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Community Health Nursing: o group

o community
Definitions:  goal of improving community health involves
multidisciplinary effort
1.) World Health Organization:  CHN works not for individual patient, family, group or
a. Special field of nursing that combines skills of community. The latter are active partners, not passive-
nursing public health… recipients of care
b. Function as part of total public health program  Practice of CHN is affected by changes in society in
for: general and by developments in health field in particular
i. Promotion of health  CHN is part of community health system, which in turn is
ii. Improvement of condition part of the larger human services system
iii. Rehabilitation of illness and
disability Barangay Health Centers
2.) Jacobsen
a. Learned practice discipline with ultimate goal 1 doctor, 1 nurse, midwives, 2 barangay health workers. 1 nurse= 5000
of contributing as individuals to promote people
client’s optimum level of functioning through
teaching and delivery of care Wednesday: check-up and free immunizations
3.) Dr. Ruth B. Freeman
a. CHN is a unique blend of nursing and public
health practice aimed at developing and
enhancing health capabilities of people. It is Roles and Functions
involved in entire spectrum of health services
for the community
 Planner: e.g. IMCI = Integrated management of childhood
4.) Tinkham and Voorhies, 1972
illnesses
a. CHN is a field of nursing in which family and
 Provider of Nsg Services: direct nursing care of sick;
communities are patients
provides patient continuity of care
b. Unique blend of nursing and public health
practice woven into human service  Manager/Supervisor: formulates individual, family, group
c. “The hallmark of CHN is that it is population or and community centered care of plan; organize work
aggregate-focused.” force
 Coordinator of Services: coordinates with individuals,
Philosophy of CHN family, group for health related services provided by GO’s
and NGO’s
 Trainer/health educator/counselor: identifies and
Dr. Margaret Shetland:
interprets training needs of RHM’s, BHW’s and hilots;
resource speaker; IEC materials
“Philosophy is based on the worth and dignity of
 Health Monitor: detects deviation from health of
man.”
individual, family, group and community through contact
visits with them; use of systematic and objective
Ultimate Goal
assessment
 Role model: provides good example/ model of healthful
“To raise level of health of the citizenry.”
living to public
 Change agent: motivates changes in health behavior of
Objectives of CHN individual, family, group and community including
lifestyle to promote and maintain health. “most difficult
1.) participate… role.”
2.) conduct researches…  Recorder/reporter/statisticiain: prepares and submits
3.) coordinate… records and reports
 Researcher: participates/assists in conduct of surveys
Concepts of CHN
Community Health Nursing:
 emphasis on importance of “greatest good for the greatest
number” History:
 assessing health needs, planning, implementing and
evaluating impact of health services on population group
 Early Christian era: virgins, noblewomen and plebeians
 priority of health promotive and disease preventive
took care of sick
strategies over curative interventions
 Phoebe: 1st visiting nurse
 tools for measuring and analyzing community health
 Mr. William Rathbone:
problems
o Philanthropist who first thought of public
 application of principles of management and organization
health nursing
of the delivery of health services to the community
o District nursing service in Liverpool in 1859
o More emphasis on midwifery
Basic Principles of Community Health Nursing o Forerunner of public health nursing system
 In the USA:
 family is the unit of care, community is the patient and o Public HN developed from visiting nursing
the four levels of clientele of CHN are: service under missionary societies and visiting
o individual nursing associations
o family

o 1877: women’s board of NY mission
established 1st visiting nurses
History of Public Health
 Babylonians
o Understood need for hygiene
o Developed medical skills
 Egyptians
o Developed variety of pharmaceutical
preparations
o Constructed earth privies and public drainage
system
 Hebrew Mosaic Law
o Maternal health, communicable disease
control, protection of food, water, waste and
sanitary disposal
 Greeks
o Linked health to environment
o Wealthy people value personal cleanliness,
exercise, diet and sanitation
 Romans
o Viewed medicine from a community health and
social medicine perspective
o Emphasized regulation of medical practice
o Provision of pure water
o Sewage systems, public food preparation
o Women visited and cared for the sick
 Christianity
o Brought idea of personal responsibility
o Started the care for the sick
 Middle Ages
o Poor sanitary conditions
o Increase in communicable diseases (cholera,
bubonic plague, smallpox)
o Religious convents and monasteries
established hospitals
o Started movement of health education and
personal hygiene
 Renaissance
o Health practices were influenced by
recognition of human dignity and worth
o Elizabeth Poor Law: established 1601,
guaranteed medical services to poor and lame
individuals
 Industrial Revolution
o Advances in transportation
o Religious women started to provide nursing
care in institutions and homes
Milestones in history of public health
 1601- Elizabeth Poor Law
 1617- Sisterhood of Dames de Charite organized by St.
