Chapter II CONCEPTUAL FRAMEWORK AND REVIEW OF RELATED LITERATURE This chapter presents the conceptual framework, review of related literature, articles, and other related concepts within the study. This helped establish the guidelines and the significance of the study conducted. The student nurses delved into numerous topics regarding community health nursing and the application of Community Organizing Participatory Action Research (COPAR) that paved its way to the realization of this community diagnosis. Conceptual Framework The community-as-client model, based on Neuman’s model of a total-person approach in viewing patients’ problems, was developed by the authors to illustrate the definition of public health nursing as the synthesis of public health and nursing. The model has
Transcript
Chapter II
CONCEPTUAL FRAMEWORK AND REVIEW OF RELATED LITERATURE
This chapter presents the conceptual framework, review of related
literature, articles, and other related concepts within the study. This helped
establish the guidelines and the significance of the study conducted. The
student nurses delved into numerous topics regarding community health
nursing and the application of Community Organizing Participatory Action
Research (COPAR) that paved its way to the realization of this community
diagnosis.
Conceptual Framework
The community-as-client model, based on Neuman’s model of a
total-person approach in viewing patients’ problems, was developed by
the authors to illustrate the definition of public health nursing as the
synthesis of public health and nursing. The model has been renamed the
community-as-partner model to emphasize the underlying philosophy of
primary health care.
There are two central factors in this model (Figure 1): A focus on
the community as partner (represented by the assessment wheel at the
top, which incorporates the community’s people as the core) and the use
of the nursing process.
The core of the assessment wheel represents the people that make
up the community. Included in the core are the population as well as their
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Figure 1.Conceptual Framework
AnalysisAnalysis
CommunityNursing Diagnosis
CommunityNursing Diagnosis
PlanPlan
InterventionsInterventions
EvaluationEvaluation
Stressors
Lines of Resistanc
e
AssessmentAssessment
values, beliefs, and history. As residents of the community, the people are
affected by and, in turn, influence the eight (8) subsystems of the
community.
These subsystems are physical environment, education, safety and
transportation, politics and government, health and social services,
communication, economics, and recreation.
The solid line surrounding the community represents its normal line
of defense, or the level of health. The normal line of defense may include
characteristics such as a high rate of immunity, low infant mortality, or
middle class income level. The normal line of defense also includes usual
patterns of coping, along with problem-solving capabilities; it represents
the health of the community.
The flexible line of defense, depicted as a broken line around a
community and its normal line of defense, is a “buffer zone” representing a
dynamic level of health resulting from a temporary response to stressors.
This temporary response may be neighborhood mobilization against an
environmental stressor such as flooding or a social stressor such as an
unwanted “adult” bookstore. The eight subsystems are divided by broken
lines to remind us that they are not discrete and separate but influence
(and are influenced by) one another. The eight divisions both define the
major subsystems of a community and provide the community health
nurse with a frame work for assessment.
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Within the community are lines of resistance, internal mechanisms
that act to defend against stressors. Lines of resistance exist throughout
each of the subsystems and represent the community’s strengths.
Stressors are tension-producing stimuli that have the potential of
causing disequilibrium in the system. They may originate inside the
community or inside the community. Stressors penetrate the flexible and
normal lines of defense, resulting in disruption of the community.
Inadequate, inaccessible or unaffordable services are stressors on the
health of the community.
The degree of reaction is the amount of disequilibrium or disruption
that results from stressors impinging on the community’s lines of defense.
The degree of reaction may be reflected in mortality and morbidity rates,
unemployment, or crime statistics are some of the examples. Stressors
and and degree of reaction become part of the community nursing
diagnosis.
Review of Related Literature
This part discusses the review of related literature needed to justify
facts regarding data gathered from the community.
Community
A community is an essential and permanent feature of human
experience. According to the World Health Organization (1974), a
community is a social group determined by geographic boundaries and/or
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common values and interests. Its members know and interact with one
another. It functions within a particular social structure and exhibits and
create norms, values and social institutions.
