NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)

PRELIMS – INTRO, CHAPTER 1

BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

Introduction Philosophy of Working Together Under a

Competent Leader for the Common Good
- The role of the nurse in the Community - It is from the primitive ages of human ages;
is multifaceted and brings many man has learnt to live together to meet their
challenges. In this course, deals with the needs.
concepts, philosophy and practices, - The basis of modern community health
principles, theories and techniques in nursing is to share responsibility of helping
the provision of basic care in terms of each other.
health promotion, disease prevention, - When it comes to considering an
restoration and maintenance and organization, equal participation of the
people working through the community
rehabilitation of population, groups and groups people with the people, for the
the community. people for their mutual benefit, change in
- It includes the study of the Different behaviour and health practices.
Fields like School Health Nursing, - A democratic team functioning is essential
Occupational and Mental Health for effective delivery of health care services.
Nursing. The learners are expected to
provide safe, appropriate and holistic Philosophy that People in the Community
nursing care to population, groups and have the Potential for Continual
Development and are Capable of Dealing
community as clients in community with their own Problems if Educated and
setting utilizing the nursing process. Helped
- An individual with average intelligence can
COMMUNITY HEALTH NURSING learn and deal with his/her own needs.
- “Community Health Nursing is a specialized Modify his/her lifestyles adjust to his or her
field of nursing practice that renders care to changing environment i.e he can learn to
individuals, families and communities, solve his or her problems.
focusing on health promotion and disease - On the basis of this philosophy, emphasis is
prevention. Nurses in the community strive placed on health education projected
to help people gain independence in health towards individuals in home, health center,
by sharing information to help them manage place of work, school, community places or
their own healthcare needs.” hospital.
COMMMUNITY HEALTH NURSING
(American Nursing Association) Philosophy of Socialism
- “Community Health Nursing is a synthesis of - Socialism as one of the social systems in the
nursing practice and public health practice community has control over production and
applied in promoting and preserving the distribution eg: food. Housing, material
health of populations. The nature of this production of all kinds, education,
practice is general and comprehensive. It is transportation, etc. should be shared with all
not limited to a particular age or diagnostic people.
group. It is continuous and not episodic. The
dominant responsibility is the population.” Principles of Community Health
COMMMUNITY HEALTH NURSING Nursing
(MAGLAYA) - Community health nursing is an established
- The utilization of the nursing process in the based on recognized needs and functioning
different levels of clientele- individuals, within the total health programme.
families, population groups and - The community health nursing agency has
communities, concerned with the promotion clearly defined objectives and purposes for
of health, prevention of disease and its services.
disability and rehabilitation. - An active organized citizens group of the
community group is an integral part of the
community health programme.
Philosophy and Practices - Community health nursing services are
Philosophy of Individual’s Right of Being available to the entire community regardless
of origin, culture or social and economic
Healthy resources, and age, sex, creed, nationality,
- Health is believed to be one of the rights of and political affiliation.
all human beings nationally and - Community health nursing recognized the
internationally according to the WHO family and community as units of service
charter. - Health Education and counselling for the
- “Everyone has the right to a standard of individual, family and community are the
living adequate for the health and well-being integral part of the community health
of himself and of his family, including food, nursing.
clothing, housing and medical care and - Recipients of health care should participate
necessary social services” (United Nations, in planning relating to goals for the
UDHR,1948) attainment of health.
- This philosophy encompasses all the aspects - The community health nurse should qualify
of the society i.e. socio-cultural, economic as a full-pledged nurse.
aspects, so that there is no hindrance of any - The community health nursing service
kind to attain these rights should be based on the needs of the patient
and there should be proper continuity of
services to patients.
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DUCAY, JHAYNE C. BSN 3D

 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

- Periodic and continuous appraisal and

evaluation of the health situation of the Brief History/ Background
patients are basic to community health - The Health Belief Model (HBM) was
nursing developed in the early 1950s by social
- The community health nurse should scientists at the U.S. Public Health Service in
function/serve as an important member of order to understand the failure of people to
the health team. adopt disease prevention strategies or
- There should be provision for qualified nurse screening tests for the early detection of
to make supervision for community health disease. Later uses of HBM were for
services. patients' responses to symptoms and
- The community health nurse does not compliance with medical treatments. The
provide material relief to patients but directs HBM suggests that a person's belief in a
the patient to appropriate community personal threat of an illness or disease
resources for necessary financial and social together with a person's belief in the
assistance. effectiveness of the recommended health
- The community health nurse should not behavior or action will predict the likelihood
accept gifts or bribes from the patients. the person will adopt the behavior.
- The community health nurse should not - The HBM derives from psychological and
belong to one section or political group. behavioral theory with the foundation that
- Community health agency should provide a the two components of health-related
continuing education programme for nurse. behavior are:
- The nurses assume responsibilities of their 1. the desire to avoid illness, or conversely
own continuing professional development get well if already ill; and,
through acquiring higher and higher 2. the belief that a specific health action
education and forming and strengthening will prevent, or cure, illness
the professional associations.
- The community health nursing services SIX CONSTRUCTS OF HBM
should develop proper guidelines in 1. Perceived Susceptibility: This refers to
maintaining records and reports. how vulnerable a person feels about getting
- There should be proper facilities and job afflicted by a disease. There are fears that
conditions. one is more prone to an illness compared to
- The community health nurse should others
maintain professional relationship with 2. Perceived Severity: This refers to the
leaders in the community and maintain serious repercussions that could follow as a
ethics at all times. result of not adopting a recommended
health behavior. This could range from
becoming bedridden, dying, to even social
Features of Community Health Nursing consequences in terms of the extent to
Six important characteristics of which it affects a family, inability to work,
community health nursing are etc.
3. Perceived Benefits: The person evaluates
particularly salient to the practice of the value of getting medical treatment by
this specialty. comparing the cost and side effects of the
o It is a specialty field of nursing treatment with the expected consequences
o Its practice combines public health of being struck by an illness.
with nursing 4. Perceived Barriers: This includes the cost
o It is population focused. of the treatment, complexity of adopting a
o It emphasizes on wellness and other new dietary/health regimen, lack of belief
than disease or illness that one has the ability to change, side
effects and length of treatment
o It involves inter-disciplinary 5. Cues to Action: These are signals that
collaboration prompt the person to take the initiative to
o It promotes client’s responsibility and treat illness. These can range from being
self-care exposed to health reports and messages in
the mass media, watching a friend or
---------------- END OF INTRODUCTION relative suffer from the disease, reading a
----------------- health pamphlet to even the onset of
_______________________________ symptoms in one’s body.
6. Self-efficacy: Refers to an individual’s
Chapter 1 perception of his or her competence to
successfully perform a behavior.
Theoretical Models
And Approaches
Health Belief Model
- The health belief model is a framework that
helps indicate whether a person will adopt
or not a recommended health behaviour.
- According to the model, an individual’s
decision to engage in a health behaviour is
based on his perceptions. Therefore, by
changing his perception, one can get him to
adopt a new behaviour.
2|Page

