NCM 104
COMMUNITY HEALTH
NURSING 1
Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
(Individual and Family as a Client)
1st SEMESTER A/Y 2021-2022
WILMA N. BERALDE, RM, RN, MAN
CLINICAL INSTRUCTOR
HEALTHY FAMILIES are
the foundation for
HEALTHY
COMMUNITIES, and
through the Sustainable
Development Goals, the
world has made a promise of
UNIVERSAL HEALTH
COVERAGE AND HEALTH
FOR ALL.
OVERVIEW OF PUBLIC HEALTH
NURSING IN THE PHILIPPINES
A. GLOBAL
AND
NATIONAL
HEALTH
SITUATION
The COVID-19 global outbreak
is challenging health systems
worldwide, both the supply side
(delivery) and the demand
side (access) of essential
family planning and
maternal/child health services
particularly in low income and
middle income countries.
GLOBAL AND NATIONAL HEALTH SITUATION
The world has never seen a health
crisis like COVID-19. It has impacted
communities everywhere in all aspects
of our lives. There has never been a
stronger, more urgent case for global
cooperation because no one is safe
until everyone is safe.
GLOBAL AND NATIONAL HEALTH SITUATION
Each year, more than 5.2 million children
under age 5 die from preventable causes,
and over 800 women and adolescent girls
die due to complications during
pregnancy and childbirth every day.
GLOBAL AND NATIONAL HEALTH SITUATION
The number of children
receiving life saving
routine childhood
immunization in
Barangay Health Stations
and Barangay Health
Centers has decreased. A
lot of children missed
routine vaccines during
pandemic because of
difficulty in
transportation and fear
of contracting COVID-
19.
GLOBAL AND NATIONAL HEALTH SITUATION
Significant rise of unintended
pregnancies because of
disruption in the delivery and
lack of supply of modern FP
commodities.
GLOBAL AND NATIONAL HEALTH SITUATION
Increasing number
of Home Deliveries
handled by Hilots.
GLOBAL AND NATIONAL HEALTH SITUATION
Increasing number of
malnourished children and
pregnant women noted in
every barangay.
GLOBAL AND NATIONAL HEALTH SITUATION
B. DEFINITION
AND FOCUS OF
PUBLIC AND
COMMUNITY
HEALTH
What is COMMUNITY HEALTH?
• part of paramedical and medical intervention/
approach which is concerned on the health of
the whole population
• aims:
1. health promotion
2. disease prevention
3. management of factors affecting health
COMMUNITY HEALTH
COMMUNITY HEALTH
- extends the realm of public health to include
organized health efforts at the community level through
both government and private efforts
COMMUNITY HEALTH
PUBLIC HEALTH
- key phrase definition: “through organized
community effort”.
- connotes organized, legislated, and tax-supported
efforts that serve all people through health
departments or related governmental agencies.
PUBLIC HEALTH
PUBLIC HEALTH
Definition of public health according to:
C. E. Winslow- “Public health is the science and art of (1) preventing disease, (2)
prolonging life, and (3) promoting health and efficiency through organized community
effort for:
1. sanitation of the environment,
2. control communicable infections,
3. education of the individual in personal hygiene,
4. organization of medical and nursing services for the early diagnosis and
preventive treatment of disease, and
5. “development of the social machinery to ensure everyone has a standard of
living adequate for the maintenance of health, so organizing these benefits as to
enable every citizen to realize his birthright of health and longevity.” (Hanlon)
PUBLIC HEALTH
PUBLIC HEALTH AS A SCIENCE
Is concerned with the KNOWLEDGE and SKILLS
required of a NURSE to be able to institute
interventions for the WELFARE of the PUBLIC.
AS AN ART: Public Health requires creativity in
executing the knowledge and skills for
the comfort of the People.
THE MISSION OF PUBLIC HEALTH is Social Justice,
which entitles all People to Basic Necessities such as
adequate Income and Health Protection and accepts
collective burdens to make it possible.
PUBLIC HEALTH
PUBLIC HEALTH EFFORTS
Focus on Prevention and Promotion of Population Health at the National Level and
Local Levels.
