CHN (Theory)

Community Health Nursing (Theory) – Midterms
1M – “Overview of Community Health Nursing”

Christine Joyce R. Ellorimo, BSN-2H (2022)
Section I: Community Health Nursing groups within the community with an

A Brief History of Community Health Nursing emphasis on health promotion and
1577 Franciscan Friar Juan Clemente opened medical illness prevention."
dispensary in Intramuros for the indigent
1690 Dominican Father Juan de Pergero worked Definitions of Health
toward installing a water system in San Juan del World Health "A state of complete physical, mental
Monte and Manila Organization and social well-being and not merely
1805 The smallpox vaccination was introduced by the absence of disease or infirmity”
Francisco de Balmis, the personal physician of Halber L. Dunn “View Health as illness- health and
King Charles IV of Spain peak wellness are on one continuum;
1876 The first medicos titulares were appointed by the health is fluid and changing. Classic
Spanish government concept of wellness, in which family,
1888 - 2-year courses consisting of fundamental community, society and environment
medical and dental subjects were first are interrelated and have impact on
offered in the University of Santo Tomas health.”
- Graduated were known as Murray "A State of well-being in which the
“cirujanosministrantes” and serve as male person is able to use purposeful,
nurses and sanitation inspectors adaptive responses and processes
1901 The United States Philippines Commission, physically, mentally, emotionally,
through Act 157, created the Board of Health of spiritually, and socially.”
the Philippine Islands with a Commissioner of the Pender "Actualization of inherent and
Public Health, as its chief executive officer (now acquired human potential through
the Department of Health) goal- directed behavior, competent
1905 “Asociacion Feminista Filipina”, Lagota de Leche self-care, and satisfying relationship
was the first center dedicated to the service of with others.."
mothers and babies Orem "A state of person that is characterized
1912 “The Fajardo Act” was created to make sanitary by soundness or wholeness of
divisions made up of one to four municipalities developed human structures and of
1947 The Department of Health was reorganized into bodily and mental functioning.."
bureaus: quarantine, hospitals that took charge
of the municipal charity clinics and health with Definitions of Community
the sanitary divisions under it McEwene &"A group of persons who socially
1954 Congress passed RA1082 (“Rural Health Act”), Neis, 2019 interact because of shared goals and
provided the creation of RHU in every interests”
municipality Allender "A collection of people who interact
1957 Amendments enacted in 1957 made certain with one another and whose common
provisions to the rural health act interests or characteristics form the
basis for a sense of unity or belonging."
Fundamental Concepts of Community Health Lundy and "A group of people who shared
Nursing
Janes something in common and interact
- Community/Public Health Nursing à synthesis of
with one another, who may exhibit a
nursing practice and public health practice
commitment with one another and
- The major goal of community health nursing is to
may share geographic boundary."
“preserve the health of the community and surrounding
Clark "A group of people who share common
population by focusing on health promotion and health
interests, who interact with each
maintenance of individual, family, and group within
other, and who function collectively
community”
within a defined social structure to
Key Terms and Definitions address common concerns."
Definitions of Term Shuster and "A locality-based entity, composed of
Social “of or relating to living together in Geopingger systems of formal organizations
organized groups or similar close reflecting society’s institutions,
aggregates” (American Heritege informal groups and aggregates.
College Dictionary, 1997)
Social Health “Connotes community vitality and is a
result of positive interaction among
Christine Joyce (Magghie) Ellorimo
collecting morbidity and mortality data) to higher levels

Types of Communities (According to Maurer of health, such as the Provincial Health Office
and Smith) ! Nurses should participate in investigative efforts to
Types of Communities determine what is precipitating the increased disease rates
Geopolitical - Traditionally recognized and work towards identifying threats or risk !
- Defined or formed by both
natural and man-made Section II: Public Health Nursing
boundaries, including Public Health Nursing
barangays, municipalities, - Public health is the science and art of preventing
cities, provinces, regions, and disease, prolonging life, and promoting health and
nations efficiency through organized community effort for:
Phenomenological - Functional communities n Sanitation of the environment
- Refers to relational, interactive n Control of communicable infections
groups, in which the place or n Education of the individual regarding physical
setting is more abstract, and hygiene
people share a group n Organization of medical and nursing services for the
perspective or identity based early diagnosis and preventive treatment of disease
on culture, values, history, n Development of the socia lmachinerty to ensure
interest, and goals everyone a standard of living adequate for
maintenance of health, organizing these benefits as
One Health Concept to enable every citizen to realize his birthright of
- A framework for community and public health nursing health and longevity
- The most effective way to act in response to the threats
of emerging infectious diseases The 9 Essential Public Health Functions
According to the WHO Regional Office for the
- Recognizing the connection between human, animal, Western Pacific
and environmental health 1. Health situation monitoring and analysis
One Health Approach Activities in the Philippines 2. Epidemiological surveillance/ disease prevention
n NRPCP à National Rabies and Control Program and control
n AIPP à Avian Influenza Protection Program 3. Development of policies and planning in public
n Philippine Inter-agency Committee on Zoonoses health
è Program Aims: 4. Strategic management of health systems and
• Aims to control and eventually eliminate services for population health gain
emerging and re-emerging diseases 5. Regulation and enforcement to protect public
- This framework guides nurses to better promote health
awareness amongst people about how these factors 6. Human resources development and planning in
impact wellness and spawn collective actions for better public health
health 7. Health promotion, social participation, and
empowerment
Determinants of Health
8. Ensuring the quality of personal and population-
1. Income and social status
based health service
2. Education
9. Research, development, and implementation of
3. Physical environment
innovative public health solution
4. Employment and working conditions
5. Social support networks Health Promotion & Levels of Prevention
6. Culture Health Promotion à activities that enhance
-
7. Genetics
resources directed at improving well-being
8. Personal behavior and coping skills
- Disease Prevention à activities that protect people
9. Health services
from diseases and effects of disease
10. Gender
Leavell and Clark’s Three Levels of Prevention
Indicators of Health and Illness 1. Primary Prevention à relates to activities
- Health status-related data released by: directed at preventing a problem before it occurs
n The National Epidemiology Center of DOH/PSA by altering susceptibility or reducing exposure for
n Local health centers/offices/departments susceptible individuals
- Forwarding information from local health 2. Secondary Prevention à early detection and
centers/offices/departments (responsible for prompt intervention during the period of early
disease pathogenesis
3. Tertiary Prevention à targets populations that - The environment affects

