Community Health Nursing 2 (POPULATION GROUPS AND 3.

In selecting appropriate activities, focus on primary

COMMUNITY AS CLIENTS) prevention.
Community Health Nursing Concepts 4. Promote a healthful physical and psychosocial environment.
The science of nursing has expanded over the years. With the 5. Reach out to all who may benefit from a specific service.
advent of modern technology and the easy access to healthcare 6. Promote optimum use of resources.
information, nurses have taken a higher plane of helping 7. Collaborate with others working in the community.
population groups achieve better health. Community health nurses Characteristics and Features of Community and Public Health
can assist in the transition of the Philippine Health Care System Nursing
from a disease-oriented system to a health-oriented system. 1. Developmental
Nurses constitute a large group of health care workers; 2. Multidisciplinary
therefore, they can create a health care delivery system that will 3. Ecology oriented
meet the health-oriented needs of the people. Community and 4. Promotes social justice
public health nursing focus on all population groups whether 5. Values consumer involvement
children, adults, elderly or collectively as families in their natural 6. Uses prepayment mechanism
environment. 7. Focuses on preventive service
Definition 8. Offers comprehensive care
Community Health Nursing is a specialized field of nursing A community has three features (Allender et al., 2009; Hunt, 2009)
practice that renders care to individuals, families and communities, 1. People
focusing on health promotion and disease prevention through 2. Location
people empowerment. Health promotion and disease prevention 3. Social system
are the core of community health nursing.
Theoretical Models/Approaches
Major goal: to preserve the health of the community and
1. Social Learning Theory – is based on the belief that learning
surrounding populations by focusing on health promotion and
takes place in a social context, that is, people learn from one
health maintenance of individuals, families, and groups within the
community. Thus, community health nursing is associated with another, and that learning is promoted by modeling or
health and the identification of populations at risk rather than with observing other people. It is anchored on the fat that persons
an episodic response to patient demand. are thinking beings with self-regulatory capacities, capable of
3 Basic Concepts of Community and Public Health Nursing making decisions and acting according to expected
1. The community as a client consequences of their behavior. The environment affects
➢ Community is a collection of people who interact with 1 learning, but learning outcomes depend on the learner’s
another & whose common interests or characteristics individual characteristics.
form the basis for a sense of unity or belonging. Examples:
2. Health as a goal – state of complete physical, mental, and • Serving as a live model (demonstrating wound care)
social well-being & not the absence of disease or infirmity. • Giving detailed verbal instructions (teaching how to do
➢ Health is more than a state of well-being. It is a deep breathing exercises)
multidimensional reality that includes socioeconomic, • Using print or multimedia strategies in health education
environmental and even political factors. (infographics) The nurse facilitates learning through
➢ Healthcare needs to be holistic. The nurse in the catching attention through different strategies, promote
community foster multidisciplinary efforts to address retention of learning by demonstrating the step-by-step
various core determinants of health. procedure, providing with occasions for the reproduction
3. Nursing as the vehicle or means to achieve its aims or imitation of the procedures and motivating the clients
➢ Nursing is the art and science of caring. by explaining the benefits derived from the behavior.
➢ According to Florence Nightingale (1973), nursing is a 2. Health Belief Model – provides the basis for much of the
means of ensuring that people are placed in an practice of health education and health promotion today. The
optimum condition where nature can contribute to HBM was developed by a group of social psychologists to
healing and wellness. explain why the public failed to participate in screening for
Philosophy and Principles tuberculosis (Hochbaum, 1958).
The health care system has been evolving from focusing on Examples: (Questions to ask)
individuals in acute care settings to being more community based • Why do people who may have a disease reject health
and population health directed. screening?
Philosophy • Why do individuals participate in screening if it may lead
1. The practice of community and public health nursing is to the diagnosis of disease?
anchored on the primary of worth and dignity of man. The HBM is used to explain behavior change and maintenance
2. Respect for people’s inherent value regardless of background of behavior change and to guide health promotion
& beliefs are edified. interventions.
3. Responsibility for health rests primarily on people and not on 3. Milio’s Framework for Prevention – provides a compliment to
agencies or professionals. the HBM and provides a mechanism for directing attention
4. The need for the attainment of independence and self- upstream and examining opportunities for nursing
reliance in health. intervention at the population level.
5. Health is a shared responsibility and therefore requires Milio’s Proposition Summary
collective efforts from all sectors. Working with communities a. Population health deficits’ result from deprivation and/or
requires active participation of the people. excess of critical health resources.
6. A fundamental commitment of community and public health Example: individuals and families living in poverty have
nurses is to adhere to the tenets of social justice. This poorer health status compared with middle- and upper-
principle speaks of promoting common good and not merely class families.
to be fair to all. b. Behaviors of populations result from selection from
7. One hallmark of the profession is having its own code of limited choices; these arise from actual and perceived
ethics. options available as well as beliefs and expectations
Principles of Community and Public Health Nursing resulting from socialization, education and experience.