•National Level: Concentrate on providing support and advisory
services to Public Health Structures at the Local Level.
•Local Level: Provide direct services to communities through Two
Avenues:
1. Community Health services which protect the Public from hazards such as
polluted water and air, tainted food and unsafe housing.
2. Personal Health Care Services such as immunization and family planning
services, well infant care and sexually transmitted disease (STD) treatment.
PUBLIC HEALTH
- Personal Health Services may be part of
the Public Health effort and often target
the Populations most at risk and in need
of services.
- Public Health efforts are multi disciplinary
because they require people with many
different skills. Community Health Nurses
work with a diverse team of public health
professionals including epidemiologists,
local health officers and health educators
CORE PUBLIC HEALTH FUNCTIONS
1. ASSESSMENT
Regular collection, analysis and information sharing about
health conditions, risks and resources in a community.
2. POLICY DEVELOPMENT
Use of information gathered during assessment to develop
local and state health policies and to direct resources toward
those policies.
3. ASSURANCE
Focuses on the availability of necessary health services
throughout the community. It includes maintaining the ability
of both public health agencies and private providers to
manage day to day operations and the capacity to respond to
critical situations and emergencies.
ESSENTIAL PUBLIC HEALTH SERVICES
1. Monitor health status to identify and solve community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate and empower people about health issues
4. Mobilize community partnerships and actions to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of health
care when otherwise is unavailable
8. Assure a competent public health and personal health workforce
9. Evaluate effectiveness, accessibility and quality of personal and population based
health services
10. Research for new insights and innovative solutions to health problems.
PUBLIC HEALTH
- The purpose of Public Health is to
improve the health of the Public by
promoting healthy lifestyles, preventing
disease and injury and protecting the
health of communities.
- In Public Health Practice, the
community is the population of interest.
THE PUBLIC HEALTH INTERVENTION WHEEL
The Intervention Wheel is a population-
based practice model that encompasses
three levels of practice (community,
systems, and individual/family) and 17
public health interventions. Each
intervention and practice level contributes
to improving population health.
The Minnesota Department of Health
(MDH) introduced the color-coded graphic
illustration, once known as the Public
Health Intervention Model, in
1998. Today, you may hear it called the
Intervention Wheel, or simply, the Wheel.
THE PUBLIC HEALTH INTERVENTION WHEEL
It Contains Three Levels of Practice
Three concentric circles inside the wheel name the levels of practice. They are
identified, from the outer ring to the inner ring: Systems-focused, community-
focused, and individual-focused.
1. Systems-focused: Changes organizations, policies, laws, and power structures.
The focus is not directly on individuals and communities but on the systems that
impact health. Changing systems often impacts population health in a more effective
and lasting way than requiring change from every individual in a community.
2. Community-focused: Changes community norms, attitudes, awareness,
practices, and behaviors. This practice level is directed at entire populations within
the community or occasionally toward target groups within those populations.
Community-focused practice is measured in terms of what proportion of the
population actually changes.
THE PUBLIC HEALTH INTERVENTION WHEEL
It Contains Three Levels of Practice
3. Individual/family-focused: Changes knowledge, attitudes, beliefs, practices,
and behaviors of individuals and families. This practice level is directed at
individuals, alone or as part of a family, class, or group. Individuals receive
services because they are identified as belonging to a population at risk.
THE PUBLIC HEALTH INTERVENTION WHEEL
Interventions Are Actions
The interventions comprising the wheel’s outer ring are
grouped by color.
Red
The five interventions in the red wedge are frequently
implemented in conjunction with one another. Surveillance is
often paired with disease and health event investigation,
even though either can be implemented
independently. Screening frequently follows either surveillance
or disease and health event investigation and is often preceded
by outreach activities in order to maximize the number of
those at risk who actually get screened. Most often, screening
leads to case finding, but this intervention can also be carried
out independently.
THE PUBLIC HEALTH INTERVENTION WHEEL
Green
The green wedge consists of referral
and follow-up, case management,
and delegated functions—three
interventions that, in practice, are often
implemented together.
Blue
Similarly, health teaching, counseling,
and consultation—the blue wedge—are
more similar than they are different;
health teaching and counseling are
especially often paired.