Vincent de Paul
 1789- Baltimore Health Department
 1798- Marine Hospital Service, nuns visited poor
 1813- Ladies Benevolent Society of Charleston, South
Carolina founded
 1836- Lutheran deaconesses provided home visits in
Germany
 1851- Nightingale visited Kaiserwerth, 3 months of
nursing training
 1855- Quarantine Board, established in New Orleans;
beginning of tuberculosis campaign in US
 1859- district nursing established by William Rathbone
 1860- Florence Nightingale Training School for Nurses
established in St. Thomas Hospital in London
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 1864- Beginning of Red Cross
Community Health Nursing Historical Background in Philippines
 1901- Act 157, est. Board of Health of Philippines
 1905- Act 1407, est. Bureau of Health, under Department
of Interior
 1912- Fajardo Act (Act 2156) – Sanitary Division,
forerunner of present Municipal Health Offices; President
of Sanitary division took charge of 2 to 3 municipalities.
Philippine General Hospital sent 4 nurses to Cebu
 1914- School of Nursing rendered by Filipino Nurse
employed by Bureau of Health in Tacloban, Leyte
 1915- Philippine Health Service; Reorganization Act 2462
created. Office of Inspector General and Office of District
Nursing headed by Dr. Rosario Pastor, a nurse and
physician
 1915-1918- Ms. Perlita Clark took charge of Public Health
Nursing Works
 1919- 1st Filipino Nurse Supervisor was appointed, 84
PHN’s assigned in 5 health stations
 1927- Office of District Nursing abolished and changed to
Section of Public Health Nursing
 1930- Section for Nursing
 1941- Outbreak of war, PHN’s were assisted to take care
of sick and wounded
 1942- 31 nurses as POW’s at Bilibid Prison, released to
Director of Bureau and Health, Dr. Eusebio Aguilar
 1948- 1st training center of Bureau of Health organized in
cooperation with Pasay City Health Department
 1950- Rural Health Demonstration and Training Center
by DOH
 1958-1965- RA 977 abolished Division of Nursing
o Annie Sand= nursing consultant, Office of
Secretary of Health
 Founded DOH National League of
Nurses Inc.
o RA 977created 8 regional offices in country
increased to 11 then to 16
Primary Health Care (Basic Health Care)
Definition
1.) World Health Organization: “essential health
care made universally accessible to individuals
and families by means acceptable to them,
through full participation and at cost that the
community and country can afford at every
stage of development.”
Conceptual Framework
 Goal: Health for all Filipinos and Health in the hands of th
epoeple by the year 2020
 Mission: to strengthen the health care system by
increasing opportunities and supporting conditions
wherein people will manage their own health care.
