Community Health Nursing Overview

Overview of Community Health Nursing (CHN)

• General-practice entry point for new nurses but already a specialized field integrating multiple disciplines (maternal & child, mental/psychiatric, public health, etc.)

• Two indispensable community attributes:

  • Geographic boundaries

  • Shared belief system / culture (shapes primordial concepts of health & illness and health-seeking behaviours)

• Community as the client → requires a collective, holistic, multidisciplinary approach that looks beyond physical well-being to socioeconomic, environmental, and political factors.

• The nurse’s mandate (rooted in Nightingale & Henderson):

  • Modify/manipulate environment to promote health.

  • Empower people toward self-reliance; patients are active partners, not passive recipients.

Learning Objectives (Post-presentation Competencies)

• Describe CHN and its scope.

• Identify clientele levels: individual, family, population/aggregate, community.

• Enumerate determinants affecting community health.

• List and explain community-health-nurse roles.

• Appreciate CHN principles as foundations of quality, public-oriented care.

Hierarchy of Nursing Science & Practice

• Nursing science builds upward from basic sciences to practice specializations.

• Main practice fields (Nies & McEwen, $2020$):

  • Community & Public Health Nursing

  • Mental Health & Psychiatric Nursing

  • Mother & Child Health Nursing

  • Adult Health Nursing

Key Concepts in CHN

• Health = dynamic, multidimensional state; shaped by socioeconomic, environmental, political realities.

• Culture dictates concepts of illness & health behaviours (e.g., Filipino “hot/cold” health notions).

• Community nurse must orchestrate holistic, multidisciplinary interventions that tackle core determinants.

• Health promotion & disease prevention are central; empowerment places “health in the people’s hands.”

Definitions of Community / Public Health Nursing

• Nies & McEwen (2020): “Specialized field rendering care to individuals, families, & communities with focus on HEALTH PROMOTION + DISEASE PREVENTION through PEOPLE EMPOWERMENT.”

• Heinrich & Freeman (1981): Human-services arena for developing & enhancing individual / collective health capabilities.

• Mengitsu (2006): Synthesis of clinical nursing + public health to promote & protect population health.

Core of CHN Practice

• Priority activities:

  1. Reduce risk for disease development.

  2. Maintain optimum functionality across life span.

• Health promotion examples: vaccination, screening.

• Disease-prevention essence = empowerment.

Characteristics & Features of CPHN

• Population-focused interventions for groups, aggregates, whole communities.

• Developmental: health is both a right & a responsibility; health education embedded in all nurse actions.

• Multidisciplinary: partnerships with sectors & professionals.

• Ecology-oriented: settings include homes, schools, workplaces, prisons, churches—each both sanctuary & risk site.

• Social-justice driven: resource allocation seeks equity, “greatest good for greatest number.”

• Consumer investment: patients are partners; community participation active at all stages.

• Pre-payment mechanism: services funded by taxes—health is a basic social service.

• Comprehensive “womb-to-tomb” care; holistic view mandated.

• Preventive focus: constant risk surveillance & vulnerability mitigation (e.g., diabetic client lifestyle modification).

Philosophy & Framework

• Public-health-nurse philosophy: promote the worth & dignity of humankind.

• Practice framework: safeguard the common good via evidence-based, equitable action.

Theoretical Models / Approaches Utilised in CHN

1. Health Belief Model (HBM) – Rosenstock, $1950s$

2. Milio’s Framework for Prevention – Nancy Milio, $1970s$

3. Pender’s Health Promotion Model (HPM) – Nola Pender, $1980/1996$

4. Green & Kreuter’s PRECEDE-PROCEED Model – $1999/2005$

1. Health Belief Model (HBM)

• Psychological model explaining/predicting preventive actions through attitudes & beliefs.

• Key Assumption: Action likely if individual …

  • Believes susceptibility to condition

  • Believes condition’s seriousness

  • Believes action lowers susceptibility/severity

  • Believes benefits outweigh barriers

• Core Constructs & Examples

  • Perceived Susceptibility – smoker fears lung disease.

  • Perceived Severity – understands diabetes complications.

  • Perceived Benefits – exercise decreases heart risk.

  • Perceived Barriers – time/cost obstacles.

  • Cues to Action – campaigns, family advice.

  • Self-Efficacy – confidence in diet adherence.

• Community Application: Dengue Prevention Campaign

  • Educate on universal risk during rainy season (susceptibility).

  • Showcase severe cases (severity).