DUCAY, JHAYNE C. BSN 3D

 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

THE HEALTH BELIEF MODEL - Milio (1976) provides that an individual’s

health selections are influenced by the
- The model, postulates that an individual get objective to maximize valued resources
a treatment if he thinks that he is prone to a therefore selection is based to personal
disease that has severe consequences. For resources and societal resources. Change in
the individual to make the decision, though, choice making among a large number of
his evaluation of whether the benefits of people in the population leads to social
taking up treatment will outweigh the change and that teaching and learning may
difficulties that he will face in the process, is be insignificant in affecting behavior
crucial. patterns if new health.
- In addition to the six factors that influence - The basic treatise is that behavioral patterns
the making of a health care decision, various of populations and individuals who make up
demographic factors like age, sex, race, populations are a result of habitual selection
social class, education, employment status, from limited choices. She challenged the
knowledge and experience play a role in common notion that a main determinant for
how a person perceives the urgency of unhealthful behavioral choice is lack of
taking proper action to deal with his health knowledge.
condition. - Governmental and institutional policies, she
-
FAILURE TO CHANGE BEHAVIOUR
- The main reasons for the failure to change
one’s lifestyle behavior are perceived
susceptibility and barriers to change. A
person, who feels that he is highly
vulnerable to being afflicted by diseases, is
more likely to pay attention to any health
message. But barriers, like social pressure,
may stop various changes even if the person
is highly motivated.

said set the range of options for personal

choice making. It neglected the role of
community health nursing, examining the
determinants of community health and
attempting to influence those determinants
through public policy
- The framework provides that the health
status existing in the population occurs due
to too little or excess critical health
sustaining resources whereby people who
have enough and safe food, shelter, water
and environment are vulnerable to
infectious diseases which too much food will
lead to obesity.
- Population behavior patterns also affect
health since knowledge and perception is
Application of the Model influenced by informal and formal learning
- Breast and Cervical Cancer: The model and also by experience (Milio, n.d). Health is
has been used to find ways in which women also influenced by organizational behavior
can be encouraged to go in for cancer which includes policy makers since they
screening. provide options available to thus influencing
- Diet Change: The model has been used to selections made by individuals.
predict the likelihood of people adopting a -
healthier diet. Health Promotion Model
- Smoking: The model is used to identify if a - Nola Pender
person is likely to quit smoking by taking - Pender’s health promotion model defines
into account various factors like peer health as “a positive dynamic state not
pressure, threat of cancer, onset of merely the absence of disease.” Health
symptoms like breathing problems, etc promotion is directed at increasing a client’s
level of well-being. It describes the multi-
Milio’s Framework for dimensional nature of persons as they
interact within the environment to pursue
Prevention Model health.
Brief History/ Background Major Concepts of the Health Promotion
- Nancy Milio a nurse and leader in public Model
health policy and public health education - Health promotion is defined as behavior
developed a framework for prevention that motivated by the desire to increase well-
includes concepts of community-oriented, being and actualize human health potential.
population focused care. (1976,1981). It is an approach to wellness.
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DUCAY, JHAYNE C. BSN 3D