have experienced diseases or injury, focuses on learning, but learning outcomes
the depend on the learner’s
individual characteristics
Theories and Models Relevant to Community - Applications of this theory can be
Health Nursing done by:
General - This theory is applicable to n Gaining attention using
Systems Theory different levels of the community different strategies
health nurse’s clientele n Promoting retention of
- Client à set of interacting learning
elements that exchange energy, n Providing opportunities for
matter, or information with the imitation of procedures
external environment to exist n Motivating people by
- Useful when analyzing explaining benefits possible by
interrelationships of the practicing behavior
elements within the client and Health Belief - Provides the basis for a wide
the environment Model expanse of health education and
- Boundaries that separate it from promotion
its environment - Information alone is rarely
- The Family Environment à enough to motivate people to act
constitutes everything that may on their health
affect it - Individuals must know how to do
NOTE: it is the FAMILY HOME and the something before they can act
COMMUNITY + INSTITUTIONS that - Utilizes models such as:
make up the immediate environment n Clinical model
and should be considered in the n Role performance model
assessment of family health status n Adaptive model
n Outputs à material products, n Eudemonistic model
energy, and information that Key Concepts:
results from the family’s - Perceived Susceptibility à one’s
processing of inputs belief regarding the chance of
n Feedback à information from getting a condition
the environment directed back - Perceived Severity à one’s
into the system, allows the belief in the seriousness of a
system to make necessary given condition
adjustments for better - Perceived Benefits à one’s
functioning belief in the ability of an advised
- Subsystem (Family Members) à action to reduce health risk or
components of a system that seriousness of a given condition
interact to accomplish their own - Perceived Barriers à one’s belief
purpose regarding the tangible and
- Suprasystems (families) à psychological costs of an advised
bigger systems composing of action
families who interrelate with and - Cues to an Action à strategies
affect one another or conditions in one’s
Social Learning - Based on the belief that learning environment that activate
Theory takes place in a social context readiness to act
- “People learn from one another, - Self-Efficacy à one’s confidence
and learning is promoted by in their ability to take action and
modeling or observing other reduce health risks
people Milo’s - Proposed that health deficits
- Assumes all personas are Framework for often result from an imbalance
thinking beings capable of Prevention between a population’s health
making decisions/acting needs and its sustaining health
according to the expected resources
consequence for their behavior - Broder than HBM
- Includes economic, political, and - Proceed à policy, regulatory,

environmental health and organizational constructs in
determinants education and environmental
Pender’s Health - Explores biopsychosocial factors development; a model for
Promotion that influence individuals to implementing and evaluating
Model pursue health promotion health programs based on
activities PRECEDE
- Depicts complex n Predisposing factors à
multidimensional factors which people’s characteristics that
people interact with as they work motivate them towards health-
to achieve optimum health related behavior
Transtheoretical - Combines several theories of n Enabling factors à conditions
Model intervention in people and the environment
- Based on the assumption that that facilitate or impede health
changes in behavior take place related behavior
over time, progressing through n Reinforcing factors à
stages feedback given by support
n Each stage is stable and is open persons/groups resulting from
to change the performance of health-
n You can return to previous related behavior
stages
Stages of Change: Community Nursing VS Public Health Nursing
1. Precontemplation à individual Community Health Nursing
has no intention to act towards - Global/umbrella term; broader and more general
behavior change in the next 6 specialty area
months; may be in this face due - Encompasses subspecialties that include:
to lack of information about the n Public health
consequences of behavior/due n Nursing
to failure or previous attempts to n School nursing
change n Occupational health nursing
2. Contemplation à individual has n Other developing fields of practice
some intention to act towards - “The synthesis of nursing practice and public health
behavior change in the next 6 practice applied to promoting and preserving health of
change – weighing pros and cons the populations (ANA, 1980)”
to change
3. Preparation à individual tends Public Health Nursing
to act within the next month, - A component or subset of community health nursing
taken steps towards behavior - The synthesis of public health and nursing practice
change – has a plan of action
4. Action à individual has changed Public Health Nursing; Definitions
overt behavior for less than 6 - Freeman (1963) à Public Health Nursing may be
months, changed behavior has defined as the field of professional practice in nursing
sufficiently reduced risk of and in public health in which technical nursing,
diseases interpersonal, analytical, and organizational skills are
5. Maintenance à the individual applied to problems of health as they affect the
has changed over behavior for community
more than 6 months, strives to - ANA (1996) à The practice of promoting and
prevent relapse – this phase may protecting the health of populations using knowledge
last months to years from nursing, social and public health sciences;
Precede- - Used for community assessment “Population-focused, with the goals of the promoting
Proceed Model - Precede à predisposing, health and preventing disease and disability for all
reinforcing, and enabling people through the creation of conditions in which
constructs in educational people can be healthy
diagnosis + evaluation is used for
community diagnosis

Community Nursing VS Community-based

Nursing
Community-based Nursing
- Application of the nursing process in caring for
individuals, families, and groups where they live, work,
go to school, or move through the health care system
- Setting-specific with emphasis on acute and chronic
care, includes practice areas such as home health
nursing and nursing in an outpatient or ambulatory
settings
- CHN à emphasizes preservation and protection of
health, the primary client is the COMMUNITY
- CBN à emphasizes management of acute and chronic
disease, the primary clients are the INDIVIDUAL and
FAMILY

2M – “Family Health Nursing”
Family Health Nursing – Key Terms Family Forms and Structures