Focus on the community as the unit of care. Example: positive and negative lifestyle choices are
1. Give priority to community needs. strongly dependent on culture, socioeconomic status and
2. Work with the community as an equal partner of the health educational level.
team.
 c. Organizational decisions and policies dictate many of the ➢ Reinforcing factors refers to feedback given by support
options available to individuals and populations and persons or groups resulting from the performance of the
influence choices. health-related behavior.
Example: health insurance coverage and availability Different Fields
d. Individual choices related to health promotion or health 1. Community Health Nursing – the synthesis of nursing
damaging behaviors are influenced by efforts to maximize practice and public health practice applied to promoting and
valued resources. preserving the health of the populations. CHN is considered
Example: Choices and behavior of individuals such as use to be a broader and more general specialty area that
of illegal drugs encompasses subspecialties that include public health
e. Alteration in patterns of behavior resulting from decision nursing, school nursing, occupational health nursing and
making of a significant number of people in a population other developing fields of practice such as home health,
can result in social change. Example: Some behaviors such hospice care and independent practice.
as tobacco use have become difficult to maintain in many 2. Public Health Nursing – has frequently been described as the
settings or situations in response to organizational and
synthesis of public health and nursing practice. It includes
public policy mandates.
f. Without concurrent availability of alternative health- technical nursing, interpersonal, analytical and organizational
promoting options for investment of personal resources, skills that are applied to problems of health as they affect the
health education will be largely ineffective in changing community.
behavior patterns. 3. Community Based Nursing – application of the nursing
Example: Addressing persistent health problems process in caring for individuals, families and groups where
(hypertension etc.) they live, work or go to school as they move through the
4. Nola Pender’s Health Promotion Model – explores many health care system.
biopsychosocial factors that influence individuals to pursue 4. School Health Nursing – aims to promote the health of school
health promotion activities. personnel and students that could hinder learning or
Health Promotion Model Variables: performance. According to World Health Organization, “to
a. Individual characteristics and experiences learn effectively, children need good health.”
b. Prior related behavior School Health Services:
c. Personal factors • Comprehensive School Health Education (Grades K-12)
d. Behavior-specific cognitions and affect • Physical Education and Activity
e. Perceived benefits of action • Nutrition Services
f. Perceived barriers to action • School Health Services
g. Perceived self-efficacy • School Counseling, Psychological and Social Services
h. Activity-related affect • Health and Safe School Environment
i. Interpersonal influences • Student, Family and Community Involvement in Schools
j. Situational influences • Health Promotion for School Staff
k. Commitment to a plan of action 5. Occupational Health Nursing – aimed at assisting workers in
l. Immediate competing demands and preferences all occupations to cope with actual and potential stresses in
m. Health -promoting behavior relation to their work and work environment.
5. Transtheoretical Model – combines several theories of 6. Community Mental Health Nursing – are specialized nurses
intervention, thus the name transtheoretical. who provide wholistic nursing services for people with
Stages of Change mental health issues, in a community setting such as caring
1. Precontemplation and confidential supports for the clients, using the recovery
2. Contemplation model for care.
3. Preparation The services may include:
4. Action 1. Treatment Planning
5. Maintenance 2. Medication Management
Decisional Balance 3. Assessment
1. Pros: benefits of behavior change 4. Counseling
2. Cons: costs of behavior change 5. Family Support
Change is difficult, even for the most motivated individuals. 6. Education
People resist change for many reasons. Change may: 7. Group Support
• Be unpleasant
8. Facilitate services with visiting psychiatrists
• Require giving up pleasure
7. Home Health Care – helps in providing nursing care to the
• Be painful
individuals and families in their own place of residence
• Be stressful
mainly to minimize the effects of illness and disability.
• Jeopardize social relationships
8. Hospice Home Care – specifically renders to terminally ill,
• Not seem important any more
intended to provide comfort to improve quality of life
• Require change in self-image
provide support to the patient and family.
6. Lawrence Green’s PRECEDE-PROCEED MODEL 9. Faith community nursing or parish nursing – the practice of
➢ The PRECEDE-PROCEED Model provides a model for art and science and nursing combine with spiritual care.