 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

- On the other hand, health protection or - Situational Influences: Personal

illness prevention is described as behavior perceptions and cognitions of any given
motivated desire to actively avoid illness, situation or context that can facilitate or
detect it early, or maintain functioning impede behavior. Include perceptions of
within the constraints of illness. options available, demand characteristics
and aesthetic features of the environment in
Three Areas of Health Promotion Model which given health promoting is proposed to
- Individual characteristics and experiences take place. Situational influences may have
(prior related behavior and personal direct or indirect influences on health
factors). behavior.
- Behavior-specific cognitions and affect
(perceived benefits of action, perceived Strengths and Weaknesses
barriers to action, perceived self-efficacy, Strengths
activity-related affect, interpersonal - The Health Promotion Model is simple to
influences, and situational influences). understand yet it is complex in structure.
- Behavioral outcomes (commitment to a - Nola Pender’s nursing theory gave much
plan of action, immediate competing focus on health promotion and disease
demands and preferences, and health- prevention making it stand out from other
promoting behavior) nursing theories.
- It is highly applicable in the community
health setting.
Sub Concepts of the Health Promotion - It promotes the independent practice of the
Model nursing profession being the
- Personal Factors: is categorized as - primary source of health promoting
biological, psychological and socio-cultural. interventions and education
These factors are predictive of a given
behavior and shaped by the nature of the
target behavior being considered. Weakness
- Personal biological factors. Include - The Health Promotion Model of Pender was
variables such as age gender body mass not able to define the nursing metaparadigm
index pubertal status, aerobic capacity, or the concepts that a nursing theory should
strength, agility, or balance. have, man, nursing, environment, and
- Personal psychological factors. Include health.
variables such as self-esteem, self- - The conceptual framework contains multiple
motivation, personal competence, perceived concepts which may invite confusion to the
health status, and definition of health. reader.
- Personal socio-cultural factors. Include - Its applicability to an individual currently
variables such as race, ethnicity, experiencing a disease state was not given
acculturation, education, and socioeconomic emphasis.
status
- Perceived Benefits of Action: Anticipated Lawrence Green’s
positive outcomes that will occur from Precede-Proceed Model
health behavior. - The PRECEDE–PROCEED model is a cost–
- Perceived Barriers to Action: Anticipated, benefit evaluation framework proposed in
imagined or real blocks and personal costs 1974 by Lawrence W. Green that can help
of understanding a given behavior. health program planners, policy makers and
- Perceived Self-Efficacy: Judgment of other evaluators, analyze situations and
personal capability to organize and execute design health programs efficiently.
a health-promoting behavior. Perceived self- - It provides a comprehensive structure for
efficacy influences perceived barriers to assessing health and quality of life needs,
action so higher efficacy results in lowered and for designing, implementing and
perceptions of barriers to the performance evaluating health promotion and other
of the behavior. public health programs to meet those needs
- Activity-Related Affect: Subjective - One purpose and guiding principle of the
positive or negative feeling that occurs PRECEDE–PROCEED model is to direct initial
before, during and following behavior based attention to outcomes, rather than inputs. It
on the stimulus properties of the behavior guides planners through a process that
itself; Activity-related affect influences starts with desired outcomes and then works
perceived self-efficacy, which means the backwards in the causal chain to identify a
more positive the subjective feeling, the mix of strategies for achieving those
greater the feeling of efficacy. In turn, objectives.
increased feelings of efficacy can generate a - A fundamental assumption of the model is
further positive affect the active participation of its intended
- Interpersonal Influences: Cognition audience — that is, that the participants
concerning behaviors, beliefs, or attitudes of ("consumers") will take an active part in
the others. Interpersonal influences include defining their own problems, establishing
norms (expectations of significant others), their goals and developing their solutions.
social support (instrumental and emotional - In this framework, health behavior is
encouragement) and modeling (vicarious regarded as being influenced by both
learning through observing others engaged individual and environmental factors, and
in a particular behavior). Primary sources of hence has two distinct parts. First is an
interpersonal influences are families, peers, "educational diagnosis" – PRECEDE, an
and healthcare providers. acronym for Predisposing, Reinforcing and

4|Page

DUCAY, JHAYNE C. BSN 3D

 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

Enabling Constructs in Educational Phases of Precede/Proceed Framework

Diagnosis and Evaluation. Second is an Phase 1: SOCIAL DIAGNOSIS
"ecological diagnosis" - In this phase, social problem that can
- PROCEED, for Policy, Regulatory, and affect the quality of life of target
Organizational Constructs in Educational and population are identified and evaluated.
Environmental Development. - During this phase, programmer try to
- The model is multidimensional and is figure out the connection between social
founded in the social/behavioral sciences, problem and quality of life affected
epidemiology, administration, and resources availability, needs of given
education. The systematic use of the population, readiness of community people
framework in a series of clinical and field towards the change and determine desired
trials confirmed the utility and predictive outcome.
validity of the model as a planning tool. - Information regarding social problem is
gained by using various methods such as
interview, focus group discussion, surveys,
community forums etc.

Phase 2: EPIDEMIOLOGICAL DIAGNOSIS

- Health problems associated with quality of
life is determined in epidemiological
diagnosis.
- Primary or secondary source data are used
for acquiring required information.
- It seeks to identify the specific health
problems and non-health factors
associated with poor quality of life.
- Health problems are described on the basis
of time, place and person.
- Priorities are set within health problem and
with target population.
PRECEDE stands for - Epidemiological data includes vital
P – Predisposing statistics, disability, incidence, prevalence
R- Reinforcing etc.
E – Enabling
C – Construct in Phase 3: BEHAVIORAL and
E- Educational ENVIRONMENTAL ASSESSMENT
D – Diagnosis - Behaviors, practices, lifestyle,
E – Evaluation environmental factors are determined
affecting health problem identified in
PROCEED stands for phase 2.
P – Policy - This assessment facilitate planner to
R – Regulatory prioritize behavior which will be targeted in
O – Organizational intervention program.
C – Construct in - Behavioral diagnosis analyzes behaviors
E – Educational that influence the problem identified in
E – Environmental phase 1 and 2.
D – Development - Environmental diagnosis analyzes
Purpose of PRECEDE/PROCEED Model: physical and social environment that would
- It provides structural framework for affect the behavior of the individual.
developing behavior change intervention. - Non behavioral factors include factors such
- This model is also used for monitoring and as climate, workplace, availability and
evaluating the intervention program. adequacy of health institutions.
- It is participatory model and involves
community participation.
- Content, methods/media for a particular
program is selected according to need.