Family - A small social group composed of a Dyad - Two people living together without
father, mother, or children in which Family children
affection is equally/mutually shared - Usually newly married or couples
n The children become self- who’ve decided they don’t want to
controlled and socially integrated have children
people - Enjoy being with themselves
- Forms à patterns of people For companionship and possible
considered by family members to be shared resources
included in the family Possible short-term arrangement,
n Each family form has unique can lead to sense of loss
problems and strength Nuclear - Mother, father, child/children living
Family - Made up of individuals and the roles Family together but apart from both sets of
Structure they play parents and relatives
Family - Nursing care in collaboration of not Sense of security and support
Nursing a single patient, but inclusive of Lower salary due to loss of work
their families can influence spending in the
Gender - Awareness of the differences in family
Awareness roles and relations between women Compound - One man or woman with several
and men Family spouses
- Recognizes the life experiences, Extended - Family composed of two or more
expectations, and needs of women Family nuclear families economically and
and men are different socially related to each other
Gender - Concept of maleness or femaleness Alternative Families
of an individual Single - Only one parent (bruh what else)
- Not focused on the anatomical Parents
structure or physical Families - No kids, might plan on adopting their
structure/outlook of the person Without own
Sex - Traits that determine the individual Children
reproductive function, being a male Blende - Remarriage or reconstituted family
or female Family/Step Increase security and resources
- Pertains the outlook or outside of a Family Rivalry for affection or material
person possessions
Gender Role - Also known as “sexual role” Gay Family - Men who have sex with men
- Social roles encompassing a range of - BEEE WHOOO YOU AREEEE
behaviors and attitudes that are Positive advantages of a nuclear
generally considered acceptable, family
appropriate, or desirable for a Suffering from discrimination
person based on biological or Intentional - Purpose in creating the family you
perceived sex Family want
Characteristics of the Family as Client Types of Families in Today’s Society

1. Family is a product of time and place Traditional - Nuclear family + two career family
2. Families develop their own lifestyle Family n TCF à when both parents focus on
3. The family operates as a group their career and less on child care
4. The family accommodates the needs of the Single - Rears children or child single-
individual members Parent handedly
5. The family relates to the community Offers unique and strong parent-
6. The family experiences a growth cycle child bond
Limited resources
Functional Family Types Adolescent - Teen parenting
- Family as Procreation à the family you create Parent - Shortage of key life skills that and
- Family as Orientation à the family you come from resources that are vital to the
parenting process
Christine Joyce (Magghie) Ellorimo – BSN-2H

Foster - Children whose parents can no longer Major Functions of the Family
Family take care of them are put into a 1. Reproduction
foster/substitute home by: 2. Status of placement of individuals in society
n Child protection agency 3. Socialization of family members
n The government 4. Physical maintenance
- The government issues money to 5. Welfare and protection
parents per child 6. Family health test
Prevents children from being raised
in large orphanage settings Family Health Tasks
Insecurity and inability to establish - Task à function accompanied by work or labor that is
meaningful relationships due to assigned or demanded of a person
frequent moves 5 Family Tasks (Maglaya, A. 2004)
Blended Increases security and resources 1. Recognizing interruptions of health development
Family Exposure to different customs or 2. Making decisions about seeking health care
culture may help children become 3. Dealing with health and non-health situations
more adaptable to new situations effectively
Rivalry or competition amongst 4. Providing care to all members
5. Maintaining a home environment conducive to
children
health maintenance
Difficulty adjusting to stepparents
Family Tasks (Freeman and Heinrich, 1981)
Gay Family (**refer to content above)
1. Providing members with access to promotion and
Additional Types of Family disease prevention
According to Descent 2. Recognizing the interruptions of health or
Patrilineal - Affiliates a person with a group of development
3. Seeking health care
relatives who are related to them
4. Managing health crisis and non-health crisis
through his father
5. Providing nursing care to the sick, disabled, or
Bilateral - Relatives on mother’s side and
dependent members of the family
father’s side are equally as important
6. Maintaining a home environment that is
from an emotional or monetary
conducive to growth
standpoint
7. Maintaining a reciprocal relationship with the
Matrilineal - Affiliates a person with a group of
community and its health institutions
relatives who are related to them
Characteristics of a Healthy Family (Defrain, 1999 and
through their mother
Montalvo, 2004)
According to Location
1. Members interact with each other (open
Patrilocal - Family resides near the domicile of
communication)
the husband
2. Establishes priorities, able to gauge what is
Matrilocal - Family resides near the domicile of valuable
the mother 3. Affirm, support, and respect each other
According to Degree of Authority 4. Engage in flexible roles/role relationships, share
Patriarchal - Authority is exercised by the father; power, respond to change
Family descent is traced through him 5. Supports growth and autonomy of others
Matriarchal - Authority is exercised by the mother; 6. Power sharing and willingness to change/support
Family “under the saya” the growth of another family member
Modern - Everybody is involved in decision. 7. Healthy families share a spiritual core,
Democratic Making attend/teach societal values
Autocratic - Rigid and strict matters of parenting 8. If a family is healthy, they give positive
Family - Children aren’t allowed to talk back contributions to the community they live in
Laissez-faire - Full autonomy 9. Fosters responsibility and value service in others
- Parents don’t mind and don’t care 10. Understands the balance of play, work, and
- Everybody is independent and able relaxation
to do their own thing 11. Healthy families can cope with crisis and grow
Matricentric - Mother decides to take charge in the from problems
presence of an absent father
Patricentric - Father takes charge in the presence
of an absent mother