THE PUBLIC HEALTH INTERVENTION WHEEL
Orange
The interventions in the orange wedge—
collaboration, coalition building,
and community organizing—while distinct, are
grouped together because they are all types of
collective action and are most often carried out at
systems or community levels of practice.
Yellow
Similarly, advocacy, social marketing,
and policy development and enforcement—
the yellow wedge—are often interrelated when
implemented. In fact, advocacy is often viewed as
a precursor to policy development; social
marketing is seen by some as a method of
carrying out advocacy.
PUBLIC HEALTH INTERVENTIONS AND DEFINITIONS
1. 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.
2. DISEASE AND OTHER HEALTH INVESTIGATION
- Systematically gathers and analyses data regarding threats to the health of the
populations, ascertains the source of the threat, identifies cases and other at risk
and determines control measures.
3. 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 service can
be obtained.
PUBLIC HEALTH INTERVENTIONS AND DEFINITIONS
4. SCREENING
- Identifies individuals with unrecognized health risk factors or asymptomatic
disease condition.
5. CASE FINDING
- Locates individuals and families with identified risk factors and connects them
with resources
6. 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.
7. CASE MANAGEMENT
- Optimizes self care capabilities of individuals and families and the capacity of
systems and communities to coordinate and provide services.
PUBLIC HEALTH INTERVENTIONS AND DEFINITIONS
8. DELEGATED FUNCTIONS
- Carries out direct care tasks under the authority of a health care practitioner as
allowed by the law.
9. HEALTH TEACHING
- Communicates facts, ideas and skills that change knowledge, attitudes, values,
beliefs, behaviours and practices of individuals, families, systems and/or
communities.
10. COUNSELLING
- Establishes an interpersonal relationship with a community, a system and a
family or individual, with intention of increasing or enhancing their capacity for
self care and coping.
PUBLIC HEALTH INTERVENTIONS AND DEFINITIONS
11. CONSULTATION
- Seeks information and generates optional solutions to perceived problems or
issues through interactive problem solving with a community system and family
or individual
12. COLLABORATION
- Commits two or more persons or organizations to achieve a common goal by
enhancing the capacity of one or more of the members to promote and protect
health.
13. COALITION BUILDING
- Promotes and develops alliances among organizations or constituencies for a
common purpose.
PUBLIC HEALTH INTERVENTIONS AND DEFINITIONS
14. COMMUNITY ORGANIZING
- Helps community groups to identify common problems or goals, mobilize
resources and develop and implement strategies for realizing the goals they
collectively have set.
15. ADVOCACY
- Pleads someone’s cause or acts on someone’s behalf, with a focus on developing
the community, system and individual or family’s capacity to plead their own
cause or act on their own behalf.
16. SOCIAL MARKETING
- Utilizes commercial marketing principles and technologies for programs designed
to influence the knowledge, attitudes, values, beliefs, behaviours and practices of
the population of interest.
PUBLIC HEALTH INTERVENTIONS AND DEFINITIONS
17. POLICY DEVELOPMENT AND ENFORCEMENT
- Places health issues on decision maker’s 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.
COMMUNITY HEALTH
3 BASIC CONCEPTS OF COMMUNITY OR PUBLIC HEALTH
- Community as a Client
- Health as a Goal
- Nursing as the vehicle or means to achieve its aims
1. COMMUNITY AS A CLIENT
Two Important Attributes of Community
1. Having geographic boundaries
2. Shared belief system or culture
What is a COMMUNITY?
• a group of people with common
characteristics or interests living together
within a territory or geographical
boundary
• place where people under usual
conditions are found
Definition and Focus of Public Health and Community Health
Definition of community according to:
a. Allender- “a collection of people who interact with one another and whose
common interests or characteristics form the basis for a sense of unity or
belonging.”
b. Lundy and Janes- “a group of people who share something in common
and interact with one another, who may exhibit a commitment with one
another and may share geographic boundary.”
c. Clark- “a group of people who share common interests, who interact with
each other, and who function collectively within a defined social structure to
address common concerns.”
d. Shuster and Goeppinger- “a locality-based entity, composed of systems
of formal organizations reflecting society’s institutions, informal groups and
aggregates.”
