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DEFINITION NURSING
COMMUNITY
• Both profession & a vocation. Assisting sick
• A group of people with common individuals to become healthy and healthy
characteristics or interests living together individuals achieve optimum wellness
within a territory or geographical boundary

• Place where people under usual conditions

COMMUNITY HEALTH NURSING
are found
• “The utilization of the nursing process in the
• Derived from a Latin word “comunicas”
different levels of clientele-individuals,
which means a group of people.
families, population groups and
communities, concerned with the
HEALTH promotion of health, prevention of disease
and disability and rehabilitation.” (Maglaya,
• “Health is a state of complete physical,
et al)
mental, and social well-being and not
merely the absence of disease or infirmity.” • Goal: “To raise the level of citizenry by
• “A resource for everyday life, not the helping communities and families to cope
objective of living. Health is a positive with the discontinuities in and threats to
concept emphasizing social and personal health in such a way as to maximize their
resources, as well as physical capacities.” potential for high-level wellness” (Nisce, et
• OLOF (Optimum Level of Functioning) al)
• Health-illness continuum
• Special field of nursing that combines the
• High-level wellness
skills of nursing, public health and some
• Agent-host-environment
phases of social assistance and functions as
• Health belief part of the total public health program for
• Evolutionary based the promotion of health, the improvement
• Health promotion of the conditions in the social and physical
• WHO definition environment, rehabilitation of illness and
disability (WHO Expert Committee of
Nursing)
COMMUNITY HEALTH
• A learned practice discipline with the
• Part of paramedical and medical ultimate goal of contributing as individuals
intervention/approach which is concerned and in collaboration with others to the
on the health of the whole population promotion of the client’s optimum level of
functioning thru’ teaching and delivery of
• Aims:
care (Jacobson)
➢ Health promotion
• A service rendered by a professional nurse to
➢ Disease prevention IFCs, population groups in health centers,
clinics, schools, workplace for the promotion
➢ Management of factors affecting health
of health, prevention of illness, care of the
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sick at home and rehabilitation (DR. Ruth B.
Freeman)
BASIC PRINCIPLES OF CHN
MISSION OF CHN • The community is the patient in CHN
• Health Promotion
• In CHN, the client is considered as an ACTIVE
• Health Protection partner NOT PASSIVE recipient of care

• Health Balance • CHN practice is affected by developments in

health technology, in particular, changes in
• Disease prevention
society, in general
• Social Justice
• The goal of CHN is achieved through multi-
sectoral efforts

PHILOSOPHY OF CHN • CHN is a part of health care system and the

• “The philosophy of CHN is based on the larger human services system.
worth and dignity of man.” (Dr. M.
Shetland)
SALIENT FEATURES OF COMMUNITY HEALTH
• This philosophy of care is based on the belief NURSING
that care to the individual, the family, and 1. Population or Aggregate-Focused
the group contributes to the healthcare of
the population, as a whole. 2. Greatest Good for the Greatest Number

