COMMUNITY HEALTH NURSING b) Control of communicable disease

c) Education of the individual

 Health - state of complete physical, mental and d) Organization of medical and nursing services
social well-being and not merely the absence of for early diagnosis and treatment
diseases and infirmity. (WHO)
e) Development of the social machinery to ensure
 Social Health - a community vitality and is the result everyone a standard of living adequately for the
of positive interaction among groups in a community maintenance of health.
with an emphasis on health promotion and illness
prevention.  3 Primary Functions of PHN

 Community - geographical boundaries combined 1. Assessment - regular collection, analysis and

with social attributes of people. information sharing about health condition, risk and
resources in the community. (Survey, Data collection)
- collection of people who interact with one another
and whose common characteristics and interests form Ex. Stray dogs in the community
for a basis of unity and belonging. 2. Policy Development - use of information gathered
- group of people who share something in common during assessment to develop local and state policies.
and interact with one another and share commitment and (Develop policies based on data gathered to solve
geographic boundary. problem gathered in the assessment)

 4 Attributes: Ex. All dogs should be inside a cage or inside the

owner’s house
1. People
3. Assurance - focuses in the availability of necessary
2. Place health service throughout the communities.

3. Interaction Ex. Sustained and permanent ang mga ipinatupad na

health programs as well as the regulations.
4. Common characteristics, interest, goals

 Geographical Communities - “territorial

community” formed by a natural and man-made  3 Levels of Prevention
boundaries.

Ex. Barangay, municipality, cities, provinces,  Level 1: Primary - preventive measure; to decrease
regions and nations risk of exposure of individual to disease.

 Phenomenological Communities - “functional - consists of activities aimed at maintaining or enhancing

community” refers to relational, interactive people’s physical, mental or social well-being.
group in which the setting is more abstract.
Ex. Health education, vaccines, immunization
Ex. Schools, colleges, universities, churches, org
 Level 2: Secondary - early identification and
intervention; halting disease progress, minimizing
severity of the disease, prevent or reduce
 Two Terms Commonly used in Public Health and complication, bring about cure.
CHN
- consists of activities for early diagnosis and prompt
1. Population - “group of people” treatment of disease which has not been prevented.
2. Aggregates - or subgroup/subpopulation that have Ex. Exam screening for STD
common characteristics
 Level 3: Tertiary - correction and prevention of
Ex. Age-groups, elderly, pregnant, teens deterioration of a disease state. Restore patient to
an optimum level of functioning

 Public Health - a science and art of: - consist of activities which are done when the disease
process has already exacted its damage and ill effects.
1. Preventing disease
Ex. Teaching diabetic monetoring, insulin injection
2. Prolonging life

3. Promoting health and efficiency through organized

community effort for:  Community Health Nursing - synthesis of nursing
practice and public health practice applied to
a) Sanitation and environment
 promoting and preserving health of population. 8. Nurse is prepared professionally to function as a
(American Nursing Association) health worker in community.

- Utilization of the nursing process in the different level of 9. Functions as a member of the health team in serving
clientele-individuals, families, population groups and the entire community.
communities, concerned with the promotion of health,
prevention of disease and disability and rehabilitation. 10. Provides nursing care for the individual patient.
(Maglaya, et al) 11. Maintain and make use of family and other service
- “Community Health Nursing-global or umbrella- Public record
Health Nursing- component or subset or subspecialty 12. Directs the family to appropriate community
nursing practice.” resources for assistance
 Public Health Nursing - a field of professional 13. Nursing supervision is done by qualified nursing
practice in nursing in public health in which technical personnel
nursing and organizational skills are applied to
problem of health as they affect the community. 14. Provides an on going staff education program.

- part of community health nursing 15. Must continue building and developing the education
professionally.

 Community-based Nursing - application of the

nursing process in caring for individuals, families  SUSTAINABLE DEVELOPMENTAL GOALS
and groups where they live, work as they move to
the health care system.
- set of 17 goals for the world’s future, through 2030
- “it emphasizes managing acute or chronic conditions”
- the blueprint to achieve a better and more sustainable
- practice area, home health nursing and nursing in
future for all.
outpatient settings
-goals are interconnected and in order to leave no one
behind, it is important to achieve each goal and target by
 Principles of CHN: 2030.