Trends and Challenges Facing the - Supporting ethical and moral

Contemporary Families values within the family
1. Marriage or remarriage - Balancing freedom with
2. Dual career marriages responsibility for young teens
3. Divorce or marital disruptions - Releasing young adults with
4. Adolescent parenting appropriate assistance
5. Cohabitation due to new sex norms and more - Strengthening the marital
tolerant parent attitudes relationship
6. increased birth rates in unmarried women - Maintain a supportive home base
7. Homosexual relationships Post-parental - Late 50s to 60s
8. Grandparent household Family - Preparing for retirement
- Adjustment to the loss of a spouse
Attributes of a Healthy Family
- Starting a family is an unending job
1. Family flexibility à being able to adapt to the way
you think and communicate with those around you Aging Family - Adjusting to retirement
2. Family resiliency à the ability to withstand and - Adjusting to the loss of a spouse
rebound from crisis and adversity - Closing of the family house
3. Family hardiness (durability) à the family’s ability
Roles and Responsibilities of the Family
to work together cohesively Members
- Roles à a pattern of behavior that goes with a certain
The Family Life Cycle
position, it varies according to our position in the family
1. Joining of a man and woman in the hand of
Role Tasks
matrimony/marriage
Wage Earner Main breadwinner of the family
2. The childbearing stage
3. Family with preschoolers and school age children Financial In charge of budgeting and
4. Family with teenagers and young adults Manager separating payments
Problem Solver Troubleshoots; uses critical thinking
Stages and Development Task of the Family to solve familial matters
Cycle Decision Maker To whom the other members look up
Stages Tasks to and wait to as to what should be
Beginning - Establishing a mutually satisfying done
Family marriage The Nurturer Focuses on diet + what is appropriate
- Planning whether to have children in terms of caring for the family
- Like the honeymoon stage Health Manager Looks after the welfare and health of
- Planning, thinking, discussing, and the family
enjoying life as a newlywed couple Environmentalist In charge of recycling, gardening +
Childbearing - Adjusting to an infant considering environmental choices
Family - Supporting the needs of all that can benefit the family
members Culture Maintains the culture of the family
- Regenerating marital relationships
- Having time for each other Concerns and Challenges of Modern Families
Family with - Adjusting to the additional
pre-school financial costs of family life
Children - Adapting to the needs of pre-
school children, stimulating
growth and development
- Coping with the parental loss of
energy and privacy
Family with - Adjusting to the activity of growing
school-aged children 1. Changing economic status
children - Promoting joint decisions 2. Dual career marriages
between children and parents 3. Homelessness
- Encouraging and supporting the 4. Domestic violence: impact of illness and injury
children’s education 5. Acute or chronic illness
Family with - Maintaining open communication 6. Trauma
teenagers and amongst family members 7. End-of-life-care
young adults 8. Marriage and remarriage
9. Marital disruptions Family Dynamics

10. Increased birthrates in unmarried women - Emotional bonding of family members
11. Increasing number of adolescent pregnancies - Distribution of authority and power
12. Grandparent households - Degree of individual autonomy
- How members communicate
Gender and Gender-Sensitive Issues - How decisions are made
- Gender consists of 3 interacting parts - How problems are solved
1. Biology (sex) à biological aspects of gender, physical - How conflict is handled
characteristics - Division of labor
è Initial basis of gender Socioeconomic and Cultural Characteristics
2. Gender Role à culturally and politically defined roles Family Social Integration
è Learned behavior of a given society that - Languages or dialects spoken
conditions activities, tasks, and responsibilities - Literacy
3. Gender Identity à represents an acceptance and - Degree of social network with friends, neighbors, and
internalization of the cultural definition of being a other relatives
man or woman - Networks with religious organizations
- Gender Anomaly à when the 3 interacting parts of - Network with social organizations
gender are not in accordance with one another - Educational experience
- Gender Role Socialization à the indiscrimination of an - Work history
individual into a pattern of gender linked expectations - Adequacy of financial resources
- Leisure time and interests
Filipino Families: Legal Perspectives Cultural Influences: Values, Attitudes, and Beliefs About:
1. Family Code of the Philippines – E.O 209 - Spirituality
n Signed by President Corazon Aquino, July 7, 1987 - Rituals
2. Responsible Parenthood and Reproductive Health – Act - Dietary habits
of 2012 (RA10354) - Health
n “The State shall protect and promote the right to - Folk diseases
health of women especially mothers in particular and - Traditional healers
of the people in general and instill health Family Environment
consciousness among them” Family Residence
- Adequacy of size
The Filipino Family and Its Characteristics
- Structural safety
- Structure à typically consist of a husband, wife,
- Water sanitation
children, and extending families
- Food preparation and storage
n Father à acknowledged as the head of the family,
- Sewage
commands full authority in the family
- Garbage disposal
n Mother à considered the light of the house (“ilaw ng
- Excreta disposal Pest and vermin control
tahanan”), responsible in all housekeeping activities,
Neighborhood
taking care of the children, planning of meals, and
- Location (urban, rural, subdivision, slum area)
budgeting family income
- Type (residential, semicommercial)
n Child à dependent on order
- Safety (traffic patterns, lighting, security)
è The eldest child helps the mother
- Population density (crowding)
è The middle child assumes the role of the eldest
- Sources of pollution (air, water, soil, noise)
è The youngest typically receives special
Activities of Daily Living
treatment
- Health history
Documentation & Forms; Information - Self-care
Family Characteristics - Risk behaviors
Family Members Living Outside the Household - Health status
- Name, age, and relationship to head of household - Home remedies
- Location of family members Healthcare Resources
- Frequency and duration of contact - Health workers
- Means of communication - Health agencies
Family Mobility
- Length of time at current address
- Address of previous residences
- Frequency of geographic movements
Data Gathering Methods Community Nursing Assessment

Observation - Uses sensory capacities 2 Major Types of Assessments
- The family’s health status can be First-Level - Process whereby existing and
inferred from the signs and Assessment potential health conditions or
symptoms of problem areas problems are categorized
reflected in the following: n Wellness state
n Communication and interaction n Health threat
patterns n Health deficit
n Role perceptions/task assumptions n Stress points
n Conditions in the home and n Foreseeable crisis
environment Data Collection
Physical - Utilizes inspection, palpation, - Family structure, characteristics, and
Examination percussion, and auscultation dynamics
- Measurement of specific body parts - Socio-economic and cultural
- Reviewing body systems characteristics
Interview - Completing the health history - Home and environment
- Health status of each member
Initial Database for Family Nursing Practice - Values and practices on health
Family - Members of the household and promotion/maintenance and disease
Structures and relationships of the head of the prevention
Characteristics family Second- - The nature or type of nursing
- Demographic data Level problems that the family encounters
- Place of residence of each Assessment in performing the health tasks with
member respect to a given health condition or
- Type of family structure problem, and the etiology or barriers
- Dominant family members in to the family’s assumption of these
terms of decision-making in tasks
matters of health - Data includes those that specify or
- General family relationship describe the family’s realities,
Socioeconomic - Income and expenses perceptions about, and attitudes
and Cultural - Educational attainment of each related to the assumption or
Factors member performance of family health tasks on
- Ethnic background and religious each health condition or problem
affiliation identified during the first level
- Significant others and the roles assessment
they play in family life
Environmental - Housing The Family Coping Index
Factors - Kind of neighborhood - Consists of 2 different parts:
- Social and health facilities n A point scale
available n A justification statement
- Communication and Terminal Rating à given at the end of a period, enables
transportation facilities available the nurse to see progress the family has made in their
Health - Medical and nursing history competence; whether the prognosis was reasonable;
Assessment of indicating past significant illnesses, and whether the family needs further nursing service
Each Member beliefs, and practices conductive and where emphasis should be placed
to illness Areas to be Assessed
- Developmental assessment of Physical Concerned with the ability to move
infants, toddlers, and preschoolers Independence about to get out of bed, to take care
- Nutritional assessment of daily grooming, walking, and other
- Physical assessment/current ADLs
health status Therapeutic This category includes all procedures
Values and - Immunization status of children Competence or treatments prescribed for the care
Practices on and family members of ill, such as giving medication,
Health - Use of other preventive services dressings, exercise, relaxation, and
Promotion - Adequacy of rest and sleep special diets