As aforementioned, a community is defined by its geographic
boundaries and thus called geographic community. It is consists of a
collecting of people located in a specific place and is made up of
institutions organized into a social system. Frequently, a single part of a
city can be treated as a community. Cities are often broken down into
census tracts, or neighborhoods. In community health, it is useful to
identify the geographic area as a community. A community demarcated by
geographic boundaries, such as a city becomes a clear target for the
analysis of health needs. A geographic community is easily mobilized for
action. Groups can be formed to carry out intervention and prevention
efforts that address needs specific to that community. Furthermore, health
actions can be enhanced through the support of politically powerful
individuals and resources present in a geographic community. On a larger
scale, the world can be considered as global community. Indeed, it is very
important to view the world this way since the world is one large
community that needs to work together to ensure a healthy today and a
healthier and safer tomorrow (Allender et. al., 2010).
A community can also be identified by a common interest or goal. A
collection of people, even if they were widely scattered geographically,
can have an interest that binds the members together. Sometimes, within
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a certain geographic area, a group of people develop a sense of
community by promoting their common interest. The kinds of shared
interests that lead to the formation of communities vary widely. On the
other hand, community can also be defined by a pooling of efforts by
people and agencies toward solving a health-related problem. The shape
of this community varies with the nature of the problem, the size of the
geographic area affected, and the number resources needed to address
the problem (Stancope et. al., 2010).
In the Philippines, a community can be classified as rural, urban,
and suburban. Rural or the open lands usually places in the provincial
areas where people make earn their living by agriculture and things of
sort. Mostly it is less dense and more spacious. Urban or the city is a non-
agricultural type of community. The community is dense and mostly
populating the whole community the major source of income are the
industrial products and technology. While suburban is usually the capital
of provinces where there is a mix of agriculture and industry, although
technology is not in its highest peak but it is utilized to increase the
productivity of both the industrial and agricultural side (Untalan, 2005).
According to Healthy People 2010 (2001), a healthy community is
characterized by a safe and healthy environment, offers access to health
care services, focusing on both treatment and prevention for all members
of the community, and has roads, playgrounds, scholls and other services
to meet the needs of the population. While In 1980’s, the WHO initiated
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the Healthy Cities movement to improve the health status of urban
populations. Who defined a healthy city as “one that is continually creating
and improving those physical and social environments and expanding
those community resources that enable people to mutually support each
other in performing all functions of life and in developing their maximum
potential (WHO, 2004).
Community Size
One of the first things community health nurses need to know
about a community is its size. The size of a community also influences the
presence of inadequate housing, the heterogeneity of the population, and
almost every conceivable aspect of health needs and services. Knowing
the community’s size provides community health nurses with important
information of planning (Allender, 2010).
The traditional notion of neighborhood was of an area that housed
a population for which one elementary school should serve its children. As
the birth rate or death rate declines, more people live alone, and more
elderly people live without children, the elementary school as a criterion of
neighborhood becomes less relevant. As more people relate to friends
and co-workers other than neighbours, the concept of neighborhood itself
becomes less compelling as an organizational building block of the
community (Green et. al, 2005).
Community size is often found to be negatively correlated with
prosocial behaviors such as formal volunteering, working on public 26
projects and informal help to friends and strangers. This may be because
people who reside in large communities simply spend less time socializing
with each other. As a result, people living in large cities have on average
fewer friends, and hence their social networks support less cooperation
(Allcott et. al, 2007).
Population Group
Considering the community as a client, one should examine the
population of the total community. The health of any community is greatly
influenced by the attributes of its population. A healthy community has
leaders who are aware of the population’s characteristics, know its various
needs and respond to its needs. Population or aggregate is collection of
people who share one or more personal or environmental characteristics.
Members of a community can be defined either in terms of geography or a
special interest and these members comprise a population (Stanhope et.
al., 2010). From the perspective of the community, the population consists
not of a specialized aggregate, but of all the diverse people who live within
the boundaries of the community.
Population group refers to the population group or groups, to which
the person belongs depending on their shared interest or goals. These
groups may be within a community or cut across many communities
(Anderson et. al., 2004). Some of these groups include: children, elderly,
men and women.
