Module 2 CHN 1

MODULE 2
THEORETICAL FOUNDATION OF COMMUNITY HEALTH NURSING PRACTICE
INTRODUCTION:
In module 2, you will learn the framework, theories, and concepts that had been the basis or pattern of
Community health nursing practice. Application of these provides us an outcome beneficial to the
client/family in the community.
LEARNING OUTCOMES
1. Know how theory provides direction to nursing.
2. Differentiate the theories according to their application to health issues.
DISCUSSION:
*A theory is like a map of territory as opposed to an aerial photograph. The map does
not give the full terrain (i.e., the full picture); instead, it picks out those parts that are
important for its given purpose
-Barnum, 1998
HISTORICAL PERSPECTIVES ON NURSING THEORY
The Era of Florence Nightingale
 Founder of Modern Nursing. formulate a conceptual foundation for nursing practice

 First Nursing theorist, the Environmental theory. Believed that clean water, clean linens, access
to adequate sanitation, and quiet would improve health outcomes, and she put these beliefs
into practice during the Crimean War
 Also known as “The lady with the Lamp”
 First to propose that nursing needs specific education and requires training.
Figure 4: How Florence

Nightingale spent her time.
1980 onwards:
Several nursing theorists, Dorothy Johnson, Sister Callista Roy, Imogene King, Betty
Neuman, and Jean Watson among them, have included community perspectives in their
definition of health.
Dorotea Orem:
 Self Care Model
 Describe family as the basic conditioning unit by which its member learns family culture, roles,
and tasks in the family and duties and responsibilities.
Sister Calista Roy:

 Adaptation Model of 1976
 She viewed that individual response to environmental stimuli, physiologically, with self
-awareness/concept, function ability, and interdependence to the system.
 Stress the importance of coping ability to stress and other external factors
Imogene King:
 Founder: Theory of Goal Attainment"
 According to her “Family is a group of individuals bonded together for socialization”. “The
individual cannot be isolated from the family.”
 Stressed that “Family as a social system transmit values and norms of behaviour across the
lifespan.”
Betty Newman:
 Founder of “Health Care Systems Theory”

 Stressed that “Family is a group of two or more persons who create and maintain common
culture.
 “Any stressor affects the stability of the family and produces stress
Learning Activity 2-1: List at least 3 nursing personalities/theorists who contributed ideas, theories, and
concepts in the definition of health and identification of health issues.
Nursing Theorists Theory Health issue/problem Idea/concept
1.
2.
3.
Other theories related to Community Health Nursing::
General systems theory:
Viewed as an “open system,” the client exchanges information with neighbors, people around
them. They are bound to contribute their potentials, energy, and share resources to their
environment.
The basic structures of a family that is found in all open systems:
 Boundaries
 Environment
 Inputs
 Outputs
 Processing (throughput)
 Feedback
 Subsystems
Health Belief Model:

Provides the basis for the practice of daily activities to promote wellness and prevent disease
through health promotion.
“Behavior is based on current dynamics confronting an individual rather than prior experiences “
- Kurt Lewin
Constructs of the Health Belief Model
Perceived severity/ seriousness

Perceived susceptibility
Perceived benefits
Perceived barriers
Cues to action
Self-efficacy
Limitations of the model:
 The client alone receives the consequences and challenges of his/her action
 It assumes that only those clients who have distorted or negative perceptions of the
specified disease or recommended health action will fail to act.
 Those who have distorted mind or strong negative philosophy in life of the specified disease
or action will not accept changes or improvement despite health information.
 This gives the community health nurse challenges on how she will design her interaction
with the client's distorted mind and negative philosophy and perception. This does not
account for the nurse's professional responsibility to reduce this health care barrier.
Milio’s Framework for Prevention:
It acknowledges the Health belief theory by which it provides a mechanism to

