CHN (First Part)

CHN: Definition and Scope

  • Community Health Nursing (CHN) is one major field of nursing; CHN is broader than Public Health Nursing.

  • Definition: CHN is the synthesis of nursing knowledge and practice and the science and practice of public health, implemented via a systematic use of the nursing process and other processes to promote health and prevent illness in population groups.

  • What is CHN? Service rendered by a professional nurse with the community, groups, families and individuals at home, in health centers, clinics, schools, and workplaces for the promotion of health, prevention of illness, care of the sick at home, and rehabilitation.

  • Notable definitions:

    • Dr. Ruth Freeman: CHN as a unique blend of nursing and public health practice woven into a human service.

    • Dr. A. Maglaya: CHN is the utilization of the nursing process across levels of clientele (individuals, families, population groups, communities) aimed at health promotion, disease prevention, disability prevention, and rehabilitation.

Salient features of CHN

  • Population or aggregate focus: CHN is community- or population-focused rather than solely individual-centered.

  • Greatest good for the greatest number: Plans aim to benefit the majority, even if not all individuals can be addressed.

  • Uses the nursing process to guide care.

  • Promotive and preventive by nature; CHN does not emphasize rehabilitative or curative goals as primary aims.

  • Utilizes a variety of instruments (e.g., spot maps) for data collection and planning.

  • Requires management skills to coordinate programs and resources.

Public Health Nursing (PHN) and its scope

  • PHN is defined as the science and art of preventing disease, prolonging life, promoting health and efficiency through organized community effort.

  • This includes: sanitation of the environment, control of communicable diseases, education of personal hygiene, organization of medical and nursing services for early diagnosis and preventive treatment, and development of social machinery to ensure a standard of living adequate for health and longevity.

  • Dr. C.E. Winslow’s definition emphasizes enabling every citizen to realize health as a birthright through organized benefits.

Other Processes in CHN

  • Management: Requires interaction with individuals in the community to ensure cooperation with planned programs.

  • Supervision

  • Research: Gathering data within the community.

  • Advocacy: Public support for planned programs.

  • Political action: Political leaders act as links to the community and aid program implementation; thus political action is needed.

Philosophy of CHN

  • Based on the worth and dignity of all people (M. Shetland).

  • Aim to help individuals become self-reliant.

  • Care directed to the individual, family, and group contributes to the health of the population.

  • All parts of the community should be addressed.

Characteristics of CHN

  • Goals are health promotion and disease prevention.

  • CHN is comprehensive, general, continual, and not episodic; it involves ongoing evaluation and revision of programs until goals are reached.

  • Clients should reach self-reliance.

  • Nurse and client have greater control in decision-making; collaboration as equals.

  • CHN workers do not work for the community alone; they work with the community.

  • Community members should understand problems to increase participation and compliance.

  • The nurse recognizes the impact of various factors on health and is aware of the client’s life and circumstances; before identifying problems, know the community and conduct research to identify factors affecting health.

Roles of the Community Health Nurses

  • Client-oriented roles: Caregiver, educator, counselor, referral resource, role model, case manager.

  • Delivery-oriented roles: Coordinator, collaborator, liaison.

  • Population-oriented roles: Case finder, leader, change agent, community mobilizer, coalition builder, policy advocate, social marketer, program implementer, researcher.

Principles of Community Health Nursing

  • The recognized need of individuals, families, and communities provides the basis for CHN practice.

  • Knowledge and understanding of agency objectives and policies facilitate goal achievement.

  • Family as the unit of service.

  • Respect for values, customs, beliefs, race, and other factors; health should be available and accessible for all.

Functions and Collaboration in CHN

  • Health education and counseling are vital for helping the community understand problems and collaborate on solutions.

  • Collaborative work relationships with other professionals and community members.

  • Periodic and continuing evaluation to assess CHN goals and objectives, with revisions as needed.

  • Continuing staff education to maintain quality services and up-to-date nursing practices.

Utilization of community resources and participation

  • Use indigenous and existing community resources to maximize success; teach community members to use resources for livelihood.

  • Active participation of individuals, families, and the community in planning and decision-making for healthcare needs; the community is a main client but other segments should not be neglected.

  • Supervision of nursing services by qualified CHN personnel provides guidance.

Documentation and Evaluation

  • Accurate recording and reporting form the basis for evaluating progress and guiding future actions; everything should be documented from assessment to evaluation.

Goals of Community Health Nursing

  • Assist individuals, families, and communities in attaining their highest level of holistic health through multidisciplinary efforts and reciprocally supportive relationships between people and their physical and social environments.