Knowledge of Concerned with the health condition Presence of Health Conditions that are conducive to
Health that is the occasion of care Threats disease and accident, or may
Condition result to failure to maintain
Application of Concerned with action in relation to wellness or realize health
the Principles maintaining family nutrition, securing potential, examples of this
of General adequate rest/relaxation for family include:
Hygiene members + carrying out preventive - Presence of risk for factors of
measures specific diseases
Health Concerned with the way the family - Threats of cross infection
Attitudes feels about health care in general, from a communicable disease
including preventive services, care of case
illness, and public health measures - Family size beyond what
Emotional Concerned with the maturity and family resources can
Competence integrity with which members of the adequately provide
family can meet the usual stresses and - Accident hazards
problems of life n Broken stairs
Family Living Concerned largely with the n Points or sharp objects,
interpersonal or group aspects of poisons
family life – how well the members of n Improperly kept medicines
the family get along with one another, n Fire/fall hazards
and the ways in which they make - Faulty/unhealthful
decisions that influence the family as nutritional/eating habits
a whole n Inadequate food intake
Physical Concerned with the home, the both in quality and quantity
Environment community, and the work n Excessive intake of certain
environment + how it affects the nutrients
family n Faulty eating habits
Use of Concerned with whether the family n Ineffective breastfeeding
Community keeps appointments, follows through n Faulty feeding techniques
Facilities with referrals, or tells others about - Stress-provoking factors
health department services n Strained marital/parent-
sibling relationship
Initial Database n Interpersonal conflicts
This consists of information such as: between family members
- Family structure, characteristics, and dynamics n Care-giving burden
- Socio-economic and cultural characteristics - Poor home/environmental
- Home environment condition/sanitation
- Health status of each family member n Inadequate living space
- Values, habits, practices of health promotion, n Lack of food storage
maintenance, and disease prevention facilities
n Polluted water supply
The Typology of Nursing Problems in Family n Presence of breeding or
Healthcare resting sites of vectors of
First Level Assessment diseases
Presence of A clinical or nursing judgement - Unsanitary food handling
Wellness about a client in transition from a - Unhealthful lifestyle and
Condition-stated specific level of wellness or personal habits
as Potential or capability to a higher level Presence of Health Instances in which there is failure
Readiness “Potential for Enhanced Capacity Deficits of health maintenance
for/Readiness for Enhanced Presence of Stress Anticipated periods of unusual
Capability for:” Points/Foreseeable demand on the individual/family
- Healthy lifestyle Crisis Situations in terms of adjustment
- Health maintenance - Marriage
- Health management - Pregnancy
- Parenting - Parenthood
- Spiritual well-being - Additional member
- Abortion Inability to - Inadequate knowledge about

- Entrance at school Provide n The disease or health condition
- Adolescence Adequate n Child development and care
- Divorce Nursing Care n The nature and extent of nursing
- Menopause to the Sick, care needed
- Loss of job Disabled, n The necessary interventions,
- Hospitalization of a family Dependent, or treatments, procedure, or care
member Vulnerable - Lack of necessary facilities,
- Death of a member Members of equipment, and supplies for care
- Resettlement in a new the Family - Inadequate family resources for
community care, specifically:
- Illegitimacy n Absence of responsible family
Second-level Assessment member
Inability to - Lack or inadequate knowledge n Financial constraints
Recognize the - Denial about its existence or n Limitations or lack of physical
Presence of severity because of fear of resources
the Condition consequences of problem - Unexpressed feelings of hostility,
or Problem diagnosis, specifically: guilt, anger, fear, or despair –
due to: n Social stigma hindering ones abilities to provide
n Loss of respect care
n Economic implications - Philosophy in life which negates or
n Physical consequences hinders caring for the sick,
n Emotional concerns disabled, dependent, vulnerable,
- Attitudes or philosophies in life or at risk family member
that hinder acceptance of - Preoccupation with own concerns
problems and interests
Inability to - Failure to comprehend the - Prolonged disability or disease
Make nature/magnitude of the problem progression, which exhausts
Decisions with or condition supportive capacity of family
Respect to - Low salience of the problem or members
Taking condition - Altered role performance
Appropriate - Feelings of confusion, Inability to - Inadequate family resources
Health Action helplessness, and/or resignation Provide a - Failure to see benefits of
due to brough about by perceived Home investment in home environment
magnitude or severity of the Environment improvement
situation Conducive to - Inadequate knowledge of:
- Lack of or inadequate knowledge Health n The importance of hygiene and
insight as to alternative courses of Maintenance sanitation
action open to them and Personal n Preventive measures
- Inability to decide which action to Development - Lack of skill in carrying out
take from amongst a list of due to measures to improve the home
alternatives environment
- Conflicting opinions among family - Ineffective communication
members/significant others patterns within the family
regarding what action to take - Lack of supportive relationships
- Lack of or inadequate knowledge amongst family members
of community resources for care - Negative attitudes or philosophies
- Fear of consequences regarding health maintenance and
- Negative attitude towards the personal development
health condition or problem - Lack of inadequate competencies
- Lack of confidence in health in relating to each for mutual
personnel or agency growth and maturation
- Misconceptions or erroneous Failure to - Inadequate knowledge of
information about proposed Utilize community resources for
course of action Community healthcare
Resources for
Healthcare - Failure to perceive the benefits of

due to healthcare services
- Lack of trust or confidence in the
agency or personnel
- Previous unpleasant experiences
with health workers
- Fear of consequences of action
- Unavailability and inaccessibility of
required care or services
- Feelings of alienation due to lack
of support from community
- Negative attitude or philosophy in
life, hindering from maximum
utilization of community
resources for healthcare

