Community Health Nursing Notes - VOCABULARY Flashcards
Community Health Nursing: Definition and Field
Definition: A 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.
One of the two major fields of Nursing: Hospital and Community.
Characteristics of Community Health Nursing:
Promotion of health and prevention of diseases (goals of professional practice).
Comprehensive, general, continual and not episodic practice.
Serves different levels of clientele: individuals, family, population group, and community.
The nurse and client collaborate as equals and have greater control in decision-making related to health care.
The nurse recognizes the impact of various factors on health and has a broad awareness of clients’ lives and situations.
Primary Qualities and Care Model in CHN
Primary Qualities:
Primary Goal – promotion of optimum level of functioning through health teaching and delivery of care.
Primary Duty – health teaching.
Primary Principle – health care for the entire community.
Primary Focus – health promotion.
Primary Methodology – health care process.
Primary Type of Care Delivery – population-focused care (mass-based).
Primary Basis – recognizing the needs of clients.
Primary Unit of Service – Family.
Primary Client and Setting – community.
Community Health Care: Broad Concepts
3 Broad Concepts:
Community – a group sharing geographical boundaries or common values/interests. Functions within a socio-cultural context; each community may be unique due to shared cultural heritage (Maglaya, 2004).
Health – a state of complete physical, mental, and social well-being, not merely absence of disease (WHO, 1995). Health is also a social phenomenon, the result of interplay of societal factors, as reflected in the Optimum Level of Functioning (OLOF) wheel:
Biological
Physical (heat, temperature)
Ecological (adaptation to environment)
Political
Economic
Caring – treatment of human responses to actual or potential health problems.
Community as a Setting for Practice – places where people are found under normal conditions (outside purely curative institutions): School, Workplace, Home.
Special Fields: Community Mental Health.
Qualities of a Healthy Community:
Resources – opened and controlled.
Empowerment – active participation.
People – health citizenry.
Awareness – community health status.
Independence – people and leaders.
Role models – parents and guardians.
Active concerns – health threats.
Sustainability – environment and needs.
Accessibility – health services.
Politics – mass-based and respected.
Classification of a Community:
Rural or open lands – agricultural or fishing; less dense, more spacious.
Urban or the City – dense, highly populated, industrialized.
Rurban or the Capitals – mixed rural and urban characteristics.
Components of CHN and Subsystems
Components of CHN: The people (core) – demographics, values, and beliefs.
8 Subsystems of the Community:
Communication – open all channels.
Housing – adequate shelter and security.
Education – health teachings, seminars.
Economic – livelihood projects.
Recreation – community activities.
Fire and safety – building and house checks.
Politics and government – selection of leaders.
Health – health services and programs.
Approaches to Community Development
Welfare Approach – immediate, spontaneous response to poverty; assumes poverty is God-given; poverty is destiny; reward in heaven.
Modernization Approach (PROJECT DEVELOPMENT APPROACH) – introduces lacking resources.
Transformative or Participatory Approach – involves empowerment and transformation of the poor; poverty is not God-given; poverty due to oppressive structures in society.
Ecosystem / Factors That Affect Community Health (OLOF)
Health – wellness wheel includes: social, intellectual, physical, spiritual, occupational, emotional, environmental aspects.
Political – power and authority to regulate the environment (safety, oppression, empowerment).
Health Care Delivery System – primary health care (PHC) as a partnership approach; goals: effective, community-based, accessible health services. Components include: promotive, preventive, curative, rehabilitative.
Behavioral – culture, habits, ethnic customs; examples: smoking, alcohol, substance abuse, lack of exercise.
Socio-Economic Influences – employment, housing, education.
Environmental Influences – air, food, water, waste, urban-rural noise, radiation, pollution.
Heredity – genetic endowment, defects, strengths, risks (familial, ethnic, racial).
Factors Affecting Health (Detailed)
Poverty and Health:
Poverty is an indicator of continuing social injustice and failure of development (in general).
In 2025, poverty incidence is 55\% according to SWS survey.
A family of five (5) needed no less than Php\;13{,}797.00 (2025) on average to meet the family’s basic needs for food for a month (food threshold) – 13{,}797.00 per month, equating to \$\$55.??\$? per meal (illustrative value from transcript: 91.98 per meal).
Under the SDGs, the Philippines committed to ending poverty in all forms and dimensions by 2030.