1. An established community activity based on

recognized needs and functioning within the total
1. End poverty in all its form everywhere.
community health program.
2. End hunger, achieve food security and improved
- it coordinates with the other agencies to determines
nutrition, and promote sustainable agriculture.
trends to meet needs of community and develop new
programs  Strengthen resilience and adaptive capacity of
small scale farmers.
- Nurses support and lead the community to identify their
problems and priorities. 3. Ensure healthy lives and promote well-being for all
ages
2. Clearly defined and stated objectives and purposes for
its services. This is so done, to avoid or prevent 4. Ensure inclusive and equitable quality education and
duplication and omission of community service. promote life-long learning opportunities for all.
3. An active organized citizen’s group representative of 5. Achieve gender equality and empower all women and
the community is an integral part of CHN. They should girls
be participatory, planning and development of health
programs that will meet community needs. 6. Ensure availability and sustainable management of
water and sanitation for all.
4. Services are available to the entire community
regardless of ethnic origin, culture and economic 7. Ensure access to affordable, reliable, sustainable, and
resources. modern energy for all

5. Family is recognized as the unit service 8. Promote inclusive and sustainable economic growth,
“family-centered” employment and decent work for all

6. Health education and counseling for client, family and 9. Build resilient infrastructure, promote sustainable
community as integral part of PHN. industrialization and foster innovation

7. Period and continuing appraisal and evaluation of the 10. Reduce inequality within and among countries
health situation of the community, family and patient.
11. Make cities and human settlements inclusive, safe, 6. Polygamous Family- a marriage with multiple wives
resilient and sustainable
7. Single-Parent Family
12. Ensure sustainable consmption and production
patterns > Stresses:

13. Take urgent action to combat climate change and its a) Child care concern
impacts b) Financial concern
14. Conserve and sustainably use the oceans, seas and c) Role overload and fatigue in managing daily
marine resources tasks
15. Sustainably manage forests, combat desertification, d) Social isolation
halt and reverse land degradation, halt biodiversity loss.
8. Blended Family- also called remarriage or
16. Promote just, peaceful and inclusive societies reconstituted family. Divorced or widowed person with
17. Revitalize the global partnership for sustainable children marries someone who also has children
development. 9. Communal Family- formed by groups of people who
 FUNCTIONS OF FAMILY choose to live together as an extended family.
Relationship to each other is motivated by social or
- protects the physical health of its member by providing religious values rather than kinship.
adequate nutrition and health care services. Providing an
environment conducive to physical growth and health, 10. Gay or Lesbian Family- homosexual unions,
creates an atmosphere that influences the cognitive and individuals of the same sex living together as partners for
psychosocial growth of its member. companionship.

11. Foster Family

1. Physical function

2. Economic function  PHASES OF DIVORCE

3. Reproductive function Phase 1: Antagonistic time

4. Socialization function Phase 2: Actual Separation

5. Affection function Phase 3: Reshaping lives

6. Perform economic, education, recreational, religious,

and political function.  STAGES OF GRIEF

1. Denial
 FAMILY FUNCTIONAL TYPE 2. Anger
 Family Orientation- family where you came 3. Bargaining
from
4. Depression
 Family of Procreation- family you yourself
created 5. Acceptance

 TYPES OF FAMILY AND ITS STRUCTURES

1. Nuclear or Traditional Family- father, mother, children

2. Dyad Family- young adult living together for financial

stability; newly married couples
DESCENT
3. Cohabitation Family- heterosexual couples who live
- cultural norms which affiliates a person with a particular
together but remain unmarried.
group of a certain social purposes.
4. Extended Family- nuclear family + grandmothers,
1. Patrilineal
grandfathers, uncles, aunt, grandchildren
2. Matrilineal
5. Intra generational Family- incorporated a new member
in the family 3. Bilatelineal
AUTHORITY 5. Children not only have to respect their parents but also
obey them
-the one who makes the decision
6. God-fearing and conservative
1. Patriarchal- full authority on the father or any
male member of the family e.g eldest son, grandfather 7. Has high value for education

2. Matriarchal- full authority of the mother or any

female member of the family e.g eldest sister
 FUNCTIONS OF DEVELOPMENTAL STAGES
3. Egalitarian- husband and wife exercise a more or
less amount of authority

4. Democratic- everybody is involved in decision  Stage 1: Marriage

making - establish a mutually satisfying relationship
5. Laissez-Faire- “full autonomy” - learn to relate well to their families or orientation
6. Matricentric- the mother decides/takes charge in  Stage 2: Early Childbearing
absence of the father (e.g father is working overseas)
- having and adjusting to infant
7. Patricentric- the father decides in absence of
mother - support needs of all three members

