NCM 210: COMMUNITY HEALTH NURSING

Ryl Johan C. Lamostre | N-28 | PRELIMS

What is a community? Factors affecting OLOF:

Community (B S P H H E)
➢ group of people who share interests, 1. Behavioral
goals, and values 2. Socio-economic
➢ Provides a sense of belonging, 3. Political
collaboration, and solidarity. 4. Hereditary
➢ Derived from latin word ‘comunicas’ 5. Health Care Delivery
(group of people) 6. Environment
➢ Ex. Neighborhood, workplaces, school,
The Health-Illness Continuum
online, etc

Community Health
➢ part of the paramedical and medical
intervention/approach.
➢ Concerned with the health of whole
population

Goal
➢ “to raise the level of citizenry by helping Explanation: (my own)
communities and families cope with the
➢ It shows that health is not constant but
discontinuities and threats to health in
instead it is always changing, a person’s
such a way as to maximize their potential
health may also be affected by their
for high-level wellness.”
outlook, attitude, and viewpoint
Aims: (HDM) significantly

Example:
1. Health Promotion
2. Disease Prevention 1. A person with a disability who has a
3. Management of Factors Affecting Health positive attitude can be on the wellness
side of the continuum. In contrast, a
WHO definition of HEALTH physically healthy person who is always
➢ A state of complete physical, mental, negative, unhappy, or anxious may fall
and social well-being and not merely the closer to the illness side. This shows that
absence of disease. a person’s outlook can affect their
mental and emotional health.
Concepts of Health: 2. A dysfunctional family shows signs of
illness like poor communication and
The modern concept of health refers to:
conflict, while a healthy family works
Optimum Level of Functioning well together, communicates effectively,
➢ The highest possible level of and uses resources wisely.
functioning especially in relationships, 3. Like families, communities can also be
work, education, and, subjective well- more or less healthy. Health is not fixed—
being. it changes over time as individuals,
families, and groups move along the
health-illness continuum.
NCM 210: COMMUNITY HEALTH NURSING
Ryl Johan C. Lamostre | N-28 | PRELIMS

THE EPIDIMIOLOGICAL TRIAD OF CAUSAL FACTORS CHN as a field of nursing

Community Health Nursing (CHN) is a nursing
practice delivered in community settings (e.g.,
homes, schools, workplaces, clinics), not just
curative institutions like hospitals.

➢ Scope of services:
1. Promotive
2. Preventive
3. Curative
4. Rehabilative

➢ The Epidemiological Triad

/Epidemiological Triangle explains the ➢ Priority: health promotion & disease
cause of diseases prevention
➢ This model helps identify the factors that ➢ Ultimate Objective: achieving the
place some people at more risk than highest possible level of community
others health.
➢ Disease results from the interaction ➢ Through: developing and enhancing the
between the agent and susceptible capabilities of individuals, families,
host in an environment that supports etc. to take care of their own health,
transmission of the agent from a source and effectively cope w/ health
to that host problems
➢ Interruption or Blocking a component ➢ Nurse works in full partnership with
disrupts transmission of disease client.
Well-Being
What is a Community Health Nurse?
➢ A state of positive health or a person’s
➢ A Community Health Nurse (CHN) is a
perception concerning positive health
registered nurse (RN) who specializes in
Influences on Health: promoting health for diverse
communities, infants, children,
1. Lifestyle
adolescents, and adults.
2. Genetics
3. Environment Why is CHN important?
Florence Nightingale ➢ Some people do not have access to
healthcare
Explored the health and illness
connection with the environment. ➢ Nurses work in community to assist
She believed that a person’s people treat their medical conditions and
health was greatly influenced by maintain their health
ventilation, noise, light,
Primary Goal of CHN:
cleanliness, diet, and a restful
bed. ➢ To enhance the capacity of individuals,
families, and communities to cope with
Nursing: Is It a Profession or Vocation?
their health need.
PROFESSION: a paid occupation, especially one
that involves prolonged training and a formal
qualification.

