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OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING
NCM 101

COMMUNITY HEALTH NURSING

Health Promotion and Public Health

Health
• A State of complete physical, mental and social well- being, not merely an absence of disease
or infirmity (WHO, 1948).
• A State of well being and using every power the individual possesses to the fullest extent
(Nightingale, 1969).
• Optimum Level of Functioning (OLOF)

Determinants of Health (World Health Organization)


• The health of individuals and communities are, to a large extent, affected by a combination of
many factors.
1. Income and social status – Higher income and social status are linked to better health.
2. Education – Low education levels are linked with poor health, more stress and lower self-
confidence.
3. Physical Environment – Safe water and clean air, healthy workplaces, safe houses,
communities and roads all contribute to good health.
4. Employment and working conditions – People in employment are healthier, particularly
those who have more control over their working conditions.
5. Social support networks – Greater support from families, friends and communities is linked to
better health.
6. Culture – Customs and traditions, and the beliefs of the family and community all affect health.
7. Genetics – Inheritance plays a part in determining lifespan, healthiness and the likelihood of
developing certain illness.
8. Personal Behavior and coping skills – Balanced eating, keeping active, smoking, drinking,
and how we deal with life’s stresses and challenges all affect health.
9. Health Services – Access and use of services that prevent and treat disease influence health.
10. Gender – Men and Women suffer from different types of diseases at different ages.

Eco-System Influences on Optimum Level of Functioning (OLOF)


1. Political - Safety, Oppression, People Empowerment
2. Behavior - Culture, Habits, Mores, Ethnic Customs
3. Heredity - Generic Endowment (Defects, Strengths, Risk, Familial, Ethnic, Racial)
4. Health Care Delivery System - Promotive, Preventive, Curative, Rehabilitative
5. Environment - Air, Food, Water Waste, Urban/Rural, Noise, Radiation, Pollution
6. Socio-Economic - Employment, Education, Housing

Public Health
• The science and art of preventing disease, prolonging life, promoting health and
efficiency through organized community effort for the sanitation of the environment, control
of communicable diseases, the education of individuals in personal hygiene, the organization
of medical and nursing services for the early diagnosis and preventive treatment of disease
and the development of the social machinery to ensure everyone a standard of living adequate
for the maintenance of health, so organizing these benefits as to enable every citizens to
realize his birthright of health and longevity. (Dr. C.E. Winslow).
• The art of applying science in the context of politics so as to reduce inequalities in
health while ensuring the best health for the greatest number. It points to the facts that public
health is a core elements of governments’ attempts to improve and promote the health and
welfare of their citizens (WHO).

Core Business of Public Health


1. Disease control
2. Injury prevention
3. Health protection
4. Healthy public policy including those in relation to environmental hazards such as in the
workplace, housing, food, water, etc.
5. Promotion of health and equitable health gain.

• The core business of public health cannot be achieved without the proper delivery of essential
public health functions which Yach described as “a set of fundamental activities that address
the determinants of health, protect a population’s health and treat disease.

Essential Public Health Functions


1. Health situation monitoring
2. Epidemiological surveillance/disease prevention and control
3. Development of policies and planning in public health
4. Strategic management of health systems and services for population health gain
5. Regulation and enforcement to protect public health
6. Human resources development and planning in public health
7. Health promotion, social participation and empowerment
8. Ensuring the quality of personal and population based health services
9. Research, development and implementation of innovative public health solutions.

Public Health Nursing


• It is a special field of nursing that combines the skills of nursing, public health and some
phases of social assistance and functions as part of the total public health programme for the
promotion of health, the improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability (WHO).
• Lillian Wald the director of Henry Street Settlement in New York coined the term “Public
Health Nursing” to denote a service that was available to all people. The term public health
nursing become associated with “public” or government agencies and in turn with the care of
the poor people.
• The National League of Philippine Government Nurses came up with the Standards of Public
Health Nursing in the Philippines 2005. This standards differentiated public health nursing and
community health nursing in one area: setting of work as dictated by funding.
- The Government is the employer of public health nurses at national and local health
agencies.
- Position title/ designation given to these nurses by the Civil Service Commission working in
these agencies are Public Health Nurses.
- The standard defined Public Health Nurses (PHNs) as nurses in the local/national health
departments or public schools.
- The standard defined Public Health Nursing as the practice of nursing in national and local
government health departments (which includes health centers and rural health units), and
public schools. It is a community health nursing practiced in the public sector.
Community Health Nursing
• As defined by Ruth Freeman, service rendered by a professional nurse with the
communities, 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 at home and
rehabilitation.