community assessment, health education planning and
evaluation. Concept of the Community
PRECEDE which stands for Predisposing, Reinforcing In recent nursing literature, community has been defined as
and Enabling Constructs in Educational Diagnosis and “a collection of people who interact with one another and whose
Evaluation is used for community diagnosis. common interest or characteristics form the basis for a sense of
PROCEED an acronym for Policy, Regulatory and unity or belonging” (Allender et al., 2009); “a group of people who
Organizational Constructs in Educational and share something in common and interact with one another, who
Environmental Development. may exhibit a commitment with one another and may exhibit a
➢ Predisposing factors refers to people’s characteristics that commitment with one another and may shade a geographic
motivate them towards health-related behavior. boundary” (Lundy & Janes, 2009); “a group of people who share
➢ Enabling factors refers to conditions in people and the common interests, who interact with each other, and who function
environment that facilitate or impede health related in collectively within a defined social structure to address common
behavior. concerns” (Clark, 2008); and “a locality-based entity, composed of
systems of formal organizations reflecting society’s institutions, a. Achieve a good quality of life
informal groups and aggregates” (Shuster & Goeppinger, 2008). b. Create a health-supportive environment
Maurer and Smith (2009) further addressed the concept of c. Provide basic sanitation and hygiene needs
community and identified four defining attributes: d. Supply access to health care
(1) people, Components of a Community
(2) place, A community can be described as a complex whole
(3) interaction, resulting from the combination of the environment, people health,
(4) common characteristics, interests, or goals. quality of life, and economics. The functionality of a community
Combining ideas and concepts, in this text, community is depends solely on these key elements. Thus, the components of
seen as group or collection of locality-based individuals, interacting the community are as follows: the environment, the people, the
in social units and sharing common interests, characteristics, economy, the culture, health, and the quality of life.
values, and /or goals. Factors Affecting Health of the Community
Types of Communities (Maurer & Smith, 2009). 1. Characteristics of the Populations
1. Geo-political communities 2. Location of the Community
➢ most traditionally recognized or imagined when 3. Social System within the Community
considering the term community. Geopolitical Determinants of Health and Disease
communities are defined or formed by both natural and The health status of a community is associated with several
man-made boundaries and include barangays, factors:
municipalities, cities, provinces, regions, and nations. 1. Health care
Other commonly recognized geopolitical communities 2. Access
are congressional districts and neighborhoods. 3. Economic conditions
Geopolitical communities may also be called territorial 4. Social
communities. 5. Environmental issues
2. Phenomenological communities 6. Cultural practices
➢ Phenomenological communities, in the other hand, refer Roles and Activities of Community Health Nurse
to relational, interactive groups, in which the place or The complex nature of the health needs of communities calls for
setting is more abstract, and people share a group a holistic response from public health nurses. This in effect
perspective or identity based in culture, values, history, demands not only collaborative interventions but at the same time
interests, and goals. Examples if phenomenological the nurse working with communities is expected to demonstrate
communities include schools, colleges, and universities; competencies demanded by different settings and situations of
churches, and mosques; and various groups or his/her clientele. The Philippine Professional Regulatory Board of
organizations. These communities may also be described Nursing (NNCCS, 2012) expects beginning professional nurses to
as functional communities. A community of solution is a be able to perform three roles: that of health care provider,
type of phenomenological community and is a collection manager-leader, and researcher. But a community and public
of people who form a group specifically to address a health nurse takes on additional roles, owing to the realities of
common need or concern. The Gawad Kalinga, whose changing times and age.
members aim to alleviate poverty by community 1. Healthcare Provider – caring is the essence of nursing and has
development, and a group of indigenous people who been widely accepted in all settings. The use of the nursing
lobby against environmental degradation of their process applied in the natural environment of the client
ancestral land are examples. These groups or social units pertains to this role. Examples include the occupational
work together to realize a level of potential “health” and health nurse conducting a physical examination of an
to address identified actual and potential health threats employee, a school nurse providing first-aid to student who
and health needs. sustained a cut, and a nurse taking the history of a pageant
➢ Depending on the situation, needs and practice woman in the village clinic.
parameters, community health nursing interventions 2. Health Educator – communicating information to help
may be directed toward a community (e.g., residents of patients make an informed choice regarding their health is a
a small town), a population (e.g., all elders in a rural key activity in public health works. It is hoped that awareness
region), or an aggregate (e.g., pregnant teens within a will impact people’s behavior to achieve health in their own
school district). hands. Instructing patients how to take their prescribed
Characteristics of a Healthy Community medicine or sharing information about the benefits of
• Shared sense of being a community based on history & healthy lifestyle illustrates this role.
values. 3. Program Implementer – nurses working under local
• General feeling of empowerment and control over
government units deliver healthcare to the grassroots. This
also requires that programs initiated by the national
matters that affects the community as whole.
government thru the Philippine Department of Health (DOH)
• Existing structures that allow subgroups within the
are executed at all levels. This includes immunization which
community to participate in decision making in offers protection against infectious disease. The nurse works
community matters. with the rural health midwife in conducting routine
• Ability to cope with change, solve problems, and manage vaccination in communities to achieve herd immunity and
conflicts within the community through acceptable contribute to the over-all goal of reducing child mortality.
means. Likewise, submitting reports per standards of documentation
• Open channels of communication and cooperation among on targets reached and missed is part of this role of the nurse
the members of the community. in community/public health.