The poor have poorer health due to lack of resources to afford basic requisites of health.
The Philippines ranked 117^{\text{th}} among 191 countries in the UNDP Human Development Index in 2025.
Culture and Health – culture as a way of life; passed across generations; includes beliefs, values, customs, practices; socialization; affects health positively via family ties and social support; supports emotional well-being and mental health.
Environment and Health – unsanitary environments contribute to disease; ecosystem deterioration linked to cancer and global health problems; climate change affects basics of health: clean air, safe water, sufficient food, secure shelter; global environmental state results from industrialization, policies, poverty, and attitudes toward the environment.
Politics and Health – policies reflect government priorities and policy makers’ values; health budget expresses political will; access issues due to financing; laws affecting health (salt iodization, food fortification); laws affecting health service delivery (Local Government Code, National Health Insurance Act, professional practice acts).
Basic Principles of Community Health Practice
The Community is the patient; the Family is the unit of care; four levels of clientele: Individual, Family, Population Group, and Community.
CH practice is shaped by developments in health technology and societal changes.
Goals of CH are achieved through multisectoral (multisectoral) efforts.
CH is part of the health care system and the broader human services system.
Public Health Nursing (PHN) vs. Community Health Nursing (CHN): historically used interchangeably in the Philippines by local and foreign authors.
Public Health Nurses (PHNs) (NLPGN, 2005) refers to nurses in local or national health departments or public schools, regardless of official title.
Philosophy and Mission of CHN
Philosophy of CHN is based on the worth and dignity of man.
Five-Fold Mission of CHN:
Health promotion – lifestyle choices.
Health protection – prevent community diseases.
Health balance – biopsychosocial homeostasis.
Disease prevention – avoid consequences
Primary prevention – immunizations.
Secondary prevention – screening.
Tertiary prevention – rehabilitation.
Social justice – right to basic life.
Objectives of CHN
ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation) over the overall community health plan.
Provide quality nursing service.
Coordinate with the health team, NGOs, and government agencies.
Research relevant to PHN services.
Continuing education and professional growth (R.A. 10192, CPD Act of 2016).
Philosophy of Community Health Care Practice
Humanistic values of the midwifery profession upheld.
Unique and distinct component of health care.
Multiple health determinants considered; client participation encouraged.
Resources considered; interdependence among health team members.
Tasks of midwives vary with time and place.
Independence and self-reliance of the people as the end goal.
Health and development are interconnected.
Public Health: Definition and Purpose
Public Health is the science and art of:
Preventing disease
Prolonging life
Promoting health
Promoting efficiency
Achieved through organized community efforts for:
Sanitation of the environment
Control of communicable infections
Education of individuals in personal hygiene
Organization of medical and nursing services for early diagnosis and preventive treatment
Development of social machinery to ensure a standard of living adequate for health and longevity; organizing benefits to enable every citizen to realize birthright of health
Dr. C. E. Winslow, 1920.
Roles of the CHN
Client-oriented Roles: Caregiver, Counselor, Educator, 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, Researcher.
Public Health the art of applying science in the context of politics to reduce health inequalities while ensuring the best health for the greatest number (WHO).
Roles of the Public Health Nurse (PHN)
Clinician/Health Care Provider – uses the health care process in home visits and public health facilities; conducts referrals to appropriate care levels.
Health Educator – improves knowledge, skills, attitudes; conducts health information campaigns (e.g., vaccines, EPI).
Coordinator & Collaborator – links with health professionals, government agencies, private sector, NGOs, and people’s organizations; addresses health problems (e.g., joint sponsorships for community programs).
Supervisor – monitors performance of Barangay Health Workers (BHWs) and auxiliary staff; initiates staff development and training programs.
Manager – program manager for health packages; e.g., National Tuberculosis Program (NTP) at barangay level.
Leader and Change Agent – mobilizes community for health improvements (e.g., water system clean-up).
Researcher – participates in disease surveillance and data collection/analysis (e.g., dengue).
Duties and Responsibilities of the Nurse
Provides health care through the health care process.
Establishes linkages with community resources and coordinates with the health team.
Provides health education to individuals, families, and communities.
Teaches, guides, and supervises students in midwifery education programs.
Conducts consultations.
Engages in activities requiring knowledge and decision-making as a registered midwife.
