1.
Roles of the community and public
Health nurse
The complex nature of the health needs of
Communities call for a holistic response from
Public health nurses. This in effect demands
Not only collaborative interventions but at the
Same time the nurse working with communities
Is expected to demonstrate competencies demanded by different settings and
Situations o his/her clientele. The Philippine
Professional egulatory Board of Nursing
(NNCCS, 2012) expects beginning professional
Nurses to be able to perform three roles; that
Of health care provider, manager-leader, and
Researcher. But a community and public health
Nurse takes on additional roles, owing to the
Realities of changing times and age.
Healthcare Provider
Caring is the essence of
Nursing and has been widely accepted in all
Settings. The use of the nursing process applied
In the natural environment of the client pertains
To this role.
Examples include the occupational
Health nurse conducting a physical examination
Of an employee, a school nurse providing first-
Aid to a student who sustained a cut, and a nurse
Taking the history of a pregnant woman in the
Village clinic
Health Educator
Communicating information
To help patients make an informed choice
Regarding their health is a key activity in public
Health work. It is hoped that awareness will
Impact people’s behavior to achieve health
In their own hands.
Instructing patients how
To take their prescribed medicine or sharing
Information about the benefits of healthy
Lifestyle illustates this role.
Program Implementer
Nurses working under local government units deliver healthcare to the
grassroots. This also requires that programs initiated by the national govemment
thru the Philippine Department of Health (DOH) are executed at all levels. This
includes immunization which offers protection against infectious disease.
The nurse works with the ural health midwife in conducting routine vaccination in
communities to achieve herd immunity and contribute to the over-all goal of
reducing child mortality. Likewise, submitting reports per standards of
documentation on targets reached and missed is part of this role of the nurse in
community/public health.
Community Organizer
Working with people in communities and providing them ownership of their
healthcare needs and to act collectively on their issues is best captured by this
role of the nurse in public health.
Manager/Leader
Community and publichealth
Work deals with competing claims specifically
On utilization of limited resources. Hence, the
Nurse employs principles of management to
Maximize resources effectively and efficiently.
Budgeting inventories, scheduling and staffing,
Conducting training sessions are likewise
Included under this role.
Researcher/Epidemiologist
The nurse is regarded as he health monitor of the community. Together with the
rural health midwife, they keep track of illnesses encountered in their areas of
jurisdiction and submits reports to health authorities as required by law. In the
event of an outbreak, community public health nurses work with other
professionals and agencies in conducting investigation to identify etiology of the
epidemic and ultimately identify potential solutions to halt the progress of the
problem. Apart from collecting actual data for research, the nurse utilizes
research indings to provide evidence to convince decision-makers to enact
policies for health.
Client Advocate
The community public health
Nurse takes a proactive stance in ensuring that
The right to health of the population he/she works with is realized and protected.
To do
This, he/she engages stakeholders in clamoring
And lobbying for policies that impact health
Of communities. The nurse in the field also
Initiates organizing activities to form coalitions
And linkages to foster awareness of people to
Various health-related issues.
2. Essential Public Health Service
• Monitor health status to identify and solve community health problems
• Diagnose and investigate health problem and health hazards in the community
• Inform, educate, and empower people about health issues
• Mobilize community partnerships and actions to identify and solve health
problems
• Develop policies and plans that support individual and community health
efforts
• Enforce laws and regulations that protect health and ensure safety
• Link people to needed personal health services and assure the provision of
health care when otherwise unavailable
• Assure a competent public health anid personal health care workforce
• Evaluate effectiveness, accessibility, and quality of personal and population-
based health services
• Research for new insights and innovative solutions to health problems
3. Public Health Interventions
Public health nurses focus onthe care of individuals, groups, aggregates, and
populations in many settings, including homes, clinics, worksites, and schools. In
addition to interviewing clients and assessing individual and family health, public
health nurses must be able to assess a population’s health needs and resources
and identify its values. Public health nurses must also work with the community
to identify and implement programs that meet health needs and to evaluate the
effectiveness of programs after implementation. For example, school nurses
were once responsible only for running first-aid stations and monitoring
immunization compliance. Now they are actively involved in assessing the needs
of their p opulation and defining programs to meet those needs through activities
such as health screening and group health education and promotion. The
activities of school nurses may be as varied as designing health curricula with a
school and community advisory group, leading support groups for elementary
school children with chronic illness, advocating for emergency equipment (e.g.,
automatic external defibrillators) in gyms and athletic fields, and monitoring the
healthstatus of teenage mothers.
Similarly, occupational health nurses are no longer required to simply maintain
an office or dispensary. They are involved in many different lypes of activities.