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Children
Children are usually the first to suffer from socioeconomic
difficulties and political problems of the country. Care of the children
presents community health nurses with significant opportunities to
influence the future health of the general population. One of the most
effective ways to improve the health status of a community is to maintain
and enhance the health of its children. Health promotion and prevention
for this age group can make a tremendous impact on the overall future
health of a population. Children, who receive effective health care
services, particularly health promotion and illness prevention services, are
far less likely to develop a variety of acute and chronic health problems. If
children are taught to engage in healthy behaviors, their lifetime health
status will be positively influenced (Stanhope et. al., 2010).
When assessing the infant and toddler, the nurse should begin by
interviewing the primary caregiver. Typically the areas covered include
nutrition, growth and development, and vision and hearing. Monitoring
growth and development is easily done by weighing the infant and
measuring length and head circumference, and plotting the results on a
growth grid (Allender, 2010).
Basic health services for the prevention of disease and the early
identification of illness or disability should be available to all children. Well-
child clinics providing assessment of growth and development, nutrition
information, nurturing and anticipatory guidance, and immunization for
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children should be available. Well-child care should be at regular intervals
and may be performed by allied health personnel other than physicians.
Parent- infant bonding and anticipatory counseling to prevent problems
will enable the child to grow up in a healthful and well-structured
atmosphere (Green et. al., 2005).
Children are healthier than ever before, certainly as measured by
the usual morbidity and mortality indicators. However, there are different
threats to the health of children and youth, often characterized as the “new
morbidity,” for which environmental (social, physical, familial, and
economic) and behavioral factors have been identified as causative and
contributive (Maurer et. al, 2009).
Elderly
The elderly may constitute a large and growing population of group
in a country. They make up a group whose health needs we do not fully
understand, and we have yet to offer the full complement of services they
require and deserve (Stancope et. al., 2010).
For community health nursing, this population group poses a
special challenge. The increasing number of elderly people in the
community multiplies the need for health-promoting and preventive
services to maximize their ability to remain independent and contributing
citizens. This group’s greater longevity, replete with all the problems
brought on by diminishing functional capacity and increasing chronic
disease and disability, brings another dimension of concern. Significant 29
economic, environmental, and social changes create a demand for greater
productive and preventive services for older adults in addition to requiring
adjustments in health care provision patterns (Maurer et. al., 2009).
No one knows conclusively all the variables that influence healthy
aging, but it is known that a lifetime of healthy habits and circumstances, a
strong social support system, and a positive emotional outlook all
significantly influence the resources people my bring to their later years.
Wellness among the older population varies considerably. It is influenced
by many factors, including personality traits, life experiences, current
physical health and societal supports and personal health behaviours
including smoking, obesity and excessive alcohol use (Allender, 2010).
Effective nursing among any population requires familiarity with that
group’s health problems and needs. Aging, in and of itself, is not a health
problem. Rather, aging is a normal, irreversible physiologic process.
However, its pace can sometimes be slowed, as researchers are
discovering, and many of the problems associated with aging can be
prevented. The elderly, like any other age group, have certain basic needs
that need to be given attention in order to maintain health (Allender, 2010).
Legal Bases
Public Health Nurses need to know the laws affecting health and
nursing practice in the Philippines. As practicing nurse in the community
setting, the public health nurse must be familiar with the existing laws and
standards that govern safe nursing practice.30
Public Health Nursing in the Philippines evolved alongside the
institutional development of the Department of Health, the government
agency mandated to protect and promote people’s health and the biggest
employer of health workers including public health nurses. Historical
accounts show that as far back as the 1900’s, nurses working in the
communities were already given the title Public Health Nurses (Public
Health Nursing, 2007).
In the light of the changing national and global health situation and
the acknowledgment that nursing is a significant contributor to health, the
Public Health Nurse is strategically positioned to make a difference in the
health outcomes of individuals, families and communities cared for (Public
Health Nursing in the Philippines, 2007).
Community Health Nursing
It is a nursing practice in the community, with the primary focus on
the health care of the individuals, families, and groups in a community.
The goal is to preserve, protect, promote, or maintain health.