Phase 4: EDUCATIONAL DIAGNOSIS

- In this phase, predisposing, reinforcing and
enabling factor that may support or form
barrier to changing environment.
- Predisposing Factors
o It includes any characteristics of
individual or population that
affects personal motivation to
bring change in their behavior. It
includes:
i. Knowledge
ii. Beliefs
iii. Values
iv. Attitudes
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DUCAY, JHAYNE C. BSN 3D

 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

v. Norms etc - There are other fields of nursing where

– E.g. believe that smoking harmful public health nurses are working. They are
for health. in schools and work settings. In schools,
public health nurses take care of the health
Reinforcing Factors needs of the students. In communities
- feedbacks from others which may be where there are workers and laborers, the
positive or negative; continued reward, public health nurse in the health centers is
incentive can motivate repetition of certain expected to provide occupational health
behavior. nursing activities to those who need them
It includes:
o Reward/Punishment
o Peer influence School Nursing
o Teacher - The Health and Nutrition Center (HNC) of
o Family etc. the Department of Education (DepEd) is
o E.g. peer pressure for smoking mandated to safeguard the health and
nutritional well-being of the total school
population. The HNC has two divisions:
Phase 5: ADMINISTRATIVE and Health and Nutrition Division. The Health
POLICY DIAGNOSIS Division has four sections, Medical, Dental,
- It identifies administrative and policy Nursing Health and Health Education
factors which should be focused before Sections.
program implementation. - School-aged children and adolescents face
- Policy diagnosis: it analyzes if goals/ increasingly difficult challenges related to
objective of program is compatible with health.
that of organization. - Education and health are interrelated. “To
- Administrative diagnosis: it analyses learn effectively, children need good
policies, resources in organizational health” – WHO
situation that facilitate or hinder - Philippine situation:
development of program. - School nurse visits 4-6 schools per month,
Phase 6: IMPLEMENTATION of PROGRAM with each visit lasting for 3 days.
- In this phase, planned program is put into - In 2006 an estimated 12.8 million children
action in targeted population. aged below 15 years were living in families
that did not meet basic requirements
Phase 7: PROCESS EVALUATION based on their income.
- In process evaluation, implementation - Every child deserves to be as fit and as
process is evaluated; it helps to determine healthy as possible to gain maximum
if the program is being conducted as benefits from his education.
planned and helps to bring modification if - The primary role -support student learning
necessary to improve the program. and ensure that educational potential is
not hampered by unmet health needs.
Phase 8: IMPACT EVALUATION - School nurses are the frontliners in the
- This evaluation is carried out immediately provisions of health and nutrition programs
after implementation of program. in the school.
- It helps to determine effectiveness and - Assist the pupils in acquiring health
efficiency of the program as well as change knowledge in developing attitudes and
in predisposing, reinforcing and enabling practices conducive to healthful living.
factors
Definition
Phase 9: OUTCOME EVALUATION - School nursing is a type of public health
nursing that focuses on the promotion of
- It evaluates if the program implemented health and wellness of the pupils/students,
produce effect favorable to outcomes teaching and non-teaching personnel of
identified in phase 1. the schools. School nurses assist young
- It measures achievement of overall people in making choices for healthy
objective of program and change in quality lifestyle, reduce risk taking behavior and
of life. focus on issues such as prevention of drug
- It determines effect of program in health and substance abuse, teenage pregnancy,
and quality of life of the community. sexually transmitted infection,
malnutrition, and communicable and non-
communicable diseases.

Objectives of School Nursing

General
- To promote and maintain the health of the
school populace by providing
comprehensive and quality nursing care
Different Fields of Nursing

Introduction Specific

6|Page

DUCAY, JHAYNE C. BSN 3D

 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

1. Provide quality nursing service to the

school population.
2. Create awareness among school
children, personnel and administrators
on the importance of the promotive and
preventive aspects of health through
health education School Nursing
3. Encourage the provision of standard - Skills needed by and provided to the
functional facilities school nurses to enable them to deliver
4. Provide nursing personnel with effective health care to the school
opportunities for continuing education populace:
and training - Assessment and Screening Skills
5. Conduct and participate in researchers - Health Counseling Skills
related to nursing care; and - Social Mobilization Skills
6. Establish/strengthen linkages with - Good Oral and Written Communication
government and non-government Skills
organization/agencies for school - Basic Management Skills
community health work - Life Skills
School Health Services Duties and Responsibilities of the School
Comprehensive School Health Education Nurses
- This is a planned, sequential, k-12 1. Health advocacy
curriculum that address the physical, 2. Health and nutrition assessment including
mental, emotional and social dimensions of other screening procedures such as vision
health. and hearing
Physical Education and Activity 3. Supervision of the health and safety of the
- This provides cognitive content and learning school plant
experiences in a variety of activity areas 4. Treatment of common ailments and
such as basic movement skills, physical attending to emergency cases
fitness rhythms and dance and aquatics. 5. Referrals and follow-up of pupils and
personnel
Nutrition Services 6. Home visits
- These provides access to a variety of 7. Community outreach like attending
nutritious and appealing meals that community assemblies and organizing
- accommodate the health and nutrition school community health councils
needs of all students. 8. Recording and reporting of accomplishments
School Health Services 9. Monitoring and evaluation of programs and
- These are services provided for students to projects
appraise, protect and promote health.
- These services are designed to ensure Functions of the School Nurse
access or referral to primary health care School Health and Nutrition Survey
services. - This shall be done initially to provide data
for evaluation and for planning purposes.
School Counselling, Psychological and The surveys shall include among others
Social Services the current health and nutritional status of
- These are services provided to improve school children, situation on health
student’s mental, emotional and social facilities on health facilities as well as
health. actual status of health education activities
- These services include individual and undertaken by the teachers and health
group assessment, interventions and personnel.
referrals.
Putting up a Functional School Clinic
Health and Safe School Environment - R. A 124 mandates that all schools are to
- This refers to the physical and aesthetic provide school clinics for the treatment of
surroundings and the psychosocial climate minor ailments and attendance to
and culture of the school. emergency cases. The school nurses
Student, Family and Community encourage the provision of this facility.
Involvement in Schools
- This pertains to an integrated schools, Health Assessment
parent and community approach for - Health assessment aims to discover the
enhancing the health and well-being of signs of illness and physical defects to
students. School health advisory councils, correct them, check on the health habits of
coalitions, and broadly based pupils and prevent the progress of those
constituencies for school health can build which cannot be corrected.
support for school health programs. - Health Assessment should include:
a) Interviewing for information
Health Promotion for School Staff gathering
- This provides opportunities for school staff b) Nutritional Assessment-height and
to improve their health status through weight measurements
activities such as health assessment, c) Vision acuity test/hearing test
health education and health related fitness d) Four methods of physical and
activities mental condition