 Stage 3: Family w/ Pre-school Child

RESIDENCE OR LOCATION - adjusting to cost of family life

[Link]
- adapting to needs of pre-school children to
[Link] stimulate growth

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 Stage 4: Family w/ School-Age Child

NAMING - adjusting to the activity of growing children

- the names of the children are derived from their names - promoting joint decision making between children
and parents
1. Patronymic
- supporting children’s educational achievements
2. Matronymic
 Stage 5: Family w/ Adolescent
3. Bynimic
- maintaining open communication among members

- supporting ethical and moral values

 TYPES OF RELATIONSHIP FROM FAMILY
- balancing freedom with responsibilities
1. Affinal
 Stage 6: Launching or Post Parental Family
2. Consanguinal- brought about by ceremony; more on
blood relations - children leave to establish their own households

3. Fictive or Ritual relationship- ceremony - may represent a loss of self-esteem for parents

 Stage 7: Family of Middle Years

 CHARACTERISTICS OF A FILIPINO FAMILY - partners might view this stage as either the prime
of their lives (an opportunity to travel, economic
1. Extension of relationship and descent patterns is independence, and time to spend on their hobbies)
bilateral or period of gradual decline (lacking the constant
2. Kinship is felt in all segment of social organization activity and stimulation of children in the home,
finding life boring without them)
3. Extended family has a profound effect on daily
decision.  Stage 8: Family in Retirement or Old Age

4. There is a great degree of equality between husband - adjusting to retirement

and wife - adjusting to loss of spouse
 FAMILY TASKS

1. Physical maintenance

2. Socialization of family member

3. Allocation of resources  INDIVIDUAL’S HEALTH STATUS

4. Maintenance of order A. Health History

5. Division of labor B. PE

6. Reproduction, recruitment, and release of family C. Physical fitness assessment

7. Placement of member into larger community D. Lifestyle assessment

8. Maintenance of motivation and morale E. Health risk appraisal

F. Health beliefs review

 FAMILY ROLES G. Life stress review

1. Nurturer

2. Provider  FAMILY HEALTH STATUS

3. Decision maker A. Develop its own lifestyle

4. Financial manager B. Operates as a group

5. Problem solver C. Accommodates to the needs of the individual

6. Health manager D. Relates to the community

7. Culture bearer E. Growth cycle and behaving,functioning organism

8. Environmentalist

9. Gate keeper  FAMILY NURSING PROCESS

FOCUS/TARGET PROCESSES:

 THE FAMILY CODE OF THE PHILIPPINES Clients (family) Nursing Process= Program
Planning, Implementation
 Executive Order no. 209 was signed into law by
and Evaluation
President Corazon Aquino on July 6, 1987.
Health Care Units 1. Management and
 Behaviors indicating a well family
Supervision
(Health Centers)
2. Quality Assurance
 HEALTH CARE PROCESS
3. Nursing research
 Process- a series of actions that lead toward a
Political Leaders Advocacy and Political
particular resort
Actions
- this process of decision making results in the
optimal health care for the client to whom the nurse
applies the process.

 STAGES OF FAMILY HEALTH NURSING

 Phases of Health Care PROCESS

1. Health Promotion I. Assessment

2. Health Prevention- early detection of disease II. Planning

3. health Restoration III. Implementation

4. Health Rehabilitation- recovery stage IV. Evaluation

DOCUMENATION - an important function of the d. prevent or resolve problems in order to achieve
community health nurses. This provides data which is health and well-being among its members are
needed to plan the client care and ensure its continuity. measured.

 Data Collection - there are 2 important things to

ensure effective and efficient data collection in
family health assessment:

 Types and Kinds of Data needed:

1. Family Structure, Characteristics, and Dynamics

 Members of the household and relationship to the

head of the family

 Demographic data

 Place of residence of each member

 Type of family structure; matriarchal or patriarchal,

nuclear or extended

 Dominant family members in terms of decision

making

 General family relationships or dynamics

2. Socio-Economic and Cultural Characteristics

 Income and expenses

- occupation and place of work of each member

- adequacy to meet basic needs

- who makes decision about family expenditure

 Ecuational attainment of each member

 Ethnic background and religious affiliation

 Significant others and roles they play in the family

 Relationship of the family to a larger community

3. Home and Environment

 Housing

- Adequacy of living space

 FAMILY HEALTH ASSESSMENT - sleeping arrangement
- involves a set of actions by which the - presence of breeding or resting sites of vectors of
diseases
a. status of a family as client, its ability to maintain
wellness - presence of accident hazards
b. its ability to maintain itself as a system and - food storage and cooking facilities
functioning unit
- water supply
c. to maintain control
- toilet facility

