CHAPTER 1- FUNDAMENTAL CONCEPTS OF COMMUNITY  Personal behavior and coping skills

HEALTH NURSING  Health services

 Gender

WHAT IS COMMUNITY HEALTH NURSING?

HEALTH PROMOTION AND DISEASE PREVENTION
 Community/public health nursing is the
synthesis of nursing practice and public health Health promotion activities enhance resources directed
practice. at improving well-being.
 The major goal of community health nursing is
Disease prevention activities protect people from
to preserve the health of the community and
disease and the effects of disease.
surrounding populations by focusing on health
promotion and health maintenance of
individuals, families, and groups within the
community. LEVEL OF PREVENTION

CONCEPTS OF HEALTH 1. Primary: general health promotion and specific

protection
 The variety of characterizations of the word 2. Secondary: early detection and prompt
illustrates the difficulty in standardizing the intervention
conceptualization of health. 3. Tertiary: reduce the effects of disease and
 Before 1996: definitions of community focused injury, and restore individuals to their optimal
on geographical boundaries, combined with level of functioning
social attributes of people.
DEFINITIONS OF PUBLIC HEALTH NURSING
 Later part of the decade: geographical location
became a secondary characteristic in the  Public health nursing may be defined as a field
discussion of what defines a community. - of professional practice in nursing and in public
Baldwin,et.al,1998 health in which technical nursing, interpersonal,
analytical, and organizational skills are applied
to problems of health as they affect the
DEFINING ATTRIBUTES OF COMMUNITIES community. -Freeman, 1963
 The practice of promoting and protecting the
1. People
health of populations using knowledge from
2. Place
nursing, social, and public health sciences -
3. Interaction
ANA/APHA, 1996
4. Common characteristics, interests or goals
COMMUNITY-BASED NURSING
Types of Communities:
 Application of the nursing process in caring for
1. Geopolitical / Territorial community
individuals, families and groups where they live,
2. Phenomenological / Functional community
work or go to school or as they move through
the health care system -McEwen and Pullis,
2008
DETERMINANTS OF HEALTH AND DISEASE
EMERGING FIELDS OF COMMUNITY HEALTH NURSING
 Income and social status
IN THE PHILIPPINES
 Education
 Physical environment  Home Health Care
 Employment and work conditions  Hospice home care
 Social support networks  EntrepreNurse
 Culture  Faith community nursing or parish nursing
 Genetics
COMPETENCY STANDARDS IN COMMUNITY HEALTH  1957: R.A. 1891 was enacted to have a more
NURSING equitable distribution of health personnel.
 1958: Regional health offices were created as a
 Safe and quality nursing care
result of decentralization efforts, thus creating
 Management of resources and environment
the position: Regional Health Officer.
 Health education
 1970: the Philippine health care delivery system
 Legal responsibility
was restructured, paving the way for the health
 Ethico-moral responsibility care system that exists to this day where health
 Personal and professional development services are classified into primary, secondary
 Quality improvement and tertiary levels.
 Research  1991: R.A.7160 or the Local Government Code
 Records management mandated the devolution of basic services,
 Communication including health services, to local government
 Collaboration and Teamwork units and the establishment of a local health
board in every province and city or municipality.
 1999: Health Sector Reform Agenda was
HISTORY OF PUBLIC HEALTH NURSING IN THE launched to direct government efforts towards
PHILIPPINES comprehensive reforms.
 2005: FOURmula One (F1) for health was
 1577: Friar Juan Clemente opened a medical
launched to provide an implementation
dispensary in Intramuros for the indigent.
framework to there for magenda.
 1690: Dominican Father Juan de Pergero
 2010: Universal Health Care was launched to
worked towards installing a water system in San
provide the
Juan del Monte (now San Juan City,
necessaryrevisionstotheF1framework.
MetroManila) andManila.
 1805:Dr. Franciscode Balmis introduced
Smallpox vaccination.
UNIVERSAL HEALTH CARE
 1876: The first medicos titula res were
appointed and worked as provincial health Health system goals:
officers.
 1888: The University of Santo Tomas opens a  better health outcomes
two-year, cirujanos ministrantes course to  sustained health financing
produce malenurses and sanitary inspectors.  a responsive health system that will provide
 1901: The Board of Health of the Philippine equitable access to health care.
Islands was created through Act 157, which HISTORICAL PERSPECTIVES ON NURSING THEORY
eventually evolved into the Department of
Health (DOH) Era of Florence Nightingale
 1912: The Fajardo Act law created sanitary  First nurse to formulate a conceptual
divisions made up one to four municipalities. foundation for nursing practice
 1905:Asociacion de Feminista Filipina founded  Believed that clean water, clean linens, access
LaGota de Leche: the first center dedicated to to adequate sanitation, and quiet would
the service of mothers and babies improve health outcomes, and she put these
 1947: The DOH was reorganized into bureaus beliefs into practice during the Crime an War
and the administration of city health
departments was placed at bureau level. 1980 onwards
 1954: The congress passed R.A. 1082 or the
 Several nursing theorists, Dorothy Johnson,
Rural Health Unit Act which provided an RHU in
Sister Callista Roy, Imogene King, Betty
every municipality.
Neuman, and Jean Watson among them, have
 included community perspectives in their  Researcher
definition of health.  Statistician
 Change Agent
HISTORICAL PERSPECTIVES ON NURSING THEORY
EDUCATIONAL QUALIFICATIONS OF PUBLIC HEALTH
 General Systems Theory- Viewed as an “open
NURSE
system,” –
 Open Systems- The basic structures of a family 1. The staff nurse employed in public health should hold
that is found in all open systems a baccalaureate degree from a college or university
 Health Belief Model- Provides the basis for which has met certain accreditation requirements
much of the practice of health education and having specific reference for the public health nursing
health promotion. field as stated in reference.
 Pender’s Health Promotion Model- Explores the
2. She should hold a current license to practice as a
many biopsychosocial factors that influence
registered professional nurse.
individuals to pursue health promotion
activities. 3. In a graduate program, the public health nurse would
be expected to achieve an understanding of the
research process as well as first-hand knowledge of the
CHAPTER 2- PUBLIC HEALTH NURSE
contributions of the multidisciplinary group in the public
health field.