• Equitable and efficient use of community resources within 4. Community Organizer – working with people in communities
the view towards sustaining natural sources. and providing them ownership of their healthcare needs and
➢ A healthy community is, in fact, the context of health to act collectively on their issues is best captured by this role
promotion defined in the Ottawa Charter (WHO, 1986) of the nurse in public health.
as “the process of enabling people to increase control 5. Manager/Leader – community and public health work deal
over and to improve their health.” with competing claims specifically on utilization of limited
➢ A healthy city is one that is continually creating and resources. Hence, the nurse employs principles of
improving those physical and social environments and management to maximize resources effectively and
expanding those community resources that enable efficiently. Budgeting, inventories, scheduling and staffing,
people to mutually support each other in performing all conducting training sessions are likewise included under this
the functions of life and developing to their maximum role.
potential. It aims to:
 6. Researcher/Epidemiologist. The nurse is regarded as the 2. Secondary data – data already collected by other
health monitor of the community. Together with the rural individuals and/ or institutions for some specific purpose.
health midwife, they keep track of illnesses encountered in Example: Population census, birth, and death certificates,
their areas of jurisdiction and submits reports to health health surveys, etc.
authorities as required by law. In the event of an outbreak, ➢ Vital Statistics is the study of the characteristics of
community/public health nurses work with other human populations. It comprises a number of
professionals and agencies in conducting investigation to
important events in human life including birth, death,
identify etiology of epidemic and ultimately identify potential
fetal death, marriage, divorce, annulment, judicial
solutions to halt the progress of the problem. Apart from
collecting actual data for research, the nurse utilizes research separation, adoption, legitimation and recognition.
findings to provide evidence to convince decision-makers to ➢ Individual records – birth, death, marriage/divorce.
enact policies for health. ➢ Population records – it serves as key demographic
7. Client Advocate – the community/public health nurse takes a variables in the analysis of population size, growth
proactive stance in ensuring that the right to health of the and geographic distribution.
population he/she works with is realized and protected. To ➢ Population indicators includes population growth
do this, he/she engages stakeholders in clamoring and indicators (crude birth rate, general fertility rate,
lobbying for policies that impact health of communities. The total fertility rate and annual growth rate) and other
nurse in the field also initiates organizing activities to form population dynamics (migration) that can affect the
coalitions and linkages to foster awareness of people to age-sex structure of the population.
various health-related issues. ➢ Population Size
1. Natural increase
Health Statistics and Epidemiology 2. Rate of natural increase
➢ Although the beginnings of epidemiology might have been ➢ Population Composition
during the time of Hippocrates when he explicated that
1. Sex composition
disease could be associated with climate and the physical
2. Age composition
environment, it is still a young science that developed rapidly
3. Age and sex composition
only after Snow’s investigation of the cholera epidemic in
➢ Population Distribution
London in 1854.
➢ Epidemiology originated from the Greek words, epi, meaning 1. Urban-Rural distribution
“upon”, demos, meaning “people”, and logos, meaning 2. Crowding index
“study”. 3. Population density
➢ Epidemiology is the study of the distribution and determinants 2. HEALTH INDICATORS
of health-related states or events in specified populations and • Fertility Rates
the application of this study to the prevention and control of 1. Crude Birth Rate (CBR) – measures how fast people
health problems. are added to the population through births.
Practical applications of epidemiology are: ➢ CBR = total number of live births for a given area
a. Assessment of the health status of the community or and time period/total population at the midpoint
community diagnosis of the time period x 1000.
b. Elucidation of the natural history of disease 2. General Fertility Rate (GFR) – the number of live
c. Determination of disease causation births per 1,000 women aged 15-49 in a given year
d. Prevention and control of disease ➢ GFR = number of registered live births in a
e. Monitoring and evaluation of health interventions year/midyear population of women 15-49 years
f. Provision of evidence for policy formulation of age x 1000.
➢ Community assessment is an essential process for • Morbidity Rates
understanding the community, identifying its needs or 1. Incidence Rate (IR) describes the occurrence of new
weaknesses and assets or strengths that is useful to achieve cases of a disease or condition in a community over a
healthy communities. It is a fundamental step that supports given period relative to the size of the population at
the actions of the community health nurse in planning and risk for that disease or conditions during that same
implementing interventions in the community. A community period.
health assessment is otherwise termed as community health ➢ IR = number of new cases of disease developing
needs assessment. from a period of time/ population at risk of
➢ The data that need to be collected depend on the objectives
developing the disease X F
of community assessment. In general, the nurses need to
2. Prevalence Rate (PR) is the number of all cases of a
collect data on the three features of a community: people,
specific disease or condition in a population at a
place and social system.
given point in time relative to the population at the
The community data base for Planned Approach to
Community Health (PATCH), a community health planning same point in time.