Definition and Focus of Public Health and Community Health
COMMUNITY HEALTH
GEOGRAPHIC BOUNDERIES
- Where people live is an important determinant of Human Behaviour and
Health. Whether humans settle near bodies of water or on the mountain slopes,
people uniquely adopt to their environment and spell much of the choices they
make in their life including healthcare.
SHARED BELIEF SYSTEM OR CULTURE
- Bound by their location, people develop common beliefs and values that
eventually evolve as culture. This set of beliefs acquired over time accounts
for why people across the globe have similarities and differences. Further, culture
spells out people’s primordial concept of health and illness and their health
seeking behaviour.
Two Important Attributes of Community
COMMUNITY HEALTH
In the Philippines, the concept of health and illness can be summed up in either
presence or absence of signs and symptoms. Without physical manifestations of
disease, people tend to cling to the false belief of being healthy . Such mindset
breeds a fatal outcome. In this context, families only seek healthcare when the
condition is advanced with full blown complications hence requiring costly
hospitalization in tertiary care.
- This scenario illustrates how culture impact health and therefore an important
aspect of community/public health nursing.
- Dealing with the community as a client entails a collective approach. Individuals,
families and population group are included. Women, children, elderly, adults form
part of our clientele.
- Community and Public Health work requires an understanding and respect for
culture in the hope of introducing meaningful health information and influencing
people to embrace a culture of health.
COMMUNITY HEALTH
2. HEALTH AS A GOAL
- Health is more than a state of wellbeing, It is a multidimensional reality that
includes socioeconomic, environmental and even political factors.
- With Health as a goal, healthcare needs to be holistic. This means that the Nurse
in the community foster multi-disciplinary efforts to address various core
determinants of health.
- Moreover, health is a shared reality. It is the common ground that connects all
people regardless of age, sex, creed and religion. Thus, healthcare should be
universal in order to achieve health as a human right.
What is a HEALTH?
a. WHO- “a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.”
b. Murray- “a state of well-being in which the person is able to use purposeful,
adaptive responses and processes physically, mentally, emotionally, spiritually, and
socially.”
c. Pender- “actualization of inherent and acquired human potential through goal-
directed behavior, competent self-care, and satisfying relationship with others.”
d. Orem- a state of person that is characterized by soundness or wholeness of
developed human structures and of bodily and mental functioning.”
Definition and Focus of Public Health and Community Health
COMMUNITY HEALTH
3. NURSING AS THE VEHICLE OR MEANS TO ACHIEVE ITS AIM
- Nursing is traditionally defined as the art and science of caring.
- Nursing is a means of ensuring that people are placed in an optimum condition
where nature can contribute to healing and wellness—Florence Nightingale. Such
assertion from Nightingale provides a powerful description of what nurses do in
community and public health work.
- Ensuring safe water access and promoting sanitary conditions are part and parcel
of promoting health and preventing diseases.
- The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or peaceful
death) that he would perform unaided if he had the necessary strength, will or
knowledge. And to do this in such a way as to help him gain independence as
rapidly as possible—Virginia Henderson
What is NURSING?
assisting sick individuals to become
healthy and healthy individuals
achieve optimum wellness.
