CONCEPT OF HEALTH AND PROMOTION

1. What is “Health” according to WHO.

The WHO constitution states: "Health is a state of complete physical, mental
and social well-being and not merely the absence of disease or infirmity."
2. Define Community Health Nursing
Community health nursing according to WHO is a population-focused,
community-oriented approach aimed at health promotion of an entire
population, and prevention of disease, disability and premature death in a
population.
Community health nursing is learned practice discipline with the ultimate
goal of contributing, as individuals and in collaboration with others to the
promotion of the patients, optimum level of functioning through teaching and
delivery of care (Margaret J Jacobson, 1979).
“The utilization of the nursing process in the different levels of clientele-
individuals, families, population groups and communities, concerned with the
promotion of health, prevention of disease and disability and rehabilitation.”
( Maglaya, et al)
3. Levels of Clientele in Community Health Nursing Practice
There are four levels of clientele: individual, family, population group (those
who share common characteristics, developmental stages and common exposure
to health problems – e.g., children, elderly), and the community.
A. Community
Their client is the community, and not any individual person. A
community comprises people of various ages, health conditions, social status
and cultures. The community health nurses are expected to focus their work on
disease prevention and health promotion, including promotion of self-care.
B. Population Group
A group of people sharing the same characteristics, developmental stage
or common exposure to particular environmental factors thus resulting in
common health problems.
C. Family
Defined by Murray and Zentner is a small social system and primary
reference group made up of two or more persons living together who are related
by blood, marriage or adoption or who are living together by arrangement over
a period of time.
 D. Individual
Basic approaches in looking at the individual.
 Atomistic: the whole is equal to the sum of its parts.
 Holistic: the whole is NOT equal to the sum of its parts; traces man’s
relationship in the suprasystem of society.

4. Levels of Prevention
A. Primary Prevention
Primary prevention aims to prevent disease or injury before it ever occurs.
This is done by preventing exposures to hazards that cause disease or injury,
altering unhealthy or unsafe behaviors that can lead to disease or injury, and
increasing resistance to disease or injury should exposure occur.
B. Secondary Prevention
Secondary prevention aims to reduce the impact of a disease or injury that
has already occurred. This is done by detecting and treating disease or injury as
soon as possible to halt or slow its progress, encouraging personal strategies to
prevent reinjury or recurrence, and implementing programs to return people to
their original health and function to prevent long-term problems.
C. Tertiary Prevention
Tertiary prevention aims to soften the impact of an ongoing illness or
injury that has lasting effects. This is done by helping people manage long-term,
often-complex health problems and injuries (e.g., chronic diseases, permanent
impairments) in order to improve as much as possible their ability to function,
their quality of life and their life expectancy.

CONCEPT OF PUBLIC HEALTH NURSING

1. Define Public Health Nursing
Public health nursing is defined as the practice of promoting and protecting
the health of populations using knowledge from nursing, social, and public
health sciences (American Public Health Association, Public Health Nursing
Section, 1996). Public health nursing practice focuses on population health,
with the goal of promoting health, and preventing disease and disability.
2. What are the Principles of Public Health?
A. Public health should address principally the fundamental causes of
disease and requirements for health, aiming to prevent adverse health
outcomes.
 B. Public health should achieve community health in a way that respects
the rights of individuals in the community.
C. Public health policies, programs, and priorities should be developed
and evaluated through processes that ensure an opportunity for input
from community members.
D. Public health should advocate and work for the empowerment of
disenfranchised community members, aiming to ensure that the basic
resources and conditions necessary for health are accessible to all.
E. Public health should seek the information needed to implement
effective policies and programs that protect and promote health.
F. Public health institutions should provide communities with the
information they have that is needed for decisions on policies or
programs and should obtain the community’s consent for their
implementation.
G. Public health institutions should act in a timely manner on the
information they have within the resources and the mandate given to
them by the public.
H. Public health programs and policies should incorporate a variety of
approaches that anticipate and respect diverse values, beliefs, and
cultures in the community.
I. Public health programs and policies should be implemented in a
manner that most enhances the physical and social environment.
J. Public health institutions should protect the confidentiality of
information that can bring harm to an individual or community if
made public. Exceptions must be justified on the basis of the high
likelihood of significant harm to the individual or others.
K. Public health institutions should ensure the professional competence
of their employees.
L. Public health institutions and their employees should engage in
collaborations and affiliations in ways that build the public’s trust and
the institution’s effectiveness.