model based on Green’s PRECEDE model includes quantitative ➢ PR = number of existing cases in population at a
and qualitative data. particular point in time/ population at the same
1. Community Profile: demographic, educational, economic specified point in time x F.
data • Mortality Rates
2. Morbidity and mortality data 1. Crude Death Rate (CDR) represents the total or
3. Behavioral data overall death rate in a given population.
4. Opinion data from common leaders CDR= number of deaths for a given area and time
A. Tools period/ size of population at risk of dying, usually
1. DEMOGRAPHY – the science which deals with the study of the taken as the estimated population at the midpoint of
human population size, composition and distribution in space. the calendar year x 1000
Sources of Data 2. Specific Death Rate represents a subset of the
1. Primary data – original data collected for a specific population or with particular classes of deaths
purpose by a researcher. Example: Data collected when SDR= number of deaths in a specified group/ midyear
there is a suspected Cholera outbreak in a community, population of the same specified group x 1000
which could include getting water sample from their 3. Cause of Death Rate gives the rate of dying due to
water source and interviewing people about their specific causes. Cause of Death Rate= number of
symptoms. deaths from a specified cause / midyear population x
1000.
 4. Infant Mortality Rate (IMR) is the number of deaths generation to exactly replace itself without
per 1,000 live births of children under one year of needing international immigration.
age. • Live Births per Woman, 2020
IMR= deaths under 1 year of age/ number of live Life Expectancy in the Philippines
births x 1000. BOTH SEXES
5. Maternal Mortality Rate (MMR) refers to deaths due 71.7 years
to complications from pregnancy or childbirth. (life expectancy at birth, both sexes combined)
MMR= number of deaths due to pregnancy, delivery FEMALES
and puerperium / number of live births x 1000. 75.9 years
6. Proportionate Mortality Ratio describes the (Life expectancy at birth, females)
proportion of deaths in a specified population over a MALES
period of time attributable to different causes. PMR= 67.7 years
number of deaths from a particular cause / total (Life expectancy at birth, males)
deaths x100.
7. Swaroop's index is the proportion of deaths aged 50 Infant Mortality Rate and Deaths of Children under 5
years and above. The higher the Swaroop's index of a Years Old in the Philippines
population, the greater the proportion of the deaths INFANT MORTALITY
who were able to reach the age of at least 50 years, 17.5
i.e., more people grew old before they died. (Infant deaths per 1,000 live births)
Swaroop’s Rate=numbers of death among those 50 DEATHS UNDER AGE 5
yrs. and over/ total deaths x 100. 24.8
8. Case Fatality Rate also called case fatality risk or case (per 1,000 live births)
fatality ratio. It is the proportion of people who die
from a specified disease among all individuals Philippines Urban Population
diagnosed with the disease over a certain period. Currently, 47.1 % of the population of the Philippines
Case Fatality Rate typically is used as a measure of is urban (50,971,408 people in 2019)
disease severity and is often used for prognosis Population Density
(predicting disease course or outcome), where The 2019 population density in the Philippines is 363
comparatively high rates are indicative of relatively people per Km2 (939 people per mi2), calculated on a
poor outcomes. It also can be used to evaluate the total land area of 298,170 Km2 (115,124 sq. miles).
effect of new treatments, with measures decreasing 2. Health Profile
as treatments improve. Case fatality rates are not Causes of Morbidity and Mortality
constant; they can vary between populations and 10 Leading Causes of Morbidity in the Philippines,
over time, depending on the interplay between the 2010 (DOH, 2010)
causative agent of disease, the host, and the 1. Acute Respiratory Infection
environment as well as available treatments and 2. Acute Lower Respiratory Tract Infection and
quality of patient care. Pneumonia
CFR= numbers of death from a specified 3. Bronchitis/Bronchiolitis
cause/number of cases of the same disease x 100 4. Hypertension
B. Philippine Health Situation 5. Acute Watery Diarrhea
1. Demographic Profile 6. Influenza
A nation’s health care delivery system has a 7. Urinary Tract Infection
tremendous impact not only on the health of its 8. TB Respiratory
people but also on their development, including their 9. Injuries
socioeconomic status. Nations go through a struggle 10. Diseases of the Heart
to overcome multiple forces in efforts to advance the 10 Leading Causes of Deaths in the Philippines, 2006
nation’s health within the context of their financial (PSA, 2016)
and political situations. 1. Ischemic Heart Disease
Anderson and MCFarlane (2011) emphasized the 2. Neoplasms
role of the following factors in shaping 21st century 3. Pneumonia
health that further influence health care delivery
system: 1. Health care reforms; 2. Demographics; 3. 4. Cerebrovascular Disease
Globalization; 4. Poverty and growing disparities; 5. 5. Hypertensive Diseases
Social disintegration. 6. Diabetes Mellitus
• The current population of the Philippines is 7. Other Heart Diseases
111,448,385 as of Thursday, October 14, 2021, 8. Respiratory Tuberculosis
based on Worldometer elaboration of the latest 9. Chronic Lower Respiratory Infections
United Nations data. 10. Diseases of the Genitourinary System
• Philippines 2020 population is estimated at C. Epidemiology and the Nurse
109,581,078 people at mid-year accrdg to UN. Definition and Related Terms
• The Philippines population is equivalent to 1.41% a. Epidemiology is defined as the study of occurrence and
of the total world population. distribution of health conditions such as disease, death,
• The Philippines ranks number 13 in the list of deformities or disabilities on human populations.
countries (and dependencies) by population. ➢ Nurse measures the frequency and distribution of
• The population density in the Philippines is 368 health conditions using VITAL STATISTICAL indices.
