CHN / CHPN  There should be accurate recording and reporting in

 “Health and longevity as birthright” Community Health Nursing

 People empowerment and care for public or community
DIFFERENT FIELDS OF CHN
DEFINITIONS OF COMMUNITY HEALTH NURSING  PUBLIC HEALTH NURSING
JACOBSON o Seen as a subspecialty nursing practice generally
 It is a learned practice discipline with the ultimate goal of delivered within “official” or government agencies.
contributing to the promotion of the client’s OLOF  SCHOOL HEALTH NURSING
(Optimum Level of Functioning) through teaching and o Aims to promote the health of school personnel
delivery of care and pupil/students. It aims to prevent health
problems that could hinder students learning and
WHO performance
 It is a special field of nursing that combines the skills of  OCCUPATIONAL HEALTH NURSING
nursing, public health and some phases of social o As defined by American Association of
assistance and functions for the promotion of health, Occupational Health Nurses (AACHN) as a
improvement of social and physical conditions and specialty practice that focuses on promotion,
rehabilitation of illness and disability prevention and restoration of health within the
context of a safe and healthy environment. It
AMERICAN NURSES ASSOCIATION (ANA) includes the prevention of adverse health effects
 “The synthesis of nursing practice and public health from environmental hazards. It provides for and
practice applied to promoting and preserving the health of delivers occupational health and safety programs
the populations.” and services to clients
 COMMUNITY MENTAL HEALTH NURSING
PHILOSOPHY OF COMMUNITY HEALTH NURSING o Unique clinical process that includes concepts of
 A philosophy is defined as “a system of beliefs that nursing, mental health, social psychology and
provides a basis for and guides action.” A philosophy community networks including social sciences.
provides the direction and describes the whats, the whys Focus is on the Mental Health Promotion.
and the hows of activities within the profession.
 Philosophy: According to Margaret Shetland, the LEVELS OF CLIENTELE IN CHN
philosophy of CHN is based on the worth and dignity of a  Individual
man  Family
 Community
PRINCIPLES OF CHN (by Mary Gardner and Cobb/Jones  Population groups
Leahy)
 Community Health Nursing is based on the recognized CHN- most important; care for the whole community; promotive
needs on recognized needs of communities, families, and preventive care
groups and individuals.
 The Community Health Nurse must fully understand the COMMUNITY
objectives and policies of the agencies she represents.  a group sharing a common location with common
 In Community Health Nursing, the family is the unit of values/interest
service.  Geopolitical community – territory; barangay, city
 Community Health Nurse must be available to all.  Phenomenological community – shares common beliefs;
 Health teaching is the PRIMARY responsibility of the values, professions, religions
Community Health Nurse
 The Community Health Nurse works as a member of the PILLARS OF CHN
healthteam  Active community participation – involvement of people in
 There must be provision for periodic evaluation of the community activities from start to end
Community Health Nurse services  Intra & intersectoral linkages – collective actions with 2 or
 Opportunities for continuing staff education programs for more larger groups
nurses must be provided by the agency.  Use of appropriate technology – using alternative
 The Community Health Nurse makes use of available resources to give the same care; being resourceful
community health resources  Support mechanisms – if hindi kaya ng CHN, refer to other
 The Community Health Nurse utilizes the already existing healthcare or officials
active organization in the community
 o Policies/Laws are will going to affect your
HEALTH PROMOTION choices
 Combination of health education and related o Alterations in pattern of behavior will result to
organizational, economical, and environmental supports change
for the behavior of individuals, groups, or communities that o Behavior of population will result from
are conducive to health selection from limited choices
 WHO – state of complete physical, mental, and social o Individual choices related to health
well-being and not merely the absence of diseases promotion/ health damaging behaviors are
influenced by efforts to maximize – valued
THEORIES – set of ideas, hypotheses; provides prediction, resources
explanation of the world o Without concurrent availability of alternative
health-promoting options, for health
1. Nole Pender’s health promotion (HPM) education will be largely ineffective on
 Individual characteristics and experiences, behavior- changing behavior patters
specific cognitions and affect, and behavioral
outcomes 4. PRECEDE-PROCEED Model
 Experience, preventive actions  PRECEED – Predisposing, Reinforcing and Enabling
 Namatay ang tito mo sa lung cancer, so para hindi Constructs in Educational Diagnosis and Evaluation
mangyari yun sayo inalagaan mo ang health mo. o Used for community diagnosis
Umiwas ka sa mga bagay na maaaring maging factor  PROCEED – Policy, Regulatory, and Organizational
para magkaroon ka rin ng sakit na ganun. You Constructs in Educational and Environmental
commit yourself to the preventive measures. Development
o For implementing and evaluating health
2. Health Belief Model (HBM) programs based on PRECEDE
 Individual must know what to do and how to do it  Predisposing factors – people’s characteristics that
before they can take action motivate them toward health-related behavior
 Major limitation: it places burden of action exclusively (individual’s attitudes, beliefs, and values); risk factors
on the client  Enabling factors – conditions in people and the
 Role of nurse: change the wrong perception for better environment that facilitates or impede health-related
outcomes behavior (skills, availability, accessibility, referral)
 Key concepts and definitions:  Reinforcing factors – feedback given by support
o Perceived susceptibility – one’s belief persons or groups resulting from the performance of
regarding the chance of getting a given the health-related behavior (support from, family,
condition peers, teachers, employers, health care providers)
o Perceived severity – one’s belief regarding
the seriousness of a given condition HEALTHY COMMUNITY
o Perceived benefits – one’s belief in the ability  shared sense of being a community based on history &
of an advised action to reduce the health risk values
or seriousness of a given condition  a general feeling pf empowerment & control
o Perceived barriers – one’s belief regarding  subgroups participate in community decision making
the tangible and psychological costs of an  ability to cope with change and solve problems & manage
advised action conflicts
o Cues to action – strategies or conditions in  open channels of communication & cooperation
one’s environment that activate readiness to  Equitable & efficient use of resources
take action
o Self-efficacy – one’s confidence in one’s WHAT CAN AFFECT COMMUNITY HEALTH
ability to take action to reduce health risks  People – population
 Location – natural & man-made variables related to
3. Milio’s Framework for Prevention location
 True is true, even if it’s wrong  Social system – existing other groups in the community
 Six propositions:
o Population health deficits leads to COMMUNITY ORGANIZING PARTICIPATORY ACTION
deprivation &/or excess of critical health RESEARCH (COPAR)
resources HRDP – human resource development program
DDU – deprived, depressed, underdeveloped community
 Mobilize the faculty / students  Man power, money
 Enrichment of health-oriented curriculum  Being resourceful
 Reorient health education
 Community 5. Value formation / clarification & capacity building
 Teach people to be self-less
HOW?
 Integrate PHC & COPAR PHASES OF COPAR
 Student’s exposure program PRE-ENTRY
 Development of CHO  Initial phase of the organizing process where the organizer
 Community-capability building looks for communities to serve or help
 Provision of health services  Background checking
 Criteria:
COPAR – social developmental approach that aims to o Socioeconomically depressed – below poverty
transform the apathetic, individualistic, voiceless poor into threshold
dynamic, participatory and politically responsive community; o Inaccessible health services – ideally dapat 30
continuous educating community mins nandun ka na sa health center
o Geographically isolated depressed areas
OBJECTIVE o Poor community health status
 Self-reliance & people empowerment o Relative peach and order situation
1. Awareness o Acceptance of the program by the community
2. Form structures o Not currently served by similar agencies /
3. Initiate responsible action organizations
o At least 100 – 200 families
PRINCIPLES  Activities in pre-entry
 People, especially the oppressed & exploited sectors are o Laying out the site criteria