The World Health Organization Expert Committee of Nursing
defines public health nursing as a “special field of nursing that combines
the skills of nursing that combines the skills of nursing, public health and
some phases of social assistance and functions as part of the total public
health program for the promotion of health, the improvement of the
conditions in the social and physical environment, rehabilitation of illness
and disability.”31
Jacobson(2004) states that community health nursing is a learned
practice discipline with the ultimate goal of contributing, as individuals and
in collaboration with others, to the promotion of the client’s optimum level
of functioning through teaching and delivery of care.
Community Health Nursing is a unique blend of nursing and public
health practice woven into a human service that properly developed and
applied has a tremendous impact on human well being. Its responsibilities
extend to the care and supervision of individuals and families in their
homes, in places of work, in schools and clinics. It is one of the basic
services of health departments. The community health nurses, as
members of the health team, are expected to integrate within the context
of family health care, the priority programs of the Department of Health
(Untalan, 2005).
Community Health Nursing is a service rendered by a professional
nurse with the community, groups, families and individuals at home, in
health centers, in clinics, in school, in places of work for the promotion of
health, prevention of illness, care of the sick at home and rehabilitation.
(Freeman, 2002).
Concepts basic to nursing are used in working with the clients:
individuals, families, group and communities. Some concepts of
community health nursing are: The primary focus of community health
nursing practice is on health promotion. The community health nurse, by
the nature of his/her work, has the opportunity and responsibility for
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evaluating the health status of people and groups and relating them to
practice; Community health nursing practice is extended to benefit not
only the individual but the whole family and community; Community health
nurses are generalists in terms of their practice through life’s continuum-
its full range of health problems and needs; Contact with the client and the
family may continue over a long period of time which include all ages and
all types of health care; The nature of community health nursing practice
requires that current knowledge derived from the biological and social
sciences, ecology, clinical nursing and community health organizations be
utilized; The dynamic process of assessing, planning, implementing, and
intervening, provide periodic measurements of progress, evaluation and
continuum of the cycle until the termination of nursing is implicit in the
practice of community health nursing (Green, 2005).
The ultimate goal of community health services is to raise the level
of health of the citizenry. To this end, the goal of community health nursing
is to help communities and families to cope with the discontinuities in
health and threats in such a way as to maximize their potential for high
level of wellness, as well as to promote reciprocally supportive relationship
between people and their physical and social environment (Allender et. al,
2010).
Community Health Nurse
Community health nurses work with these clients while looking at
the effect of their health status on the health of the community as a whole. 33
Most community health nurses and many staff public health nurses- both
historically and at present- focus on providing direct care services,
including health education, to persons or families outside of institutional
settings, either in the home or clinic. Historically, the term community
health nurse applied to all nurses who practiced in the community,
regardless of whether they had preparation in public health nursing.
Specifically, the community health nurse operates from a health care
focus that is based on an understanding of broader community needs. The
nurse is continually evaluating the community to see if changes are
occurring that will influence the health of the people who live here
(Allender et. al, 2010).
Evidence that community health nurses are practicing effectively in
the community would include the provision of the following: Provides
quality services that can control costs; Focuses on disease prevention and
health promotion; Organizes services where people live, work, play, and
learn; Works in partnerships and with coalitions; Works across the life
span and with culturally diverse populations; Works with at- risk
populations to promote access to services; Develops the community’s
capacity for health; Works with policy makers for policy change; Works to
make the environment healthier (Flynn, 1998).
The community health nurse promote health through education
about prevailing health problems, proper nutrition, beneficial forms of
exercise, and environmental factors such as safe food, water, air, and
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buildings. The community health nurse is likely to be involved in
immunizing individuals as well as organizing the immunization programs
for vaccinating the community for influenza, for example, and educating
the community about the value of this service. Other individual and family
services include maternal and child health care, treatment of common
communicable and infectious diseases and injuries, and providing basic
screening programs for such problems as lice, vision, hearing, and
scoliosis (Zotti et. al., 1996).