➢ Nurse identifies the factors related to time, place and
per Km2 (952 people per mi2).
person characteristics in order to explain how the
• Total land area is 298,170 Km2 (115,124 sq.m) disease developed in the community.
• 47.5 % of the population is urban (52,008,603 ➢ The focus is the population, whether at the global
people in 2020) level, country, city, school or neighborhood. This also
• The median age in the Philippines is 25.7 years. shows that the scope is not only diseases but also
Fertility in the Philippines health-related states and events; described in terms
• A Total Fertility Rate (TFR) is the average number of distribution, including their determinants and their
of children per woman needed for each prevention and control.
 ➢ Epidemiology follows the scientific method; from 6. Cluster refers to an aggregation of cases grouped in
defining the problem, gathering data or information, place and time that are suspected to be greater than
analyzing and interpreting them to come up with a the number expected, even though the expected
sound conclusion and set a recommendation. number may not be known.
➢ The study of epidemiology focuses on the frequency 7. Pandemic refers to an epidemic that has spread over
and pattern of health events in a population.
several countries or continents, usually affecting a
b. Frequency refers to the number of health events, such as
the number of cases of COVID 19 or Dengue in a large number of people.
population. Epidemiological Triangle
c. Pattern refers to the occurrence of health conditions or ➢ In understanding diseases or poor health outcomes, it is also
disease by time, place and person. important to understand the risk factors or any attribute,
d. Time patterns maybe annual, seasonal, weekly, daily, characteristics or exposure of an individual that increases the
hourly or any other breakdown of time that may influence likelihood of developing a disease or health condition.
health condition or disease. There are three models of disease causation:
e. Place patterns include geographic variation, such as 1. Epidemiological triad – is the traditional model for
urban/rural differences and location such as schools or infectious diseases, consisting of susceptible host, an
workplace. external agent and an environment that brings the host
➢ Epidemiologic methods are used to study both and agent together. In this model, disease results from
communicable and non-communicable diseases and the interaction between the susceptible host and the
other health-related states or events. Epidemiologic agent in an environment that supports transmission of
methods and tools are important for accurate the agent from a source to that of the host (CDC, 2012).
community assessment and diagnosis and in planning 2. Iceberg principle – shows the disease situation where the
and evaluating effective community interventions. problem is subclinical, unreported or hidden from view.
Types of Health Indicators and their Examples Only the tip of the iceberg is known, eg, resulting deaths
1. Morbidity – prevalence, incidence from suicides or reported cases of AIDS. The public
2. Mortality – crude and specific death rate, maternal health goal is to find out through screening and early
mortality, infant mortality, neonatal mortality detection those who are exposed or affected so that
3. Population – Age-sex structure of the population, proper interventions can be done.
population density, migration 3. Web of causation – shows the relationship between
4. Indicators of the provision of healthcare – access to different multiple factors that contribute to the cause of
health program a disease. This model proposes that diseases are caused
5. Risk reduction indicators – Cases consulting a health by the interaction between genetic factors and
provider environmental factors. Personal behaviors also affect
6. Social and economic indicators-level and distribution of this interaction and interventions can be done through
economic wealth, types and levels of employment health promotion.
7. Environmental – potability of drinking water Investigations, Epidemiological Process and Investigation
8. Disability – chronic mobility limitations Screening and Surveillance are important in identifying risk
9. Health policy – allocation of manpower factors and monitoring health and disease conditions in the
population. Evidence from surveillance studies is often used to
Natural History of Disease
develop screening programs, prevention and treatment
➢ In studying the course and outcome of diseases,
policies.
epidemiology gives a picture of the natural history of Screening is the active search or process of detection for
diseases in individuals and groups. It describes the disease or disorders among apparently healthy people. The
subclinical changes to signs and symptoms of the clinical primary aim of screening is to identify risk factors and diseases
disease until its resolution to either recovery to death. in their earliest stage. Screening of whole populations aims to
The moment the pathogen enters a susceptible host is detect those at risk of a specific disorder or condition who are
referred to as exposure. The pathogen will invade the likely to benefit from further investigations and possibly
target organ or tissue and multiply there. The human treatment or action to prevent the disorder or condition or its
body will start its immune system response at which stage consequences.
there is already an acknowledged infection whether the Surveillance is the systematic, ongoing and analytic process of
patient is symptomatic or asymptomatic. This period monitoring to scrutinize disease condition. Surveillance
between exposure and infection is called latent period involves investigating the distribution and possible causes of
since the pathogen is present in a latent stage without disease and conditions within the population. Information
clinical symptoms or signs of infection in the host. The from surveillance inform planning and improving health
period between exposure and onset of clinical symptoms services and understanding the factors that contribute
is called incubation period. The host may become towards disease, as well as the long-term effects of these
infectious at any moment of the infection. diseases.