3. Utilizes the Nursing Process

CHN PRACTICE IS GUIDED BY THE FOLLOWING 4. Promotive-Preventive by Nature

BELIEFS:
5. Uses a Variety of Instruments
MEMORY AID: HUMANISTIC
6. Requires Management Skills
• Humanistic values of the nursing profession
upheld
• Unique and distinct component of health
care
• Multiple factors of health considered THEORETICAL MODELS/
• Active participation of clients encouraged APPROACHES
• Nurse considers availability of resources
• Interdependence among health team
members practiced
HEALTH BELIEF MODEL/HBM
• Scientific and up to date (BECKER, 1975)
• Tasks of CH nurse vary with time and place INTRODUCTION AND CONCEPT
• Independence of self-reliance of the people
is the end goal • This model is based on the premise that for
• Connectedness of health and development a behavioral change to succeed, individuals
regarded must have the incentive to change, feel
threatened by their current behavior, and
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feel that a change will be beneficial and be at d) Cues to action
acceptable cost.
i. internal: fatigue,
• Describes the relationship between a uncomfortable, symptoms
person’s belief and behavior. ii. external: mass media, disease
effect on family/friends,
• Individual perceptions and modifying factors recommendations from health
may influence health beliefs and preventive care professional, advice from
health behavior. others
• Assumes that preventive health behaviors • Likelihood of taking recommended preventive
are taken primarily for the purpose of health action depends on:
avoiding disease. ➢ Perceived benefits of preventive action.
➢ Perceived barriers to preventive action.
• Emphasizes change at the individual level. i. Preventive health behavior may
• They must also feel competent to implement include lifestyle changes
that change. increased adherence to medical
therapies, search medical advice
PURPOSE or treatment.
ii. Perceived barriers to preventive
• The purpose is to predict or explain health
action may be due difficulty in
behaviors.
adhering to lifestyle changes;
• Describes the likelihood of taking an action
social pressures, physical
to avoid disease based on the following:
symptoms such as fatigue, joint
➢ Individual perceptions include the
pains, etc.; economic factors
following:
accessibility of health care
a) Perceived susceptibility to an illness
facilities.
e.g., family history to DM increases
iii. Perceived benefits minus
risk to develop the disease.
perceived barriers to taking
b) Perceived seriousness of illness e.g.
action
DM is a lifelong disease.
c) Perceived threat of an illness e.g.,
causes damage to the brain, heart,
MILIO’S FRAMEWORK FOR PREVENTION
eyes, kidneys, blood vessels.
INTRODUCTION AND CONCEPT
➢ Modifying factors include the following:
• Nancy Milio developed a framework for
a) Demographic variables (age, sex, prevention that includes concepts of
race, etc.) community – oriented, population- focused
care.
b) Socio-psychologic variables (social
pressure or influence from peers, • Milio stated that behavioral patterns of the
etc.) populations-and individuals who make up
populations – are a result of habitual
c) Structural variable (knowledge
selection from limited choices.
about the disease and prior contact
with it)
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• She challenged the common notion that a • Describes the interaction between the nurse
main determinant for unhealthful behavioral and the consumer while considering the role
choice is lack of knowledge. of the environment in health promotion.

• Milio’s framework described a sometimes, • Does not consider health risk as a factor that
neglected role of community health nursing provokes change.
to examine the determinants of a
• Examines factors that affect individual
community’s health and attempt to
actions to promote and protect health.
influence those determinants through public
policy. • The goal of the HPM is not just about helping
patients prevent illness through their beliefs
• Complements the health belief model.
and attitudes, but also seek the means in
• Emphasizes change at the community level. which a person can pursue better health or
ideals.
• Identifies relationship between health
deficits and availability of health • According to Pender, the HPM makes four
promoting resources. assumptions:

• Theorizes that behavior changes within a ➢ Individuals strive to control their own
large number of people can ultimately lead behavior.
to social change.
➢ Individuals work to improve themselves
and their environment.

NOLA PENDER’S HEALTH PROMOTION ➢ Health professionals comprise the

INTRODUCTION AND CONCEPT interpersonal environment, which
influences individual behaviors.
• Nola J. Pender (1941– present) is a nursing
theorist who developed the Health ➢ Self-initiated change of individual and
Promotion Model in 1982 and revised in environmental characteristics is
1996. essential to changing behavior.

• This was designed to be a “complementary • These assumptions can help clients prioritize
counterpart other needs, especially health concern
to models of health protection.” It
3 KEY FOCUS AREAS
defines health as a positive dynamic state
not merely the absence of disease. Health • Focuses on three areas: individual
promotion is directed at increasing a client's characteristics and experiences, behavior-
level of well-being. specific cognitions and affect, and behavioral
outcomes.
• The Health Promotion Model (HPM) focuses
• Describes the multidimensional nature of
on helping people achieve a higher level of
persons as they interact within their
well-being and provide health professionals
environment to pursue health.
with positive resources to help patients
achieve behavior specific changes.

• Similar to Health Belief Model.