Community health nurses have always been involved in providing
family-centered care to individuals, families and groups across the life
span; they also work to identify high-risk groups in the community. Once
such groups are identified, the community health nurse can work with
others to develop appropriate policies and interventions to reduce risk and
provide beneficial services. Both community health nurses and
community- based nurses must be aware of the cultural diversity and
provide care that is appropriate to the needs of the recipient. Likewise,
both groups of nurses provide care in homes (Green, 2005).
Community Nurse’s Involvement in Community Activities
Nursing care provision is an inherent function of the nurse. Her
practice as a nurse is based on the science and art of caring, in whatever
setting she may be or role she may have, providing nursing care is at the
heart of it. Public health nursing is caring for individuals, families and
communities toward health promotion and disease prevention; as such 35
Public Health Nurses are expected to provide nursing care (Zotti et. al.,
1996).
This function of the Public Health Nurse brings activities or group of
activities systematically into proper relation or harmony with each other.
Public Health Nurses are the care coordinators for communities and their
members. They are actively involved both socially and politically to
empower individuals, families and communities as an entity to initiate and
maintain health promoting environments (Allcott et. al, 2007).
The Public Health Nurse understands that in the performance of
her function in health promotion and education her activities go beyond
health teachings and health information campaigns. She understands that
health is determined by various factors such as physical and political
environment, socio-economic status, personal coping skills and many
other circumstances, and it is inappropriate to blame or credit a person’s
health to himself alone because he is unlikely to control many of these
factors. Understanding the multidimensional nature of heath will enable
her to plan and implement health promoting interventions for individuals
and communities (Maurer et. al, 2009).
As an educator, the nurse provides clients with information that
allows them to make healthier choices and practices. Giving health
education is a very important function of the public health nurse. It is a
basic health service. A health education activity is a major component of
any public health program. In order to improve individual, family and
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community health, correct knowledge, attitude and skill should be taught
and subsequently practiced (Public Health Nursing in the Philippines,
2007).
Primary Health Care
According to the WHO (1978), PHC is more broadly defined than
primary care. Primary care refers to personal health care that provides for
first contact and continuous, comprehensive, and coordinated care. It
addresses the most common needs of patients within a community by
providing preventive, curative, and rehabilitative services to maximize their
health and well-being. While PHC includes a comprehensive range of
services including public health, preventive, diagnostic, therapeutic, and
rehabilitative services. It is an essential health care made universally
accessible to those individuals and families in the community by means
acceptable to them through their full participation and at a cost that the
community and country can afford every stage of development. Full
community participation means that individuals within the community
participate in defining health problems and developing approaches to
address the problems. Any community in any country can be a setting for
health care.
The concept of primary health care is characterized by partnership
and empowerment of the people that shall permeate as the core strategy
in the effective provision of essential health services that are community
based, accessible, acceptable and sustainable at a cost which the 37
community and the government can afford. It is a strategy, which focuses
responsibility for health on the individual, his family and the community. It
includes the full participation and active involvement of the community
towards the development of self-reliant people, capable of achieving an
acceptable level of health and well being. It also recognizes the
interrelationship between health and the overall political, socio-cultural and
economic development of society (Public Health Nursing, 2007).
Public Health
Public health is a scientific discipline that includes the
epidemiology, statistics and assessment-including attention to behavioral,
cultural, and economic factors-as well as program planning and policy
development. In the recent years, efforts in the United states to change
the way in which health care is delivered have focused heavily on looking
at ways to change the delivery of medical care and health insurance.
Limited attention has been focused on looking at the health of the
population. Although people are excited when a new drug is discovered
that cures a disease or when a new way to transplant organs is perfected,
it is important to know about the significant gains in the health of
populations that have come largely from public health accomplishments
(Public Health Nursing, 2007).
Another way of looking at the benefits of public health practice is to
look at how early deaths can be prevented. The U.S. Public Health
Service estimates that the medical treatment can prevent only about 10% 38
of all early deaths in the U.S., whereas population-focused public helth
approaches could health prevent about 70% of early deaths in America
through measures that influence the way people eat, drink, drive, engage
in exercise, and treat the environment(U.S. Department of Health and
Human Services, 2000). Public health practice provides many benefits,
especially considering the small portion of te health care in the United
States that is used for this prevention and population-focused specialty
(Public Health Nursing, 2007).