3M – “Healthcare Delivery Systems”
National Health Plan n Providing training to member

The World Health Organization countries in various fields
- UN founded in 1945 – creation of a global health Give support in monitoring health
organisation situations with tools for measurement and
- Founded in 1948 evaluation + resource sharing
- Headquartered in Geneva, Switzerland
- Objective: Attainment by all peoples of the highest Sustainable Development Goals (Agenda 2030)
possible level of health - AIM: to continue to achievement of MDGs (millennium
development goals)
Core Functions of the World Health Organization n 17 goals with 169 targets, covering years 2016-2030
Leadership - The WHO provides leadership on n Includes social determinants of health, shaping global
matters critical to health and local healthcare delivery systems
- Engage in partnerships within 1. No poverty
member nations when joint action is 2. Zero hunger
needed 3. Good health and well-being
- The WHO focus is collaboration with 4. Quality education
member states 5. Gender equality
Research - Shape research agenda globally, 6. Clean water and sanitation
targeting problems and stimulating 7. Affordable and clean energy
generation, translation, and 8. Decent work and economic growth
dissemination of valuable knowledge 9. Industry, innovation, and infrastructure
- The WHO strategy for research 10. Reduced inequalities
includes capacities, priorities, 11. Sustainable cities and communities
standards, translation, and 12. Responsible consumption and production
organisation 13. Climate action
Five Strategies for Research: 14. Life below water
- Capacity à capacity building to 15. Life on land
strengthen national health research 16. Peace, justice, and strong institutions
systems 17. Partnerships for the goals
- Priorities à focuses research
surrounding health needs, especially Department of Health
in low/middle income countries - National health agency mandated to lead the health
- Standards à promote good research sector for quality healthcare for all Filipinos
practices and sharing of research - VISION: Filipinos are amongst the healthiest people in
evidence, tools, and materials Southeast Asia by 2022, and Asia by 2040
- Translation à qualifying evidence and - MISSION: to lead the country in the development of a
turning it into products and policies productive, resilient, equitable, and people-centred
- Organisation à strengthening the health system for UHC
research culture in WHO Major Roles of the DOH
Monitoring - Involves setting norms and Leader in - Planning and formulating health
promoting/monitoring implantation Health policies/services in the community
of programmes and policies - Monitoring and evaluating of the
EXAMPLE: monitoring immunisation, implantation of various projects,
maternal/childcare, environmental health programmes, and all other
conditions in different countries services
Ethics - Articulating ethical and ethics-based - Advocating for health promotion
policy options and healthy lifestyle
EXAMPLE: concerns for topics like human - Serving technical authority and
organ/tissue transplantation, reproductive disease control + prevention
health, and response to infectious diseases - Providing administrative and
Support - Providing technical support and technical leadership in healthcare
creating change within different - Financing and implementing the
nations, building their sustainability national health insurance law
and capacity (PHILHEALTH