most open to change & are able to bring about change o Site selection
o Power must reside in the people
o Courtesy call to the local government unit of the
o The interests of the poorest sectors of society
selected site (barangay level)
o Lead to a self-reliant community & society o Statement of objectives & realization of copar
guidelines
PROCESS USED IN COPAR o Meeting with the “will be” foster parents of the
 ARAS – action reflection, action session health care students
o Small group teachings, identification of issues,
problems in the community and let them self- ENTRY
reflect  Establish rapport and assess the needs of the community
 Continuous raising – easy to catch up  Most critical
 Participatory / mass-based – all process must be directed  Social preparation phase
those who are poor, powerless & oppressed communities
 Integration of the community
 Group centered
 Guidelines in integration:
o Recognize local authorities – courtesy call
5 CRITICAL TASKS
o Adapt the lifestyle of the community
1. Community diagnosis
o Choose a modest dwelling
 Before implementing some projects
 State of health o Avoid expectation from the people
 Get data from that community o Be clear with your objectives and limitations
o Participate in the production process
2. Leader’s identification / core group formation o Make house calls and seek out people where
 Nurse is just a facilitators and sharers of expertise they usually gather
o Participate in social activities
3. Community mobilization / organization  Activities in the entry
 Mobilize / organize the people according to the identified o Courtesy call to mayor and to barangay level
problem in the community according to sustainable ways o Meeting with foster parents
also o Appreciating the environment
o Meeting with community officials and residents
4. Resource mobilization / project management o General assembly
 o Preparation of survey forms o Planning for the actual gathering of data
o Actual survey o Data gathering: training on data validation
o Analysis of data gathered (tabulation)
o Integrate with community residents o Presentation at the study & recommendation
o Conduct depending social investigation
o Dissemination of information / sensitives
community residents on the program & PHC PHASE 1
o Formulate criteria for selection of core group  Problem identification
members  Problem analysis
o Define roles and function of the core group  Classification of problems
members  Identification of data to be gathered based on the prob
o Deliver essential basic health services analysis
 Identification of possible informants / respondents
ORGANIZATIONAL-BUILDING PHASE  Selection of research methodology
 The formation of more formal structures and the inclusion  Selection of research instruments
of more formal procedures of planning, implementing and  Planning for actual data gathering (gantt chart)
evaluating community-wide activities. It is at this phase
where the organized leaders or groups are being given PHASE II
trainings to develop their ASK (attitude, skills, and  Data tabulation
knowledge) in managing their own concerns/programs  Look for trends / patterns (compare to look for future
 Criteria for selection of potential leaders health implications); (literature from sources)
o Belong to the poor sectors and classes and is  Data analysis
directly engaged in production  Presentation of data – there must be acceptance of
o Well-respected by members of the community community so that addressing the identified problem is
and has relatively wide influence shared responsibility
o Desirous of change and is willing to work for
change PRIORITIZATION COMMUNITY (POINTS TO CONSIDER IN
o Must be able to communicate effectively PRIORITY SETTING)
o SALT – self-awareness and leadership training  Technology
 Planning / Designing Phase (SMART)  Magnitude
 5 areas of community life (HELPS)  Social concern
o Health  Health policies / programs
o Education
o Livelihood COMMUNITY ORGANIZATION AND CAPABILITY BUILDING
o Physical environment PHASE
o Socio-spiritual / psychosocial  Signals the start community self-management
 Activities:  Formal structures > the CHO
o Meeting with the officials  Formal procedures of planning
o Identifying problems  Implementing
o Spreading awareness and soliciting solution or  Evaluation community – wide activities
suggestion  Activities
o Analysis of the presented solution o Activities
o Planning of the activities o Community meetings to draw up guidelines for
o Organizing the people to build their own org the organization of the CHO
o Registration of the org o Election of CHO organizers
o Implantation of the panned activities o Development of management systems and
o Evaluation procedures
o Team building
COMMUNITY STUDY / DIAGNOSIS o Working out legal requirements systems for the
 Helps classify the problems in the community establishments of CHO
 Primary problem should be health related o Organization of working communities / task group
 Activities o Training of CHO officers & community leaders
o Selection of research team
o Train community research team FIVE COMMUNITY ACTION PHASE
 Organization and training of CHW  This phase should be stated during entry phase so that
o Level 1 basic the people will be ready for this phase
o Level 2 advanced  The org built should be ready to sustain the test of the
o Level 3 specialized health skills community itself because the real evaluation will be done
by the residents of community itself
 Activities
o Leaving the immersion site
SUSTENANCE AND STRENGTHENING PHASE o Documentation
 Refer to the capacity of the programs / projects to
continuously provide or deliver its positive impacts to the METHODS OF ESTABLISHING PARTNERSHIP
beneficiaries  Networking
 Occur when the community organization has already been o Exchanging information about the organizational
established goals and objectives, services or facilities. It
 At this point, the different committee set-up in the provides awareness of the organization’s
organization-building phase is already expected to be capabilities to accomplish the network’s goals
functioning by way of planning, implementing and and objectives
evaluating their own programs, with overall guidance from  Coordination
the community-wide organization o Modifying the orgs activities responsive to the
 Activities needs of the community
o Meeting with the org leaders  Cooperation
o Evaluation of the programs o Sharing information and resources to
o Re-implementing of the programs (for unmet accommodate the org’s agenda
goals)  Collaboration
o Education and training o Assisting organization to enhance their
o Networking and linking capabilities in performing their tasks and quality
o Implementation of livelihood projects of services
o Developing secondary leaders  Coalition
o Formulation & ratification of constitution & by- o Forming partnership between the org and the
laws members of the community
o Identification & development of secondary
leaders THE COMMUNITY HEALTH WORKER AS A
o Setting-up & institutionalization of financing DOCUMENTER / REPORTER
scheme  The community health worker keeps a written account of
o Assess / re-plan community health programs services rendered, observations, condition, needs,
o Formalizing & institutionalizing of linkages, problems and attitude of the client in community activities,
networks, & referral system accomplishments made and etc.
o Development & implementation of viable  Records – forms on which information pertaining the client
management systems & procedures, committees, is noted
continuing education, training of leaders, CHWs,  Reports – refers to periodic summaries of the services /
& community residents activities of an organization / unit or the analysis of certain
phases of its work
CRITERIA OF EVALUATION (effectivity, efficiency,  Purpose:
appropriateness, adequacy) o Measure service / program directed to the clients
 3 types of evaluation o Provide basis for future planning
o Process – evaluate how the program was o Interpret the work to the public and other
implemented agencies, community
o Impact – how the program affects the people in o Aid in studying the conditions of the community
the community o Contributes to client care
o Outcome – evaluate if the lives of the community
members improved APPLICATION OF THE PUBLIC HEALTH TOOLS
THREE IMPORTANT TOOLS
PHASE OUT  Demography
 When the health care workers are leaving the community  Vital statistics
to stand-alone  Epidemiology
DEMOGRAPHY attention in terms of health services and
 Mathematical and statistical study of: size, composition, programs
spatial distribution
 SOURCES METHODS IN DETERMINING POPULATION SIZE
o Census METHOD 1
o Sample surveys  Natural increase
o Registration system NI = no of births – no of deaths
o Continuing population registers: voter’s
registration, school enrollment, income tax  Rate of natural increase
returns, SSS, hospital records RNI = CBR-CDR