VOCATION: a person’s employment especially

regarded as particularly worthy and requiring
great dedication.
NCM 210: COMMUNITY HEALTH NURSING
Ryl Johan C. Lamostre | N-28 | PRELIMS

Government agency is responsible for promoting 10. The community health nurse utilizes the
health care and awareness among Filipinos already existing active organized groups in
the community.
The Department of Health (DOH)
is mandated to be the over-all Basic Principles of CHN:
technical authority on health. The 1. The community is the patient in CHN, the
major mandate of DOH is to
family is the unit of care and there are four
provide national policy direction
levels of clientele.
and develop national plans,
2. In CHN, the client is considered as an
technical standards, and
guidelines on health. ACTIVE partner, NOT A PASSIVE recipient
of care.
FACTS of CHN 3. CHN practice is affected by
developments in health technology, in
Focus: promotion and preservation of health.
particular, changes in society.
Area of Content: skills and knowledge relevant 4. The goal of CHN is achieved through
to both nursing and public health. multi-sectoral efforts.
5. CHN is a part of health care system and
Clients: general population (indiv., families, the larger human services system.
communities)
Basic Concepts of CHN:
Time: continual, not limited to episodic care 1. The primary focus of community health
nursing practice is on health promotion.
Scope: comprehensive and general, not limited
2. Community health nursing practice is
to a particular age or group.
extended to benefit not only the
individual, but the whole family and
Basic Concepts & Principles:
community.
Formulated by Mary S. Gardner and Leahy, 3. Community health nurses are generalist
Cobb, and Jones in terms of their practice through life
1. Community Health Nursing is based on continuum – its full range of health
recognized needs of communities, families, problems and needs.
groups and individuals. 4. Contact with the client and/or the family
2. The community health nurse must may continue over a long period of time,
understand fully the objectives and policies which include all ages and all types of
of the agency she represents. care. (from womb to tomb).
3. In CHN, the family is the unit of service. 5. The nature of community health nursing
4. CHN must be available to all regardless of practice requires that current knowledge
race, creed and socio-economic status derived from the biological and social
5. Health teaching is primary responsibility of sciences, ecology, clinical nursing and
the community health nurse. community health organizations be
6. The community health nurse works as a utilized.
member of the health team. 6. The dynamic process of assessing,
7. There must be provision for periodic planning, implementing and interviewing,
evaluation of CHN services. provide periodic measurements of
8. Opportunities for continuing staff progress, evaluation and a continuum of
education programs for nurses must be cycle.
provided by the CHN agency. The
community health nurse also has a
responsibility for his/her own professional
growth.
9. The community health nurse makes use of
available community health resources.
NCM 210: COMMUNITY HEALTH NURSING
Ryl Johan C. Lamostre | N-28 | PRELIMS

Settings for CHN Services: (summarized) THE FAMILY

I. Role and Placement of a Community Health ➢ Focus care is on the family as a whole
Nurse (CHN) in the Philippines unit.
➢ Individual members with certain defined
➢ Employed by a public health agency.
or medically-diagnosed health problems
➢ Assigned to a specific community:
are seen as features or part of the
➢ Typically, a town, city, or municipality.
situation in a given family.
➢ Characterized by defined spatial
boundaries. A Group
➢ Population range: 10,000 to 50,000
➢ Nurses direct and focus their activities
people.
to certain population groups with
➢ Nurse-population ratio: Varies depending
common unique health needs, are at
on different factors across towns, cities,
risk of developing or have already
and municipalities.
developed certain defined health
II. Primary Work Base problems.
➢ To whom the nurse delivers health
➢ Usually a health center.
promotive, preventive, curative or
➢ Provides an office space for the nurse.
rehabilitative nursing services.
➢ Services offered to clients and patients
within the health center include: A COMMUNITY
➢ Prenatal clinics
➢ The community as a whole is the
➢ Well-baby clinics
client/patient to whom the nurse delivers
➢ General clinics for sick cases
nursing services addressed to
III. Expanded Service Delivery Settings community-wide health problems, in
➢ Beyond clinic/health center services, the cooperation and coordination with
nurse provides nursing care in various other members of the health team &
community settings: relevant intersectoral teams
➢ Clients' and patients' homes What is a Family?
➢ Schools
➢ Places of work (e.g., factories, other A. Family as a Basic unit of Society
industrial establishments)
➢ Basic unit in society, and is shaped by
➢ Any other community setting where
all forces surrounding it.
services are required.
➢ Refers to two or more individuals joined
Levels of Clientele or related by ties of blood, marriage or
adoption, and who constitute a single
1. THE INDIVIDUAL
household, interact with each other in
2. THE FAMILY their familial roles and who create and
3. A SPECIFIC POPULATION GROUP maintain a common culture (cited by
4. THE COMMUNITY AS A WHOLE Bailon-Reyes)
➢ “The family is composed of two or more
THE INDIVIDUAL
persons who are joined together by bonds
➢ Provide care to specific clients/patients of sharing and emotional closeness and
in various health conditions of health and who identify themselves as being part of
illness the family” -Friedman et al. (2003)
➢ From the healthy/well to the dying and all ➢ It consists of those individuals, male or
age groups- from birth to senescence. female, young or adult, legally or not
(the condition or process of deterioration legally related, genetically or not
with age) genetically related, who are considered
by others as their significant persons
(Berman, et.al.).
NCM 210: COMMUNITY HEALTH NURSING
Ryl Johan C. Lamostre | N-28 | PRELIMS