“Upstream” its direction
The nurse is provided a wide scope of understanding client's health behaviors about his
surroundings.
Greater opportunity to explore health issues to analyze health problems, thus making a
diagnosis considering the economic, social, environmental, and political determinants.
Deprivation or oversupply of resources affects the health of the population or society.
Behaviors of people depend on opportunities given by society. This option makes them choose
according to their beliefs and expectations which come from their experience, education, and
from socializing others.
Decisions and opportunities depend greatly on the organization's regulations and policies which
give the population opportunity and options like resources and other health modalities.
Milio’s Propositions:
Efforts to maximize valued resources depend on the choices of individuals to value health
promotion or continue to practice his damaging health behaviors.
Social change can be influenced by a significant number of people to alter the pattern of
behavior.
Without the support of the government and non-government organizations and their resource
availability, health promotion strategies will be largely ineffective to change the population's
health behavior.
Pender’s Health Promotion Model:
Physiologic and psychological factors of an individual influence greatly in the performance of

health promotion activities.
To motivate clients of all ages, Pender uses threats and disagreement on health issues.
Introduces the 7 variables to influence behavioral changes.
1. Prior related behaviors
2. Personal factors
3. Behavior specific cognition and affect
a. Perceived benefits of action
b. Perceived barriers to action
c. Perceived self-efficacy
4. Activity-related affect
a. Interpersonal influences
b. Situational influences
5. Commitment to a plan of action
6. Immediate competing demands and preferences
7. Health-promoting behavior
Transtheoretical Model:
This refers and includes a combination of several theories of intervention, thus naming it as
“transtheoretical”.
Assumed that behavior changes take in a progressive sequence of stages, developing gradually.
Assumes that changes may occur with stability and openness.
Constructs of the Transtheoretical Model:
Stages of Change
1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
Decisional Balance
a. Pros
b. Cons
Precede-Proceed Model:
Developed by Dr. Lawrence W. Green and colleagues.

Provides a model for family/community nursing process emphasizing health promotion.
PRECEDE: stands for Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and
Evaluation. This provides an analysis/diagnosis of identified health problems.
PROCEED: stands for Policy, Regulatory, and Organizational Constructs in Educational and
Environmental Development. This serves as a model for implementing and evaluating health
programs based on Precede.
Predisposing factors refer to people’s characteristics that motivate them towards health-
related behaviour.
Enabling factors to refer to conditions in people and the environment that facilitate or
impede health-related behaviour.
Reinforcing factors refer to the effort given by a person or group of persons resulting in the
individual's health-related behavior.
Learning Activity 2-2: Select 1 theory related to community nursing,

State how it gives direction to nursing. You can write it
In a narrative form, not more than 50 words.
SUMMARY OF KEY CONCEPTS

The relatedness of these theories to your role as a community nurse is very important. These theories
could be applied when you have your clinical practice not only in your planning of an intervention, but
your perception on how to manage your care and services to the family and the community.
REFERENCES
Nursing Care of the Community Zenaida Famorca, et al. MPH, RN 2013 pp- 35- 44
https://www.slideshare.net/brissomathewarackal/theories-applied-in-community-health-nursing
https://www.slideshare.net/arunmadanan/application-of-theories-models-and-conceptual-frameworks-into-
family-health-care?next_slideshow=1

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MODULE 2

THEORETICAL FOUNDATION OF COMMUNITY HEALTH NURSING PRACTICE

The Era of Florence Nightingale

 Founder of Modern Nursing. formulate a conceptual foundation for nursing practice

Figure 4: How Florence

Sister Calista Roy:

 Founder of “Health Care Systems Theory”

Nursing Theorists Theory Health issue/problem Idea/concept

Other theories related to Community Health Nursing::

General systems theory:

Health Belief Model:

Constructs of the Health Belief Model

Perceived severity/ seriousness

Milio’s Framework for Prevention:

It acknowledges the Health belief theory by which it provides a mechanism to

Pender’s Health Promotion Model:

Physiologic and psychological factors of an individual influence greatly in the performance of

Developed by Dr. Lawrence W. Green and colleagues.

Learning Activity 2-2: Select 1 theory related to community nursing,

SUMMARY OF KEY CONCEPTS

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