CENSUS METHOD 2
 Total process of collecting, compiling, and establishing  Absolute increase/year
demographic, economic, and social data AI/Y = (Pt – Po / t) x 100
 Two types of census allocation
o De jure method – usual residence Where:
Pt – pop size at a later time
o De facto method – physically present
Po – pop size at an earlier time
 Essential features of a population census: t – no of years between 0 and time
o individual enumeration – counted and
enumerated; separately counting everybody  Relative increase
o universality within a defined territory – everybody RI = (Pt – Po / Po) x 100
should be included
o simultaneity – counted with one reference state Where:
o periodicity – done by regular intervals (every 10 Pt – pop size at a later time
years) Po – pop size at an earlier time

USUAL INFORMATION OBTAINED IN A CENSUS STEPS TO COMMUNITY HEALTH

 Geographic information  Needs assessment
 Household or family information o Identify and engage stakeholders
 Personal characteristics o Define the community
 Economic characteristics o Collect and analyze data
 Cultural characteristics o Select priority community health issues
 Educational characteristics o Document and communicate
 Fertility data o Plan improvement strategies
o Implement/ improvement plans
POPULATION SIZE o Evaluate progress
 Refers to the number of people in a given place or area in
a given time POPULATION PYRAMID – graphical representation of the age
 Allows the nurse to make comparisons about population and sex composition of a population
changes over time
 Helps rationalize the types of health programs or STEPS IN CONSTRUCTING A POPULATION PYRAMID
interventions which are going to be provided for the  Data needed
community o Population distribution by age and sex
 Compute the percentage falling under each age – sex
POPULATION COMPOSITION group, using the total population as the denominator
 Pertaining to population size’s variables such as:  Construct the population pyramid using the percentages
o Age computed. The following general rules are followed:
o Sex o Each group is represented by a horizontal bar,
o Occupation with the first bar at the base of the pyramid
o Educational level representing the youngest age group
o Commonly described in terms of its age and sex o The bars for males are traditionally represented
o Nurse utilizes data on age and sex composition on the left side of the central vertical axis while
to decide who the population groups merits the bars for females are presented on the right
side
 o The length of each bar corresponds to the % of
population falling in the specific age and sex ACCORDING TO TIME REFERENCE
group being plotted a. Intercensal estimates
b. Postcensal estimates
INTERPRETATION c. Projections
 Type 1 pyramid
o Broad base and gently sloping sides ACCORDING TO DETAIL DESIRED
o High rates of birth rate & death rate a. Total population vs population subgroups
o Characterized by high dependency ratio b. Population by selected characteristics (age and sex)
 Type 2 pyramid
AGE COMPOSITION
o Broader base than type 1, sides bow in much
1. Median Age of the Population – it is the age below which
more sharply as they slant from the 0-4 age
50% of the population fall and above which the rest of
group to the top
other 50% of the population fall
o Beginning to grow rapidly
o Low child/infant mortality 2. Dependency ratio – represents the no of dependents that
o Fertility level is not reduced need to be supported by every 100 population in the
 Type 3 beehive working age group; the dependency ratio provides an
o Counties with level of birth and death rates found index of the age-induced economic drain on manpower
in the western European counties resources
o Median age is highest  Economically dependent
 Type 4 bell-shaped o 0 – 14 y.o
o Transitional type of pyramid o 65 – and above
o Low death rate  Economically productive
o Fertility rate are in base o Within 15 – 64 y.o
 Type 5 pentagon-shaped
o Rapid decline in fertility DR = (pop aged 0-14 + pop aged 65+ / pop aged 15-16) x 100
o Low death rate
o Ex: Japan
SEX COMPOSITION
CONSEQUENCES / EFFECTS OF AGE AND SEX  The sex ratio represents the number of males for every
STRUCTURE 100 females in the population
 Consumption patterns SR = (no of males / no of females) x 100
 Death rate is affected by age structure
 Migration rates SOME GENERALIZATIONS OF THE SEX COMPOSITION OF
 Variations in age and sex structure affect the probabilities A POPULATION
of marriage for men and women  Sex ratio at birth is generally 105
 Power structure  The sex ratio tends to decrease with age, eventually falling
below 100
POPULATION DISTRIBUTION  Sex ratio is higher in rural areas than in urban areas
 The measure helps the nurses decide how meager  Frontier communities and colonies have higher sex ratios
resources can be justifiably allocated based on
concentration of population in a certain place VITAL SIGNS – tool in estimating the extent or magnitude of
o Urban-rural distribution the health needs & problems in the community
o Crowding index
o Population density STATISTICS OF MORBIDITY AND MORTALITY
 Population census
ACCORDING TO METHOD OF ESTIMATION  Registration of vital data
a. Component Method (inflow – outflow method)  Health survey
Pt = Po + (B-D) + (I-O)  Studies and research

