COMMUNITY HEALTH NURSING OVERVIEW DEFINITIONS: Community A complex interrelated structure of interaction patterns on the basis of which certain

ain relevant functions are performed (Warren, 1987) A group of people sharing common geographical boundaries &/or common values & interest; it functions within a particular socio-cultural context It is a core dimension of people with 8 subsystems: (Anderson & McFarlane, 1988) Physical Environment Education Safety & Transformation Politics & Government Health & Social Services Communication Economics Recreation Has three attributes of defining characteristics: People Place & Social Interaction Common characteristics, interests & goals Health A state of physical, mental, social well-being & not merely the absence of disease or infirmity (WHO) The optimum level of functioning (OLOF) or individuals, families & communities as affected by factors in the ecosystem: Politics safety, oppression, people empowerment Behavior culture, habits, mores & ethic customs Heredity genetic endowment, defects, strengths, risks (familial, ethnic, racial) Environmental Influences air, food, water, wastes, urban/rural, noise, radiation & pollution Socio-Economic Influences employment, education & housing Health Care Delivery System Community Health Nursing A special field of nursing that combines the skills of nursing, public health & some phases of social assistance & functions as part of the total public health program for the promotion of health, improvement of the conditions in the social & physical environment, rehabilitation of illness & disability (WHO) Is a service rendered by a professional nurse with the community groups, families, & individuals at home, in health centers, in clinics, in schools & in places of work for the promotion of health, prevention of illness, care of the sick & rehabilitation (Ruth B. Freeman) DEFINITIONS OF PUBLIC/COMMUNITY HEALTH: According to Anderson Gaylord An organized community program designed to prolong efficient life; whatever impairs or shortens efficient human life is a matter of public concern & it is the

duty of the health department as an agent of the people or the community to prevent unnecessary illness According to Dr. C.E. Winslow The art & science of preventing disease, prolonging life, promoting health & efficiency through organized community effort for the sanitation of the environment, control of communicable disease, the education of individuals in personal hygiene, the organization of medical & nursing services for the early diagnosis & preventive treatment of disease & the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits is to enable every citizen to realize his birthright of health & longevity According to Hanlon Is dedicated to the common attainment of the highest level of physical, mental, & social well-being & longevity consistent with available knowledge & resources at a given time & place; it holds this goal as its contribution to the most effective total development & life of the individual & his society According to Jacobson Is a learned practice discipline with the ultimate goal of contributing, as individuals & in collaboration with others to the promotion of the clients OLOF through health teaching & delivery of care According to Purdom Is the delivery of basic health needs of the people for the survival of the human specie According to Maglaya The use of nursing process to benefit the levels of clientele in CHN: family, community, & population group HISTORY OF CHN: Pre-Christian Period Human beings in their fight for survival devised their own measures to cope with birth, death & illness with mythical, magical or religious rites High priest held a reserved place in their society Christian Period Phoebe first visiting nurse went among the people to bring physical & spiritual comfort to the sick & dying Nursing care was provided through the religious orders of nuns & monks Nursing became an outlet for devoted religious expression St. Vincent de Paul founded & directed the work of the sisters of charity visiting the sick & aiding the poor in their program Modern Nursing Florence Nightingale founder of modern nursing Nurse is responsible for teaching basic health principles & practices to the patient & his family CHN first appeared in Liverpool, England William Ruthbone founded the modern visiting nurse organization 20th Century Emphasis was placed on the nurses role in the community adopting to the rapid cultural changes, family mobility & urbanization CHN History in the Philippines 1901: Act No. 157 creation of Board of Health of the Philippines 1905: Act No. 1407 reorganization act; taken over by Bureau of Health under the Department of Interior 1912: Act No. 2156 aka Fajardo Act; creation of Sanitary Division 1919: First Filipino Nurse Supervisor was appointed under the Bureau of Health Miss Carmen del Rosario