  • Promote mosquito-net use & water-container cleanup (benefit).

  • Arrange community clean-up days (barrier removal).

  • Post reminders via BHWs & social media (cues).

  • Train residents to spot breeding sites (self-efficacy).

  • Outcome: Increased participation, reduced dengue incidence.

2. Milio’s Framework for Prevention

• Premise: Population behaviours arise from limited choice shaped by resources, policy, culture, SES, education.

• Health problems = imbalance between population needs & available resources.

• Organizational policies dictate many environmental options.

• Community Applications

  • Diabetes in low-income barangay → assess food access, lobby LGU feeding program, run glucose-check clinics, mount lifestyle campaigns.

  • Policy-level interventions essential (e.g., walking parks, vegetable-garden incentives).

3. Pender’s Health Promotion Model (HPM)

• Health = positive, dynamic state (not mere disease absence).

• Explores biopsychosocial influences on individuals’ pursuit of well-being.

• Community use:

  • Focus on proactive programmes (e.g., teen exercise clubs) rather than reactive disease care.

• HPM Constructs & Examples (teen physical-activity project):

  • Personal Factors – age, BMI, interests.

  • Perceived Benefits – more energy, better body image.

  • Perceived Barriers – safety, gym access.

  • Self-Efficacy – group workouts to build confidence.

  • Interpersonal Influences – peer leaders model behaviour.

  • Situational Influences – safe courts, Zumba in barangay hall.

  • Commitment – teens set personalised goals.

HBM vs. HPM Comparison

• HBM: disease prevention, risk/fear-based, reactive.

• HPM: optimal health promotion, motivation/self-growth, proactive.

4. PRECEDE-PROCEED Model (Green & Kreuter)

• Planning structure for needs assessment → programme design → implementation → evaluation.

• PRECEDE (Phases $1$–$4$): diagnostic/planning.

  1. Identify ultimate desired result.

  2. Prioritise health issues & behavioural/environmental determinants.

  3. Analyse predisposing, enabling, reinforcing factors.

  4. Evaluate administrative / policy context; locate best practices & resources.

• PROCEED (Phases $5$–$8$): action/evaluation.

  5. Implement intervention.

  6. Process evaluation – are planned activities done?

  7. Impact evaluation – immediate behavioural/environmental change?

  8. Outcome evaluation – long-term quality-of-life improvement?

• Participatory, stakeholder-driven; works backward from outcomes.

• Barangay Example – Teenage Smoking:

  • Phase $1$: reduce teen smoking.

  • Phase $2$: high peer pressure + easy store access.

  • Phase $3$: curiosity (predisposing) / access (enabling) / peer influence (reinforcing).

  • Phase $4$: no enforcement vs. sales to minors.

  • Phase $5$: campaign + ordinance.

  • Phase $6$–$8$: monitor sessions & ordinance; measure smoking rates; evaluate youth-health indicators after $1$ year.

Comparative Summary of Models

• HBM: individual cognition of risk & benefit.

• Milio: structural/policy determinants & limited choice.

• HPM: positive motivation & holistic well-being.

• PRECEDE-PROCEED: systematic community planning & evaluation.

Fields of Community & Public Health Nursing (CPHN)

• Core: Community / Public Health Nursing (generalist)

• Specialty Areas:

  1. Occupational Health Nursing

  2. School Health Nursing

  3. Faith Community (Parish) Nursing

  4. Correctional Nursing

  5. Community Mental Health Nursing

  6. Emerging: Nursing Entrepreneurship (Entreprenurse)

1. Occupational Health Nursing (OHN)

• AAOHN Definition: focuses on promotion, prevention, restoration of health within a safe work environment; prevents adverse effects from occupational & environmental hazards.

• Hazards Types & Examples

  • Physical: noise, heat, radiation, machinery.

  • Chemical: solvents, gases.

  • Biological: viruses, bacteria.

  • Ergonomic: poor posture, repetitive motion.

  • Psychosocial: stress, bullying.

• Roles

  • Clinician: first aid, emergency care, routine checks.

  • Educator: PPE training, ergonomics.

  • Advocate: worker rights & privacy.

  • Coordinator: referrals, RTW plans.

  • Health Promoter: wellness programmes.

  • Policy Advisor: safety protocol development.

• Interventions: risk assessment, surveillance, ergonomic education, wellness campaigns.

• Control Measures

  • Administrative: job rotation for noise ≥ $85$ dB/8-h shift.