Public health is best described as what society collective does to
ensure that conditions exist in which people can be. Public health is a
community-oriented, population-focused specialty area. The overall
mission of the public health is to organize community efforts that will use
scientific and technical knowledge to prevent disease and promote health
(Institute of Medicine, 2003).
Hanlon(2006) stresses that “public health is dedicated to the
common attainment of the highest level of physical, mental and social
well-being and longevity consistent with available knowledge and
resources at a given time and place. It holds this goal as its contribution to
the most effective total development and life of the individual and his
society.
Factors Affecting Health
Social and economic factors predispose people to vulnerability –
Poverty, a limited social support, and examples of limitations in physical 39
and environmental resources. People with preexisting illnesses, such
those with communicable or diseases or those with chronic illnesses such
as cancer, heart disease or chronic airway disease, have less physical
ability to cope with stress than those without such physical problems.
Human capital refers to all the strengths, knowledge and skills that enable
a person to live a productive, happy life. People with little education have
less human capital because their choices are more limited than are those
of people with higher levels of education. Some groups such as poor, the
homeless and migrant workers are “invisible” to society as a whole and
tend to be forgotten in health and social planning. Health disparities refer
to the wide variations in health services and and health status among
certain population groups (U.S. Department of Health and Human
Services, 2001).
The World Health Organization defines health as a “state of
complete physical, mental, and social well-being, not merely the absence
of disease or infirmity”. The modern concept of health refers to optimum
level of individuals, families and communities (Kozier, 2007).
Demography
Demography is the science which deals with the study of the
human population’s size, composition and distribution in space e.
Population size simply refers to the number of people or area at a given
time. When the population is characterized in relation to certain variables
such as age, sex, occupation or educational level, then the population 40
composition is being described. The nurse also describes how people are
distributed in a specific geographic location (Maglaya, 2004).
Demography reflects population diversity and trends by studying
population composition, growth, and movement. Birth, death, and
migration data from demography combine with the study of disease
transmission and distribution in population constitute epidemiology. We
introduced human ecology, the study of population interactions with
physical and biological environments, in the last chapter. We intended this
to social ecology in examining how these interactions develop as a
function of social processes. Demography takes up the study of population
trends as measured over time by three sets of data. One consists of vital
indexes such as birthdates and death rates. A second consists of
measures of population diversity such as ethnic composition, density,
rural-urban-suburban residential patterns, and migration. The third
consists of socioeconomic indicators such as income, occupation, and
educational attainment (Stanhope et. al, 2010).
Seasonal variations in population movement and vital rates result
partly from climate and partly from cultural and social conditions affecting
employment and traditions associated with seasons and holidays. In North
America, for example, the highest death rates tend to occur in the winter
months. The holiday season of Christmas and New Year’s and contribute
a large share of the increase through automobile crashes, suicides, and
heart attacks. the relatively higher incidence of respiratory conditions and
41
associated deaths in the winter attest to some climate effect, but not just
because of exposure to cold temperatures. Some of it is attributable to
being more exposed to tge transmission of communicable diseases
among people confined indoors. The latter explanation suggests that
social norms of adaption to climate conditions are important in providing
protection and in exposing the individual to additional risk (Green et. al.,
2005).
Sources of Demographic Data
Population demographics have also affected the demand for health
care services. A community can be assessed by analyzing the
characteristics of the people in that community. These characteristics are
defined through the demographics of the community, which include the
number, composition by age, rate of growth and decline, social class, and
mobility of the people in the community. Other vital statistics include the
birth rate, overall death rate (mortality), mortality by cause and by age,
and infant mortality rate. Of these, the infant mortality rate is considered to
be the most important statistical indicator regarding the level of maternal-
infant health in a community. Vital statistics also include morbidity or rate
of a particular disease within a community. These vital statistics are the
vital signs of the community. They tell a very important story about the
health of a community or population (Hunt, 2009).
