1961 population group (those who
 Annie Sand organized the share common characteristics,
National League of Nurses of developmental stages and
DOH. common exposure to health
1967 problems – e.g. children,
 Zenaida Nisce became the elderly), and the community.
nursing program supervisor and  In CHN, the client is considered
consultant on the six special as an ACTIVE partner NOT
diseases (TB, leprosy, V.D., PASSIVE recipient of care
cancer, filariasis, and mental  CHN practice is affected by
health illness). developments in health
1975 technology, in particular,
 Scope of responsibility of changes in society, in general
nurses and midwives became  The goal of CHN is achieved
wider due to restructuring of through multi-sectoral efforts
the health care delivery system.  CHN is a part of health care
1976-1986 system and the larger human
 The need for Rural Health services system.
Practice Program was
implemented. 12 Principles of Community Health
1990- 1992 Nursing
 Local Government Code of 1. The recognized need of
1991 (RA 7160) individuals, families and
1993-1998 communities provides the basis
 Office of Nursing did not for CHN practice. Its primary
materialize in spite of persistent purpose is to further apply
recommendation of the officers, public health measures within
board members, and advisers the framework of the total CHN
of the National League of effort.
Nurses Inc. 2. Knowledge and understanding
Jan. 1999 of the objectives and policies of
 Nelia Hizon was positioned as the agency facilities goal
the nursing adviser at the achievement. The mission
Office of Public Health Services statement commits Community
 Health Nurses to positively and needs of Community
actualize their service to this Health Nurses are considered in
end. planning staff development
programs of the agency.
9. Utilization of indigenous and
3. CHN considers the family as the existing community resources
unit of service. Its level of maximizing the success of the
functioning is influenced by the efforts of the Community
degree to which it can deal with Health Nurses. The use of local
its own problems. Therefore the available ailments. Linkages
family is an effective and with existing community
available channel for the most resources, both public and
of the CHN efforts. private, increase the awareness
4. Respect for the values, customs of what care they need what
and beliefs of the clients are entitled.
contribute to the effectiveness 10.Active participation of the
of care to the client. CHN individual, family and
services must be available community in planning and
sustainable and affordable to all making decisions for their
regardless of race, creed, color health care needs, determine,
or socio-economic status. to a large extent, the success of
5. CHN integrated health the CHN programs. Organized
education and counseling as community groups are
vital parts of functions. These encouraged to participate in the
encourage and support activities that will meet
community efforts in the community needs and interests.
discussion of issues to improve 11.Supervision of nursing services
the people’s health. by qualified by CHN personnel
6. Collaborative work relationships provides guidance and direction
with the co-workers and to the work to be done.
members of the health team Potentials of employees for
facilities accomplishments of effective and efficient work are
goals. Each member is helped developed.
to see how his/her work 12.Accurate recording and
benefits the whole enterprise. reporting serve as the basis for
7. Periodic and continuing evaluation of the progress of
evaluation provides the means planned programs and activities
for assessing the degree to and as a guide for the future
which CHN goals and objectives actions. Maintenance of
are being attained. Clients are accurate records is a vital
involved in the appraisal of responsibility of community as
their health program through these are utilized in studies and
consultations, observations and researches and as legal
accurate recording. documents.
8. Continuing staff education
program quality services to
client and are essential to
upgrade and maintain sound
nursing practices in their
setting. Professional interest
 develop competencies to solve
their health problems and meet
their health and nursing needs