Definition and Focus of Public Health and Community Health
DEFINING ATTRIBUTES OF
COMMUNITIES
1. PEOPLE
2. PLACE
3. INTERACTION
4. COMMON CHARACTERISTICS, INTERESTS OR GOALS
-MAURER AND SMITH, 2009
DETERMINANTS OF HEALTH AND
DISEASE
• INCOME AND SOCIAL STATUS
• EDUCATION
• PHYSICAL ENVIRONMENT
• EMPLOYMENT AND WORK CONDITIONS
• SOCIAL SUPPORT NETWORKS
• CULTURE
• GENETICS
• PERSONAL BEHAVIOR AND COPING SKILLS
• HEALTH SERVICES
• GENDER
LEVEL OF PREVENTION
1. PRIMARY: GENERAL HEALTH PROMOTION AND SPECIFIC PROTECTION
2. SECONDARY: EARLY DETECTION AND PROMPT INTERVENTION
3. TERTIARY: REDUCE THE EFFECTS OF DISEASE AND INJURY, AND RESTORE
INDIVIDUALS TO THEIR OPTIMAL LEVEL OF FUNCTIONING
-LEAVELL AND CLARK, 1958
9 Essential public health functions according to WHO Regional Office for the
Western Pacific
1. Health situation monitoring and analysis
2. Epidemiological surveillance/ disease prevention and control
3. Development of policies and planning in public health
4. Strategic management of health systems and services for population health
gain
5. Regulation and enforcement to protect public health
6. Human resources development and planning in public health
7. Health promotion, social participation and empowerment
8. Ensuring the quality of personal and population-based health service
9. Research, development, and implementation of innovative public health
solution
PUBLIC HEALTH
Public Health Nursing: the term used before for
Community Health Nursing
What is Community Health Nursing?
“The utilization of the nursing process in the different
levels of clientele-individuals, families, population
groups and communities, concerned with the
promotion of health, prevention of disease and
disability and rehabilitation.”
- Maglaya, et al
COMMUNITY HEALTH NURSING
PUBLIC HEALTH
- Community/public health nursing is
the synthesis of nursing practice
and public health practice.
- The major goal of community
health nursing is to preserve the
health of the community and
surrounding populations by
focusing on health promotion and
health maintenance of individuals,
families, and groups within the
community.
COMMUNITY HEALTH NURSING (CHN):
• a specialized field of nursing practice
• a science of Public Health combined with
Public Health Nursing Skills and Social
Assistance with the goal of raising the level of
health of the citizenry, to raise optimum level
of functioning of the citizenry (Characteristic
of CHN)
COMMUNITY HEALTH NURSING
COMMUNITY HEALTH NURSING
- Is defined as a specialized field of nursing practice that renders care to
individuals, families and communities; focusing on health promotion and
disease prevention through people empowerment.
CORE OF COMMUNITY HEALTH NURSING
1. Health Promotion: directed at improving the well-being
2. Disease Prevention: Protects people from disease and the effects of disease
- Efforts to help people reduce their risks from developing disease and maintain their
optimum functioning is a priority in this field.
- Preventive measures like vaccination and screening activities for certain diseases for early
detection and prompt treatment are packaged into health programs for communities.
- Nurses in the Community strive to help people gain independence in health by sharing
information to help them manage their own healthcare needs. This is the essence of
empowerment, that people enjoy health in their own hands.
STANDARDS OF PUBLIC HEALTH NURSING IN
THE PHILIPPINES
STANDARDS OF CARE
Standard 1 The public health nurse collects comprehensive data
ASSESSMENT pertinent to the health status of the population.
Standard 2
POPULATION The public health nurse analyses the assessment data
DIAGNOSIS to determine the population diagnosis and priorities.
PRIORITIES
Standard 3 The public health nurse identifies outcomes for a plan
OUTCOMES that is based on population diagnosis and priorities.
IDENTIFICATION
Standard 4 The public health nurse develops a plan that reflects
PLANNING best practices by identifying strategies, action plans
and alternatives to attain expected outcomes.
STANDARDS OF PUBLIC HEALTH NURSING IN
THE PHILIPPINES
STANDARDS OF CARE
Standard 5 The Public Health Nurse implements the identified plans
IMPLEMENTATION by partnering with others.
a. Coordination
- Coordinates programs, services and other activities to
implement the identified plan.
b. Health education and Health Promotion
- Employs multiple strategies to promote health, prevent
disease and ensure a safe environment for population.
c. Consultation
- Provides consultation to various community groups and
officials to facilitate the implementation of programs and
services.
d. Regulatory Activities
- Identifies, interprets and implements public health laws,
regulations and policies.
STANDARDS OF PUBLIC HEALTH NURSING IN
THE PHILIPPINES
STANDARDS OF CARE
Standard 6 The Public Health Nurse evaluates the health status of
EVALUATION the population.
Standard 7 Public Health Nurse systematically enhances the quality
QUALITY OF and effectiveness of nursing practice.