3. Roles and Functions of:

A. Public Health Nurse
Public health nurses work in underserved communities to identify a specific
population's health care needs and help build healthier communities. They
routinely work with at-risk populations, such as the homeless, to improve their
health and well-being.
B. Planner/Programmer
Identifies needs, priorities, and problems of individuals, families, and
communities.
Formulates municipal health plan in the absence of a medical doctor.
Interprets and implements nursing plan, program policies, memoranda, and
circular for the concerned staff personnel.
Provides technical assistance to rural health midwives in health matters.
C. Provider of Nursing Care
Provides direct nursing care to sick or disabled in the home, clinic, school, or
workplace.
Develops the family’s capability to take care of the sick, disabled, or dependent
member.
D. Manager/Supervisor
Nursing supervisors provide a critical link between hospital management and
clinical care, overseeing patient-care operations, assigning and monitoring staff
nurses and identifying and implementing quality improvements.
E. Community Organizer
Motivates and enhances community participation in terms of planning,
organizing, implementing, and evaluating health services.
Initiates and participates in community development activities.
F. Coordinator of Services
Coordinates with individuals, families, and groups for health-related services
provided by various members of the health team.
Coordinates nursing program with other health programs like environmental
sanitation, health education, dental health, and mental health.
G. Trainer/Health Educator
Identifies and interprets training needs of the RHMs, Barangay Health Workers
(BHW), and hilots.
H. Health monitor
Detects deviation from health of individuals, families, groups, and communities
through contacts/visits with them.
I. Role Model
Provides good example of healthful living to the members of the community.
J. Change Agent
Motivates changes in health behavior in individuals, families, groups, and
communities that also include lifestyle in order to promote and maintain health.
K. Recorder/Reporter/Statistician
1) Prepares and submits required reports and records.
2) Maintain adequate, accurate, and complete recording and reporting.
3) Reviews, validates, consolidates, analyzes, and interprets all records and
reports.
4) Prepares statistical data/chart and other data presentation.
L. Researcher
Participates in the conduct of survey studies and researches on nursing and
health-related subjects.
Coordinates with government and non-government organization in the
implementation of studies/research

4. Nursing Theories Related to CHN (relate the theories to community health

nursing concept)
A. Nightingale’s Theory of Environment
Florence Nightingale's environmental theory is based on five points, which
she believed to be essential to obtain a healthy home, such as clean water and
air, basic sanitation, cleanliness and light, as she believed that a healthy
environment was fundamental for healing.
B. Orem’s Self Care model
Dorothea Orem's Self-Care Deficit Theory defined Nursing as “The act of
assisting others in the provision and management of self-care to maintain or
improve human functioning at the home level of effectiveness.”
C. Neumann's Healthcare System Model
The Neuman Systems Model views the client as an open system that
responds to stressors in the environment. The client variables are physiological,
psychological, sociocultural, developmental, and spiritual. The client system
consists of a basic or core structure that is protected by lines of resistance.
D. Roger's Model of the Science and Unitary Man
The Science of Unitary Human Beings. Rogers envisions the human
being as a system of energy in motion within other such systems, themselves
forming more complex systems. Each human being is said to be "unitary" and
he or she cannot be considered in isolation, separate from his or her
environment.
E. Pender's Health Promotion Model (HPM)
According to Pender, the HPM makes four assumptions: Individuals
strive to control their own behavior. Individuals work to improve themselves
and their environment. Health professionals, such as nurses and doctors,
comprise the interpersonal environment, which influences individual behaviors.
F. Roy's Adaptation Model
According to Roy adaptation model, the aim of nursing is to increase
compliance and life expectancy. Roy Adaptation Model evaluates the patient in
physiologic mode, self-concept mode, role function mode and interdependence
mode aiming to provide holistic care.