CHN – PROCESS
 A community nurse is 2. Assessment of Health needs
responsible for providing and Health problems
general and comprehensive  The community health nurse
public health and nursing comes to know the health
services to the people at large needs and problems of the
in a defined community. community as she explores the
 He/she is vested with the community.
responsibility of helping people 3. Setting objectives
to solve their health and  Once the problems are
nursing care problems in their prioritized, it is very important
place of living and work. to set up objectives relevant to
 Community Health Nursing each of the problems identified.
Process is a systematic, 4. Planning and
scientific, dynamic, ongoing implementation of
interpersonal process in interventions
which the nurses and the  This is otherwise called the
clients are viewed as a system action plan.
with each affecting one and 5. Evaluation of action plan
other and both being affected  Evaluation of interventions
by the factors within the determines the effectiveness of
behaviour. actions implemented –
 Community Health Nursing i.e.whether the desired results
Process refers to a intended are achieved or not.
systematic series of steps
which are followed by public PRINCIPLES OF COMMUNITY
health nurses in community HEALTH
health and nursing problems 1) Community health nurse must
using community approaches explore and know various
and resources”. aspects of a defined community
 Community Health Nursing to be able to plan and
process is an effective tool implement health services.
to help people solve their 2) Community health nurse must
health problems and meet their make a map of the community
health and nursing needs. showing the geographical
boundaries, important roads,
STEPS IN NURSING PROCESS streets, housing networks,
1. Establishing and church/temple/mosque, school,
maintaining working post office. This helps in
relationship plotting the house for care.
 Community health Nursing 3) Community health nurse must
process is helping community establish good working
people and families identify relationship as it helps in
their health problems and providing need based care.
4) Community health nurse must all without any discrimination of
know the health care delivery age, gender, colour, caste,
system, health policies, health nationality, political affiliation,
goals, health actions, national religion, as every individual has
health care programmes while a right to optimum health.
rendering health services.
5) The community health nurse 13) The community health
should provide realistic health nurse must not interfere with
services ( in terms of available people’s religious, political
resources, funds). beliefs, but respect every one
6) community health nurse must without any prejudice.
organize health services at 14) Community health
large for the community and nurse should work in close
render the services to the consultation with employing
family which is the unit of authority (Govt, public trust,
community. NGO).
7) Community health nurse must 15) Community health nurse
continuously keep in touch with should develop and maintain
the community and provide professional relationship with
wellness oriented health and health allies
comprehensive services agencies (Block Development
continuously. Office, Panchayats, Voluntary
8) community health nurse must Organizations)
work in collaboration with other 16) Community health nurse
team members… therefore she must never accept any bribe or
needs to know the roles and gift against professional ethics.
responsibilities of the other 17) The community health
team members. nurse must have an active
9) Community health nurse participation with the
educates in giving care to community people in taking
individual, family and care of their own needs and
community. The health health problems. (This can be
education should aim at done by mass awareness
providing a comprehensive campaign).
health knowledge to the 18) The community health
community. nurse must be aware and
10) Community health nurse closely co- ordinate with the
must maintain proper health local formal and informal
records, registers. (These are leaders.
legal documents) These records
help in planning and evaluation EPIDEMIOLOGY
of the services.  Epidemiology is the study of the
11) The community health distribution and determinants of
nurse must evaluate her health and disease in human
services to find out populations (World Health
achievement. Eg., population Organization, 2017) and is the
covered, actions planned and principal science of public
recorded. health.
12) The community health  It entails a body of knowledge
nurse must provide services to derived from epidemiological
 research and specialized outbreak and to implement
epidemiological methods and control measures to prevent
approaches to scientific additional illness.
research.

 Community health nurses use Role of a nurse in epidemiology

epidemiological concepts to can be explained in 4 aspects
improve the health of Preventive role
population groups by  The nurses working in a
identifying risk factors and community deal with people in
optimal approaches that reduce various settings and help them
disease risk and promote solve their health problems.
health. They make the nursing process.
Promotive role
CALCULATION OF RATES  Set priorities for health
programs according to the
immediate health needs.
 They establish the health
resources more effectively, by
giving more emphasis to urgent
health problems needing
attention.
 Plan the strategies to meet the
new health needs
Curative role
Morbidity: Incidence and  They may deal with the
Prevalence Rates problem independently
 They identify sources of
infection and methods of
spread of infection.
Rehabilitative role
 They evaluate the effectiveness
of measures used to control
specific disease or disorder.
 They can help people in the
restoration of family and social
life.
 They can also play a role in
psychological rehabilitation
Conducting an Epidemiologic
Investigation HEALTH EDUCATION
 Epidemiologic investigations are  A process aimed at encouraging
usually conducted in outbreak people to want to be healthy,
situations. The primary to know who to stay healthy, to
reasons for conducting an do what they can individually
epidemiologic investigation are and collectively to maintain
to determine the cause of an health (Alma ata declaration)
  Aims for bridging the gulf  Health education should aim at
between the health knowledge encouraging people to work
and health practices for the actively with health worker and
people. others in identifying their own
health problems.
Motivation
 Awakening the desire is called
motivation.