 Concept: Primary Health Care (PHC) characterized by
partnership and empowerment of people shall permeate
as core strategy in effective provision of essential health
services
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Legal Basis f. Foundation of health committees

g. Establishment of community health
 Letter of Instruction (LOI) 949: signed on Oct. 19, 1979 by organizations
then Pres. Ferdinand E. Marcos h. Mass health campaigns and community
 Historical Background mobilization
o 1974- WHO and UNICEF conducted a joint 4.) Self-reliance
study a. Community generates support for health care
o 1975- World Health Assembly passed a b. Mobilization of health resources
resolution giving priority to the development c. Training of community leaders on leadership
of PHC and managerial skills
o 1977- World Health Assembly decided that d. Income-generating projects
main target of government and WHO is the 5.) Recognition of interrelation of health and development
attainment of the level of health that would a. Convergence of health, food, nutrition, water,
allow or permit them to lead a socially and sanitation and population services
economically productive life by year 2000 b. Integration of PHC into national, provincial,
o September 6-12, 1978- 1st International municipal and barangay development plan
Conference on Primary Health Care in Alma 6.) Social Mobilization
Ata, USSR a. Establishment of effective health referral
o 1979- WHA launched global strategy to attain system
health for all b. Multi-sectoral and inter-disciplinary linkages
o 1980- PHC endorsed for implementation by c. Integration, Education, Communication (IEC)
respective regional community support using multimedia channels
d. Collaboration among government agencies,
Why Philippines Adopted PHC non-government organizations and community
groups
1.) magnitude of health problems 7.) Decentralization
2.) inadequate and unequal distribution of health resources a. Reallocation of budgetary resources
3.) increased cost of medical care b. Advocacy for political will and support
4.) isolation of health care activities from other c. Re-orientation of health profession
developmental activities
Strategies of PHC
Principles of PHC
1.) reorientation and reorganization by local government
1.) Accessibility, acceptability, availability, and affordability code of 1991 or RA 7160
of health services 2.) effective preparation and enabling process for health
a. Health services are delivered where people live action at all levels
and work 3.) mobilization of people to know their communities and
b. Development of indigenous or resident identify basic health needs
volunteer health workers to provide health 4.) development of utilization of technology
care with an ideal ration of 1:10-20 households 5.) organization of communities arising from needs
c. Use of low cost, appropriate technology 6.) increase opportunities
sustainable by community
d. Combined utilization of traditional medicines Essential Components of Primary Health Care
and essential drugs
2.) Partnership between community and health agencies in 1.) Multi-Sectoral Approach
provision of quality, basic and essential health services a. Intrasectoral linkages
a. Community needs and priorities are basic for b. Intersectoral linkages
planning health services and activities 2.) Community participation
b. Training curriculum of community health a. Identify problem
workers I based on community health b. Identify solution
problems and task analysis of community c. Mobilizing resources
health workers d. Barriers
c. Regular supervision and periodic evaluation of i. Lack of motivation
community health workers’ performance by ii. Indifference on part of community
health staff to community iii. Resistant to change
d. Development of promotive, preventive, iv. Bureaucracy of government
curative and rehabilitative care v. Lack of managerial skills
e. Recognition of role and traditional healers in vi. Dependence on part of community
delivery of health services 3.) Appropriate Technology
3.) Community Participation a. 6 criteria:
a. Awareness building and consciousness raising i. effectiveness and safety
on health and developmental issues ii. less complex
b. Community building and organizing iii. less costly
c. Planning, implementation, monitoring and iv. broader scope of technology
evaluation done by community v. acceptability to local culture
d. Community discussions done through small vi. feasibility
group discussions 4.) Community involvement
e. Selection of community health workers by a. Involvement level:
community i. Individual
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ii. Family-monitor growth and  Health Care System- organized plan of health services
development of child and able to  Health Care Delivery- rendering services to people
address to problems in government  Health Care Delivery System- network of health facilities
iii. Community- organizations formed and personnel which carries out task of rendering health
to promote health development care to people
 Philippine Health Care System- complex set of
Concepts of Primary Health Care organizations interacting to provide an array of health
services
1.) PHC represents supplementary health system  RA 7160
2.) Equip community with capability to solve its own o Local Gov’t Code of 1991
problems by conducting trainings o Provides for decentralization
3.) Come into being only when community recognizes and o Places in local gov’ts to manage health care
accepts problems system