- garbage disposal
 - drainage system 8. Family Coping Index

 Kind of neighborhood

 Social and health facilities available  Data Gathering Methods and Tools

 Communication and transportation facilities 1. Observation

available
2. Physical examination

3. Interview
4. Health status of each Family Member
4. Record Review
 Medical history indicating current or past significant
illnesses or beliefs and practices conducive to 5. Laboratory/Diagnostic Tests
health and illness

 Nutritional assessment (anthropometric data,  FIRST LEVEL ASSESSMENT

dietary history, eating/feeding habits/practices)

 Risk factor assessment indicating presence of major

and contributing modifiable risk factors for specific - the process whereby existing and potential health
liestyle diseases conditions or problems of the family are determined.

 Physical assessment indicating presence of illness - it relates what health problems exist and will exist.
states

 Results of laboratory/diagnostic and other screening

 Categories:
procedures supportive of assessment findings.
A. Wellness state

B. Health threats
5. Values, Habits, Practices on Health Promotion,
Maintenance and Disease Prevention C. Health deficits
 Immunization status D. Foreseeable crisis
 Healthy lifestyle practices

 Adequacy of: A. Presence of Wellness Condition

- rest and sleep - clinical judgement about a client in transition from a
specific level of wellness or capability to a higher level
- exercise/activities
 Wellness Potential - based on client’s current
- use of protective measures
performance, current competencies, or clinical data
 Use of promotive-preventive health services but NO explicit expression of client desire.

 Readiness for Enhanced Capability - explicit

expression of desire to achieve a higher level of
6. Family APGAR state or function.
 Adaptational

 Partnership B. Presence of Health Threats

 Growth - conditions that are conducive to disease and accident,
 Affection or may result to failure to maintain wellness or realize
health potential.
 Resolve

C. Presence of Health Deficits

7. Genogram
- instances of failure in health maintenance
- a diagram that details family structure and provides
information about the family’s health history and roles of
various family members across several generation. D. Presence of Foreseeable Crisis
- anticipated periods of unusual demand on the individual
or family in terms of adjustment/family resources.
 Health Threats

1. Presence of risk factors of specific diseases

 SECOND LEVEL ASSESSMENT
2. Threat of cross infections from a communicable
disease

- defines the nature or type of nursing problems that the 3. Family size beyond what resources can adequately
family encounters in performing the health tasks with provide
respect to a given health condition or problem, and the
etiology or barriers to the families’ assumption of these 4. Accident hazards
tasks. 5. Faulty/unhealthful nutritional/eating habits for feeding
- explains the family’s problems related to maintaining techniques/practices
health and wellness. 6. Stress provoking factors
- it specified the measures that the family did not do due 7. Poor environmental condition
to inability.
8. Unsanitary food handling and preparation

9. Unhealthful lifestyle and personal habits

10. Inherent personal characteristics

- Determine if the family recognize the presence of the
condition or problem and if not, explore the reason why. 11. Inappropriate role assumption

- if family RECOGNIZE the presence of the 12. Lack of communication

condition, determine if something has been done to
13. Family disunity
maintain the wellness state or resolve the
problem.

- if the family has NOT done anything about it,  Health deficits
determine reasons why.
1. Illness state (wellness diagnosed or undiagnosed)
- If family has DONE something about condition,
determine if the solution is effective. 2. Failure to thrive/develop according to normal rate

- Determine if the family encounters either problems in 3. Disability

implementing the interventions for wellness
state/potential, health threat, health deficit or crisis,
identify these problems.  Foreseeable Crisis
- Determine how all the other members are affected by 1. Marriage
the wellness state/potential, health threat, health deficit,
or stress point. 2. Pregnancy