5. What are the Principles of Community Health Nursing?

A. The recognized need of individuals, families and communities provides
the basis for CHN practice.
B. Knowledge and understanding of the objectives and policies of the
agency facilities goal achievement.
 C. CHN considers the family as the unit of service.
D. Respect for the values, customs and beliefs of the clients contribute to the
effectiveness of care to the client.
E. CHN integrated health education and counseling as vital parts of
functions.
F. Collaborative work relationships with the co-workers and members of the
health team facilities accomplishments of goals.
G. Periodic and continuing evaluation provides the means for assessing the
degree to which CHN goals and objectives are being attained.
H. Continuing staff education program quality services to client and are
essential to upgrade and maintain sound nursing practices in their setting.
I. Utilization of indigenous and existing community resources maximizing
the success of the efforts of the Community Health Nurses.
J. Active participation of the individual, family and community in planning
and making decisions for their health care needs, determine, to a large
extent, the success of the CHN programs.
K. Supervision of nursing services by qualified by CHN personnel provides
guidance and direction to the work to be done.
L. Accurate recording and reporting serve as the basis for evaluation of the
progress of planned programs and activities and as a guide for the future
actions.

6. Standards in Community Health Nursing

CHNs “are expected to know and use the following five standards of practice:
1. Promoting health which includes:
a) Health promotion
b) Prevention and health protection, and
c) Health maintenance, restoration and palliation
2. Building individual and community capacity;
3. Building relationships;
4. Facilitating access and equity; and
5. Demonstrating professional responsibility and accountability”
A. Theory – Applies theoretical concepts as basis for decisions in practice.
B. Data Collection – Gathers comprehensive, accurate data systematically.
C. Diagnosis – Analyzes collected data to determine the needs or health
problem.
D. Planning – Develop plans that specify nursing actions unique to needs of
client.
E. Intervention – Guided by the plan, intervenes to promote, maintain or restore
health, prevent illness and institute rehabilitation.
F. Evaluation – Evaluate responses of clients to evaluation to note progress
toward goal achievement, revise data base, diagnoses and plan.
G. Quality Assurance and Professional Development – Participates in peer
review and other means of evaluation to assure quality of nursing practice.
H. Interdisciplinary Collaboration – Collaborates with other members of the
health team, professionals and community representatives in assessing
planning, implementing, and evaluating programs for community health.
I. Research – Indulge in research to contribute to theory and practice in
community health nursing.

7. Specialized Fields in Community and Public Health Nursing

A. School Health Nursing
Application of nursing theories and principles in the care of the school
population. It carried out school health services such as maintaining school
clinic and screening in all children. It also acts as an educator and monitors
health such as mental health, environment health, and school community
linkages.
B. Occupational Health Nursing
It is the application of nursing principles and procedures in conserving the
health of workers in all occupations. It focuses on promotion. Protection, and
restoration of workers health within the context of safe and healthy work
environment. It also aimed at optimizing health, preventing illness and injury
and reducing health hazards.
C. Community Mental Health Nursing
It is defined as state of well-being where a person can realize his or her own
abilities, to cope with the normal stresses of life and work productively. The
modern trend in the care of the mentally ill is usually home care mgt. Acute
cases are the referred to and treated at the national center for mental health
(NCMH) or hospitals with facilities for psychiatric care where they are later
discharged or confined if continued supervision or care is needed.
It is composed of the following components such as stress management, drug
and alcohol abuse rehab, treatment and rehab of mentally ill patients and special
project for vulnerable groups.