PRACTICE
Standard 8 The Public Health Nurse attains knowledge and
EDUCATION competency that reflects current nursing and public
health practice.
Standard 9 The Public Health Nurse evaluates one’s own nursing
PROFESSIONAL practice in relation to professional practice standards
PRACTICE and guidelines, relevant statutes, rules and regulations
EVALUATION
STANDARDS OF PUBLIC HEALTH NURSING IN
THE PHILIPPINES
STANDARDS OF PROFESSIONAL PERFOMANCE
Standard 10 Public Health Nurse establishes collegial partnership
COLEGIALITY AND while interacting with representatives of the
PROFESSIONAL population, organizations and health and human
RELATIONSHIP services professionals and contributes to the
professional development of peers, students,
colleagues and others.
Standard 11 The Public Health Nurse collaborates with the
COLLABORATION representatives of the population, organization and
health and human service professionals in providing
for and promoting the health of the population.
Standard 12 The Public Health Nurse integrates ethical provisions
ETHICS in all areas of practice.
STANDARDS OF PUBLIC HEALTH NURSING IN
THE PHILIPPINES
STANDARDS OF PROFESSIONAL PERFOMANCE
Standard 13 The Public Health Nurse Integrates Ethical Provisions
RESEARCH in all areas of practice.
Standard 14 The Public Health Nurse considers factors related to
RESOURCE safety, effectiveness, cost and impact on practice and
UTILIZATION in the planning and delivery of nursing and public
POPULATION health programs, policies and services.
Standard 15 The Public Health Nurse provides leadership in
LEADERSHIP nursing and public health.
PUBLIC HEALTH INTERVENTIONS
Public Health Nurses focus on the care of:
- Individuals
- Groups
- Aggregates
- Populations in many settings including homes, clinics,
worksites and schools
Public Health Nurses must be able also 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.
TARGET POPULATION (IFC) ARE:
1. I ndividual
2. F amily
3. C ommunity
COMMUNITY HEALTH NURSING
3 Elements considered in CHN:
Science of Public Health (core foundation in
CHN),
Public Health Nursing Skills and
Social Assistance Functions
COMMUNITY HEALTH NURSING
OBJECTIVES OF PUBLIC HEALTH: CODES
C ontrol of Communicable Diseases
O rganization of Medical and Nursing Services
D evelopment of Social Machineries
E ducation of IFC on personal Hygiene→ Health
Education is the essential task of every health worker
S anitation of the environment
COMMUNITY HEALTH NURSING
3 ELEMENTS IN HEALTH EDUCATION: IEC
• I nformation: to share ideas to keep population group
knowledgeable and aware
• E ducation: change within the individual
3 Key Elements of Education:
K nowledge
A ttitude
S kills
3 ELEMENTS IN HEALTH EDUCATION: IEC
• C ommunication: interaction involving 2 or more
persons or agencies
3 Elements of Communication:
Message
Sender
Receiver
PUBLIC HEALTH WORKERS (PHW)
PHW’s: are members of the health team who are
professionals namely
§ Medical Officer (MO)-Physician
§ Public Health Nurse (PHN)-Registered Nurse
§ Rural Health Midwife (RHM)-Registered Midwife-
§ Dentist
§ Nutritionist
§ Medical Technologist
§ Pharmacist
§ Rural Sanitary Inspector (RSI)-must be a sanitary engineer
HISTORY OF PUBLIC HEALTH NURSING
IN THE PHILIPPINES
• 1577: FRIAR JUAN CLEMENTE OPENED A MEDICAL DISPENSARY IN INTRAMUROS
FOR THE INDIGENT.
• 1690:
DOMINICAN FATHER JUAN DE PERGERO WORKED TOWARDS INSTALLING A
WATER SYSTEM IN SAN JUAN DEL MONTE (NOW SAN JUAN CITY, METRO MANILA) AND
MANILA.
• 1805: DR. FRANCISCO DE BALMIS INTRODUCED SMALLPOX VACCINATION.
• 1876: THE FIRST MEDICOS TITULARES WERE APPOINTED AND WORKED AS
PROVINCIAL HEALTH OFFICERS.
