Family and Community Health:

Basic concepts

Ns. Tita Septi Handayani, S.Kep, MNS

Objectives of this session:

• Principles and concepts of family and

community health nursing
• Roles of community health nurse/public
health nurse
• Concepts related to family and community
health nursing
Topics to be covered:
• Definitions: CHN vs. PHN
• Roles of CHN/PHN
• Health systems and health service system
• Levels of care
• Primary care and PHC
• Community empowerment
• Self care
• Health promotion and disease prevention
• Community participation
What is “Family”?
•Two or more persons related by blood,
marriage, or adoption, AND living in the
same residence.
(Fields and Casper 2001)

•A basic unit within which, health

behaviours, health values, health risk
perceptions are developed, organized and
performed.
 What is community?

A collection of inter-dependent people

with residential ties to a particular
locality.
Concepts of community can be:
–Geographical bond
–Shared interest
–Shared characteristics: ethnicity,
occupation, etc
 HEALTH

Health is a state of complete physical,

mental, and social well-being
and
not merely the absence of disease or
infirmity.
 Health System

"A conglomerate of organizations, institutions and

resources devoted to producing actions whose
primary intent is to improve health"

Two major components of health system:

• Public health
• Medical Care
 Public health - Health of the Public

Science and art of promoting, protecting, maintaining

and improving health of communities through various
methods, including education and promotion of
healthy lifestyles.

WHO/SEARO, 2011
 Medical care

Personalized curative and rehabilitative part of a care

that an individual seeks from a health-care provider
when afflicted with disease.
 Health care System

Tertiary

Secondary

Primary

Referral system
Universal coverage
Health care services and Equity in • MDG
Health • National and international
health goals

Self care-PHC
(Community)
 Primary Health Care

“Essential health care based on practical, scientifically

sound and socially acceptable methods and
technology made universally accessible to individuals
and families in the community through their full
participation and at a cost that the community and
the country can afford to maintain at every stage of
their development in a spirit of self-determination”
 Primary Health Care (PHC)

• Effective tool for public health interventions

• Principles of PHC:
• Universal coverage and equity in health
• Inter-sectoral collaboration
• Community participation
• Use of appropriate technology
Goal of Health system: equity in Health
• All citizens attain the highest possible level of
physical, psychological and social well-being.

Equity in health care:

• Health care resources allocated according to
needs;
• Services are accessible, acceptable and
affordable by people, and in response to
people’s expectations.
Health systems strengthening using PHC approach
 Why comprehensive family and
community health care is crucial?
CONTEMPORARY AND EMERGING HEALTH
CHALLENGES IN
SOUTH-EAST ASIA
The rise of non-communicable diseases

Non-communicable diseases cause

over half the deaths in SEAR

Source: http://intranet/LinkFiles/Non_Communicable_Diseases_Fact_Sheet.pdf
 Communicable Diseases in S E Asia: some facts and figures
HIV:
• 3.5 million HIV cases in the South-East Asia Region
• Unsafe sex is still the major risk factor
• Problem of sharing needles among IDU, especially in Bangladesh, India,
Indonesia
TB:
• High Multiple Drug Resistance, nearly one third of global-burden
Malaria:
• 172 997 420 cases worldwide, 100 491 743 in SEAR (2008)
• High rate of drug resistance

Source: WHO/SEARO. Tuberculosis Control in the South-East Asia Region 2011

Strategies to tackle problems/challenges
• Community organization;
• Health education and training;
• Community empowerment;
• Partnership/inter-sectoral cooperation;
• Technical interventions; and
• Referral system.
 PHN/CHN
Operational Definition

Nurses, Midwives or Nurse-midwives who:

are community oriented and population focused;
 may or may not specially trained in public health or
community nursing but working in community;
 apply public health, nursing or related sciences in
providing comprehensive health care services
Community health nursing:
An art and a science that synthesizes knowledge
from the public health sciences and nursing
theories.
Aiming to determine health needs of systems and
offer comprehensive quality nursing services to
help people attain, maintain or regain maximum
level of wellness.
 Roles and Attributes
 Assessment and diagnosis of population/community
 Partnering with others
 Creating an environment for care
 Advocacy
 Evaluation and research
 Awareness, respect and humility
 Recognizing the multiple social determinants of health
 Capitalizing on community strengths
 Leadership
 Achieving cultural competence
 Roles in WHO/SEAR

• Health promoter and educator.

• Community organizer.
• Health care provider.
• Coordinator.
• Advocate for health
• Leader and manager.
 Required Knowledge

• Public health sciences;

• Nursing sciences;
• Behavioral science;
• Psycho-social and cultural sciences,
related to human health and their
environment.
 Required Attitudes

• Recognizing people’s ability to

think,
decide,
act for self care
• Willing to work in the community and with
the community
 Required Skills

• Analytical and thinking

• Public health
• Communication, advocacy and facilitation
• Leadership
• Social, cultural and community organization
• Management
• Teamwork
Principles of community health nursing
Good professional relationship.
Building capacity of people in self-care and
continuity of care.
Evidence-based practices: using nursing process
to guide intervention-assessment, diagnosis,
planning, implementation, evaluation.
Guiding principles for implementation:
Ensuring needed comprehensive health services
are provided in community.
Care of vulnerable groups is a priority.
Clients must be partners in planning and
evaluation of services.

WHO, 1974
Expected outputs/outcomes: People are
• health literate
• empowered
• able to practice self care and appropriately seek
professional care when needed
• living in healthy environment
• in good health
• improved quality of life
Empowerment:
The process by which people gain control
over the factors and decisions that shape
their lives through increasing their assets
and attributes and building capacities to
gain access, partners, networks, and/or a
voice.

People cannot be “empowered” by others,

but they empower themselves.

(Laverack, 2008)
‘Self care’

“The care taken by individuals

towards their own health and
well being, and includes the care
extended to their children,
family, friends and others in
neighbourhoods and local
communities”.
 Continuum of Self Care

Early
Absence of detection of
signs and signs & Sick
symptoms symptoms Rehabilitation

Promotion & Self Professional Rehabilitation

prevention treatment Treatment

-Nutrition - Simple remedies • Professional care -Nutrition

-Exercise - Herbal/traditional • etc -Exercise
-Emotion medicines -Emotion
-Safe environment -Etc -Safe environment
-Disease prevention - Know when to -Complication
seek prof. care
-etc prevention
-etc

Self Care
Community participation
A process by which individuals and families
assume responsibility for their own health
and welfare and for those of the community,
and develop capacity to contribute to their
and community’s development.

Anderson & MacFarlane, 2000; Wass, 2000; WHO 1999

Some useful Glossaries

• Holistic care: interaction among physical, psychological, social

and spiritual well-being. Interconnectedness between the
individual, family and community is recognized.
• Integrated care: different care dimensions to derive the best
benefit including primary, secondary and tertiary prevention (i.e.
health promotion and disease prevention, curative care and
support, and rehabilitation).
• Continuous care: continuation of care between home/
community and health facilities, including the referral system.
Examples of community- and home-based health care activities