WHAT ARE THE ROLES OF A PUBLIC HEALTH NURSE?

PUBLIC HEALTH NURSE CHAPTER 3- PRIMARY HEALTH CARE

 Public health nurses comprise the largest HISTORY OF PRIMARY HEALTH CARE
professional segment of the workplace in public
 Alma Ata Conference of Sept. 6 -12, 1978
health and are involved in the prevention,
o Alma Ata Declarations of PHC
education, advocacy, activism, assessment, and
o Health as Basic Fundamental Right
evaluation of Public Health.
o Global Burden of Health inequalities
 They hold a vital role in the prevention of
o Economic and Social Development
disease and help to promote community health
o Government responsibility
and safety.
o LOI 949, PHC adopted in the Philippines
 While most nurses care for one patient at a
time, public health nurses care for entire
populations.
HEALTH DEFINED BY THE WHO
 The main focus of community health nurse is
health promotion. In the PHC declaration, the WHO defined health as “a
 The recipient of care of community public state of complete physical, mental and social wellbeing,
health nursing practice is extended not only the and not merely the absence of disease or infirmity”.
individual but also to benefit the whole family
and community.
DEFINITION OF PRIMARY HEALTH CARE (PHC)
ROLES AND RESPONSIBILITIES OF A PUBLIC HEALTH Alma Ata Declaration: PHC
NURSE
“is essential health care based on practical, scientifically
 Programmer/Planner sound and socially acceptable methods and technology
 Health Educator/Trainer/Counsel or Community made universally accessible to individuals and families
Organizer in the community through their full participation and at
 Provider of NursingCare a cost that the community and country can afford to
 Health Monitor
maintain at every stage of their development in the IS PRIMARY HEALTH CARE THE SAME AS PRIMARY
spirit of self-reliance and self-determination”. CARE?

PRIMARY HEALTH CARE IS NOT PRIMARY CARE…

HEALTH FOR ALL: UNIVERSAL GOAL OF PHC

 Health for all means an acceptable level of

health for all the people of the world through
community and individual self-reliance.
 This policy agenda of “health for all by the year
2000” technically, was a global strategy
employed in achieving three main objectives:
o promotion of healthy lifestyles,
o prevention of diseases, and
o therapy for existing conditions.

KEY PRINCIPLES OF PRIMARY HEALTH CARE

 Accessibility, affordability, acceptability, and

availability Support mechanisms
 Multi sectoral approach
 Community participation
 Equitable distribution of health resources
 Appropriate technology

ELEMENTS OF PRIMARY HEALTH CARE (SOURCE: WHO)

CHAPTER 4- COMMUNITY ORGANIZING: ENSURING

HEALTH IN THE HANDS OF THE PEOPLE

WHAT IS COMMUNITY ORGANIZING?

•Community organizing as a process consists of steps or

activities that instill and reinforce the people’s self-
confidence on their own collective strengths and
capabilities (Manalili, 1990).

•Basic values in communityorganizing:

1. Human Rights

2. Social Justice

3. Social Responsibility
CORE PRINCIPLES OF COMMUNITY ORGANIZING COMMUNITY ORGANIZING PARTICIPATORY ACTION
RESEARCH (COPAR)
 People Centered
 Participative •Is a community development approach that allows the
 Democratic Developmental community (participatory) to systematically analyze the
 Process-Oriented situation (research), plan solution, and implement
projects/programs (action) utilizing the process of
PHASES OF COMMUNITY ORGANIZING community organizing.
 Pre-entry
 Entry
 Community Integration CHAPTER 5- FAMILY HEALTH NURSING
 Social Analysis BASIC UNIT OF SOCIETY: FAMILY
 Indentifying Potential Leaders
 Core Group Formation DEFINITIONS OF A FAMILY
 Community Organization “The family is a group of persons usually living together
 Action Phase and composed of the head and other persons related to
 Evaluation the head by blood, marriage or adoption. It includes
 Exit and Expansion both the nuclear and extended family”. –National
Statistical Coordination Board, 2008
GOALS OF COMMUNITY ORGANIZING
“A family is two or more persons who are joined
 People’s Empowerment
together by bonds of sharing and emotional closeness
 Building People’s Organizations
and who identify themselves as being part of the
 Improved quality of life
family”. –Friedman, Bowden and Jones, 2003

PARTICIPATORY ACTION RESEARCH (PAR)

-Is an approach to research that aims at promoting

change among theparticipants.