b. Mathematical methods RATIO

 Arithmetic methods  relative number expressing the magnitude of one
 Geometric method occurrence or condition in relation to another
 Exponential method
 these quantities need not necessarily represent the same AR = (no of persons acquiring a disease
entities, although the unit of measure must be the same registered in a given year / no of exposed to
from both numerator and denominator of the ratio same disease in same year) x 100
 ex: sex ratio and dependency ratio
 Mortality rate
RATE o Crude death rate (CDR)
 shows the relationship between a vital event and those CDR = (total no of deaths registered in a given
persons exposed to the occurrence of said event, within a calendar year / estimated population as of July 1
given area and during a specified unit of time of the same year) x 1000
 numerator (experiencing) and denominator (total)
 the occurrence of events over a given interval of time o Specific mortality rate (SMR)
relative to the size of the population at risk of the event SMR/SDR = (deaths in specific class or group
during the same time interval registered in a given calendar year / estimated
 ex: crude birth rate population as of july 1 of the same specific class
or group of the said year) x 100,000
TABULATED BY  Age specific death rate
 date of occurrence rather than by date of registration  Cause specific death rate
 by place of residence rather than by place of occurrence  Sex specific death rate

IMPORTANT FACTORS TO CONSIDER IN INTERPRETING o Age specific death rate (ASDR)

RATE AND RATIO ASDR = (deaths, all causes in particular age
 the source of the numbers group / average population of same age group) x
 accurate count 100,000
 time period
o Age and Sex specific death rate (ASSR)
 measure
ASSR = (deaths in particular age & sex grp /
 magnitude
average population of same age & sex group) x
100,000
CRUDE OR GENERAL RATES – these rates are referred to
the total living population