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DUCAY, JHAYNE C. BSN 3D

 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

e) Taking of vital signs recognition of hearing loss is extremely

f) Appraisal of the general physical important not only because it may
and mental conditions interfere with the teaching-learning
g) Recording of findings process as well as school achievement
- Frequency but also because the development of
o Every school child should be examined clear speech and social skills is facilitated
once a year and as the need arises like by good hearing. This will also help in
during epidemics. attaining effective treatment and
rehabilitation.
Height and Weight Measurement and
Nutritional Status Determination
o To determine the nutritional status of
children.
o In the DepEd, weight-for-age and height-
for-age indicators for children below 10
years are used while Body Mass Index
(BMI) is used for children 10 years and
Important Reminders: above. This is done at the beginning and
a) If the health personnel are of the end of the school year.
opposite sex, it must be done in the o Appropriate school feeding programs with
presence of other school personnel rice, milk or fortified noodles are given to
preferably of the same sex. children with below normal nutritional
b) Discuss with the teacher and the status for 120 feeding days to overcome
pupil concerned the results of the nutritional deficiencies. Deworming is a
findings and what should be done pre-requisite before feeding, parental
after the assessment is finished. consent is a must before deworming.
c) Treat cases needing treatment during
the special treatment periods and not
during the inspection except in case
of emergency.
d) Refer cases which cannot be handled
by the nurses promptly. Medical Referrals
e) Parents must be informed of the o Whenever necessary, the school nurse
findings. may recommend that a student with an
existing condition be referred for further
Standard Vision Testing for School assessment and intervention by the
Children appropriate professional/agency. It is
o Vision is a very important sensory skill recommended that parents/guardians
that affects a child’s learning and general take these referrals seriously and return
development. Early detection and each referral form completed by the
treatment of eye and vision problems can appropriate medical resource as soon as
prevent childhood blindness and visual possible. This helps to ensure the proper
disorder. follow up planning and care of the
o This procedure aims to: returning student.
a) Screen students with poor visual
acuity and identify other ocular Attendance to Emergency Cases
problems; o It is incumbent upon the nurses to attend
b) Refer students with eye diseases to emergency cases while they are in
and errors of refraction for further school. However, majority of the nurses
examination and management. are assigned to several schools. In their
o Important: absences, the school authorities and the
1. After the pupils has been screened clinic teacher have the responsibility of
by either the nurse or the teacher, attending and referring them promptly.
the school physician should examine Parents must be informed of the
the child with an eye problem for occurrence of the emergency as soon as
validation and referral purposes. possible
2. A child with visual acuity of 20/40 or Student Health Counselling
poorer due to error of refraction
should be referred. In the same o Occasionally, parents, teachers, or other
manner, pupils who have visual staff members, observe a student who is
complaints or exhibit deviation from presenting signs and symptoms of
the normal should be referred for physical or emotional problem. School
professional examination regardless nurses welcome the opportunity to help
of the result of visual acuity test. concerned parents and guardians of
3. Parents should be informed of the students in any form of individual health
defective vision/eye problem of their counseling. The school nurse also helps
children to make appropriate referrals either to
school-provided or outside counselling
Ear Examination services whenever necessary.
o Children who do not see or hear well will
often experience difficulty in the Health and Nutrition Education Activities
educational environment. The early
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 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

o The school nurse takes every opportunity f) Teachers’ Health Profile

to talk on health-related topics both in g) Records of emergency cases
formal and informal settings. She should attended to
be willing to use her ability, knowledge h) Records of referral made
and background to influence the school i) Inventory of clinic equipment and
and community in a healthy and positive supplies
way. j) Health and nutrition activities in
o It is considered a great privilege to help school
improve the health knowledge and the k) Records of accomplishments of
behavior of students, teachers and school health services
parents and help enhance the quality of l) Records of officers/officials of the
their lives by way of the following: school-Community Health Council
a) Plans/conducts training programs, and their accomplishments
conferences/workshops on health m) Action Plan
and nutrition for clinic teachers, n) Performance Contract
pupils, and parents
b) Acts as resource person on any School Plant Inspection for Healthy
health/nutrition related Environment
activity/activities - The school plant shall be inspected in order
c) Disseminate to teachers’ health and to provide a healthful environment and
nutrition messages/health and safety in schools. Aside from the minimum
nutrition assessment findings and standards for schools in relation to school
their prevention and control during site, area, location, space and sanitation,
meetings classroom and other rooms and facilities
shall be inspected for size, lightning,
ventilation and arrangement of seats.
Organization of School-Community Health Particular attention shall focus on the
and Nutrition Councils provision and maintenance of toilets, school
- The school nurse shall initiate/encourage the clinics, water supplies, sanitation of school
organization/reactivation of School canteen, and safety and nutritional value of
Community Health Council, the membership foods being served.
of which shall come from both school and
community. Members of the community Rapid Classroom Inspection
should be motivated to take active o Rapid classroom inspection is done as a
participation in the solution of school- routine procedure when frequent and
community health-related problems and regular visits can be made to a school
concerns. The school shall conduct school- during the year, in addition to the
community assemblies to interpret the individual health assessment.
school health problems/programs in the This aims to:
community. o Detect cases of communicable diseases
o Note corrections that have been made
o Note if eyeglasses are correctly adjusted
o Note the general cleanliness of pupils;
and
Communicable Disease Control o Note new ailments.
- Prevention and control of communicable
disease is a responsibility shared by parents,
school personnel, community and the
Department of Health. If a child is suffering
from a recognized contagious or infectious
disease, he/she should be referred and sent Home Visitation
home and not be permitted to return until o Before home visitation, safety has to be
the school authorities are satisfied that any considered, hence, all precautionary
contagious and infectious disease does not measures should be observed. If security
exist. is assured, the nurse should plan for the
Establishment of Data Bank on School visit. She should prepare herself with all
Health and Nutrition Activities available facts relative to the family and
- Accurate and up-to-date health records are the child in whose interest the visit is
essential in helping monitor the health of made. School principals should know the
students while they are in schools. Findings home conditions of the pupils and maybe
are recorded in the health examination card consulted. The nurse should know the
and reviewed and updated annually. correct name and address of the child
and the exact nurse of the defect/ailment
Data bank shall include the following: for which she advises the correction
a) Treatment in the school clinic o The following are some cases
b) Records of the school visit (RHU and needing home visitation:
school health personnel) 1. Pupils whose parents are afraid of
c) Health Assessment Report of the some medical procedures.
School Health personnel 2. Pupils who get re-infected because of
d) Health and Nutritional Status of home conditions.
pupils/students 3. Pupils suffering from communicable
e) Form 86 of teaching and non- diseases.
teaching personnel
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 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