➢ Infectious period is defined as the time during which time Event based surveillance are for rapid detection, notification,
the host can infect another susceptible host; whereas verification and assessment of public health events such as
noninfectious period is the period when the host’s ability clusters of disease, rumors of unexplained deaths.
to transmit the disease to other hosts ceases. Indicator-based surveillance are routine reporting of cases of
Level of Disease Occurrence (CDC, 2020) disease such as notifiable disease surveillance systems.
1. Sporadic refers to a disease that occurs infrequently Basic Steps in an Outbreak Investigation (Friis & Sellers, 2004)
and irregularly. 1. Operationally define what constitutes a case
2. Endemic refers to the constant presence and/or usual 2. Based on the operational definition, identify the cases.
prevalence of a disease or infectious agent in a 3. Based on the number of cases identified, verify the
population within a geographic area. existence of an outbreak.
3. Hyperendemic refers to persistent, high levels of 4. Establish descriptive epidemiologic features of the cases.
disease occurrence. 5. Record the clinical manifestations of cases.
4. Epidemic refers to an increase, often sudden, in the 6. based on clinical manifestations, incubation period,
number of cases of a disease above what is normally available laboratory findings and other information
expected in that population in that area. gathered, formulate a hypothesis regarding the probable
5. Outbreak carries the same definition of epidemic but etiologic agent, the sources of infection, the mode of
is often used for a more limited geographic area. transmission and the best approach for controlling the
outbreak.
 7. Test the hypothesis by collecting relevant specimens from As specified by EO No. 352, the FHSIS is the official
the patients and from the environment. recording and reporting system of the Department of
8. Based on the results of the investigation, implement Health and is used by the Philippine Statistics Authority to
prevention and control measures to prevent recurrence generate health statistics. The FHSIS is an essential tool in
of similar outbreak. monitoring the health status of the population at different
PIDSR (Philippine Integrated Disease and Response) levels.
Disease surveillance and notification have been recognized as Recording Tools in FHSIS
effective strategy for the prevention and control of diseases a. Individual treatment record
most especially epidemic prone diseases. b. Target client list
Disease Surveillance is the continuous scrutiny of occurrence c. Summary table
of diseases and health-related events to enable prompt d. Monthly Consolidation table
intervention for the control of diseases. Reporting Forms in FHSIS
Disease Notification is an integral part of disease surveillance. a. Monthly form (Program Report, Morbidity Report)
Two examples of surveillance systems in the Philippines are b. Quarterly form (Program Report, Morbidity Report)
the Philippine Integrated Disease Surveillance and Response c. The annual form
(PIDSR) and the Unified Registry Systems on Chronic • Disease registries – a listing of persons diagnosed
Noncommunicable Diseases, Injury Related cases, Persons with a specific type of disease in a defined
with Disabilities and Violence Against Women and Children. population. Data collected through disease
The PIDSR is an enhanced surveillance that monitors notifiable registries serve as basis for monitoring, decision
diseases and other health-related events of public health making and program management (DOH, 2011).
importance utilizing an integrated approach. It integrates • Census data – a periodic governmental
health statistics generated through the major disease enumeration of the population.
surveillance in the country namely: B. Community Diagnosis
1. Notifiable Disease Reporting System (NDRS) Eight Steps to Community Health Needs Assessment
2. Field Health Service Information System (FHSIS) 1. Identify and engage in stakeholders.
3. National Epidemiology Sentined Surveillance System 2. Define the community.
4. Expanded Program on Immunization Surveillance System 3. Collect and analyze data.
5. HIV-AIDS Registry 4. Select community priority health issues.
5. Document and communicate.
Nursing Process in the Care of Population Groups and Community 6. Plan improvement strategies.
A. Community Health Assessment Tools 7. Implement improvement plans.
Primary Data- data that have not been gathered before and are 8. Evaluate progress.
collected by the nurse through observation (Ocular/windshield Community Organizing (CO) is a process of educating and
survey and participant observation), survey, informant interview, mobilizing members of the community to enable them to resolve
community forum, and focus group discussion. community problems.
Collecting Primary Data The emphasis of community organizing in primary health care are
• Rapid observation of a community may be done through an the following:
ocular or windshield survey, either by driving or riding a 1. People from the community working together to solve their
vehicle or walking through it. This gives the nurse the own problems
chance to observe people as well as take note of 2. Internal organizational consolidation as a prerequisite to
environmental conditions and existing community facilities. external expansion
Participant observation is a technique that suits community 3. Social movement first before technical change.
organizing and participatory action research. 4. Health reforms occurring within the context of broader social
• Survey is necessary when there is no available information transformation.
about the community or specific population group to be Basic Values in Community Organizing
studied. 1. Human rights
• Informant interview are purposeful talks with either key 2. Social Justice
informants or ordinary members of the community. Key 3. Social Responsibility
informants consist of formal or informal community leaders Participatory Action Research (PAR) aims at promoting change
or persons of position and influence, such as leaders in local among the participants. Members of the group being studied
government, schools or business. participate as partners in all phases of the research, including
• Community forum is an open meeting. design, data collection, analysis and dissemination (Brown, 2008).