SPECIFIC RATE – the relationship is for specific population,

o Age-sex & cause specific death rate (ASCSDR)
class or group
ASCSDR = (deaths from particular cause in sex
& age grp / average population of same age &
 Fertility rates
sex grp) x 100,000
o Crude birth rate (CBR)
CBC = (Total no of live births registered in a o Cause of death rate (CDR)
given calendar year / Estimated population as of
CDR = (no of deaths from specific cause for a
July 1 of the same year) x 1000
given calendar year / no of registered cases) x
100
o General fertility rate (GFR)
GFR = (no of livebirths in 1 year / no of women o Infant mortality rate (IMR)
15-44 yrs) x 1000
IMR = (total no of deaths under 1 year of age
registered in a given calendar year / total no of
 Morbidity rate
registered livebirths of the same calendar year) x
o Incidence rate (IR) 1000
IR = (no of new cases of a particular disease
registered during a specific period of time / pop at o Neonatal Death Rate (NDR)
risk) x 100,000 NDR = (no of deaths under 28 days of age are
registered in a given calendar year / no of
o Prevalence rate (PR) livebirths registered of same year) x 1000
PR = (no of new and old cases of a certain
disease registered at a given time / total no of o Post-neonatal mortality rate (PNMR)
person examined at same given time) x 100 PNMR = (infant deaths 28 days to <1 year / total
livebirths) x 1000
o Attack rate (AR)
 o Fetal death rate (FDR) o Disease is usually the result of the imbalance
FDR = (total no of fetal deaths registered in a between the agent and the host
given calendar year / total no of livebirths o The nature of the imbalance would depend on
registered of same year) x 1000 the characteristics of the agent and the host
o The environment places a direct relation to the
o Maternal mortality rate (MMR) conditions of the agents and host
MMR = (total no of deaths from maternal causes
registered from a given year / total number of AGENT OF THE DISEASE
livebirths registered of same year) x 1000  An element, substance, force, or a situation / event, either
animate or inanimate, the presence or absence of which
o Proportionate mortality rate (PMR) may, following effective contact with the susceptible
PMR = (no of registered deaths from a specific human host, under proper environmental conditions,
cause or age for a given calendar year / no of  serve as a stimulus to initiate or perpetuate a disease
registered deaths from all causes, all ages in process
same year) x 100  Types of agents
o Biological – viruses or bacteria (microorganisms)
o Swaroops index o Nutritive – nutrition (lack or excess)
SI = (total deaths, 50 years and above / total o Mechanical – injuries that is cased by mechanical
deaths, all ages in same year) x 100 force (accidents, penetrations, crashes, trauma)
o Physical – different forces on external
o Case fatality rate (CFR) environments (noise, light, temperatures)
CFR = (no of registered deaths from a specific o Psychological – events or situations that leads to
disease for a given year / no of registered cases anxiety or stress
from same specific disease in same year) x 100 o Chemical – toxic agents (substances – natural or
manmade)
EPIDEMIOLOGY
 Study of the determinants of health and the causes and
HOST
distribution of disease and injuries in the human
 Organism, simple or complex
population
 Capable of being infected by a specific agent
o Epi – on; upon
 Human being
o Demos – people
 Host factors (intrinsic susceptibility) – predisposing factors
o Logos – study
o Age
 Two main areas of concern
o Sex
o Study of occurrences and distribution of diseases
o Race or ethnicity
(frequency); how many are afflicted with the
o Genetics
disease?
o Search for the determinants (causes) of the o Religion
disease and its observed distributions (patterns); o Size of family
 Two underlying general concepts o Status or class
o Multiple causation theory – combination of  Other host factors
multiple factors o Occupation
o Levels of prevention of health problems o Nutritional state and consultation
o Intercurrent infection
ECOLOGIC CONCEPT OF DISEASE STATES THAT: o Human behavior
 Disease arises within an ecological system o Personality
o Hence, an ecologic approach is necessary in o Resistance
explaining disease occurrence
 Also called multiple causation or multiple etiology of multi- ENVIRONMENT
factorial theory  Sum total of all external conditions and influences that
affect life and development of an organism
ECOLOGIC TRIAD (responsible for the development of  Components:
disease) o Physical environment – inanimate surrounding
 Agent (causing the disease) (temp, humidity, topographic area, climate)
 Host o Biological environment – normal flora around you
 Environment (vectors, cockroach)
 o Socio-economic environment – occupation, NATURAL HISTORY OF DISEASE
income, rural/urban area, population, social  The course of disease over time, unaffected by treatment
disruptions like war / revolutions o Stage of Susceptibility (risk)
o Stage of pre-symptomatic (may sakit pero
IF THE TRIAD GETS DISRUPTED asymptomatic pa)
 Inapparent or no infection o Stage of clinical disease (changes in physiology,
 Apparent or Infection multiplication of bacteria or virus; s/sx)
o Stage of disability (residual defects, short term or
THE INTERRELATIONSHIPS IS ILLUSTRATED BY THESE long term disease)
ECOLOGIC MODELS
 The triangle – emphasizes the agent EPIDEMIOLOGICAL APPROACH (what, when, where)
 The lever – emphasizes the environment PHASES
 The when – deemphasizes the agent  Descriptive epidemiology – collection of data, distribution
 The web – different factors operating at different time and or frequency of the disease
place; deemphasizes the agent  Analytical epidemiology – after gathering the data; analyze
the cause; making hypotheses; logical guess
PATTERNS OF OCCURRENCE AND DISTRIBUTION  Intervention or experimental epidemiology – intervene or
1. Sporadic – intermittent occurrence; rabies, leptospirosis implement different methods to prevent the disease
2. Endemic – continuous occurrence in 1 country; palawan-  Evaluation epidemiology – measure the effectiveness of
malaria the interventions in controlling the disease
3. Epidemic – large number of cases for a short period of
time; covid-19 in wuhan ASPECTS OF DESCRIPTIVE EPIDEMIOLOGY
4. Pandemic – if simultaneous occurrence althroughout the ASPECT 1 – observation and recording of existing patterns of
world, large case, it gets out of control occurrence of the health condition under study (dapat sure
tayo nay un ang sakit)
LEVELS OF PREVENTION OF HEALTH PROBLEM  Screening – identify unrecognized disease by using s/sx,
 Promoting health and preventing health problems lab and diagnostic procedures
 Make up most of the nurse’s activities in the community  Case finding – looking for people that are afflicted with the
same s/sx that you have found and confirmed in your
PREVENTION screening
 Refers to identification of potential problems  Screening and case finding
o Sensitivity – measures the probability of the test
PRIMARY PREVENTION correctly identifying the person who is positive
 Directed to the healthy population o Specificity – for people who are negative in
 Health teachings, vaccinations, provision of nutrition, results
healthy lifestyle  Attack rate – the no which represents the incidence of the
 In communicable disease prevention – before the agent illness among the exposed individuals (ilan ang pwedeng
enters the host mahawa)
 Primordial prevention – focused on prevention of
emergence of risk factors ASPECT 2 – description of the disease / condition as to
 Specific protection – removal of the risk factors or person, place, and time characteristics
reduction of their levels  After the disease or condition has been identified with
reasonable certainty; the number of persons who possess
SECONDARY PREVENTION (curative) the disease are recorded
 Identify and treat existing health problems at the earliest  Some variables provide clues as to the probable cause of
possible time the disease
 Person is already sick  In viewing the susceptibility of the community as a host;
community and its population
TERTIARY PREVENTION (rehabilitation) o Herd immunity – the immunity level is inversely
 Limits disability progression proportional to susceptibility level (the more
o The nurse attempts to reduce the magnitude or people that are immune, the lesser the chance of
severity of the residual effects of: spreading the disease)
 Infectious diseases o Exposure or contact rate
 Non-communicable diseases  Frequency of contact
 Facility of transmission
 o Chance – probability of contact between the:  To enhance the capacity of individuals, families, and
 Source of infection communities to cope up with their health needs
 Susceptible host
 Disease occurrence can be described by the following: 4. Most prominent feature of PHN
o Short time fluctuation common in epidemics  Public health nursing focuses on preventive, not curative
 Common source epidemic – large no of services
susceptible persons that are exposed to
an infectious agent; sabay sabay na 5. C.E Winslow, goal of PH
nahawa  For people to attain their birthright and longevity
 Propagated epidemic – secondary
infections; person to person 6. “Public health services are given free of charge”
transmission  False, people pay indirectly for public health services
o Cyclic variation – increase and decrease in a (taxes)
period of time (month, year)
o Secular variation – changes in disease 7. CH nurse is not a provider
frequency; pagtaas at pagbaba ng cases every
year 8. Refers to feedback, support persons
 Reinforcing factors
ASPECT 3 – analysis of the general pattern of occurrence of
the disease or condition 9. Difference between no of births and no of deaths
 Establishing the:  Natural increase
o Disease frequency
o Disease distribution in a population 10. Group of people with common characteristics or interests
 Defining the characteristics of the disease or condition in living together within a territory or geographical boundary
relation to:  Community
o Time
o Place 11. Relevance of land and water forms as geographic areas of
o Person community (features: population, location, social system)
 Correlating the data and formulate a causal association  Influences their food sources, plays vital role in disaster,
between the: depicts common occupation in the community
o Disease under study
12. Consults the people in the community as to what they
o Probable factors surrounding it
think are the pressing health issues of their neighborhood
 Assessment
THE USES OF EPIDEMIOLOGY
 To understand disease causation
13. Nutritional assessment of children <5 years of age, what
 To explain local disease patterns method of data gathering?
 To describe the natural history of the disease (how the  Survey
disease changes over time; progression of the disease)
 To provide data for logical planning, implementation and 14. Analysis of the community’s demographic characteristics:
evaluation of health programs or measures (planning for size, composition, and geographical distribution
prevention and control)  Demographic variables