HISTORY OF PUBLIC HEALTH NURSING
IN THE PHILIPPINES
• 1888:THE UNIVERSITY OF SANTO TOMAS OPENS A TWO-YEAR, CIRUJANOS
MINISTRANTES COURSE TO PRODUCE MALE NURSES AND SANITARY INSPECTORS.
• 1901: THE BOARD OF HEALTH OF THE PHILIPPINE ISLANDS WAS CREATED THROUGH
ACT 157, WHICH EVENTUALLY EVOLVED INTO THE DEPARTMENT OF HEALTH (DOH)
• 1912: THE FAJARDO ACT LAW CREATED SANITARY DIVISIONS MADE UP ONE TO FOUR
MUNICIPALITIES.
• 1905: ASOCIACION DE FEMINISTA FILIPINA FOUNDED LA GOTA DE LECHE: THE FIRST
CENTER DEDICATED TO THE SERVICE OF MOTHERS AND BABIES
HISTORY OF PUBLIC HEALTH NURSING
IN THE PHILIPPINES
• 1947: THE DOH WAS REORGANIZED INTO BUREAUS AND THE ADMINISTRATION OF
CITY HEALTH DEPARTMENTS WAS PLACED AT BUREAU LEVEL.
• 1954: THE CONGRESS PASSED R.A. 1082 OR THE RURAL HEALTH UNIT ACT WHICH
PROVIDED AN RHU IN EVERY MUNICIPALITY.
• 1957:
R.A. 1891 WAS ENACTED TO HAVE A MORE EQUITABLE DISTRIBUTION OF
HEALTH PERSONNEL.
• 1958: REGIONAL HEALTH OFFICES WERE CREATED AS A RESULT OF
DECENTRALIZATION EFFORTS, THUS CREATING THE POSITION: REGIONAL HEALTH OFFICER.
HISTORY OF PUBLIC HEALTH NURSING
IN THE PHILIPPINES
• 1970: THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM WAS RESTRUCTURED,
PAVING THE WAY FOR THE HEALTH CARE SYSTEM THAT EXISTS TO THIS DAY WHERE HEALTH
SERVICES ARE CLASSIFIED INTO PRIMARY, SECONDARY AND TERTIARY LEVELS.
• 1991: R.A.7160 OR THE LOCAL GOVERNMENT CODE MANDATED THE DEVOLUTION OF
BASIC SERVICES, INCLUDING HEALTH SERVICES, TO LOCAL GOVERNMENT UNITS AND THE
ESTABLISHMENT OF A LOCAL HEALTH BOARD IN EVERY PROVINCE AND CITY OR
MUNICIPALITY.
HISTORY OF PUBLIC HEALTH NURSING
IN THE PHILIPPINES
• 1999:HEALTH SECTOR REFORM AGENDA WAS LAUNCHED TO DIRECT GOVERNMENT
EFFORTS TOWARDS COMPREHENSIVE REFORMS.
• 2005: FOURMULA ONE (F1) FOR HEALTH WAS LAUNCHED TO PROVIDE AN
IMPLEMENTATION FRAMEWORK TO THE REFORM AGENDA.
• 2010: UNIVERSAL HEALTH CARE WAS LAUNCHED TO PROVIDE THE NECESSARY
REVISIONS TO THE F1 FRAMEWORK.
ROLES OF A 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 OF HIS/HER CLIENTELE.
THE PHILIPPINE REGULATORY BOARD OF NURSING EXPECTS
BEGINNING PROFESSIONAL NURSES TO BE ABLE TO PERFORM
THREE ROLES: THAT OF A HEALTH CARE PROVIDER, MANAGER-
LEADER AND RESEARCHER.
BASIC PRINCIPLES OF CHN
The community is the patient in CHN, the family is the
unit of care and there are four levels of clientele:
individual, family, population group (those who share
common characteristics, developmental stages and
common exposure to health problems – e.g. children,
elderly), and the community.
In CHN, the client is considered as an ACTIVE partner
NOT PASSIVE recipient of care
COMMUNITY HEALTH NURSING
BASIC PRINCIPLES OF CHN
CHN practice is affected by developments in health
technology, in particular, changes in society, in
general
The goal of CHN is achieved through multi-sectoral
efforts
CHN is a part of health care system and the larger
human services system.