Enabler and - Provide logistical support Municipal - Also known as “rural health physician”
Capacity n Support LGUs (local government Health - Heads the municipal level with the
Builder units) of the communities + Officer following roles:
private sector and other (MHO) 1. Administrator of the RHU
agencies 2. Prepares the municipal health plan
- Serve as the lead agency of health and budget for the vicinity/zone
and medical research as part of 3. Monitors the implementation of
capacity building basic health services
- Protecting standards of excellence 4. Manages the RHU staff
in the training and education of 5. Being a communication
healthcare providers 6. Conducts epidemiological studies
- DOH = mother agency 7. Formulates health education
Administration - Roll out of services in specific campaigns on disease prevention
of Specific health facilities, including at the 8. Prepares and implements control
Services subnational levels measures regarding rehabilitation
- Provide specific programmes + plans
programme components for the 9. Being a medical-legal officer of the
larger population (i.e., TB, malaria, municipality
HIV) - Medical-legal à people who
- Aid in development of strategies encounter, for example, motor
as a response to emerging health vehicular accidents
needs Public - Supervisor à supervises & guides all
- Providing leadership in health Health RHMs
emergency preparedness and Nurse - Data Manager à prepares the Field
response services (PHN) Health Service Information System
(FHSIS) quarterly & annual reports
Rural Health Unit - Health Care Provider à uses the
- Aka Health Centre, a primary level facility in the nursing process in responding to the
municipality health needs of individuals, families,
- FOCUS: preventive and promotive health services and and communities including health
supervision of Barangay Health Stations (BHS) promotion and disease prevention
- Recommended ratio for Human Resource for Health activities
(manpower) and Health Facilities Ratio to Population: - Collaborator à collaborates with other
n 1 RHU/HC Physician: 20,000 stakeholders to address the
n 1 Public Health nurse: 10,000 community’s health problems
n 1 Public Health midwife: 5,000 Rural - Supervisor à supervises BHWs
n 1 Public Health dentist: 50,000 Health - Manager à manages the BHS,
n 1 RHU: 20,000 Midwife including data needed at their level
n 1 BHS: 5,000 (RHM) (they ensure data management daily)
n 1 BHW: 20 HOUSEHOLDS - Health Care Provider à renders
n 1 MEDICAL TECHNOLOGIST: 50,000 midwifery services: patient
n 1 NUTRITIONIST: 20,000 assessment, normal deliveries,
n 1 SANITARY ENGINEER (POLICY MAKING): 20,000 referrals, family planning/cp
n 1 SANITARY INSEPCTOR: 20,000 Rural - Ensures a healthy physical
Sanitation environment
Sections of the RHU Inspector - Anything to do with the environment
Barangay - First contact healthcare facility at the (RSI) falls under the responsibilities of an RSI
Health barangay level - They advocate for monitoring and
Station n If people are affected by an illness or regulating activities including
(BHS) disease, this is where they go to first inspection of water supply, unhygienic
- Satellite station of the RHU, being household conditions, etc.
manned by volunteer barangay health Barangay - Interface between the community and
workers under the supervision of the Health the RHU
RHM Worker - Mediators between rural health
units/barangay health stations to the
community
- Accredited by the local health board Service Delivery How is health being administered
- Trained in preventive health care with i.e., accessibility, availability, safety
a strong emphasis on maternal and Governance and Appointing people in office to
childcare, family planning, Performance implement different health
reproductive health, nutrition, and Assembly programmes
sanitation
Universal Healthcare (UHC) Coverage
Factors Measuring the Health Status of the View All individuals and communities receive the
Population health services they need without suffering
1. Income and social status hardships (value of equity)
- Higher the income and social status, you are linked to Inclusion Essential, quality health services from health
better healthcare promotion to prevention, treatment,
- The greater the gap between the rich and the poor, the rehabilitation, and palliative (**disease or
greater the health differences illnesses without cure) care
2. Education and health services Law RA 11223 (February 2019) covers all Filipinos
- Low education levels are linked to poor health under the National Health Insurance
- The more educated the more you know Program of the Philippines (PhilHealth)
- Access to health services for disease and prevention Objective To provide all Filipinos access to
treatment can impact the levels of health comprehensive and cost-effective health
3. Physical environment care that covers all spectrums of services
- The very. Basics needed to live such as water and food Priority Marginalized and those who can’t afford
quality healthcare
4. Employment and working conditions
- Employed people are healthier, especially those with Public Health Programs
control over their working conditions 1. Reproductive and maternal health
- If the workers are happy with their working 2. Expanded Garantisadong Pambata (child health)
environment, and they’re treated well, there is a lower 3. Control of communicable diseases
risk for hazards 4. Control of non-communicable or lifestyle diseases
5. Social support networks 5. Environmental health
- The people you affiliate with influence your health
status, this includes friends, family, and communities Healthcare Delivery Systems
6. Culture, genetics, and gender - HCDS à the network of health facilities and personnel
- Culture can be linked to those practicing traditional which carries out the task of rendering health care to
disease prevention methods that aren’t backed up by the people
science Q: Why was the HCDS created?
- Genetics is linked to diseases we inherit from our family - Problems: lack of coordination across the different
7. Personal behaviour and coping skills levels of care and continuity in services provided, and
- Coping skills is linked to personal behaviour and the to meet the demands and needs of constituents
way we deal with stress - Goal: to reintegrate hospitals and public health services
for a holistic delivery of health care
Global Health Sector Reforms Relevant Acts and Orders for HCDS
- The aim of reforms is to strengthen local healthcare RA 7160 Local Government Code of 1991
delivery + to improve health outcomes of the local - The LGU functions as the head of
population the local government
- Despite reforms since 1999, universal and equitable - Acts to decentralize power,
healthcare for all has not been achieved authority, and resources from the
**Fourmula One (2005-2010) national level towards LGUs
** Kalusugan Pangkalahatan n They’re given relevant statistics
** Duterte Health Agenda – 2016 and equipment needed to
** FOURmula one Plus (F1 Plus) implement health programs
EO 205 Establishment of Interlocal Health Zones
The 4 Pillars of the DOH - Issued by the president to establish
Financing Responsible for budget allocation LILHZs to create/cluster several
Regulation Concerned with policies involved in adjacent municipalities and cities
the different healthcare n Allows for population groupings,
programmes which opens up appropriate
healthcare facilities for these

groups Levels of Healthcare Delivery
- They need to be: Primary - Municipal health office
n A defined population - Rural health units
n Have a specific geographical area - Health centers
n Composed of referral/partner - Barangay health stations
hospitals alongside primary level - Cater to basics of healthcare
facilities Secondary - Provincial health office
- Aims to prioritize zones to provide - District hospitals
more comprehensive and accessible - Emergency hospitals
healthcare - Provincial hospitals or medical
RA 11223 “Universal Health Care Act” centers
- Established in 2019, - Non-departmentalized hospitals
- Aims to provide continuous, - Offer facilities for patients with
coordinated, and integrated symptomatic stages of the disease
healthcare facilitated by different requiring moderate knowledge and
health provider networks treatment
- Key term: moderate
Health Care Delivery Systems: Program Profile Tertiary - National hospitals
- These 6 profiles are part of achieving the goals of the - National medical centers and
HCDS specialized hospitals
Public Health - Owned by the public sector - Regional hospitals or regional
Care - Created by linking a group or medical centers
Provider clustering primary public care - Teaching and training hospitals
Network providers - Key term: severe
- Clinicians and facilities are linked - Offered by large medicals centers
together and hospitals
- The HCPN consists of 2 subtypes:
1. Public à to deliver population- DOH Administrative Order (2012-0012)
based and individual-based health - Concerns rules and regulations governing the new
services classification of hospitals and other health facilities in
• Geopolitical boundaries the Philippines
2. Private à to deliver individual- Classification Scheme of Health Facilities
based health services Hospitals Other Health Facilities
Contractual arrangements between General a. Primary care facilities
public and private facilities allows for - Level 1 à basic b. Custodial care facilities
collaboration - Level 2 à moderate c. Diagnostic/therapeutic
- Level 3 à high-end facilities
n Teaching/training d. Specialized facilities
Structure of the Philippine Public Health Care
Systems Local health Boards
- Local Government Code (RA7160)
n Enacted to bring forth genuine and meaningful local
autonomy
n Enables LGs to be self-reliant communities and be
effective partners for attainment of national goals
n Mandates devolution of basic services from the
national government to LGUs
- Chairman of the LHB: provincial governor/mayor
- Vice Chairman: provincial/city/municipal health officer
- Members:
n Chairman of the committee on health of the
Sanggunian (a representative from the private sector
or NGO involved in health services)
n DOH representative