-Members of the group being studied participate as

partners in all phases of the research, including design,
data collection, analysis, and dissemination (Brownetal.,
2008).

COPAR MODEL
WHAT ARE THE DIFFERENT FAMILY FORMS?

Nuclearfamily Dyad III. Families with adolescents

Extendedfamily Blendedfamily a) Developmentofincreasing

autonomyforadolescents
Compound family Cohabiting family
b) Midlife reexaminationofmarital andcareerissues
Single parent Gay or Lesbian family c) Initial shifttowardconcernfortheoldergeneration

IV. Families as launching centers

FUNCTIONS OF A FAMILY a) Establishment of independent identities for

parents and grownchildren
Functions that meet the needs of the society: b) Readjustment of relationships to include in-laws
 Procreation and grandchildren
 Socialization c) Dealing withdisabilities and
 Status placement deathofoldergeneration
 Economic function V. Aging families
Functions that meet the needs of individuals: a) Maintenance of couple and individual
functioning while adaptingto theaging process
 Physical maintenance (survival needs)
b) Support roleofmiddle generation
 Welfare and protection
c) Support andautonomyofoldergeneration
d) Preparation for own death and dealing with the
FAMILY AS A CLIENT loss of spouse and/orsiblings andotherpeers

 Community health nursing has long viewed the

family as an important unit of health care, with
FAMILY HEALTH ASSESSMENT
awareness that the individual can bebest
understoodwithinthesocial contextofthefamily.  Interviews
 Observing and inquiring about family  Observation
interaction enables the nurse in the community  Physical Examination
to assess the influence of family  Secondary Data
membersoneachother.

STAGES AND TASKS OF THE FAMILY LIFE CYCLE

WHAT IS GENOGRAM?
I. Marriage:joining of families
Genogram is a tool that helps the nurse outline the
a) Formationofidentityas acouple family's structure.
b) Inclusion of spouse in realignment of
relationships with extendedfamilies Ex. Family Health Tree: Based on the genogram, the
c) Parenthood:making decisions family health tree provides a mechanism for recording
the family's medical and health histories .
II. Families with young children

a) Formationofidentity as acouple
b) Inclusion of spouse in realignment of WHAT IS ECOMAP?
relationships with extendedfamilies Ecomap: Tool that is used to depict a family's linkages to
c) Parenthood:making decisions othersystems.
  Hypodermic needles (g. 19, 22, 23, 25)
 Sterile dressing
OTHER SOURCES OF FAMILY HEALTH ASSESSMENT
 Cotton balls
 Specific diagnoses as proposed by NANDA  Cord clamp
International (NANDA-I) serve as a common  Microporeplaster
framework of expressing human  Tape measure
responsestoactual andpotential  1 pair of sterile gloves
healthproblems.  Baby’s scale
 Alcohol lamp
 An alternativetoolis theFamilyCoping Index.  2 test tubes
 Test tube holders
 This tool is based on the premise that  Solutions of: Betadine, 70% alcohol,
nursing action may help a family in Zephiransolution
providing for a health need or resolving a  Hydrogen peroxide
health problembypromoting thefamily’s  Spirit of ammnonia
coping capacity.
 Ophthalmic ointment
 Acetic acid
 Family nurse contacts: Clinic Visit, Group
 Benedict’s solution
Conference,
Telephone,WrittenCommunication Note: BP apparatus and stethoscope are carried
separately and are never placed in the PHN bag.

HOME VISIT

A professional, having purposeful interaction that takes PRINCIPLES OF THE BAG TECHNIQUE
place in the family’s residence aimed at promoting,
 Bag technique shouldhelpthenursein
maintaining or restoring the health of the family or its
infectioncontrol.
members.
 Bagtechnique allowsthenursetogive care
efficiently.
 Bag technique should not take away the nurse’s
PHASES OF A HOME VISIT
focus on the patientand thefamily.
 Pre-Visit Phase  Bag technique may beperformedin
 In-Home Phase differentways.
 Post-Visit Phase

THE PUBLIC HEALTH NURSE BAG

CONTENTS OF A PUBLIC HEALTH NURSE BAG:

 Paper lining
 Extra paper for making waste bag
 Plastic/linen lining
 Apron
 Hand towel
 Soap in a soap dish
 Thermometers (oral and rectal)
 2 pairs of scissors (surgical and bandage)
 2 pairs of forceps (curved and straight)
 Disposable syringes with needles (g. 23 & 25)