1923: establishment of government nursing schools in Zamboanga & Baguio City intended to train women & prepare them to render service among their people 1941: public health nurses were assigned to devastated areas of WWII to attend to the sick & wounded 1948: first training center of the BOH named Dona Marta Health Center 1953: RA No.1082 or the Rural Health Act was approved 1961: Ms. Annie Sand founded the Department of Health National League of Nurses, Inc. 1975: restructuring of the health care delivery system; defined the roles of nurse & midwife; aim 1 RMW : 5000 population 1976-1986: required medical & nursing graduates to serve the community for two months before issuance of license; this program was stopped when the nursing graduates reached 12,000/annum 1990-1992: RA7160 or the Local Government Code was passed & implemented; devolution of power from the national to the local government PHILOSOPHY OF CHN: According to Dr. Margaret Shetland: Community Health Nursing is based on the worth & dignity of man. CONCEPTS OF CHN: The primary focus of CHN is health promotion; the CHN by the nature of her work has the opportunity & responsibility for evaluating the health status of people & groups & relating them to practice CHN practice is extended to benefit not only the individual but the whole family community CHN are generalists Contact with client may continue over a long period of time which includes all ages & all types of health care The nature of CHN practice requires that current knowledge derived from biological & social sciences, ecology, clinical nursing & community health organization be utilized The dynamic process of ADPIE is implicit in the practice of CHN GOAL OF CHN: The goal of CHN according to Zenaida Nisce is: To help communities & families to cope with the discontinuities in health & threats in such a way as to maximize their potential for high level wellness as well as to promote reciprocally supportive relationship between people & their physical & social environment. OBJECTIVES OF CHN: To practice in the development of an overall health plan for the community & its implementation & evaluation To provide quality nursing services to clients To coordinate nursing services with various members of the health team To participate in &/or conduct researches relevant to community health & disseminate results for improvement of care To provide CHN personnel with opportunities for CPE PRINCIPLES OF CHN: (Adapted from those formulated by Mary S. Gardner & Leahey, Cobb & Jones) CHN is based on the recognized needs of communities, families, groups & individuals The community health nurse must understand fully the objectives & policies of the agency she represents

In CHN, the family is the unit of service CHN must be available to all regardless of race, creed & socio-economic status Health teaching is a primary responsibility of the community health nurse The community health nurse works as a member of the health team There must be provision for periodic evaluation of CHN services Opportunities for continuing staff education program for nurses must be provided by the CHN agency. The community health nurse also has a responsibility for his/her own professional growth The community health nurse makes use of available community health resources The community health nurse utilizes the already existing active organized groups in the community There must be provision for educative supervision in CHN There should be accurate recording & reporting in CHN ROLES/FUNCTIONS OF A CHN/PHN (NURSE II & III) Planner/Programmer Identifies needs, priorities & problems of individuals, families & communities Formulates nursing component of health plans In doctorless area, he/she is responsible for the formulation of the municipal health plan Interpret & implement the nursing plan, program & policies, memoranda, circulars for the concerned staff/personnel Provide technical assistance to rural health midwives in health matters like target setting, etc. Provider of Nursing Care Provides direct nursing care to the sick, disabled in the home, clinic, school or place of work Develops the familys capability to take care of the sick, disabled or dependent member Provides continuity of patient care Manager/Supervisor Formulates individual, family, group & community-centered care plan Interprets & implements program policies, memoranda, circulars Organizes work force, resources, equipments & supplies & delivery of health care at local levels Requisition, allocation & distribution of materials (medicines & supplies); records & reports equipment Provides technical & administrative support to RHM Conducts regular supervisory visits & meetings to different RHMs & gives feedback on accomplishments/performances Community Organizer Responsible for motivating & enhancing community participation in terms of planning, organizing, implementing & evaluating health programs/activities Coordination of Services Coordinates with individuals, families, groups for health & health-related services provided by various members of the health team & other GOs & NGOs Coordinates nursing program with other health programs such as environmental sanitation, health education, dental & mental health Trainer/Health Educator/Counselor

Identifies & interprets training needs of RHMs & BHWs & hilots Formulates appropriate training program designs for PHMs BHWs & hilots Provides & arranges learning experience for RHMs & other health workers Conducts pre & post consultation conference for clinic patients Acts as a resource speaker/person on health & health related services Participates in the development & distribution of Information Education & Communication (IEC) materials Conducts IEC orientation for selected groups on specific programs/projects Initiates the use of tri-media for health education purposes Conduct premarital counseling Health Monitor Detects deviation from health of individuals, families, groups of the community through contact/visits with them Uses symptomatic & objective observation & other forms of data gathering like morbidity, registry, questionnaire, checklist & anecdotal report/record to monitor growth & development & health status of individuals, families & communities Role Model Provide good example/model of healthful living to the public/community Change Agent Motivates changes in health behavior of individuals, families, groups & community including lifestyle in order to promote & maintain health Recorder/Reporter/Statistician Prepares & submits required reports & records Maintain adequate, accurate & complete recording & reports Reviews, validates, consolidates, analyzes & interprets all records & reports Prepares statistical data/charts & other data presentation for display & for presentation in staff meetings, conferences & seminar/workshops Researcher Participates/assists in the conduct of survey studies & researches on nursing & health-related subjects Coordinates with government & non-government organization in the implementation of studies/research