  • Engineering: soundproofing, substitution, automation.

  • Material Provision: PPE, immunisations, vitamins.

• Legal Framework (Philippines)

  • OSHS (DOLE), RA $11058$ (OSH Law) & DO $198-2018$ IRR.

  • RA $11036$ (Mental Health Act), RA $1054$ (Free medical services).

2. School Health Nursing

• Provides health education across curriculum; supports students, staff, families.

• Roles & Examples

  • Clinician: first aid, medication administration.

  • Health Screener: vision, hearing, dental, BMI.

  • Case Manager: asthma, diabetes care plans.

  • Counselor: mental-health identification, support.

  • Infection-control lead: COVID-19 measures, vaccination drives.

• Programmes Managed: School Deworming, WASH, Adolescent Health, Mental Health Week, Dental/Nutrition Week, Anti-Smoking/Drug Campaigns.

• Sample Activities: mini-health fair, classroom first-aid kits, IEC materials, menstrual-hygiene lessons, emergency drills.

3. Community Mental Health Nursing

• Provides nursing & medical therapies and physical assistance for clients with anxiety, depression, eating disorders, etc.; emphasises recovery monitoring across life spans.

4. Faith Community / Parish Nursing

• Combines nursing science with spiritual care; positions may be paid/unpaid.

• Functions: educator, personal health counsellor, support-group coordinator, integrator of health & healing.

• Spirituality is core; practises within healing ministry.

5. Correctional Nursing

• Subset of forensic nursing with clients = inmates.

• Goals: safe, secure, humane environment; manage acute & chronic conditions (e.g., high TB & dermatologic disease due to overcrowding).

6. Entrepreneurship in Nursing (Entreprenurse)

• Independent practice or cooperative ventures (child wellness clinics, wound-care centres, home-health services). Launched $2013$ (DOLE + PRBoN + DOH + PNA).

Concept & Types of Community

• Community: group sharing rights/privileges, common interests, interactions, sense of belonging, and functioning within defined social structure.

• Urban (> $2{,}500$ population): dense housing, modern infrastructure (e.g., Tokyo, Manila).

• Sub-Urban (residential outskirts): low-density, commuting distance, cheaper housing (e.g., Ayala Alabang).

• Rural: low density, agriculture-based, inexpensive housing, fresher food (e.g., Siargao).

Characteristics of a Healthy Community (Hunt $1997$; Duhl $2002$)

• Shared history & values; empowerment to control community matters.

• Structures enabling subgroup participation.

• Capacity for change, problem-solving, conflict management.

• Open communication & cooperation.

• Equitable, sustainable use of resources.

Framework for CHN Practice

• Influenced by: scope of practice, DOH policies/standards, community health needs/problems.

• Macro-Components

  • Health-Care Delivery System (HCDS) + CHN subsystem.

  • Clients: individual, family, population groups, community.

  • Health (goal).

  • Economic, sociocultural, political, environmental determinants.

• Philippine HCDS

  • Public (tax-based): DOH (national, retained hospitals), LGU (provincial/district hospitals, RHUs, BHS).

  • Private: profit (clinics, labs) & non-profit (socio-civic, religious foundations).

Levels of CHN Clientele

1. Individual – any person, sick or well.

2. Family – blood/marriage/adoption household sharing culture & interaction.

3. Population Group/Aggregate – people with shared traits/exposures (e.g., prenatal mothers, rural poor, migrant workers, mentally ill, inmates).

4. Community – sum of population groups within geographic/cultural bounds.

Levels of Health Prevention

• Level $1$ Primary – prevent before occurrence (legislation, education, immunisation).

• Level $2$ Secondary – early detection & prompt intervention (screenings, low-dose ASA, modified work).

• Level $3$ Tertiary – soften impact of ongoing disease (rehab programmes, support groups, vocational retraining).

Factors Affecting Health

• Poverty & Inequality

  • $24.5\%$ (2016) → $21.9\%$ (2018) poverty incidence (World Bank).

  • 5.2 million families experienced food deprivation (July $2020$).

  • Out-of-pocket health spending ≈ >50\%; limited national health budget (only $4.45\%$ of GNP $2017$ vs WHO $5\%$ recommendation).

• Culture

  • Transmits beliefs, values, customs (diet, pregnancy care, family support) → can positively bolster emotional well-being.

• Environment

  • Direct influence: disasters, pollution, climate; pesticide fatalities $\approx 20{,}000$ deaths/year (WHO).