4. Pupils who are absent frequently 4. Supplementation – Health care and

because of sickness. laboratory workers could be provided with
5. Pupils who are malnourished. multivitamins to increase resistance to
infections
Occupational Health Nursing
Introduction Duties & Function of Occupational Health
- The practice of occupational health nursing Nurses
requires a broad base of knowledge in (Rule 1965.04 of the Amended OSHS by
nursing, public health, and human relations. DOLE)
The focus of this specialty is the 1. Organizing and administering heath
preservation and restoration of the health of service program integrating occupational
workers and working populations. safety in the absence of a physician;
Occupational health nursing is an otherwise, these activities of the nurse
autonomous practice requiring independent shall be in accordance with the
decisions and creative solutions to complex physician.
occupational and environmental health and 2. Providing nursing care to injured or ill
safety problems. workers.
3. Participating in health maintenance
- The public health nurse can be an examination.
occupational health nurse who is in a prime 4. Participating in the maintenance of
position to assess the health needs of the occupational health and safety by giving
working population and design healthful suggestions in the improvement of
working interventions. The integration of working environment affecting health
public health theory and principles with the and well-being of workers.
roles of occupational health nurses, increase 5. Maintaining a reporting and record
its effectiveness in serving the working system, and , if a physician is not
population. available, preparing and submitting an
annual medical report using the
Definition prescribed form to the employer.
- “The specialty practice that focuses on the
promotion, prevention and restoration of Functions of Public Health Nurse as an
health within the context of a safe and Occupational Health Nurse
health environment. It includes the (Referred from the PD 856, Chapter VII-
prevention of adverse health effects from Industrial Hygiene of the Sanitation Code of the
occupational and environmental hazards. It Philippines)
provides for and delivers occupational and 1. Work with the occupational health team
environmental health and safety programs to lead the sanitary and industrial
and services to clients.” - American hygiene of all industrial establishments
Association of Occupational Nurses including hospitals to determine their
compliance with the sanitation code and
Occupational Health Concerns its implementing rules and regulations.
- Health Hazards 2. Recommends to Local Health Authority
o Elements in the work environment the issuance of license/business permits
that can cause work related disease and suspensions or revocation of the
to worker. same for any violation of the condition
- Safety Hazards upon which said licenses or permits had
o The unsafe conditions or unsafe been issued, pursuant to existing rules
acts that significantly increase the and regulations.
risk of worker to be injured. 3. Coordinates with other government
agencies relative to the implementation
of the implementing rules and
regulations.
4. Attends to complaints of all
establishments in the area of assignment
related to industrial hygiene and
recommends appropriate measures for
immediate compliance.
5. Participate to provide, install and
maintains in good condition all control
facilities and protective barriers for
Categories of Health Hazards potential and actual hazards.
1. Administrative control – refers to the 6. Informs all affected workers regarding
development and implementation of the nature of hazards and the reasons
policies, standards, trainings, job design and for the control measures and protective
the like. equipment.
2. Engineering – refers to the adaptation of 7. Makes a periodic testing for physical
physical, chemical or technological examination of the workers and other
improvements to limit the exposure of health examinations related to worker’s
workers to hazards in the workplace. exposure to potential or actual hazards
3. Material provision – refers to providing in the workplace.
the workers with supplies or supplements 8. Provides control measures to reduce
that can decrease their exposure or noise, dust, health and other hazards.
susceptibility to occupational hazards.
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 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