  • Strive for a self-reliant community where health is accessible to all.

Recipients of care by CHN

  • The individual: A person with specific health needs.

  • The family: A group connected by affinity, consanguinity, or co-residence.

  • The population group: Vulnerable groups and those at risk due to specific factors.

  • The community.

The Community as a Client Model and Eight Subsystems

  • The community is treated as a client with multiple interacting subsystems that influence health.

  • Eight subsystems include:

    • Physical environment

    • Education

    • Safety and transportation

    • Politics and government

    • Health and social services

    • Communication

    • Economics

    • Recreation

Theoretical Models / Approaches in CHN

  • Health Belief Model (HBM): Guides health promotion and disease prevention by explaining and predicting individual changes in health behaviors.

    • Key factors influencing health behaviors:

    • Perceived susceptibility: individual’s perceived risk of getting a disease.

    • Perceived severity: beliefs about the seriousness of a disease and its consequences.

    • Perceived benefits: perceived positive benefits of taking action.

    • Perceived barriers: perceived obstacles to action; cues to action prompt action.

    • Cues to action: triggers that prompt engagement in health behavior.

    • Self-efficacy: confidence in ability to succeed.

  • Pender’s Health Promotion Model (HPM): Explores psychosocial factors influencing health promotion; threat is not a universal motivator and may not apply across all ages.

    • Core components:

    • Individual characteristics and experiences.

    • Behavior-specific cognitions and affect.

    • Perceived benefits of action.

    • Perceived barriers to action.

    • Perceived self-efficacy.

    • Activity-related affect.

    • Interpersonal influences (family, peers, providers); norms, support, models.

    • Situational influences; options and demand characteristics.

    • Commitment to a plan of action.

    • Health-promoting behavior (outcome).

  • PRECEDE-PROCEED MODEL (PPM): A planning framework for health promotion; PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation; PROCEED stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development.

    • Purpose: Provides a structured approach to designing, implementing, and evaluating health programs.

Phases of PRECEDE-PROCEED (as described in the transcript)

  • Phases 1-5: PRECEDE model phases

    • Phase 1: Social assessment and readiness to change; assess social needs and quality of life; identify community resources.

    • Phase 2: Identify associated factors affecting quality of life; collect statistics (e.g., morbidity and mortality rates).

    • Phase 3: Behavioral, lifestyle, and environmental factors; determine why assessment in Phase 2 is occurring; identify factors affecting health.

    • Phase 4: Administrative and policy assessment and intervention alignment (implied by Phase 5 in the transcript).

    • Phase 5: Identify a focused plan before implementing programs; analyze goals, compatibility with the community, availability of resources and leaders.

  • Phases 6: Process evaluation (and implied subsequent phases 7 and 8 in the transcript):

    • Phase 6-7: Process evaluation, impact evaluation, and outcome evaluation to determine program efficacy, necessary revisions, and ultimate changes in quality of life.

    • Phase 8: Outcome evaluation.

Nancy Milio's Framework for Prevention (1976)

  • Strategic Prevention Framework components:

    • What's going on? (What, who, when, where, why, how)

    • Planning and resources: Capacity, resources & readiness

    • Implementation with fidelity

    • Assessment and Evaluation

    • Sustainability and Cultural Competence

  • Purpose: Provides a comprehensive approach to prevention with emphasis on community-oriented, population-focused care.

Milio’s Propositions

  • Propositions describe how population health is shaped by environmental and social factors beyond knowledge alone:

    • Health resources: Availability and accessibility of resources like food, shelter, healthcare; insufficient resources worsen health, while excess resources can lead to issues like obesity.

    • Behavioral choices: Health behaviors are not dictated solely by knowledge; choices are shaped by the environment and socio-economic status.

    • Community context: Health choices are influenced by the social milieu, including community resources, policies, and cultural factors.

  • The framework argues that habitual health behaviors arise from limited choices and a mismatch between health needs and available resources, rather than simply a lack of knowledge.

Key Propositions (Summary)

  • Health resources and access affect outcomes; resource limitations can produce poor health outcomes, while abundance can create other health issues.

  • Behavioral choices are constrained and shaped by environmental and socio-economic factors, not just knowledge.

  • The community context, including policies, resources, and cultural norms, shapes health behaviors and outcomes.

Closing

  • The notes above consolidate the major concepts, models, and frameworks presented in the transcript to support exam preparation in Community Health Nursing.