15. Tertiary level example

OCTOBER 20, 2021  Rehabilitation of alcoholic and drug dependents
WEEK 7 – RATIONALIZATION OF PRELIM EXAM
16. 45-year-old female adult statement would require the
1. CHN is a community-based practice.
nurse to give teaching
 The CHN has to conduct community diagnosis to
 Breakfast: always hotdogs, sausage, longganisa
determine nursing needs and problems
17. Health education about measles among mothers,
2. CHN by WHO
verbalization of mother: it is important to protect my child
 Skills of nursing public health and some phases of social except:
assistance  Perceived barriers
3. Primary goal of CHN
18. Health promotion and disease prevention example:
 Teaching pregnant mothers about the benefits of exclusive 31. First level prevention program against ascariasis
breastfeeding during the first 6 months of her child’s life  Health teaching of children on personal hygiene, teaching
proper disposal of excreta, discourage nail biting
19. You will provide occupational health services in which of
the ff settings in your municipality. 32. in order to get a picture of the health and social status of
 Lahat ng may trabaho the community, it is necessary that you conduct a
 community health survey
20. Primary prevention in school health setting
 Conducting an information drive on health eating habits 33. community features
and regular exercise  population. Social system, location

21. Sub-specialty of CHN aims to halt health probs that could 34. family economic, education, communication, political,
hinder students learning & performance legal, religions, recreational
 School health nursing  social system

22. Health issues in prisons that can be addressed by the 35. study of size, territorial distribution & composition of
nurse: population, changes therein
 Provision of hygiene kit, risk of tb spread, poor nutritional  demography
habits
36. components of population growth
23. PHN statement that is incorrect:  death, migration, birth
 Health professionals employed under government service
are the only public health workers 37. source of demographic data
 census, registration system, sample survey
24. Description of community
 Live together within geographical boundary 38. difference between live births and deaths in a specified
period of time
25. Universal declaration of human rights art. 25, sec. 1 states  natural increase
that health is basic human rights
 Everyone has the right to standard of living adequate for 39. PHN needs to develop his/her skills on
health and well-being of himself and his family  Information gathering and analysis, social communication

26. Healthy community 40. Patient deaf and blind, primary responsibility of nurse is
 Awareness that they are community, setting of disputes  Provide secure environment for the patient
through legitimate mechanisms, conservation of natural
resources 41. CHN needs to adapt in the following to be able to succeed
in her health education program
27. Unhealthy community  Give accurate info, communication, teaching learning
 Very strong inclination towards family’s welfare instead of strategies
the community’s interest, decision making is done by the
learned and powerful, absence of distributive justice 42. First symptom of TB
 Cough with expectoration of mucoid sputum
28. Primary focus of CHN practice in terms of maintaining the
people’s optimum level of functioning life 43. Physically present
 Health promotion  De facto

29. Families from lower income groups are the one mostly 44. Population composition
served by the public health services and by the CH nurses  Number of people living in a community
because
 They have proportionally greater numbers of illness and 45. Population distribution
health problems  Formation of agglomeration

30. Current number of Filipinos 117, 959, 400 in demography 46. Demographic processes
this is?  Fertility, mortality, migration
 Population size
  Table and graphs to present the data (appropriate)
47. Production of female births o Bar graph – values across different categories
 Reproduction o Line graph – for trends or patterns over time
(plotting by the use of dots, increasing or
48. Function of epidemiology decreasing)
 Evaluating the effectiveness of disease control o Pie graph – distribution or percentage of group
inside the population (variables na konti lang,
49. Primary purpose of epidemiologic investigation should not be more than 6, ideally 2 or 3
 Delineate the etiology of the epidemic variables)
 Online community format
50. Person to person spread characteristics o Acknowledgement – thank you letter for all the
 Gradual build up of cases before epidemic becomes easily people who helped
noticeable o Introduction – follow the research format (TIPS);
serve as a glimpse of your study (no word
51. Comparing the present frequency of the disease with the limitation)
usual frequency at this time of the year, done during which o General and specific objectives
stage of investigation? o Significance of the study – why did you do the
 Establishing the epidemic study, who will benefit from it? (barangay, sa
inyo, health workers, future researchers)
52. RA 1054 o Scope and limitation – who are going to be
 Location of the workplace in relation to health facilities involved, how you implement, who is included
and who are not.
53. Function of the nurse during epidemic o Methodology – How long did it take u to get that
 Participating in the investigation to determine the source of data (descriptive interview)
epidemic o Definition of terms – alphabetically arranged
o Community profile – community fact sheet,
54. disease occur every now and then affecting only small
research about the community.
number of people relative to total population
o Demographic data
 Sporadic
o Social cultural
55. no of cases that usually increases towards the end of the o Economic base
rainy season, pattern of occurrence is? o Political profile
 Cyclical variation o Quality of life and priority problem
 Problems in the community should be addressed by the
56. will answer questions about the effectiveness of new nurse
methods for controlling diseases or for improving FOR INDICES
underlying conditions  1 sheet = 1 family
 Intervention of experimental epidemiology  Present first the pop pyramid then do gender distribution
(pie graph)
57. set of standard criteria  After describing, health implications (get RRLs)
 Case definition o RRLs or Sex ratio, dependency ratio,
socioeconomic kineme etc.
58. salk vaccine  Community health programs (always dapat may graph)
 Jonas salk  Best community diagnosis will get perfect score in RLE