  • Determinants: industrialisation, policy, poverty, attitude.

• Politics & Policy

  • Health budget mirrors political will; inequities persist.

  • Key laws: RH Law, RA $8976$ food fortification (Vit A & iron), iodised salt, minimum-wage, women/child protection.

Conditions in the Community Influencing Health

• People: size, density, composition, growth rate, mobility, education, social class.

  • Overcrowding → communicable-disease spread, stress, infrastructure degradation.

• Location: geography/climate predispose to disasters; rural poverty $\approx 80\%$ of national poor.

• Social System: interrelationships among family, economy, education, politics, religion, recreation, health services (formal & informal organisations).

Sustainable Development Goals (SDGs) Relevant to CHN

1. No Poverty

2. Zero Hunger

3. Good Health & Well-Being

4. Quality Education

5. Gender Equality

6. Clean Water & Sanitation

7. Affordable & Clean Energy

8. Decent Work & Economic Growth

9. Industry, Innovation & Infrastructure

10. Reduced Inequalities

11. Sustainable Cities & Communities

12. Responsible Consumption & Production

13. Climate Action

14. Life Below Water

15. Life On Land

16. Peace, Justice & Strong Institutions

17. Partnerships for the Goals

Roles & Functions of the Public Health Nurse (PHN)

• Provider of Nursing Care – home, clinic, school, workplace; teaches family caregiving.

• Planner/Programmer – assesses needs, sets priorities, drafts municipal health plans when MD absent.

• Manager/Supervisor – organises workforce, resources, implements policies/memos.

• Community Organiser – mobilises participation, initiates development activities.

• Coordinator of Services – links nursing with other health programmes (sanitation, dental, mental health).

• Health Monitor – detects deviations through visits/contacts.

• Role Model – exemplifies healthful living.

• Change Agent – motivates behaviour/lifestyle change.

• Recorder/Reporter/Statistician – maintains accurate records, compiles & analyses data/charts.

• Trainer/Health Educator – identifies training needs; trains RHMs, BHWs, hilots; conducts conferences; delivers health talks.

• Researcher, Leader, Integrator of services (implied in overarching role list).

Principles of Health Education

• Reflect economic & social context; aim to improve habits/attitudes & foster responsibility for family/community/national health.

• Requires motivation, experience, continuous change; utilises community resources & supplementary aids.

• Occurs at home, school, community; demands teamwork among all health personnel.

• Must address needs/interests/problems of target group; slow, iterative with constant revisions.

Goals & Ultimate Objective of CHN

• Enhance Filipino health status by developing capabilities of individuals, families, groups, and communities to care for their own health and cope effectively with health problems.

Mathematical / Statistical References (LaTeX-formatted)

• Poverty incidence progression: $24.5\%\,(2016) \rightarrow 23.1\%\,(2017) \rightarrow 21.9\%\,(2018)$.

• Noise threshold requiring administrative control: $85\,\text{dB}$ over an $8\text{-hour}$ shift.

• Urban classification: population >2{,}500.

• PHN health-budget share $=4.45\%$ of GNP vs $\ge 5\%$ WHO benchmark.

Ethical / Practical Implications

• Social justice & equity must underpin service delivery; taxation funds confer universal entitlement.

• Cultural competence vital for effective multicultural care.

• Environmental stewardship entwined with population health responsibilities.

• Policy advocacy integral: nurses lobby for structural changes (food fortification, smoke-free ordinances).

Real-World Relevance & Cross-Lecture Connections

• CHN intersects with Sustainable Development, Disaster Nursing, Environmental Health, Health Economics, and Health Policy modules.

• Theoretical models provide common analytical frameworks also used in Epidemiology & Health Promotion courses.

• Workplace-hazard controls mirror principles in Ergonomics & Industrial Hygiene classes.

• PHN roles dovetail with Leadership & Management in Nursing competencies.

Summary Mnemonic (CHN “COMPASS”)

C – Clientele levels (Individual→Family→Population→Community)
O – Objectives (health promotion, disease prevention, empowerment)
M – Models (HBM, Milio, HPM, PRECEDE-PROCEED)
P – Practice Characteristics (population-focused, preventive, partnership-based)
A – Areas/Fields (Occupational, School, Faith, Correctional, Mental, Entrepreneurship)
S – Social-justice orientation & Sustainable-development synergy
S – Scope of nurse roles (care provider, organiser, manager, educator, advocate, statistician, etc.)