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• It provides a comprehensive structure for
assessing health and quality of life needs,
and for designing, implementing, and
Individual Behavior- Behavioral evaluating health promotion and other
Characteristic Specific Outcomes public health programs to meet those
s and Cognitions and needs.
Experiences Affect • One purpose and guiding principle of the
• Prior • Perceived • Immediat PRECEDE–PROCEED model is to direct initial
related benefits of e attention to outcomes, rather than inputs.
behavior actions competin • It guides planners through a process that
• Personal • Perceived g
starts with desired outcomes and then works
factors: barriers to demands
backwards in the causal chain to identify a
• Biological actions (low
mix of strategies for achieving those
• Psychologi • Perceived control)
self- and objectives.
cal
• Sociocultu efficacy preferenc • A fundamental assumption of the model is
ral • Activity- es (high the active participation of its intended
related control) audience — that is, that the participants
affect • Commitm ("consumers") will take an active part in
• Interperson ent to a defining their own problems, establishing
al plan of their goals and developing their solutions.
influences: action • In this framework, health behavior is
(family, • Health regarded as being influenced by both
peers, promotin individual and environmental factors, and
providers); g
hence has two distinct parts.
norms, behavior
• First is an "educational diagnosis" –
support,
models PRECEDE, an acronym for Predisposing,
• Situational Reinforcing and Enabling Constructs in
influences: Educational Diagnosis and Evaluation.
options, • Second is an "ecological diagnosis" –
demand PROCEED, for Policy, Regulatory, and
characteris Organizational Constructs in Educational
tics, and Environmental Development.
aesthetics • The model is multidimensional and is
founded in the social/behavioral sciences,
LAWRENCE GREEN’S (PRECEDE-PROCEED) epidemiology, administration, and
INTRODUCTION AND CONCEPT education. The systematic use of the
framework in a series of clinical and field
• The PRECEDE–PROCEED model is a cost– trials confirmed the utility and predictive
benefit evaluation framework proposed in validity of the model as a planning tool.
1974 by Lawrence W. Green that can help
health program planners, policy makers and DESCRIPTION
other evaluators, analyze situations and • The PRECEDE–PROCEED planning model
design health programs efficiently. consists of four planning phases, one
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implementation phase, and 3 evaluation patients during mental illness and
phases rehabilitation.

PRECEDE phases PROCEED phases School Health Nursing

Phase 1 – Social Phase 5 –
Diagnosis Implementation • The application of nursing theories and
Phase 2 – principles in the care of the school
Epidemiological, population.
Phase 6 – Process • Components of School Health Nursing
Behavioral &
Evaluation
Environmental 1. School Health Services – maintain
Diagnosis school clinic, screening all children –
Phase 3 – Educational & Phase 7 – Impact visual, hearing, scoliosis.
Ecological Diagnosis Evaluation 2. Health instruction – as health
Phase 4 – educator/counselor.
Phase 8 – Outcome
Administrative & Policy 3. Health monitoring
Evaluation
Diagnosis a. Mental Health – substance abuse,
sexual health
DIFFERENT FIELDS IN COMMUNITY HEALTH b. Environmental Health – food
NURSING sanitation, water supply, safe
School Health Nursing environment, safe toilet.
c. School community linkage – as
• He/she provides health supervision and
community organizer
nursing interventions to school children,
• Aims of the Program
conducts home visits or home follow-up,
➢ The aim of school nursing is to promote
identifies cases needing immediate medical
the health of school children and
attention and makes the necessary referrals
prevent health problems that would
as needed.
hinder the learning process and
Occupational Health Nursing performance of their developmental
task. Health is considered an important
• He/she provides health supervision and requisite for education.
nursing interventions to workers in factories • DepEd Health and Nutrition Center
or workplaces especially in areas where they
are exposed to certain health hazards: ➢ The Health and Nutrition Center (HNC)
institutes appropriate health preventive and under the Department of Education has
promotive measures. the responsibility to safeguard the
health and nutritional well-being of the
Community Mental Health Nursing total school population.
• He/she assesses the environment in the ➢ It has two divisions:
home and community to identify factors
which may aggravate or trigger mental a. Nutrition division and
illness. Psychiatric nursing is concerned with b. Health Division which has 4 sections:
the promotion of mental health, prevention
of mental disorders and the nursing care of • Medical
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• Dental 3. Health assessment involves:

• Nursing and a. Interviewing for data-gathering

• Health Education b. Thorough physical examination –

percussion, palpation, auscultation
• Determinants of School Health Nursing
and percussion
1. Characteristics of the clientele
c. Taking vital signs
2. Policies of the Department of Education
d. Vision acuity test/hearing test
3. Programs of the Department of Health
e. Appraisal of general physical and
4. Standards of the Nursing Profession mental condition

• Duties and Responsibilities of School Nurse f. Recording of findings

1. Height and weight measurement and 4. The nurse looks for signs of illness, physical
nutritional status determination- defects, and bad health habits. The
corresponding health teachings or advice
2. Medical referrals must be given.
3. Attendance to emergency cases 5. Standard vision testing for school children
Treatment of the common ailments and and referring child with 20/40 visual acuity
attending to emergency cases. or poorer to an eye specialist. Parents should
4. Student health counselling. be informed ASAP.

5. Health and Nutrition education activities 6. Ear examination – the primary concern of
the nurse is to detect hearing difficulties or
6. Recording and reporting disorders as early as possible through:
of accomplishment.
a. Observation
7. Monitoring and evaluation of programs
and projects. b. Using penlight or otoscope for visual
inspection
• Function of the School Nurse
c. Conducting screening tests like
1. School health and nutrition program whisper test, conversation voice
includes current health and nutritional test, ballpen click test, and tuning
status of school children, status of health fork test.
facilities and actual status of health
education activities being undertaken by 7. Height and weight measurement and
the teachers and health personnel. nutritional status determination- to
determine the nutritional status of school
2. Putting up a functional school clinic for children, the DepEd uses the weight-for-age
the treatment of minor ailments and and height for age indicators for children
attendance to emergency cases as below 10 10 years old while the BMI (Body
mandated by R.A. 124. Mass Index) is use to 10 years old and
above which is done at beginning and end
of school year.
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a. School feeding programs with rice, milk
or fortified noodles- are given to
children with below normal nutritional
status for 120 days.
b. Deworming is done to the feeding
program and must be accomplished by
parent’s consent.
8. Medical referrals – a student with an
existing medical illness or condition may be
referred for further assessment or
intervention by the appropriate
professional or agency. The parents must
return the referral slip duly signed by the
medical resources or physician.
9. Attendance to emergency cases –
administers appropriate first aid measures
and refers immediately to the appropriate
medical facility.
10. Student health counselling –
especially o matters of emotional and
physical problems. Parents and guardians
should also be involved in these activities.
11. Health and Nutrition education activities –
the nurse can do this in both formal and
informal settings
12. Organization of school and community
health and nutrition
13. Communicable disease prevention and
14. Establishment of data bank on school health
nutrition activities
15. School plant inspection for healthy
environment
16. Rapid classroom inspection
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INTRODUCTION, CONCEPTS, SCOPE OF COMMUNITY HEALTH NURSING