59. use of census and vital registration PRELIMINARY SOCIAL INVESTIGATION

 William farr WEEK 2 PREPARATORY PHASE
 Ano gagawin before pumasok ng community?
OCTOBER 22, 2021  BEFORE ANYTHING ELSE…
WEEK 7 RLE o What are the things that we need to consider
8 steps before partnering with a community?
1. Identify and engage with stakeholders o FAMORCA
2. Define the community (urban or rural)  Ocular visit – puntahan mo yung
3. Collection and analysis of data (survey, observations, community mo;
interviews, open forums, or review data)
  if not feasible at the moment, review the o Social Status
record from barangay hall,  The position or rank that a person holds
 review available profile of the in relation to the other members of the
community; community
 can also be from referrals;  Ascribed Status – assigned at birth; ex:
 meetings with LGU pinanganak kang miyembro ng tribo
o DOH  Achieved Status – natapos mo sa
 When choosing a community, it must buhay, like education, degree.
satisfy a criterion: Graphically Isolated  Pwedeng same ang status na makuha
and Disadvantage Area (GIDA) mo, ex: unang aeta na doctor
 Geographically challenged dapat yung o Social Roles
community  Obligations and behaviors based on an
 Before entering to GIDA, ask yourself: individual’s status in life
Sila ba ay nangangailangan ng tulong,  Ex: if you’re a farmer, trabaho
Willing bang matulungan, (perception, mo magtanim; if you’re a
willingness/hostility, safety, virgin or no nurse, manggamot
other groups are in there)  CULTURAL
o Ways of life
PRELIMINARY INVESTIGATION o Shared
COMMUNITY STRUCTURES o Learned
 SOCIAL o Developed
o Rules and expectations
o Accepted
o Regulates and manage their interaction
o Own symbols and languages
o Centered on addressing the people’s basic needs
o Norms
of the people
 Refers to specific cultural expectations
on how to behave in a given situation
 Folkways (general standards of
behavior)
 Mores (strict norms that control
moral and ethical behavior) –
ex: sariling set ng batas sa
loob ng community; unwritten
but they know it
 Laws (proscriptive norms
written in a legal code)
o Values and Beliefs
 Values (abstract standards in a
community that define the ideal
o Social networks and groups principles of what is good, just, and
 Primary group – family, peers, desirable)
neighborhood  Beliefs (source of values which refers to
 Secondary group – gangs, fraternity, the shared ideas of what is held
political parties, labor unions
 Informal group – bonded by common
interest, ex: mga nagbibingo, nag
totong-its
 Formal group – formed by community
organizing
 In group – considered their selves as
member of the community
 Out group – considered their selves as
non-member of the community, ex: mga
nakikita lang, temporary renting,
marginalized people, tribes, members of
the third sex
 collectively true by people in a individuals within a localized group
community) setting
o Rituals  Pluralist (harmonious evenly
 Refers to the established sacred or distributed centers of power) –
secular procedures and ceremonies that LGU officials
people in the community regularly  Egalitarian (concentrated
perform powers in the hands of the few)
 Ex: alay-lakad, pagpapako sa krus – ex: tribes in Visayas and
o Artifacts Mindanao (datus)
 Refers to any objects or things that have  Factional (power resides in
special meaning for people in the different groups struggling to
community control or dominate) – group A
 Ex: statues, poong nazareno vs group B
 POLITICAL  Amorphous (absence of an
o Ways of allocating power identifiable power structure) –
o Decision-making magugulong community
o Running o Leadership structure
o Managing community affairs  Refers to the composition of recognized
o Political organizations leaders (formal – elected by the people
 Refers to the groups in the community and informal – not elected but people
who are engaged in partisan politics listen to them) in the community and the
(rivalry) where they campaign for certain lines or workflow of their authority
people to become leaders in their local  Hierarchical (top-down
government leadership)
o Citizenship Norms  Egalitarian (horizontal
 Refers to shared set of expectations leadership)
about the citizen’s role in politics  ECONOMIC
(Dalton, 2008) o Ways and means
 Political (selecting leaders and o Produce goods
influencing the behavior of o Services
political decision-makers) o Allocation of limited resources
 Policy (participation in the o Generate wealth
crafting of laws and policies) o Capital assets
 Social (encouraging others to  Refers to a poverty or anything that is
be involved with social issues owned and has an economic value,
and help promote the common which is expected to generate profit for
good) a long period of time
o Power Relations  Human capital
 Pertains to how different groups in the  Social capital
community are able to interact with and  Natural capital
control other groups  Physical capital
 Dominant groups (are usually  Financial capital
those who are able to control o Vulnerability context
the value systems, rewards,  Pertains to the insecurity in the well-
and resources of the being of individuals and households in
community) the community
 Minority groups (are those  Anthropogenic or natural
people whose voices are disasters
muted and are considered
 Seasonality
subordinate to either the
 Critical trends (demography,
authority or influence of the
poor governance, inflation etc.)
dominant group)
o Business climate
o Power structure
 Refers to the attitudes, laws,
 Refer to hierarchical interrelationships
regulations, and policies of the
that govern the interaction among
government and lending institutions
 toward businesses, enterprises, and  Go to the community
business activities  When doing interview, don’t forget to ask for their consent
o Trade
 Pertains to small, medium, and even 7. Data collation
large-scale enterprises and business  Putting together all information, the summarize data (tally)
activities involving the sale and o Mutually exclusive – make sure that does not
purchase of goods, services, and overlap, walang duplicity; ex: choose one
information between age or birthday
o Exhaustive – anticipate everything or all answers
COMMUNITY DIAGNOSIS 1 o Open-ended questions – construct categories
 Community Diagnosis 8. Data presentation
o Process of determining the health status of the  Descriptive – describe their health beliefs
community and the factors responsible for it;  Numerical data – tables or graphs
o It allows identification of the problem and areas of  After mo magawa to, babalik ka sa community para
improvement and action ibahagi yung nakuha mo; Shared responsibility – if
o Usually, it’s the community organizer who judge nalaman ng community, matutulungan ka nila; serves as
the community health status verification if true or not
 Our responsibility is to determine the 9. Data analysis
resources and potential of the  To view the significance of the problems and their
community to change implications on the health status
o When you do community organizing, community  Literatures
diagnosis is actually needed so that we could 10. Identify the community health nursing problems
elicit the health action-potential of the community  Health status problems
 If they know the problem in their o Increase of decrease mortality, morbidity, fertility,
community, there will be a big possibility
etc.
that they will help you to address the
 Health resources problems
problems that exist in the community
o Lack of manpower, money, materials
STEPS IN CONDUCTING COMMUNITY DIAGNOSIS  Health related problems
1. Determining the objectives o Existence of environmental, economic, social,
 Decide if comprehensive or problem-oriented and political factors that aggravate illness
o Comprehensive – in general; all problems will be 11. Priority-setting
seen  Criteria
o Problem-oriented – specific; includes chosen o Nature of the condition/problem presented
group  Health status – mostly naaddress ng
2. Defining the study population nurses
 Identifies the population group to be included in the study  Health resources
o Age, gender – specific  Health related
o Magnitude of the problem (severity of the
o Whole community – in general\
problem; measured through naapektuhan at hindi
3. Determine the data to be collected
naapektuhan)
 Determining the sources of data
 75-100%
o Primary – first hand (surveys)
 50-74%
o Secondary – from records  25-49%
4. Collecting of data  <25%
 Ocular survey, interview, etc. o Modifiability of the problem (look for: current
o 1st – site visit, observation, survey, interview, knowledge, resources ng family, resources ng
forums, focus group discussions nurse, resources ng community)
o 2nd – records, registry of vital events, FHSIS  High – if 4/4
5. Developing the instrument  Moderate – if 2-3/4
 Sometimes this comes first (kase dapat bago ka pumunta,  Low – if 1/4
may nadevelop ka nang instrument)  Not modifiable – if 0-1/4
o Survey questionnaires o Preventive potential (probable ways to control the
o Interview guide problem) (gravity/severity, duration, current
o Observation checklist management, exposure/vulnerability)
6. Actual data gathering  High – if everything is good
  Moderate – 2-3/4  Problem: Risk of maternal
 Low – 1/4 complications leading to
 How can you justify the preventive maternal mortality
potential, explain lahat ng apat.  Population: among pregnant
o Social concern (perception of the family or women in the community
community sa problem that affects them;  Factors: related to cost and
readiness of the community to act on the inaccessibility of community
problem) health workers and their
 Urgent community concern perception of childbirth
 Expressed readiness recognized as a
problem but not needing urgent PLANNING COMMUNITY HEALTH INTERVENTIONS
attention Priority Setting
 Not a community concern  WHO criteria
o Significance of the problem
FORMAT OF NURSING DIAGNOSES FOR POPULATION  Number of people in the community
GROUPS affected by the problem
 THREE PART STATEMENT  If the prob is a disease,
o P: The health risk or specific problem to which kelangan mo malaman yung
the community is exposed prevalence. The higher the
o P: The specific aggregate (sinong part ng prevalence, the higher its
population) or community with whom the nurse significance to the community
will be working to deal with the risk or problem  If potential prob, you need to
take note of the people at risk.
The higher the people is at risk,
the higher the significance
o Community awareness
 The “priority” its members give to the
health concern
 How are they willing to act or to
go
o Ability to reduce risk
 Availability of expertise
o Cost of reducing risk
 Economic, social and ethical requisites
and consequences of planned actions
o Ability to identify the target population
 Availability of data resources
 FHSIS
o Availability of resources
 Linkages