AIMS OF HEALTH EDUCATION

 The aim of Health Education is Comprehension
to help people to achieve health  In health education, we must
by their own actions and efforts know the level of
The WHO has stated the aims: understanding and literacy of
 To ensure that health is valued people to whom the teaching is
as an asset to the community directed.
 To equip the people with skills, Reinforcement
knowledge and attitudes to  Repetition and interval is
enable them to solve their necessary
health problems by their own Known to unknown
actions and efforts.  From particular to general,
 To promote the development simple to cmore complicated
and proper use of health Setting an example
services.  The health educator set a good
 Health education is most example in life things
important tool of community Good human relation
health  Sharing of information, ideas
and feelings happen most easily
SCOPE OF HEALTH EDUCATION between people who have a
 Preventing diseases good relationship
 Promoting health Feedback
 Curative aspect (drug, diet,rest)  For effective communication
 Rehabilitation and follow-up feedback is necessary
 Utilizing the services Leaders
 National health programmes  We learn best from people
whom we respect and regard
PRINCIPLE OF HEALTH
EDUCATION AREAS OF HEALTH EDUCATION
Credibility  Human biology
 It is the degree to which the  Nutrition
message to be communicated is  Hygiene
perceived as trustworthy by the  Care of mother and children
receiver  Prevention of communicable
Interest diseases
 It is psychological principle that  Mental Health
people are unlikely to listen to  Prevention of accidents
those things which are not to  Use of health services
their interest
Participation
 Programs of Health Promotion:
 Information dissemination
 Health Risk appraisal and
wellness assessment
 Lifestyle and behavioral change
 Environmental control programs

Methods of health education Nurses role in Health Promotion

Individual methods  Model healthy lifestyle
 Interviews behaviors and attitudes
 Dialogues  Facilitate client involvement in
 Interpersonal communication the assessment,
 Counseling implementation and evaluation
Group Methods of health goal
 One way methods – lecturer,  Teach client health care
films, charts, flannel graph, strategies to enhance fitness
exhibits and flash cards improve nutrition, manage
 Two way methods – group stress and enhance
discussion, panel discussion, relationships
symposium, work shop, role
play, demonstration, LEVELS OF PREVENTION
programmed instructions Primodial Prevention
 It is the prevention of
METHODS OF HEALTH EDUCATION emergence of risk factors in
 Posters population, in which they have
 Press nott get appeared
 Health magazines  Intervention: Individual and
 Films mass health education
 Radios
 Television Primary Prevention
 Health exhbitions  Primary prevention xan be
 Health museums defined as action taken prior tp
the onset of diseases, which
HEALTH PROMOTION removes the possibility that a
 Health promotion as a disease will ever occur
“behavior motivated bythe  Strategy: Population strategy
desire to increase wellbeing and and High risk strategy
actualize human health  Interventions:
potential”  Health education
 Health promotion is a process  Environmental
of enabling people to increase modification
control over the determinants  Nutritional interventions
of health and their by improve  Lifestyle and behavioral
their health changes
 Specific protection
  Immunization among pupils, teachers and
 Chemoprophylaxis other school personnel.
 Use of specific nutrients School Health services
 Protection agains  It refers to the need based
occupational hazards comprehensive services
 Avoidance of allergens rendered to pupils, teachers,
 Protection from air and other personnel in the
pollution school to promote protect their
health and prevent and control
disease and maintain health.

Secondary Prevention
 The action which halts the
progress of a disease at its COMMON HEALTH PROBLEMS
incipient stage and complaints AMONG SCHOOL CHILDREN
 Intervention:  Dental problems
 Early detection  Malnutrition
 Prompt treatment  GI problems
 Skin problem
Tertiary prevention  Vision problems
 All measures available to  Respiratory problems
reduce or limit impairment and  Behavioral problems
disabilities, minimize suffering  Other problems
caused by existing departures
from good health and to HEALTH PROMOTION AND
promote the patient adjustment PROTECTIVE SERVICES
irremediable conditions.  Wholesome school environment
 Interventions  Maintenance of personal
 Disability limitation hygiene
 Rehabilitation  Nutritional services
 Rehabilitation  Recreational services
 Medical rehabilitation  Mental health of children
 Vocational rehabilitation  Health education
 Social rehabilitation  Immunization
 Psychological
rehabilitation Therapeutic measures
 Health appraisal
SCHOOL HEALTH NURSING  Treatment and follow-up
School  First aid and emergency care
 Is defined as an educational  Rehabilitative services
institution where group of  School health records
pupils pursue studies.
School Health SCHOOL HEALTH TEAM
 Refers to the state of complete Principal
physical, mental and spiritual  Set up school health committee
wellbeing and not merely  Ensure teachers training
absence of diseases or infirmity School teacher
 Daily inspection of children
  Giving first aid emergency
Parents
 Providing information regarding
past and present history of
medical problems and
immunization status
 Help in correction of defects
Community
 Providing suitable land for
school building
 Participation in school health
committees and contributes
the information activities

Children
 Learn values of medical and
health examination, personal
hygiene, good nutrition and
environmental sanitation
Medical officer
 Making diagnosis
 Prescribe the treatment
 Initiating promotive and
preventive program
School nurse
 Health promotion and specific
protection
 Prevention of complications and
rehabilitation
 Training and guidance
 Evaluation