• Focus group differs from community forum in the sense that Comparison of Traditional Research Approach and COPAR
the focus group is made up of a much smaller group, usually Points of Traditional Research
COPAR
6-12 members only. Comparison Approach
Secondary Data – are taken from existing data sources. Sources Decision Top-down Bottom-up
consist of vital registries, health records and reports, disease making Expert/nurse- Community-driven process
registries and publications. Emphasis driven process Premium is placed on the
Secondary data sources Much premium is process
• Registry of vital events placed on the data
Act 3753 established the civil registry system in the and output.
Philippines and requires the registration of civil events, such Roles Nurses as Community members as
as births, marriages and deaths. researcher; researchers: the nurse is a
RA 7160 (Local Government Code) assigned the function of the community facilitator and recorder
civil registration to local governments and mandated the members are Data analysis is done
appointment of Local Civil Registrars. The National Statistics subjects or objects collectively by the
Office (NSO) serves as the central repository of civil of research community
registries and the NSO Administrators and the Civil Registrar Data analysis is
General of the Philippines before 2014. All these functions done by the nurse,
are now under the Philippines Statistics Authority (PSA) by and then
virtue of RA 10625 otherwise known as the “Philippine presented to the
Statistical Act of 2013”. community
• Health Records and Reports Methodology Research tools and Research tools and
 methodologies are methodologies are concerns requires more immediate consideration and what actions
pre-determined/ identified and developed may be undertaken to achieve goals and objectives.
prepackaged by by the community 1. Priority Setting
the nurse- WHO Special Considerations:
organizer • Significance of the problem
Output Upon completion, Conclusions and • Community awareness
the study is recommendations are • Ability to reduce risk
packaged, made by the community. • Cost of reducing risk
submitted to the These will lead to agreed • Ability to identify the target population
agency and community • Availability of resources
published. actions/projects. Steps in Priority Setting
Recommendations The whole research cycle 1. From a scale of 1 to 10, 1 being the lowest, the members
are made by the continues until it becomes give each criterion a weight based on their perception
researcher based part of community life, of its degree of importance in solving the problem. For
on the findings of leading towards example, each member assigns a weight to the
the study. community development. significance of the problem in response to the question,
Community members “How important is significance of the problem to its
formulate the solution?”
recommendations. 2. From a scale of 1 to 10, 1 being the lowest, each member
Schemes in Staffing rates the criteria in terms of the likelihood of the group
• Community Diagnosis being able to influence or change the situation. For
Community diagnosis is the process determining the health example, each member rates significance of the
status of the community and the factors responsible for it. problem in response to the question, “Can the group
• NANDA nursing diagnostic labels focused more on individual influence the significance of this problem?”
rather than the community responses to health conditions, 3. Collate the weighs (from step 1) and ratings (from step 2)
have included diagnosis at the community level. made by the members of the group.
Shuster and Goppingen proposed a practical adaptation of a format 4. Compute the total priority score of the problem by
of nursing diagnosis for population groups previously presented by multiplying collated weight and rating of each criterion.
Green and Slade (2001). The three part consists of: 2. Formulating Goals and Objectives
1. The health risk or specific problem to which the community is As in family health nursing, goals are the desired outcomes at
exposed. the end of interventions, whereas objectives are the short-
2. The specific aggregate or community with whom the nurse term changes in the community that are observed as the
will be working to deal with the risk or problem. health team and the community work towards the
3. Related factors that influence how the community will attainment of goals. Objectives serve as instructions, defining
respond to the health risk or problem. what should be detected in the community as interventions
OMAHA System is the framework for the care of individuals, are being implemented. It should be specific, measurable,
families and communities by nurses, nursing educators, physicians attainable and time bound.
and other health care provider. (pls see OMAHA System Website) 3. Deciding on Community Interventions/ Action Plan
• Domains and Problems of the Problem Classification Scheme Because of their inherent differences, what may work for one
a. environmental domain community may not be effective in another. The group
b. psychosocial domain analyzes the reasons for people’s health behavior and directs
c. physiological domain strategies to respond to the underlying causes. For example,
d. health-related domain reasons for preference of home delivery over facility-based
C. Planning Community Health Interventions delivery should be identified. If the majority of the women
As in other fields of nursing practice, planning for community would choose to have a home delivery because of cost or
health interventions is based on findings during assessment and lack of access of birthing facilities, strategies should then be
formulated nursing diagnosis. Planning is a logical process of focused on improving facility-based services.
decision making to determine which of the identified health