9. Ensure strict compliance on the regular - Analyze trend for case management
use and proper maintenance of Personal - Conduct research base on case
Protective Equipment (PPE). management outcome
10. Provide employees/workers occupational - Workforce, Workplace and
health services and facilities. Environmental Issues
11. Refers or elevates to higher authority all - Having knowledge of worksite
unsolved issues in relation to operations, manufacturing processes
occupational and environmental health and job tasks.
problems. - Identifying and monitoring potential
12. Prepares and submit yearly reports to and existing workplace exposure
the Local and National Government. - Having knowledge of toxicological,
epidemiological and ergonomics
Levels of Prevention in Occupational principle.
Health Nursing - Understanding appropriate
Primary Prevention – health promotion and engineering and administrative control
disease prevention to prevent workplace hazards.
o Weight and cholesterol reduction, - Performing risk assessment
AIDS awareness, ergonomics - Managing health surveillance
training and smoking cessation programs
o Performing “walkthrough” surveys Legal and Ethical Responsibilities
in the workplace, recognizing - Being knowledgeable of state of
potential or existing hazards. nursing practice act and ability to
o Negotiate with employer for practice occupational health,
provision of on-site fitness center. environmental health within
o Immunization guidelines, laws and standard of
practice.
Secondary Prevention – aimed at early - Being knowledgeable of current legal
diagnosis, early treatment interventions and trends and confidentiality parameters
attempts to limit disability. - Influencing regulatory and legal
o Preplacement, periodic and job processes.
transfer evaluation to ensure that the - Management and Administration
worker is being place or continuing to - Managing budget
work in a job that is safe. - Hiring staff and management of staff
performance
Tertiary Prevention – rehabilitation and - Fostering professional development
restoration of the worker to an plans
o optimal level of functioning based on - Developing program goals and
the limitations imposed by the objectives
disability or illness - Writing audits
o Case management, negotiation of - Performing audits and quality
workplace accommodations, assurance
counselling and support for workers - Handling workers compensation and
who will continue to be affected by allocating appropriate staff resources
chronic disease. - Participating in strategic operations
planning
- Health Promotion and Disease
Skills and Competencies for Prevention
Occupational Health Nursing Practice - Conducting needs assessments
Clinical and Primary Care - Planning, developing, implementing
- Applying the nursing process in the and evaluating health programs to
delivery of care meet the needs of specific employee
- Providing first aid and primary care groups or organizations
according to treatment protocols - Integrating all levels of prevention into
- Being knowledgeable about company culture
immunization protocols - Occupational and Environmental
- Identifying employees’ emotional Health and Safety Education
needs and providing support and - Creating effective professional and
counseling technical support networks both
- Using a multidisciplinary problem- functionally and cross functionally
solving approach to occupational - Developing and implementing training
health illness and injury programs for workers and
- Maintaining records professionals
- Being knowledgeable about trends in - Research
health-related issues - Identifying researchable problems
Case Management - Systematically collecting, analyzing
- Identifying the need for case and interpreting data from sources
management services - Recognize trends in health outcomes
- Conduct, develop, implement, monitor by department, work area or work
and evaluate case management process
programs and outcomes - Planning and developing and
- Develop policies and programs for conducting research
case management - Professionalism
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 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

- Engaging in lifelong learning plans 2. Extreme Life Experience

- Maintaining currency in practice o Provision of mental health and
- Acting as a professional role model for psychosocial support (MHPSS) during
students and colleagues personal and community wide
- Advancing the specialty through disasters
knowledge and science

Partner Institutions
o NGAs ( DOLE, DSWD, DepEd, Tesda, CHED,
DILG)
o NGOs (WHO, PPA, PAP, PNA, PLAE, AWIT
Foundation, WAPR, NGF)

Legislations Policies and Laws

- Presidential Decree (PD) 442 – o DOH Administrative Order No. 8 Series of
Philippine Labor Code 2001 the National Mental Health Policy
- The Administrative Code of o DOH Administrative Order No. 2016-0039
Enforcement of Safety and Health Revised Operational Framework for a
Standards Comprehensive National Mental Health
- The Occupational Safety and Health Program
Standards (OSHS) o Republic Act No. 11036 Mental Health Act
- Executive Order 307 – Creating Strategies, Action Points and Timeline
Occupational Safety and Health Center - Governance
under Employees Compensation - Service coverage
Commission - Advocacy
- PD 626 – Employees Compensation and - Evidence
State Insurance Fund - Regulation
- Hazard-specific laws regarding
antisexual harassment
- RA 9165 – Comprehensive Drugs Act of Calendar of Activities
2002 - September 10 - World Suicide
- RA 6969 – Toxic Substance Act • RA Prevention Day
9231 – Special Abuse, Exploitation and - October 10 -World Mental Health Day
Discrimination Act - 2nd Week of October - National Mental
- RA 11058 – Strengthening Compliance Week
with Occupational Safety and Health
Standard Act of 2017
Community Mental Health Nursing
Mental Health Program
o Mental health and well-being is a concern of
all. Addressing concerns related to Mental,
Neurological and Substance contributes to
the attainment of the SDGs. Through a
comprehensive mental health program that
includes a wide range of promotive,
preventive, treatment and rehabilitative
services; that is for all individuals across the
life course especially those at risk of and
suffering from MNS disorders; integrated in
various treatment settings from community
to facility that is implemented from the
national to the barangay level; and backed
with institutional support mechanisms from
different government agencies and CSOs,
we hope to attain the highest possible level
of health for the nation because there is no
Universal Health Care without mental health

Program Components
1. Wellness of Daily Living
o All health/social/poverty
reduction/safety and security
programs and the like are protective
factors in general for the entire
population
o Promotion of Healthy Lifestyle,
Prevention and Control of Diseases,
Family wellness programs, etc
o School and workplace health and
wellness programs
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 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

is more abstract and people share a

group perspective or identity based
on culture, values, history, interests
and goals

TYPES OF COMMUNITY
ACCORDING TO SOCIOLOGY
1. Rural community
a. Necessary facilities such as schools,
hospitals, police stations, etc. are
mostly absent from such a
community life. Such communities
are often perceived as ‘backward’
due to a lack of proper
infrastructure. Typically, inhabitants
of a rural community have to travel
to the nearest city or town for
access to necessary facilities like
medical care, etc.
b. Rural communities are mostly made
up of smaller populations that
spread out to self-sustaining areas
where natural resources are readily
available
2. Sub-urban Community
a. Suburban communities are often
perceived as intermediate to rural
and urban communities. That is why
it is known as “suburban.”
b. They are more abundant in
population as compared to the rural
community and less in number
relative to an urban community.
Such communities are often out-
lying a larger city. They have limited
resources and little political
Chapter 3 autonomy.
c. Sub-urban areas are often referred
to as single-family homes or
COMMUNITY housing divisions that are close to
- A community is a group of people living each other.
in one locality, composed of individuals, 3. Urban community
families or group of people, who a. An urban community is often
interact with one another with common perceived as the opposite of a rural
interests or characteristics. community. The lifestyle of an urban
- Community is a group of people, who community is highly impersonal,
share something in common and complex, and heterogeneous in
interact with one another, who may their identities and lifestyle.
exhibit a commitment with one another b. Communities are the product of
and may share a geographic boundary. rational choice. There is a complex
(Lundy and Janes) division of labor with specialization
in professions and jobs, which
Defining Attributes of Communities shapes up the identity of an urban
- A community is a group of PEOPLE who: community. Modern facilities and
o Has common interests or characteristics infrastructure are also central to
o Interacts with one another urban communities. State officials
o Has sense of unity or belonging and diplomatic activities are also
o Functions collectively within a defined social fundamental to urban communities.
structure to address common concerns
TYPES OF ORGANIZATIONAL COMMUNITIES
Types of Communities 1. Unaffiliated
1. Geopolitical / Territorial community a. It is among the types of community
that is based on individuals who are
a. Defined or formed by both natural not closely associated with each
and man-made boundaries and other. This can also account for
include barangays, municipalities, subordination in some cases. Such
cities, provinces, regions and community members are not
nations. designated or affiliated with a
2. Phenomenological / Functional community or board.
community
a. Refer to relational, interactive b. They might only be present at any
groups, in which the place or setting validly convened meeting where