COMMUNITY HEALTH NURSING ➢ Community development

• Community Health Nursing, also called
➢ What they do depends on the
Public Health Nursing or Community
communities they serve; lower income,
Nursing, combines primary healthcare and
school and culturally diverse
nursing practice in a community setting.
communities all have different needs.
• Community Health (CH) Nurses provide
CH nurses also work for public health
health services, preventive care,
departments or parishes.
intervention and health education to
communities or populations
• In the past, public health nurses worked for
COMMUNITY HEALTH NURSE SPECIALTIES
the government or the public health
• Nurse working with lower income
department. Their role has since expanded.
populations will evaluate their healthcare
In fact, some may not work directly with
needs and then find free or low-cost
patients.
services.
• The American Nurses Association (ANA),
• They may cover some or all these areas:
the Association of Public Health
➢ Disability identification and support
Nurses (APHN) and others use the definition
➢ Pregnancy and infant care education and
of public health nursing coined by the
referrals
American Public Health Association (APHA):
➢ Child development assessments
“Public health nursing is the practice of
➢ Domestic violence support
promoting and protecting the health of
➢ Self-care, healthcare, and nutrition
populations using knowledge from nursing,
education
social and public health sciences.”
➢ Some cultures have customs that affect
the care they wish to receive. Nurses
COMMUNITY HEALTH NURSE must learn about the cultures they work
• Unlike a nurse who works with patients one- with, building relationships and gaining
on-one, public and community health trust within communities. Developing
nurses focus on communities. CH nurses can genuine cultural competence and
have various roles in a community setting. understanding allows nurses to
advocate for their community, ensuring
• They may provide some or all the following:
cultural knowledge, beliefs, customs and
➢ Health education experiences are respected and valued.
• The healthcare workforce is becoming more
➢ Community advocacy
diverse, which is one of the biggest changes
➢ Screening services in nursing — and a benefit to patients.
Nurses with similar cultural backgrounds to
➢ Preventative care the communities they serve may already
➢ Ensuring a safe and healthy environment understand structures of respect,
communication, and cultural values within
➢ Abuse and neglect prevention the community. Plus, improving cultural
➢ Policy reform representation in the healthcare workforce
can help rebuild trust in healthcare systems,
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promote health equity and foster more CORE COMPETENCIES

diversity in the next generation of healthcare The Core Competencies are organized into eight
workers. domains of skills:

1. Data Analytics/Assessment
SCHOOL NURSES
2. Policy Development/Program Planning
• Another community health specialist is the
school nurse. Children who do not feel well 3. Communication
go to the school nurse and report their
symptoms. If it turns out multiple students 4. Health Equity
have the same illness, the nurse informs the 5. Community Partnership
school’s community that there is an illness
going around, educates the community on 6. Public Health Sciences
the illness’ symptoms and gives advice on 7. Finance And Management
what to do. Some school nurses may also
communicate with residents who live near 8. Leadership And Systems Thinking
the school to let them know about any The core competency domains are broken down into
trending illnesses or other public health sub competencies organized in three tiers,
issues. representing “different types of responsibilities
within public health organizations.”

ESSENTIAL SKILLS AND COMPETENCIES OF • Tier 1 is front-line staff.

COMMUNITY HEALTH NURSES
• Tier 2 is program management and
• Community nurses rely on data and analysis
supervision.
to assess communities, create plans of
action and establish procedures. The skills • Tier 3 is senior management.
needed for such public health roles are
outlined in the Core Competencies for
Public Health Professionals (Core WHAT EDUCATION DO YOU NEED TO BE A
Competencies), developed, and revised in COMMUNITY HEALTH NURSE?
2021 by the Council on Linkages Between • CH nurses have the same qualifications as
Academia and Public Health Practice. other licensed nurses. A CH nurse must be
licensed as a registered nurse (RN). Some
• The Core Competencies align with the 2020
roles require the higher level of education
revision of the 10 Essential Public Health
and training that a Bachelor of Science in
Services (EPHS) framework, which focuses
Nursing (BSN) degree program can provide.
on removing “systemic and structural
The BSN integrates communications,
barriers that have resulted in health
analytics, scientific reasoning, and culture,
inequities” in order to achieve equity and
which correlate with the eight domains. RNs
“optimal health for all.
can earn this qualification through
completing an online RN to BSN degree
program.
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INTRODUCTION, CONCEPTS, SCOPE OF COMMUNITY HEALTH NURSING

• The COVID-19 pandemic shed light on the

need to reinvest in America’s public health
infrastructure even in Philippines setting. An
essential component of this is rebuilding the
community health nursing workforce.
Working in community nursing takes
patience, advanced communication skills,
political savvy, and organization. With great
challenge comes great rewards, especially
for those who work with culturally and
socioeconomically diverse populations.