➢ The family is a group of people affiliated 7. Extended family has a profound effect on
by consanguinity, affinity or co-residence daily decisions.
(Castro, C. 2012). 8. There is a great degree of equality
between husband and wife.
Consanguinity- blood related, kinship, or
9. Children have to respect their parents
common ancestry
and obey them.
Affinity- close relation based on marriage or 10. The older siblings have somewhat the
adoption authority of their parents.

Co-residence- living in the same home

Family Nursing in the Community:
Household- based on arrangements made by
Nurses are responsible for the ff:
persons, individually or in groups, for providing
themselves with shelter, food, and other 1. Helping families promote their health.
essentials of living (U.N.) 2. Meeting family health needs
3. Coping with health problems within the
The Family is considered as a unit of context of the existing family structure
service for the ff. reasons: and community resources.
1. The family is considered as the natural and 4. Collaborating with families to develop
fundamental unit of society. useful interventions
2. The family as a group generates, prevents, I. Essential Knowledge and Self-Awareness for
tolerates, and corrects health problems Nurses
within its membership.
3. The family acts as the basic care provider. It ➢ Nurses must possess knowledge
is the family that works to achieve certain regarding:
health goals. ➢ Family structures
4. The health problems of the family are ➢ Family functions
interlocking. Illness in one member affects ➢ Family processes
the entire family. ➢ Family roles
5. The family is the most frequent focus of Nurses must be aware of and understand:
health decisions and actions in personal
care. ➢ Their own values and attitudes.
6. The family is an effective and available ➢ Their attitudes pertaining to their own
channel for much of the community health families.
is realized only through improved health of Nurses must maintain an open-minded
families. approach towards:
The Filipino Family and its Characteristics: ➢ Different family structures.
1. The basic social unit of Philippine society ➢ Diverse cultures.
is the nuclear family. II. The Importance of Family Nursing in
2. Although the basic unit is the nuclear Community Health
family, the influence of kinship is felt in all
segments of social organizations. ➢ Current Healthcare Trend: Shift of
3. Extensions of relationships and descent healthcare delivery towards community
patterns are bilateral. settings.
4. Kinship circles is considerably greater ➢ Consequence: Family nursing is crucial
because effective range often includes for nurses practicing community health.
the third cousin. ➢ Nature of Family Nursing:
5. Kin group is further enlarged by filial, ➢ A specialized area of nursing.
spiritual or ceremonial ties. Filipino ➢ Underpinned by a robust theoretical
marriage is not an individual but family foundation.
affair. ➢ Extends beyond mere "common sense" or
6. Obligation goes with this kinship system. simply seeing the family as a backdrop for
individual healthcare.
NCM 210: COMMUNITY HEALTH NURSING
Ryl Johan C. Lamostre | N-28 | PRELIMS