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 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

their action is required for a 6. Equitable and efficient use of community

common objective. resources, with the view towards sustaining
natural resources
2. Federated
a. Such communities are associated
with each other due to a common
purpose or cause. They cooperate in
a standard and collective
environment. It can be seen as a
partially individualistic and unified
community.
3. Affiliated
a. Affiliated communities are the ones
that have some commonality or
shared interest among its members
due to a connection to an
organization. For example, an
affiliated military community would
mean that they spend some portion
of their life has a direct link to
military lifestyle such as servicing in Factors Affecting Health of the Community
the military or having a kinship, etc. - Characteristics of the Population
4. Hybrid - Population variables that affect the
a. A hybrid community is one of the health of the community include:
types of community that is based o Size
on the model of a hybrid society o Density
that has two or more modes of o Composition
subsistence. For example: o Rate of growth or decline
transitioning from one state to o Cultural characteristics
another like agrarian to industrial. A o Mobility
modern-day hybrid community is
based on socio-technical o Social class and educational
advancements, such as the level
emergence of virtual communities. - Location
5. Managed o The health of the community is
a. It is a type of managed community affected by both natural and
where some management exists for man-made variables related to
the coherence of the community location.
Dimensions of Community o Natural factors consist of
- Aggregate of people geographic features, climate,
o A community composed of people who have flora and fauna.
similar demographic characteristics such as o Community boundaries, whether
age, sex, ethnic backgrounds or common the community is urban or rural,
activities, concerns and goals. the presence of open spaces,
- Location in space the quality of soil, air and water
o The physical location or geographic and the location of health
boundaries of a group of people may define facilities are influenced by
a community. human decisions and behavior
- Social Systems - Social System
o The relationship of members that forms one o Social system is a patterned
another is a major dimension of a series of interrelationships
community. The interaction of members to existing between individuals,
fulfill their essential functions to achieve a groups and institutions and
goal makes them up as a community. forming a coherent whole.
o Social system components that
affect health include the family,
economic, educational,
Characteristics of a Healthy Community communication, political, legal,
1. A shared sense of being a community based religious, recreational and
on history and values. health systems
2. A general feeling of empowerment and Roles of the Community Health Nurse
control over matters that affect the - Health monitor
community as a whole. o Detecting deviations from
3. Existing structures that allow subgroups health in individuals, families,
within the community to participate in specific population groups and
decision making in community matters. the community as a whole.
4. The ability to cope with change, solve - Provider of nursing care to the sick
problems and manage conflicts within the and disabled
community through acceptable means. - Health teacher
5. Open channels of communication and o Health education is one of the
cooperation among the members of the most used interventions by the
community. nurse.
- Counselor
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 NCM 113: Community Health Nursing 2 (Population Groups and Community as Clients)
PRELIMS – INTRO, CHAPTER 1
BERNADETTE WAYNE TOSOC RN, MAN College of Health & Sciences |F 5:00PM – 9:00PM 1st SEMESTER –
A.Y 2024 - 2025

o Giving appropriate advice and 3. Maintain coordination/linkages with other

broadening a client’s insights health teams, government and non-
about a problem so that government agencies.
appropriate decisions are made 4. Initiates and conduct researches.
- Client/Patient advocate 5. Undertakes human resource training for
o Advocate is on who intercedes professional growth and development
and pleads the cause of 6. Guide and supervise student’s affiliates
another; promote and defend
the rights of clients/patients.
- Change agent
o Changing individual, family,
group or community behavior,
including lifestyle and the
environment, in order to
promote and maintain health.
- Community organizer
o Nurse stimulates and enhances
the community’s participation in
planning, organizing,
implementing and evaluating
health programs and services,
initiates community
development activities and
strengthens the community’s
capabilities to recognize and
manage health and health
related-problems
- Team member
o Community health nurse is a
member of a health team that
includes traditional health care
providers, community health
workers and volunteers as well
professionals in the health field
and intersectoral teams.
- Trainer, supervisor
o Formulate staff development.
Participate in training, the
guidance of affiliated students.
Schedule and assign staff for
training on particular programs.
- Manager
o Objectives can be done through
planning, organizing, staffing,
directing and controlling
- Coordinator of health and related
services
o Coordinate services provided by
various members of health and
related intersectoral teams.

- Researcher
o Planning and conduct of nursing
and related studies that
contribute to the improvement
of nursing and health services.
- Role model
o Nurse is called upon to provide
a good example of healthful
living to the community, to
practice and demonstrate what
she preaches

Duties and Responsibilities

of a Community Health Nurse
1. Participate in the development of an
overall health plan.
2. Provides quality nursing care to the four
clientele.
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