4.) Government officials don’t work in place of community
and vice versa Levels of Health Care Facilities
5.) Community involvement is the heart and soul of PHC
6.) Good health is related to living conditions and lifestyle 1.) Primary level
7.) Provide opportunity to underprivileged majority to a. Composed of barangay, municipal and
develop to an acceptable level medicare health facilities
a. Basic minimalistic needs: b. 1st contact emergency care
i. Food c. rural health units, chest clinics, malaria
ii. Clothing eradication units, schistosomiasis control units,
iii. Shelter and clean environment puericulture units, private clinics, company
iv. Health clincis
v. Education and information d. early symptomatic stage
vi. Security of life 2.) Secondary level
vii. Means of livelihood a. Consists of district health care institutions with
8.) Community must take its role and responsibility to capabilities and facilities for cases with
develop basic needs hospitalization
9.) PHC activities must be in harmony with existing b. Smaller non-departmentalized hospitals
institution including emergency and regional hospitals
10.) PHC activities must be flexible in its application 3.) Tertiary level
11.) Must be related to public health services and technical a. Highly technological and sophisticated services
support levels of public… b. Specialized centers, regional health care
institutions and provincial health care centers
Elements of Primary Health Care
Multi-Sectoral Approach to Health
1.) Education
2.) Locally Endemic Diseases  Intersectoral
a. Filariasis o Sectors most closely related to health
b. Schistosomiasis o Agriculture, education, public works, local
3.) Essential basic drugs governments, social welfare, population
a. Cotrimoxazole control, private sectors
b. Amoxicillin  Intrasectoral
c. Rifampicin
d. Isoniazid Restructured Healthcare Delivery System
e. Ethambutol
f. Paracetamol
Rationale
g. Pyrazinamide
h. Oresol
 healthcare system serves only small portion of rural
i. Nifedipine
4.) Maternal and Child Health Care population
5.) Expanded program of immunization  diseases do not require sohphistication
a. BCG- bacillus calmette guerin  some problems can be handled by other postiions besides
b. OPV- oral polio vaccine MHO (Municipal Health Officer)
c. AMV- anti-measles vaccine
d. DPT- dyptheria pertussis tetanus Solutions
e. Anti-Hep B
6.) Nutrition  3 levels of health care provided by RHU (rural health unit)
a. IDD- iodine deficiency disorder staff, with referral and supervisory system support
b. IDA- iron deficiency anemia  redefinition of roles and relationships among RHU staff
c. PEM- protein energy malnutrition  establishment of satellite health centers in selected
7.) Treatment of common diseases barangays
8.) Safe water supply and sanitation
9.) Prevention and control of leading communicable diseases Features of DOH reorganization
10.) Promotion of dental health
11.) Elderly and disabled’s physical and mental health  1958- RA 1082
o 1st Rural Health Act
The Philippine Healthcare Delivery System
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o employment of more physicians, dentists, 2. Stress reduction

nurses, midwives and sanitary inspectors 3. Parenting
assigned to RHU’s 4. Dietary conditioning
o 1st 81 rural health units b. Faith Healing
 1972- RA 5435 i. Believes that disease is a state of mind so
o defined authorities of regional directors for one can alter his state of mind so he will
more meaningful decentralization be healed
o 13 regional health offices c. Chiropractic
 1974 i. System of manipulation treatment which
o IBRD- RHCDS implemented RHM were sent to teaches that all diseases are caused by
BHS to man BHS impringement on spinal column and
o Midwives were trained and roles expanded corrected by spinal adjustment
 1982- EO 851 ii. Daniel Palmer- founder
o integrated public health and hospital systems d. Acupuncture
with emphasis on importance of putting i. Insertion of needles into selected body
together promotive, preventive, curative and parts to control pain
rehabilitative components of health care e. Acupressure
o utilization of BHW i. Finger pressure to control pain in body
o implementation of DOH impact programs parts
f. Kinesiology
Role of Society in RHCDS i. Study of movement which applies
principles of anatomy to movement
 participation in information drive of HCDS g. Reflexology
 identifying problems i. Systematic massage of soles of feet
 identify sources ii. Applies same principles as applied in
acupressure
h. Massage
Local Health Board
i. Relieves tension, enhances flexibility and
creates coordination between mind and
 propose annual budget body
 identify problems i. Homeopathy
 identify what programs i. Use of variety of herbs, drugs and
 Chairman, vice-chairman, chairman of committee on chemicals that when used in small
health, DOH representative, NGO representative quantities can cure or prevent disease
caused by same substance in larger doses
Two-way referral system

Referral- intervention to direct client to another healthcare facility to

continue his/her treatment

Population
Health Promotion, Health Maintenance, and Disease Prevention
BHS Midwife BHS
Health Promotion
BHW
 Defintion
Sanitary Inspectors RHU Midwife
o WHO- “Health promotion includes encouraging
PHN
healthy lifestyles, creating supportive
environments for health, strengthening
Physician
community action, reorienting health services
to place primary focus on promoting health
Secondary Health Care Facility and preventing disease, and building healthy
public policy.”