Engages in midwifery and health human resource development (training and research).
Responsibilities of the CHN
Participates in development, implementation, and evaluation of an overall health plan for communities.
Provides quality health care services to four levels of clientele.
Maintains coordination/linkages with health team members and NGOs/government agencies.
Initiates and conducts research relevant to community health services.
Initiates and provides opportunities for professional growth and continuing education.
In care of families: provision of primary health care services; development/utilization of health care plans.
In care of communities: community organizing, mobilization, community development, people empowerment; case finding; epidemiological investigation; program planning, implementation, and evaluation.
Influencing executive and legislative bodies on health and development.
CHN: Framework and Practice
CHN employs the nursing process across different levels of clientele: individuals, families, population groups, and communities.
Framework for Community Health Care (macro framework) has 4 components:
The Health Care Delivery System (CHN as a subsystem).
The clients (individuals, family, population groups, and community).
Health (the goal of the health care delivery system).
Economic, sociocultural, political, and environmental factors that affect the health care delivery system, CH practice, and people’s health.
Health and Public Health Foundations
Health is a basic human right and a fundamental right of every person; viewed as a continuum (measurement) and the goal of public health and CHN.
Health is prerequisite for development; CHNs contribute to economic and social development by promoting health and preventing disease.
Specialized Fields of Community Health
Community Health Care – integration of health care, mental health, social psychology, psychology, community networks, and the basic sciences.
School Health – application of theories and principles in care of school populations.
Preventive Approach to Health: The Three Levels of Prevention
Primary Prevention – activities aimed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals.
Elements:
1) Health promotion – resilience-building, protective factors; targets well populations; examples: good nutrition, adequate shelter, regular exercise.
2) Specific protection – reduce or eliminate risk factors; examples: immunization, water purification.
Secondary Prevention – early detection and prompt intervention during early pathogenesis; after problem begins but before signs/symptoms; targets high-risk populations; examples: mammography, BP screening, mass sputum examination for TB, newborn screening.
Tertiary Prevention – targets populations with disease/injury; aims to reduce disability and rehabilitation; examples: diabetes management, occupational therapy after spinal cord injury.
Emerging Fields in the Philippines
Home Health Care – care provided at home to minimize illness impact; enables patients to remain at home (examples: chronically ill, convalescent, elderly, disabled, high-risk pregnancies).
Hospice Home Care – care for terminally ill patients to provide comfort and quality of life; support for patient and family; emphasizes palliative care.
Faith Community – midwife integrates health care with spiritual care; roles include health educator, personal health counselor, developer and coordinator of support groups within faith communities.
Levels of Clientele in Community Practice – four levels: Individual, Family, Community, Population Groups.
Levels of Clientele in the Community
In community settings, four levels of clientele:
Individual
Family
Community
Population groups
Since the midwife addresses the health needs of the community, the community is the client and the family is the unit of care.
The Individual as a Client
The Individual deals with sick or well people on a daily basis.
The individual is the entry point for work with family/community.
The Atomistic vs. Holistic Approaches in CHN
Atomistic Approach (Byrne and Thompson): views man as an organism with organ systems; analysis is reductionist; parts are organized to function and the whole is the sum of its parts.
Levels of organization: chemical level, organelle, cellular, tissue, organ, system.
Emphasizes parts rather than the whole.
Holistic Approach: views man as a whole, interrelated with the suprasystem (society); context of situational stimuli; behavior reflects whole-person responses; emphasizes the whole organism functioning in context.
Key idea: The five dimensions of man are interrelated and changes in one dimension affect others.
The Five Dimensions of Man
Physical being – genetic endowment, sex, biological structure and function.
Social being – capable of relating to others; socialization via family; family as primary agent of socialization; socialization is acquiring knowledge, skills, attitudes, and roles by sex, social class, and culture.
Spiritual being – virtues like faith, hope, charity; belief in a power beyond oneself; transcending limitations to improve.
Thinking (Intellectual) being – perception, cognition, and communication.
Psychological being – feelings, rationality, conscious and unconscious mental states; rationality fosters mercy, kindness, compassion.
All dimensions are interconnected; the whole is more than the sum of its parts.
The Family as a Client
Family: a collection of people who are integrated, interacting, and interdependent.
Family interacts with each member; actions of one affect others; family fulfills health tasks; capable of providing primary support.