Functions of the Local Health Board: Health RHU, BHS, other health facilities,
1. Proposing to the Sanggunian annual budgetary Facilities district/provincial hospitals
allocations for the operation and maintenance of Health DOH personnel, district or provincial
health facilities and services within the Workers hospitals, RHUs, BHSs, private clinics,
province/city/municipality volunteer health workers NGOs,
2. Serving as an advisory committee to the community-based organizations
Sanggunian on health matters - Primary Health Care à over-all approach to provide
3. Creating committees that shall advise local health people access to basic healthcare and ultimately
agencies on various matters related to health improve health of communities
service operations
(**chapter 11 – textbook notes; required reading)
Health Referral Systems Global Health Issues
- Referral à set of activities undertaken by a HCP or - Global health is about improving health of the people
facility in response to its inability to provide the and achieving health equity for all
necessary health interventions to satisfy a patient’s n Transcends national borders
needs n Globally impacts politics and economics
- Internal Referral à occur within the health facility from n Requires global cooperation in response, planning,
one health personnel to another prevention, preparedness, and care (Edmonson et al,
- External Referral à movement of patient from one 2017)
health facility to another - The Global Burden of Disease Study 2016 showed that:
n Vertical à from lower to higher level of health facility n Deaths from noncommunicable diseases = 72.3%
and vice versa n Deaths from communicable, maternal, neonatal, and
n Horizontal à referral to similar facilities in different nutritional diseases = 19.8%
catchment areas n Deaths from injuries = 8.4%
- There is a global shift from premature mortality
Functional Referral Systems (CMNN) diseases to those regarding old age
- Ensures continuity and complementation of health and (cardiovascular disease, stroke, etc.)
medical services n There are declining rates of CMNN across different
- Comprehensive, encompassing promotive, preventive, levels of sociodemographic index
curative, and rehabilitative care Shifts in causes of death reflects the need for improving
- Engages all health facilities from the lowest to the workforce capacity and higher cost-effective treatments
highest level for chronic conditions and new challenges brought about
- Involves movement of a patient from the health center by conflicts, terrorist, and climate change
(first contact) and the hospital (first referral level)
- When a hospital intervention is completed, the patient Communicable, Maternal, Neonatal, and Nutritional
is referred to the health center (two-way referral Diseases
system) - Communicable diseases decreased as a cause of death,
mainly due to reductions in deaths caused by HIV/AIDS,
Inter-Local Health Zone malaria, tuberculosis, and other diarrheal diseases
- ILHZ à the clustering of several adjacent municipalities
and cities Cause of Death % Decrease
- Each ILHZ has HIV/AIDS 45.8%
1. a defined population Tuberculosis 20.9%
2. defined geographical area
Diarrhea 24.2%
3. composed of core referral hospitals and several
Malaria 25.9%
primary level facilities, such as RHUs, BHS, and
Leishmaniasis 54.1%
DOH
Intestinal Infectious Diseases 14.7%
- Goal: a more responsive healthcare delivery to
communities
ILHZ Components
People Recommended population size by
WHO is 100,000-500,000
Boundaries To establish accountability and
responsibility of health service
providers

Class Review n Custodial care facility à long-term patients

- RA 1123 à universal health care act è Period of rehabilitation (6-8 weeks)
- RA 7160 à local government code of 1991 è Rehab, psychiatric, nursing homes
n Decentralizing authority power and resources from n Diagnostic or therapeutic facility à different
the national to local communities laboratory procedures
n Members of the Local Health Board n Specialized outpatient facility
è Chairman of the board (mayor of governor) è Minor or walk in ambulatory clinic
è Vice-chairman (provincial health officer or
municipal health officer) COMMUNITY à BHS à RHU à MUNICPAL DISTRICT
è DOH representative HOSPITALS à PROVINCIAL HOSPITALS à MEDICAL
è Private Sector/NGO representative REGIONAL HOSPITALS
- EO 205 à establishment of inter-local health zones
- Inter Local Health Zones à divisions of areas according
to geography, population
n PEOPLE = 100,000-500,000
n Boundaries
n Health Facilities = (at least 1 core hospital)
è Primary Care Facilities = several (i.e.., RHU,
PARAMEDIC STATIONS, HOSPITALS)
n Health Workers
- (**PHCPN) Public Healthcare Provider Network
n Owned by the government
n Public healthcare delivers care to the community at
all levels of care
n Public sectors can’t shoulder all the health needs of
the population
è Private and public sectors collaborate by making
contractual agreements between public and
private hospitals so they can augment/increase
the health services that are lacking from the public
sector
- Types of Referrals:
n Internal
n External
è Vertical external referral (lower to higher and vice
versa)
è Horizontal external referral (similar health facilities
in different regions or places)
n Two way referral à when patients comes back to
where they were originally referred
- Levels of Care/Facilities:
n Primary health care à barangay health station, basic
services (emergency services), RHU health center,
municipal health office, city health office, birthing
homes
n Secondary health care à moderate and
intermediate care, provincial health office, district
hospitals, emergency hospitals, provincial hospitals
n Tertiary health care à national hospitals, specialized
hospitals, regional hospitals, training hospitals
- Classification of Hospitals and Other Health Facilities
n General à give primary, secondary, tertiary levels of
care
n Specialty Hospitals
- Other Facilities:
n Primary care facility à short-term patients

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Community Health Nursing (Theory) – Midterms

1M – “Overview of Community Health Nursing”

Section I: Community Health Nursing groups within the community with an

collecting morbidity and mortality data) to higher levels

3. Tertiary Prevention à targets populations that - The environment affects

- Includes economic, political, and - Proceed à policy, regulatory,

Christine Joyce (Magghie) Ellorimo

Community Nursing VS Community-based

Christine Joyce (Magghie) Ellorimo

Family Health Nursing – Key Terms Family Forms and Structures

Characteristics of the Family as Client Types of Families in Today’s Society

Christine Joyce (Magghie) Ellorimo – BSN-2H

Christine Joyce (Magghie) Ellorimo – BSN-2H

Trends and Challenges Facing the - Supporting ethical and moral

9. Marital disruptions Family Dynamics

Data Gathering Methods Community Nursing Assessment

Christine Joyce (Magghie) Ellorimo – BSN-2H

- Abortion Inability to - Inadequate knowledge about

Healthcare - Failure to perceive the benefits of

Christine Joyce (Magghie) Ellorimo – BSN-2H

National Health Plan n Providing training to member

Christine Joyce (Magghie) Ellorimo – BSN-2H

healthcare facilities for these

Christine Joyce (Magghie) Ellorimo – BSN-2H

Christine Joyce (Magghie) Ellorimo – BSN-2H

Class Review n Custodial care facility à long-term patients

Christine Joyce (Magghie) Ellorimo – BSN-2H

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