Tertiary Health Care Facility o Pender, 1996- “Health promotion is a behavior
motivated by the desire to increase well being
and actualize human health potential.”
 Health promotion includes any activity that helps people
Types of Health Care Systems to change or maintain lifestyles that support a state of
optimal health or balance of physical, emotional, social,
1.) Traditional spiritual and intellectual health.
a. E.g. client provider  Prominence of health promotion came about as a result of
2.) Non-Traditional changing patterns of health and corresponding emphasis
a. Holistic Health Centers on “lifestyle” as a factor.
i. Believes that time, space and  PHE (Public Health Education) can only have impact on
encouragement can help people find PH only if joined other sectors and brought multiples
strength to deal with problems social forces to bear.
confronting them  Green- “Behavioral changes that health education is able
ii. Spiritual, physical and psychological care to effect can only be maintained if supportive
iii. Acts:
1. Pastoral counseling
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environment were provided via: political, economic,  Setting priorities, making decisions,
social, biological and other sectors.” planning strategies and
 1st use of term, health promotion- 1945, Henry E. Sigerist implementing
o Defined 4 major tasks of medicine  Heart of this process is
 Promotion of health Empowerment of communities
 Prevention of illness  Community development helps to
 Restoration of the sick enhance self-help and social support,
 Rehabilitation to develop flexible system for
o Sigerist: “Health is promoted by providing a strengthening public participation in
good labor condition, education, physical and direction of health matters
culture and means of rest and recreation.” o Develop Personal Skills
 Concepts used and found in Ottawa  Through providing information,
Charter for Health Promotion which education for health and enhancing
occurred 40 years later life skills
 1986, WHO, Health and Welfare Canada and Canadian  Enabling people to learn throughout
Public Health Association organized an International life, to prepare themselves for all of
Conference on Health Promotion its stages and to cope with chronic
o later known as Ottawa Charter illnesses and injuries
o Guiding principle in health promotion efforts o Reorient Health Services
currently  Health services are shared among
individuals; community groups,
Ottawa Charter for Health Promotion health service institutions and
government
 “Process of enabling people to increase control over and
to improve their health”
 To reach a state of complete physical, mental and social
well-being , an individual or group must be able to
identify and to realized aspiration; to satisfy needs and to
change and cope with environment
 Health promotion is not just a responsibility of the health
sector, but goes beyond healthy lifestyles to well-being.
 Prerequesite for Health
o Peace
o Shelter
o Education
o Food
o Income
o A stable eco-system
o Sustainable resources
o Social Justice
o Equity
 In order to operationalize the concept of Health
Promotion, the Charter recommended the following
areas.
o Build Health Public Policy
 Coordinated action that leads to
health, income and social policies
that foster greater equity
o Create Supportive Environment
 Societies are complex and
interrelated
 Overall guiding principle is the need
to encourage reciprocal
maintenance to take care of each
other, our communities and our
natural environment
 Conservation of natural resources
throughout world should be
emphasized as a global
responsibility
 Changing patterns of life; work and
leisure leave a significant impact on
health
 Systematic assessment of health
impact of rapidly changing
environment, especially in areas of
technology, works, energy
production and urbanization
o Strengthen Community Action