COMMUNITY HEALTH NURSING CONCEPTS  Health is “absence of disease” ie if one

is free from disease than he is

Objectives: considered healthy.
 Based on germ theory of disease. 
Upon mastery of this module, you should be  Question – malnutrition, chronic
able to:  disease, accidents, drug abuse, mental
 Define community health and illness , environmental pollution etc
distinguish it from public health.  which lead to ecological concept
 Explain the concept of community. 
 Discuss and apply the various
concepts related to community 2. Ecological concept 
health nursing.  Ecologists 🡪 health is dynamic
 Demonstrate knowledge and use of equilibrium between man and his
nursing process as it applies to the environment, and disease is
philosophy and principles of maladjustment of the human organism
community health nursing to his environment. 
 Identify the different features of  “Health implies the relative absence of
community health nursing. pain and discomfort and a continuous
adaptation and adjustment to the
Community health  environment to ensure optimal function”
 is the identification of needs, along with  Raised two questions 
the protection and improvement of 🡪Imperfect man 
collective health, within a geographically 🡪Imperfect environment 
defined area.  History shows that improvement
in human adaptation to natural
Community  environment can lead to longer
 refers to a collection of people who and better quality of life- even
with the absence of modern
interact with one another and whose
health delivery services.
common interests or characteristics
form the basis for a sense of unity or
belonging
 It can be a society of people holding 3. Psychosocial concept 
common rights and privileges (e.g.,  Development in social science 🡪 Health
citizens of a town), sharing common is not only a biomedical phenomenon,
interests (e.g., a community of farmers), but it is influenced by 
or living under the same laws and  social, 
regulations (e.g., a prison community).  psychological, 
 cultural, 
The term “community health nursing” is  economic and 
composed of three major concepts:  political factors of the people
concerned, 
Community - Client  “Health is both a biological and social
Health - Goal phenomenon”
Nursing - The means
PHILOSOPHY AND PRINCIPLES 
Concept of Health: 
 Biomedical concept  Philosophy of community health nursing:
 Ecological concept 
 Psychosocial concept 
 Holistic concept 1. Philosophy of individual’s right of being
healthy.

1. Biomedical concept 
  Health is believed to be one of the right production and distribution example for
of all human being nationally and housing material production of all kinds
internationally according to wh0 charter. education transportation etc.
 Goal of health for all is based on the
philosophy of individuals right of being 12 Principles of Community Health Nursing:
healthy
 This philosophy encompasses all the The recognized need of individuals, families
aspect of the society e.g. socio cultural, and communities provides the basis for CHN
economic aspects that there is no practice. Its primary purpose is to further apply
hindrance of any kind to attain this public health measures within the framework of
rights. the total CHN effort.

2. Philosophy of working together under a 1. Knowledge and understanding of the

competent leader for the common good. objectives and policies of the agency
 It is from the primitive ages of human facilities goal achievement. 
ages, man has learnt to live together to 2. CHN considers the family as the unit of
meet their needs. service. 
 The basis of modern community health 3. Respect for the values, customs and
nursing is to share responsibility of beliefs 
helping each other. 4. CHN integrated health education and
 When it comes to considering a counseling as vital parts of functions. 
Organisation, equal participation of the 5. Collaborative work relationships with the
people working through the community co-workers and members of the health
group /people with the people, for the team facilities accomplishments of
people for their mutual benefit, change goals. 
in behaviour and health practices. 6. Periodic and continuing evaluation
 A democratic team Functioning is provides the means for assessing the
essential for effective delivery of Health degree to which CHN goals and
care services. objectives are being attained. 
7. Continuing staff education program
quality services to client and are
3. Philosophy that people in the community essential to upgrade and maintain
have the potential for continuous sound nursing practices in their setting. 
development and are capable of dealing 8. Utilization of indigenous and existing
with their own problems if educated and community resources maximizing the
helped. success of the efforts of the Community
Health Nurses. 
 An individual with average intelligence
9. Active participation of the individual,
can learn and deal with his or her own  
family and community in planning and
his or her lifestyles adjust to his or her
making decisions for their health care
changing environment and solve
needs, determine, to a large extent, the
the problems.
success of the CHN programs. 
 On the basis of philosophy, Emphasis is
10. Supervision of nursing services by
placed on health education projected
qualified by CHN personnel provides
towards individual in home, Health
guidance and direction to the work to be
Centre, place of work, School,
done. 
community places or Hospital.
11. Accurate recording and reporting serve
 This helps to modify their behaviour as the basis for evaluation of the
Respective to health. progress of planned programs and
activities and as a guide for the future
actions. 
4. Philosophy of socialism
 Socialism is one of the social system in Features of CHN
the community has control over
Eight characteristics of community health
nursing: 
1. It is a field of nursing.  Theories or parts of theoretical
2. It combines public health with frameworks to guide practice best
nursing. achieves the goal of improving nursing
3. It is population focused. practice- including that of public health.
4. It emphasizes prevention, health
 A theory is like a map of a territory as
promotion, and wellness.
opposed to an aerial photograph. The
5. It promotes client responsibilities
map does not give the full terrain (i.e.,
and self-care.
the full picture); instead it picks out
6. It uses aggregate measurement and
those parts that are important for its
analysis.
given purpose 
7. It uses principles of organizational
-Barnum, 1998
theory.
Historical Perspectives on Nursing Theory:
8. It involves inter professional
collaboration.