PRIORITY SETTING PROCESS

 Weight based on perception of its degree of importance in
solving the problem
 In terms of likelihood of the group being able to influence
or change the situation
 Collate weights
 Compute the total priority score of the problem
 Get the priority score of the problem
o Example:
o F: Related factors that influence how the
community will respond to the health risk or
problem
 Example:
Get the average weight from the two questions, then tally. IMPORTANCE OF COPAR
(weight x rating)  COPAR is an important tool for community development

COPAR
 First introduced in 1990s
 Not actually for nurses, but for social psychology

COMMUNITY ORGANIZING PARTICIPATORY ACTION

RESEARCH
 A social development approach that aims to transform the
apathetic (walang pakialam), poor into dynamic,
participatory and politically responsive community
 A collective, participatory, transformative, liberative,
sustained and systematic process of building people’s
organizations by mobilizing and enhancing the capabilities
and resources of the people for the resolution of their
exploitative conditions (1994 National Rural CO and people empowerment as this helps the community
Conference) workers to generate community participation in
development activities
 A process by which a community identifies its needs and
objectives, develops confidence to take action in respect  COPAR prepares people to eventually take over the
to them and in doing so, extends and develops management of a development program in the future. It
cooperative and collaborative attitudes and practices in maximizes community participation and involvement;
the community (Rose, 1967) community resources are mobilized for health
development services
 A continuous and sustained process of educating the
people to understand and develop their critical awareness
PRINCIPLES OF COPAR
of their existing conditions, working with the people
collectively and efficiently on their immediate needs.  Change
Mobilizing toward solving their long-term problems  Poor
(Famorca)  People-centered
 Participative
BASIC VALUES IN COMMUNITY ORGANIZING (Famorca)  Democratic
 Human rights  Development
 Social justice  Process-oriented
 Social responsibility  Self-reliance = high degree of self-awareness among
 Apostolate work of the church people

APPROACHES IN COMMUNITY ORGANIZING PROCESS / METHODS USED IN COPAR

 Social welfare / Dole-out  A progressive cycle of action-reflection-action
o The intermediate and/or spontaneous response o Which begins in small, local and concrete issues
o Assumes that poverty is God-given identified by the people and the evaluation and
o The poor should accept their condition reflection of and on the action taken by them
o Bad luck and natural disaster o Progressive cycle of action-reflection-action
o Not recommended: because the community will  Usually, copar begins with identified
problems and the activities for those
develop dependency
particular identified problems are
 Modernization / Project Development
approved upon and are identified by
o Technological development
people in the community. Sila mismo
o Lack of education ang nagsabi ng problem, you have to
 Participatory action approach plan projects for them.
o The process of empowering / transforming the  When it gets implemented, ask them to
poor and the oppressed sectors of society so that evaluate and reflect
they can pursue more just and humane society  Gawin ang project, then evaluate and
o Recommended: because you teach/help them to reflect, then improve what you did
stand on their own  Consciousness-raising
 o Through experiential learning is central to the
COPAR process because it places emphasis on
the learning that emerges from concrete action
and which encircles succeeding action
 You will only learn something, if you do
it and do it properly
 COPAR is participatory and mass-based
o Because it is primarily directed towards and
biased in favor of the poor, the powerless and the
oppressed
 Pang-masa
 COPAR is group-centered
o Not leader-centered
o Leader are identified, emerge and are tested
through action rather than appointed or selected
by some external force or entity

STEPS IN COPAR
 Pre-entry
 Entry
 Organizing
 Sustenance and strengthening
 Phase-out

ENVIRONMENTAL AND HEALTH SANITATION

ENVIRONMENTAL HEALTH
 Branch of the public health that deals with the study of
preventing illness by managing the people’s environment
and changing their behavior to reduce their exposure to
biological and non-biological agents
 DI PA TAPOS TONG PART NA TO. TINATAMAD NA
KASI AKO