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General Household Data and Economic Data
In 2001, the average life expectancy at birth was 69.25 years- 71.9
for females and 66.6 for males- up from 68.6 years in 1999. The country’s
population is very young; thirty-nine percent (39%) of the total population
in 1994 was estimated to be in the 0-14 age group. Only 5% were 60
years old and above. Given these percentages, the dependency ratio was
computed to be 79, that is, there are 79 people who depend on 100
people in the productive age group (15-59) (www.doh.gov.ph, 2005).
According to the National Statistics Office, the simple literacy rate
of the Philippines as of year 2000 is 92.3 % in the year 1997. The average
annual income of a family is 147,888 as of 2003 from the year 1997 of
127,168 and expenditure 99,537 in year 1997.
The poverty incidence is 31.88 % of total families in the year 1997
(poverty threshold 2000 in rural areas of SOCSKARGEN region is 11,238
and 14,396 in urban areas). The Philippines has an 8.2% as of April 2006
from 16.9% as of January 2001 as our unemployment rate and 25.4 %
April 2006 unemployment rate from the 1997: 11.4 % unemployment rate.
The underemployment rate of the Philippines is continuously
increasing and the unemployment rate of the Philippines is continuously
decreasing. Also the literacy rate of the Filipinos is decreasing. There are
35,224 Filipinos who are in the labor force and 1,591 of them are from
Region 12. There are only 32,384 people employed in our country today
and 1,497 of them are from Region 12. (www.census.gov.ph, 2006).
43
Social and Cultural Factors
Every community, every social or ethnic group has its own culture.
Furthermore, all the individual members behave in the context of that
specific culture. Each of us belongs to a group or set of overlapping
groups that influences our thoughts and actions. Even very small elements
of everyday living are influenced by our culture. For instance, culture
determines the distance we stand from another person while talking.
Consider how culture influences our perception of time. When we make an
appointment to see someone, we expect the other person to be on time or
not more than a few minutes late (Hunt, 2009).
Culture profoundly influences thinking and behavior, is an essential
dimension of health care. Just as physical and psychological factors
determine clients’ needs and attitudes toward health and illness, so too
does culture. Kark emphasizes that “culture is perhaps the most relevant
social determinant of community health”. Culture influences diet ad eating
practices. Culture determines how people rear their children, react to pain,
cope with stress, deal with death, respond to health practitioners, and
value the past, present, and future, yet the concept of culture is not always
clearly understood or incorporated into health care. Culture includes more
than race and ethnicity and may include a person’s gender, religion,
socioeconomic status, sexual orientation, age, environment, family
background, and life experiences. Barriers to providing culturally
competent care are stereotyping, prejudice and racism, ethnocentrism,
44
cultural imposition, cultural conflict, and cultural shock (Stanhope et. al,
2010).
Although all cultures are not the same, all cultures have the same
basic organizing factors. These factors should be explored in a cultural
assessment because of the potential for differences among groups.
Variations among cultures are reflected in verbal styles and in nonverbal
styles.
Basic to successful interactions between clients and providers is
the understanding that we are all different from one another, with different
ethnic and cultural backgrounds, and therefore, different health and illness
beliefs and practices. But despite our differences, we come together at a
mutually agreed on place to achieve a common goal: to maintain or regain
health. The dilemma presented here is that health means different things
to each of us; we recognize it and measure changes in it differently, act in
diverse ways when faced with these changes, and seek different methods
for achieving healing outcomes (Anderson et. al., 2008).
Socioeconomic Status
Socioeconomic factors contribute greatly to understanding
perceptions of health and illness among minority. These groups may not
have opportunities for education, occupation, income earning, and
property ownership similar to those of the dominant group. Socioeconomic
status is a critical factor in determining access to health care and the
development of some chronic health problems. The proportion of poor 45
families in a minority group is greater. Consequently, minority group is
greater. Minority families are disproportionately represented on the lower
tiers of the socioeconomic ladder. Poor economic achievement is also
common characteristic found among populations at risk, such as those in
poverty, the homeless, migrant workers, and refugees. Data suggest that
when nurses and clients come from the same social class, it is more likely
that they operate from the same health belief model and consequently
there is opportunity for misinterpretation and health problems in
communication (Stanhope et. al, 2010).