These activities might include maintaining records of workers exposed to
physical or chemical risks, monitoring compliance with Occupational Safety and
Health Administration standards, teaching classes on health issues, acting as
case managers for workers with chronic health conditions, and leading support
group discussions for workers with health-related problems.
Non-government organizations, such as the Philippine National Red Cross,
employ. Public health nurses for their organizational ability and health-related
skills. Other public health nurses work with multidisciplinary groups of
Drofessionals, serve on boards of voluntary health associations, work as case
managers for insurance companies, and are members of health planning
agencies and councils.
The public health intervention wheel
The Public Health Intervention Model was initially proposed in the late 1990s by
nurses from the Minnesota Department of Health in the USA to describe the
breadth and scope of public health nursing practice (Keller et al., 1998) This
model was later revised and termed the Intervention Wheel (Keller et al., 2004a;
Keller et al., 2004b), and it has become increasingly recognized as a framework
for community and public health nursing practice.
The Intervention Wheel ontains hree important elements:
(1) it is population based;
(2) it contains three levels of practice (community, systems, and
individual/family);
(3) it identifies and defines 17 public health interventions.
The levels of practice and interventions are directed at improving population
health (Keller et al. 2004a) Within the Intervention Wheel, the 17 health
interventions are grouped into five “wedges”. These interventions are actions
taken on behalf of communities, systems, individuals, and families to improve or
protect health status.
Public Health Interventions and Definitions
Surveillance. Describes and monitors health events through ongoing and
systematic collection, analysis, and interpretation of health data for the purpose
of planning, implementing, and evaluating public health interventions.
Disease and other health event investigation. Systematically gathers and
analyzes data regarding threats to the health of populations, ascertains the
source of the threat, identifies cases and others at risk, and determines control
measures.
Outreach. Locates populations of interest or populations at risk and provides
information about the nature of the concern, what can be done about it, and how
services can be obtained.
Screening. Identifies individuals with unrecognized health risk factors or
asymptomatic disease conditions.
Case Finding. Locates individuals and families with identified risk factors and
connects them with resources.
Referral and follow-up. Assists individuals, families, groups, organizations, and/or
communities to identify and_access necessary resources to prevent or resolve
problems or concerns.
Case Management. Optimizes self-care capabilities of individuals and families
and the capacity of systems and communities to coordinate and provide
services.
Delegated functions. Carries out direct care tasks under the authority of a health
care practitioner as allowed by law.
Health Teaching. Communicates facts, ideas, and skills that change knowledge,
attitudes, values, beliefs,. Behaviors, and practices of individuals, families,
systems, and/or communities.
Counseling. Establishes an interpersonal relationship with a community, a
system, and a family or individual, with the intention of increasing or enhancing
their capacity for self-care and coping.
Consultation. Seeks information and generates optional solutions to perceived
problems or issues through interactive problem solving with a community system
and family or individual.
Collaboration. Commits two or more persons or organizations to achieve a
common goah by enhancing the capacity of one or more of the members to
promote and protect health.
Coalition Building. Promotes and develops alliances among organizations or
constituencies for a common purpose.
Community Organizing. Helps community groups to (dentify common problems
or goals, mobilize resources, and develop and implement strategies for realizing
the goals they collectively have set.
Advocacy. Pleads someone’s cause or acts on someone’s behalf, with a focus on
developing the community, systemn, and individual or family’s capacity to plead
their own cause or act on. Their own behalf.
Social Marketing. Utilizes commercial marketing principles and technologies for
programs designed to influence the knowledge, attitudes, values, beliefs,
behaviors, and practices of the population of interest.
Policy Development and Enforcement. Places health issues on decision makers’
agendas, acquires a plan of resolution, and determines needed resources,
resulting in laws, rules, regulations, ordinances, and policies. Policy enforcement
compels others to comply with laws, rules, regulations, ordinances, and policies.
The Intervention Wheel is further dissected into levels of practice, in which the
interventions may be directed at an entire population within a community, a
systemn that would affect the health of a population, and or the individuals and
families within the population. Thus each intervention can and should be applied
at each level. For example, a systems-level intervention within “disease
investigation” might be the community health nurse working with the city health
department and national vaccine program to coordinate a response to an
outbreak of measles in the community. An example of a population- or
community-level intervention for “screening would be public health nurses
working with local high schools to give each student a profile of his or her health
to promote nutritional and physical activity lifestyle changes to improve the
student’s health. Finally, an individual-level implementation of the intervention
“referral and follow-up” would occur when a nurse receives a referral to care for
an individual with a diagnosed mental illness who would require regular
monitoring of his or her medication compliance to prevent rehospitalization
(Keller et al., 2004b).