• As defined by Jacobson, it encompasses nursing practice in a wide variety of community


services and consumer advocates areas, and in a variety of roles, at times including
independent practice… community nursing is certainly not confined to public health
nursing agencies.

Philosophy
Based on the worth and dignity of man, according to Dr. Margaret Shetland.

Concepts
1. The primary focus is on health promotion.
2. Practice is extended to benefit not only the individual but the whole family and community.
3. These nurses are generalists in terms of practice through life’s continuum – its full range of
health problems and needs
4. Contact may continue over a long period of time which includes all ages and all types of
health care.
5. The nature of practice requires that current knowledge derived from biological and social
sciences, ecology, clinical nursing and community health organizations be utilized.
6. The dynamic process of assessing, planning, implementing and intervening provide
periodic measurements of progress and evaluation.

Goal
To raise the level of health of the citizenry

Principles
1. Community Health Nursing is based on recognized needs of communities, families,
groups and individuals.
2. The community health nurse must fully understand the objectives and policies of the
agency she represents.
3. The family is the unit of service.
4. Community Health Nursing must be available to all regardless of race, creed and socio-
economic status.
5. Health Teaching is a primary responsibility of community health nurse.
6. Community health nurse works as a member of the health team.
7. There must be provision for periodic evaluation of Community Health Nursing services.
8. Opportunities for continuing staff education programs for nurses must be provided by the
Community Health Nursing agency. She has a responsibility for his/her own professional
growth.
9. The community health nurse makes use of available community health resources.
10. Community health nurse utilizes the already existing active organized groups in the
community.
11. There must be provision for educative supervision in Community Health Nursing
12. There should be accurate recording and reporting in Community Health Nursing.

Clients of the Community Health Nurse


Individual
• The Public Health Nurse deals with individuals – sick or well – on a daily basis.

Family
• It is generally considered as the basic unit of care in the community.
• It may contribute knowingly or unknowingly to the development of health and nursing problems
of its members.
• It performs health-promoting, health maintaining and disease preventing activities.
• In many cases, the family is the locus of decision making on health matters.

Population Group
• A population group or “aggregate” is a group of people who share common characteristics,
developmental stage or common exposure to particular environmental factors, and
consequently common health problems.

Children
• Children are usually the first to suffer from socio-economic difficulties and political upheavals in
a country.
• Children in especially difficult circumstances (CEDC) deserve immediate attention from
government and other concerned groups because of the magnitude and urgency of their
problems.

Elderly
• Probably the most commonly documented problems of older people are those related to their
health.
• A major problem among poor older people is access to health care.
• Health care services for older people are limited because these are intended for the general
population.
c
Community
• The community is a group of people sharing common geographic boundaries and/or common
values and interests.
• A community is regarded as an organism with its own stages of development. Just like a
person, if subjected to different situations, a community matures through time.
• Urban and rural communities differ in terms of a number of characteristics such as physical
environment, population size and density, economy, culture, political dynamics, availability and
adequacy of social services, and availability and accessibility of health resources.

Characteristics of a Healthy Community


1. Awareness that ‘we are community.’
2. Conservation of natural resources.
3. Recognition of, and respect for, the existence of subgroups.
4. Participation of subgroups in community affairs.
5. cPreparation to meet crises.
6. Ability to problem-solve.
7. Communication through open channel.
8. Resources available to all.
9. Setting of disputes through legitimate mechanisms.
10. Participation by citizens in decision making.
11. Wellness of a high degree among its members.

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