 Era of Florence Nightingale

 First nurse to formulate a
conceptual foundation for
nursing practice 
THEORETICAL MODELS / APPROACHES
 Believed that clean water, clean
linens, access to adequate
Theoretical Foundations of Community sanitation, and quiet   would
Health Nursing Practice  improve health outcomes, and
she put these beliefs into
Objectives: practice during the Crimean War
 1980 onwards
Upon completion of this module, the  Several nursing theorists,
students will be able to: Dorothy Johnson, Sister Callista
Roy, Imogene King, Betty
1. Describe different theories and their Neuman, and Jean Watson
application to community/public health among them, have included
nursing. community perspectives in their
2. Critique a theory in regard to its definition of health. 
relevance to population health issues.
3. Explain how theory-based practice General Systems Theory
achieves the goals of community/public
health nursing by protecting and
promoting the public's health.
 Viewed as an “open system,” the client
is considered as a set of interacting
Introduction:
elements that exchange energy, matter,
or information with the external
environment to exist.
 Disease management in the community  This concept is particularly useful when
is challenging as illnesses are analyzing interrelationships of the
interwoven with social, economic, elements within the client, as well as
genetic and environmental risks in ways those of the client and the environment. 
that are difficult to understand and more
difficult to change.
 In the face of these challenges, how can Open Systems
nurses succeed in their goal to improve
public health?  
The basic structures of a family that is found in
all open systems:
Nursing Theories:
  Boundaries
 Environment
 Inputs  Provides a complement to the Health
 Outputs Belief Model
 Processing (throughput)  Provides a mechanism for directing
 Feedback attention “upstream.”
 Subsystems  Provides for the inclusion of economic,
political, and environmental health
Health Belief Model (HBM) determinants; therefore, the nurse is
given broader range in the diagnosis
and interpretation of health problems. 
 Encourages the nurse to understand
 Provides the basis for much of the
health behaviors in the context of their
practice of health education and health
societal milieu.
promotion.
 Developed by a group of social
psychologists to explain why the public Milio’s Propositions
failed to participate in screening for
tuberculosis.
 “Behavior is based on current dynamics  Population health results from
confronting an individual rather than deprivation and/or excess of critical
prior experiences “ –Kurt Lewin health resources. 
 Behaviors of populations result from
Constructs of the Health Belief Model selection from limited choices; these
arise from actual and perceived options
available as well as beliefs and
expectations resulting from socialization,
 Perceived severity/ seriousness
education and experience. 
 Perceived susceptibility
 Organizational decisions and policies
 Perceived benefits (both governmental and non-
 Perceived barriers governmental) dictate many of the
 Cues to action options available to individuals and
 Self-efficacy  populations and influence choices. 
 Individual choices related to health
Limitations of the model: promotion or health damaging behaviors
is influenced by efforts to maximize
valued resources. 
 It places the burden of action  Alteration in patterns of behavior
exclusively on the client.  resulting from decision making of a
 It assumes that only those clients significant number of people in a
who have distorted or negative population can result in social change. 
perceptions of the specified disease  Without concurrent availability of
or recommended health action will alternative health-promoting options for
fail to act. investment of personal resources,
 It focuses the nurse's energies on health education will be largely
interventions designed to modify the ineffective in changing behavior
client's distorted perceptions, patterns.
without acknowledging the health
professional's responsibility to
reduce or alter health care barriers
other than patients’ perspectives  Nola Pender’s Health Promotion

Milio’s Framework for Prevention

  Explores the many biopsychosocial
factors that influence individuals to PRECEDE-PROCEED MODEL 
pursue health promotion activities. 
 Contains seven variables related to
health behaviors, as well as individual
 Developed by Dr. Lawrence W. Green
characteristics that may influence a
and colleagues.
behavioral outcome.
 Provides a model for community
 Does not include threat as a motivator,
assessment, health education planning
as threat may not be a motivating factor
and evaluation. 
for clients in all age groups. 

Seven Variables of Pender’s Health

Promotion Model  PRECEDE: stands for Predisposing,
 Prior related behaviors Reinforcing, and Enabling
 Personal factors Constructs in Educational  
                                    Diagnosis and
 Behavior specific cognition and affect
Evaluation.
 Perceived benefits of action
 A model for community
 Perceived barriers to action
diagnosis
 Perceived self-efficacy
 Activity-related affect
 Interpersonal influences
 Situational influences  PROCEED: stands for Policy,
 Commitment to a plan of action Regulatory, and Organizational
Constructs in Educational and 
 Immediate competing demands and
                                    Environmental
preferences
Development
 Health-promoting behavior
 a model for implementing and
evaluating health programs
based on PRECEDE 
Transtheoretical Model
Predisposing factors 
 refer to people’s characteristics that
 Combines several theories of motivate them towards health-related
intervention, thus the name behavior
“transtheoretical”.
 Based on the assumption that behavior Enabling factors 
change takes place over time,  refer to conditions in people and the
progressing through a sequence of environment that facilitate or impede
stages. health-related behavior
  Assumes that each of the stages is
both stable and open to change. 
Reinforcing factors 
 refer to feedback given by support
Constructs of the Transtheoretical Model persons or groups resulting from the
performance of the health-related
behavior.   
 Stages of Change
 Precontemplation
 Contemplation
 Preparation
 Action
 Maintenance
 Decisional Balance
 Pros
 Cons