COMMUNITY HEALTH NURSING
ROLES OF THE PUBLIC HEALTH NURSE
• Clinician, who is a health care provider, taking care of the sick people at
home or in the RHU
• Health Educator, who aims towards health promotion and illness
prevention through dissemination of correct information; educating
people
• Facilitator, who establishes multi-sectoral linkages by referral system
• Supervisor, who monitors and supervises the performance of midwives
COMMUNITY HEALTH NURSING
ROLES OF A COMMUNITY AND PUBLIC
HEALTH NURSE
BUT A COMMUNITY AND PUBLIC HEALTH NURSE TAKES ON
ADDITIONAL ROLES, OWING TO THE REALITIES OF
CHANGING TIMES AND AGE.
HEALTHCARE PROVIDER
- CARINGIS THE ESSENCE OF NURSING AND HAS BEEN
WIDELY EXPECTED IN ALL SETTINGS. THE USE OF THE
NURSING PROCESS APPLIED IN THE NATURAL
ENVIRONMENT OF THE CLIENT PERTAINS TO THIS ROLE.
- EXAMPLE:TAKING THE HISTORY OF A PREGNANT
WOMAN IN THE VILLAGE CLINIC (BARANGAY HEALTH
CENTER).
ROLES OF A COMMUNITY AND PUBLIC
HEALTH NURSE
HEALTHCARE 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.
- EXAMPLE: INSTRUCTING PATIENTS HOW TO TAKE THEIR
PRESCRIBED MEDICINE OR SHARING INFORMATION
ABOUT THE BENEFITS OF HEALTHY LIFESTYLE.
ROLES OF A COMMUNITY AND PUBLIC
HEALTH NURSE
PROGRAM IMPLEMENTER
- NURSES WORKING UNDER LOCAL
GOVERNMENT UNITS DELIVER HEALTHCARE
TO THE GRASSROOTS. THIS ALSO REQUIRES
THAT PROGRAMS INITIATED BY THE
NATIONAL GOVERNMENT THRU THE
DEPARTMENT OF HEALTH ARE EXECUTED AT
ALL LEVELS.
- EXAMPLE: IMPLEMENTATION OF THE
DIFFERENT HEALTH PROGRAMS (NIP,
MATERNAL, FP, NCD, CD, ENVIRONMENTAL
SANITATION) AND SUBMISSION OF REPORTS.
ROLES OF A COMMUNITY AND PUBLIC
HEALTH NURSE
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.
- COMMUNITY ORGANIZING IS A FORM OF COMMUNITY
ENGAGEMENT THAT SEEKS TO RALLY PEOPLE TO WORK
TOGETHER AND ACT ON ISSUES OWNED, IDENTIFIED, AND
SOLVED THRU AND BY THE PEOPLE’S OWN EFFORTS.
- EDUCATING THE PEOPLE AND MOBILIZING ALL
STAKEHOLDERS TO ADDRESS PROBLEMS.
ROLES OF A COMMUNITY AND PUBLIC
HEALTH NURSE
MANAGER/LEADER
- COMMUNITY AND PUBLIC HEALTH 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 CONDUCTING TRAINING
SESSIONS ARE LIKEWISE INCLUDED IN THIS ROLE.
ROLES OF A COMMUNITY AND PUBLIC
HEALTH NURSE
RESEARCHER/EPIDEMIOLOGIST
- THENURSE IS REGARDED AS THE HEALTH MONITOR OF THE
COMMUNITY. THEY KEEP TRACK OF ILLNESSES ENCOUNTERED
IN THEIR AREAS OF JURISDICTION AND SUBMITS REPORTS TO
HEALTH AUTHORITIES AS REQUIRED BY THE LAW. IN EVENT OF
AN OUTBREAK, 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
FINDINGS TO PROVIDE EVIDENCE TO CONVINCE DECISION
MAKERS TO ENACT POLICIES FOR HEALTH.
ROLES OF A COMMUNITY AND PUBLIC
HEALTH NURSE
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.