There is also danger in believing that certain cultural behaviors,
such as folk practices, are restricted to lower socioeconomic classes.
Nurses must conduct a cultural assessment for all individuals when they
first come in contact with them. Nurses should have guidance in
integrating cultural concepts with other aspects of client care to meet their
client’s total health care needs. Nurses should be able to distinguish
between issues of culture and socioeconomic class and not misinterpret
behavior as having a cultural origin, when in fact it should be attributed to
socioeconomic (Stanhope et. al, 2010).
Geography, Topography and Climate
Geography refers to the surface of the earth. Topography indicates
the detailed mapping or charting of the features of a relatively small area,
district, or locality. With climate, the composite or generally prevailing
weather conditions of a region, as temperature, air pressure, humidity, 46
precipitation, sunshine, cloudiness, and winds, throughout the year,
averaged over a series of years (Zotti et. al., 1996).
Environmental Health
Environment is the accumulation of physical, social, cultural,
economic and political conditions that influence the lives of communities.
The community’s health depends on the integrity of the physical
environment, the humaneness of the social relations in the environment,
the availability of the resources necessary to sustain life and manage
illness, the equitable distribution of health risks, attainable employment
and education, cultural preservation and tolerance of diversity among
subgroups, access to historical heritage, and a sense of empowerment
and hope (Hall et. al., 2007).
Environmental health is of ever-increasing importance to
community health nursing practice. Accumulated evidence shows that the
environmental changes of the past few decades have profoundly
influenced the status of public health. The safety, beauty, and life-
sustaining capacity of the physical environment are unquestionably of
global consequence (Hunt, 2009).
The ultimate goal of the critical practice of community health
nursing is liberating people from health-damaging environmental
conditions (Bent, 2003). From a critical standpoint, helping communities
become more aware of the environmental effects on health and helping
47
them make needed changes in their environment are legitimate nursing
actions (Hall et. al., 2007).
Nutrition
American Medicine Association, defined Nutrition as the science of
food, the nutrients and the substances therein, there action, interaction,
and balance in relation to health and diagnosis, and the focus by the
organism ingest, digest, absorbs, transports, utilizes and excretes food
substances. This is one key to developing and maintaining a state of
optimal health. In addition, it is an essential component of life and
therefore an important body of knowledge to consider in discussion of
child growth and development. The body requires a wide array of intake
products, such as carbohydrates, proteins, fat and micronutrients like
vitamins and minerals (Wardlaw et. al., 2007).
Promoting good nutrition and dietary habits is one of the most
important parts of maintaining child health. The first 6 years are the most
important for developing sound lifetime eating habits. The quality of
nutrition has been widely accepted as an important influence on growth
and development. It is now becoming recognized for an important role in
disease prevention. Atherosclerosis begins during childhood. Other
diseases, such as obesity, diabetes, osteoporosis, and cancer, may have
early beginnings also. Low income and minority families are at increased
risk for poor nutrition, but all groups show poor dietary habits (Stancope
et. al., 2009).48
Growth Monitoring
Growth monitoring involves following changes in a child's physical
development, by regular measurement of weight, and sometimes of
length. It is an important tool in individual care, for early detection of health
and nutrition problems in growing children (Healy et. al., 1988).
Immunization
The development and widespread use of immunization has been
one of the great breakthroughs of modern medicine. It is one of the
important elements of health promotion and disease prevention. This
provides artificial immunity to a number of dangerous infections, including
measles, mumps, rubella, diphtheria, tetanus, pertussis, poliomyelitis and
varicella (Pilliteri, 2008).
Immunization recommendations rapidly change as new information
and products are available. The main goal of the guidelines is to provide
flexibility to ensure that the largest number of children will be immunized.
All health care providers are urged to access immunization status at every
encounter with children and to update immunizations whenever possible
(Stancope et. al., 2009).
Breastfeeding
The natural first food of babies is breast milk and its intake should
be encouraged for all infants, American Association for pediatrics believes
that breastfeeding is the best source of nutrition for babies through the first
49
birthday and should be encouraged by health professionals. It provides