III. Core Principles of Family Nursing Types of Families:

➢ Collaborative Effort: Involves nurses and Nursing Implication:
families working in partnership.
➢ Objective: To ensure the successful ➢ The CHN must formulate a personal
adaptation of the family and its members definition of family and be aware of the
to responses related to health and illness. changing definitions held by other
disciplines, professionals and family
IV. Inclusive Healthcare Planning groups.
➢ Nurses must inquire from individuals ➢ There are many types of families. They
about who they consider to be their change overtime as a consequence of
family. birth, death, migration, separation and
➢ These identified family members should growth of family members (could be
then be incorporated into the healthcare traditional or non-traditional).
planning process.
Family Structure
HEALTH AS A GOAL OF FAMILY HEALTH CARE: ➢ Refers to the characteristics and
➢ Health Threat- These are the conditions demographics of individual members who
that makes it more likely for accidents, make up family units; more specifically,
disease or failure to thrive or develop to the structure of a family defines the roles
occur. It is any situation or factor that and positions of family members
may represent a danger to the health of A. Based on Structure
people.
1. Nuclear Family
➢ HEALTH DEFICIT- This refers to
conditions of health breakdowns or - Family of marriage, parenthood, and
advent to illness in the family (instances procreation
of failure in health maintenance).
- Composed of husband, wife, and immediate
➢ Experiences a problem with their health.
children natural or adopted
➢ These include:
o Illness states, regardless of 2. Extended Family
whether it is diagnosed or
- composed of two or more nuclear families
undiagnosed.
economically and socially related to each other.
o Failure to thrive/develop according
to normal rate. -It is multigenerational, including married
➢ Foreseeable Crisis- These are brothers and sisters, and their families.
anticipated periods of unusual demand
-It exists because of cultural values, the family's
on the family in terms of time or
financial status or safety concerns or because
resources.
older parents or other disabled family members
➢ Wellness Potential- Refers to states of
cannot care for themselves physically,
wellness and the likelihood for health
financially or emotionally.
maintenance or improvement to occur
depending on the desire of the family. 3. Single Parent
➢ Salience of the Problem- Refers to the - Results from death of spouse, separation or
family’s perception and evaluation of the pregnancy out of wedlock.
problem in terms of seriousness and
urgency of attention needed. 4. Blended/Reconstituted Family

- Results from union where one or both spouses

bring a child or children from a previous marriage
into new living arrangements.
NCM 210: COMMUNITY HEALTH NURSING
Ryl Johan C. Lamostre | N-28 | PRELIMS

5. Compound ➢ AUTOCRATIC – unquestioning obedience

- -A man who has more than one spouse. rather than healthy development is
- PD #1083 Code of Muslim Personal Laws fostered.
of the Philippines ➢ LAISSEZ-FAIRE – the French phrase
6. Communal laissez faire literally means “allow to do”,
- More than one monogamous couple with the idea of “letting people do as they
sharing resources. choose”.
7. Cohabiting Family
D. Based on Decent (cultural norms, which
- “Live-in” arrangement between an
affiliate a person with a particular group of
unmarried couple who are called
kinsman for certain social purpose
common-law spouses and may have
child/children. ➢ PATRILINEAL- Affiliates a person with a
8. Dyad Family group of relatives who are related to
- Consisting only of husband and wife, him/her though his/her father.
such as the newly married couples and ➢ MATRILINEAL - Affiliates a person with a
“empty nesters” group of relatives who are related to
9. Gay/Lesbian him/her though his/her mother.
- Homosexual couple living together with or ➢ BILATERAL-Both parents
without children.
D. Based on Residence
10. No-kin
➢ PATRILOCAL - Family resides/stays
- A group of at least two people sharing a with/near domicile of the parents of the
relationship and exchange support who have husband.
no legal or blood tie to each other. ➢ MATRILOCAL - Family resides/stays
11. Foster with/near domicile of the parents of the
wife.
- Substitute family for children whose parents
➢ NEOLOCAL- Their own separate
are unable to care for them
residence, independent of their parents.
B. Based on Functional Type
➢ FAMILY OF PROCREATION – refers to the
family you yourself created.
➢ FAMILY OF ORIENTATION – refers to the
family where you came from
C. Based on Decisions in the Family (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. elder sister, grandmother).
➢ EGALITARIAN – husband and wife
exercise more or less same amount of
authority, father and mother decides.
➢ MATRICENTRIC – the mother
decides/takes charge in absence of the
father
➢ PATRICENTRIC – the father decides/takes
charge in absence of the mother.
➢ DEMOCRATIC – everybody is involved in
decision making.