3. Parenthood

 TYPOLOGY OF PROBLEMS IN FAMILY HEALTH 4. Additional family member

5. Abortion

FIRST LEVEL ASSESSMENT 6. Entrance to school

 Wellness Condition 7. Adolescence

1. Potential for enhanced capability for: 8. Divorce

2. Readiness for enhanced capability for: 9. Menopause

a) Healthy lifestyle 10. Loss of job

b) Health Maintenance 11. Hospitalization

c) Parenting 12. Death of a member

d) Breastfeeding 13. Resettlement in a new community

e) Spiritual well-being
SECOND LEVEL ASSESSMENT 6. Inadequate family resources of care

7. Significant person’s unexpressed feeling

 Inability to recognize the presence of the condition 8. Philosophy in life which negates or hinders caring for
or the problem due to: the sick, disabled, dependent, and at risk member

1. Lack of inadequate knowledge 9. Member’s preoccupation with own concerns or

interests
2. Denial about its existence or severity as a result of
fear of consequences of diagnosis of problem. 10. Prolonged disease or disability progression with
exhaust supportive capacity of family members
3. Attitude/philosophy in life which hinders
recognition/acceptance of a problem 11. Altered role performance

 Inability to make decisions with respect to taking  Inability to provide home environment conducive to
appropriate health action due to: health maintenance and personal development due
to:
1. Failure to comprehend the nature/magnitude of the
problem/condition 1. Inadequate family resources

2. Low salience of the problem 2. Failure to see benefits of investment in home and
environment improvement
3. Feeling of confusion, helplessness, and/or resignation
brought about by perceived magnitude/severity of the 3. Lack of knowledge of preventive measures
situation or problem
4. Lack of skill in carrying out measures to improve home
4. Lack of knowledge as to alternative courses of action environment
open to them
5. Ineffective communication patterns with the family
5. Inability to decide which action to take from among a
list of alternatives. 6. Lack of supportive relationship among family
members
6. Conflicting opinions among family members
7. Negative attitude in life which is not conducive to
7. Lack of knowledge of community resources for care health maintenance and personal development

8. Fear of consequences 8. Lack of competencies in relating to each other for

mutual growth and maturation
9. Negative attitude towards the health condition or
problem.

10. Inaccessibility of appropriate resources for care  Failure to Utilize Community Resources for Health
due to:
11. Lack of trust/confidence in the health
personnel/agency 1. Lack of knowledge of community resources for health

12. Misconceptions of erroneous information about 2. Failure to perceive the benefits of health services
proposed courses of action
3. Lack of trust or confidence in the agency or personnel

4. Previous unpleasant experience with health worker

 Inability to provide inadequate care to the sick,
disabled, dependent, or vulnerable/at risk member 5. Fear of consequence in action
of the family due to: 6. Unavailability of required care
1. Lack of knowledge about the disease/health condition 7. Inaccessibility of required care
2. Lack of knowledge about child development and care 8. Inadequate family resources
3. Lack of knowledge of the nature and extent of care 9. Feeling of alienation to the community
needed
10. Negative attitude in life which hinders effective
4. Lack of the necessary facilities, equipment and utilization of community resources for health care
supplies of care

5. Lack of inadequate knowledge and skill in carrying out

the necessary interventions  Prioritizing Health Problems
Criteria: Weight: - Reduce death, severity of illness, and improve
growth and development
 Nature or condition of the problem 1

Scale:  Components of IMCI

Wellness State (3) 1. Upgrading case management and counseling skills of
Health Deficit (3) health care provider.

Health Threat (2) 2. Strengthen the health system for effective

managemnet of childhood illnesses.
Foreseeable Crisis (1)
3. Improving family and community practice related to
child health and nutrition.

 Modifiability of the problem 2

Scale:  Color Code Triage System:

Easily modifiable (2)

Partially modifiable (1) PINK - Severe; Urgent Referral Rystem

Not modifiable (0) YELLOW - Specific medical treatment

GREEN - Home management

 Preventive Potential 1

Scale:  Elements of IMCI Case Management Process

High (3) 1. Assessment

Moderate (2) 2. Classify - categorize the color

Low (1) 3. Identify which body part has the problem

4. Treatment - management

 Salience 1 5. Counseling - health teaching

Scale: 6. Give follow up care

Needs immediate attention (2)

Does not need immediate attention (1)

Not perceived as a problem (0)

 IMCI - Integrated Management of Childhood

Illnesses (WHO collaboration w/ UNICEF)

 Focus:

1. Nutrition

2. Malnutrition

3. Immunization

4. Disease prevention

5. Health promotion - delegation of info

 Objectives of IMCI