Family unit is a small social system and primary reference group of two or more persons related by blood, marriage/adoption or cohabitation.
Characteristics include: face-to-face contact, bonds of affection, loyalty, emotional and financial commitment, harmony, shared goals, and family-specific rituals.
Why work with families?
Family is a critical resource for health promotion.
The Ripple Effect: dysfunction in one member affects the whole family.
Midwife can assess individuals and family, identify risks for the entire unit.
Types of Families (based on composition):
Nuclear family: father, mother, and children.
Extended family: nuclear plus relatives, spanning at least three generations.
Beanpole family: four or more generations, each generation small; longevity extends lineage.
Single-parent family: one parent with children.
Stepfamily/Blended/Reconstituted family: includes one or both partners with children from previous relationships; may include other stepchildren.
Single state: never married; privacy and independence; high mobility.
Same-sex family: two partners with or without adopted child/stepchild.
Cohabiting/Communal family: unrelated individuals living together for companionship and resource sharing.
Compound family: one man with multiple spouses (where culturally or legally allowed).
Based on Locus of Power:
Patrifocal/Patriarchal – man holds main authority.
Matrifocal/Matriarchal – woman holds main authority.
Egalitarian – roughly equal authority.
Matricentric – mother-dominant due to situational factors (e.g., OFWs).
Based on Place of Residence:
Patrilocal – live with groom’s family.
Matrilocal – live with bride’s family.
Bilocal – choose to live with either family.
Neolocal – independent residence away from both families.
Avunculocal – reside near the maternal uncle.
Based on Descent:
Patrilineal – kinship through father’s side.
Matrilineal – kinship through mother’s side.
Bilateral – kinship through both parents.
Stages and Tasks of Family Development (Family Life Cycle)
Married couple (without children): formation of couple identity; realignment with extended families; partner inclusion.
Childbearing family: birth of first child; integration of child into family; financial and household adjustments; parenting roles.
Families with Preschool Children: oldest child > 30 months up to 6 years; parenting tasks; adjusting routines.
Families with School-Age Children: oldest child up to 12 years; education-related activities; changing family dynamics.
Families with Adolescents: autonomy development; midlife reassessment of marriage/career; concern for older generation.
Families as Launching Centers: independence for parents and grown children; renegotiation of marital relationships; in-laws and grandparent roles; handling disabilities/death of older generation.
Aging Families: maintaining functioning; support role of middle generation; autonomy of older generation; preparations for own death; coping with loss.
Stages and Tasks of the Family Life Cycle (Detailed Tasks)
Marriage: identity formation as a couple; inclusion of spouse in relationships with extended family.
Parenthood: decisions and roles as parents.
Families with Young Children: integration of children; parenting tasks; education and finances.
Families with Adolescents: autonomy and planning for future; family adjustments.
Families with Young Adults (Launching): establishing independent identities; renegotiation of marital roles; shifting in-law dynamics.
Aging (Elderly): adjusting to aging; planning for retirement; end-of-life considerations.
Functions of Family as a Social System
Physical functions – Parents provide food, clothing, shelter, protection, bodily repair; address illness and fatigue of dependents.
Welfare and Protection – Provide companionship, emotional security, love; meet affective, sexual, and socioeconomic needs; motivation and morale.
Procreation – Family as the primary institution for reproduction and child-rearing.
Social Functions – Learn productivity, social integration, identity, social roles, responsibility; first teacher of societal rules; fosters self-esteem and personal identity within a family.
Status Placement – Confers social rank; may shift with social mobility.
Economic Function – Rural families as production units; urban families as consumption units; variation in economic roles.
Population Group as Client
Population group: group sharing common characteristics, developmental stage, or exposure to environmental factors; shares health problems and issues; aggregates with developmental needs (e.g., maternal, newborn, infants) and vulnerable populations (rural, poor, migrant workers, minority groups).
Usual targets of social services and health programs.
The Population Group as Client includes subcategories: Children, Elderly, Women.
Children – highly vulnerable to disease, especially under socioeconomic stress.
Elderly – age 60+; potential changes in life; avoid stereotyping; assess competencies.
Women – integral part of community health; participation in health system and community development.
Community as a Client (Summary)
The community is viewed as the client, with the population and environment forming the context for health planning and action.
Emphasizes multisectoral collaboration and community participation in health development.