Republic of the Philippines - Community health nurses are generalists in
Mindanao State University-Marawi City
College of Health Sciences
In consortium with
Mindanao State University-Sulu
College of Arts and Sciences
Department of Nursing
NSG 101 COMMUNITY HEALTH NURSING
UNIT ONE
CONCEPT ON HEALTH PROMOTION/DISEASE
PREVENTION
A. Definition of Related Terms
1. Health: (as defined by the World Health Organization)
is a state of
complete physical, mental, and social well-being
and not
merely the absence of disease or infirmity.
2. Community Health Nursing
: Service rendered by a professional nurse with
the
community, groups, families, and individuals.
: Special field of nursing that combines the skills
of nursing, public health and some phases of
social assistance. (WHO Expert Committee on
Nursing).
: A learned practice discipline (Jacobson)
Dr. Ruth B. Freeman’s definition:
- Community Health Nursing is a service
rendered by a professional nurse with
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.
Philosophy
According to Dr. Margaret Shetland, the
philosophy of Community Health Nursing is
based on the worth and dignity of man.
Concepts
- The primary focus of community health nursing
practice is
on health promotion. (coined by Henry Sigerist)
- Community health nursing practice is extended
to benefit
not only the individual but the whole family and
community.
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terms of their practice through life’s continuum –
its full range of health problems and needs.
- Contact with the client and/or the family may
continue over a long period of time which
includes 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.
Goal
The ultimate goal of community health services is
to raise
the level of citizenry.
The primary goal of CHN is enhancement of self
The new goal of CHN is optimum level of
functioning (OLOF)
Objectives
1. To participate in the development of an over-all health
plan for the community and in its implementation and
evaluation.
2. To provide quality nursing services to individuals,
families, and communities
3. To coordinate nursing services with various members
of the health team, community leaders and significant
others.
4. To participate in and/or conduct researches relevant to
community health and community health nursing services
and disseminate their results for improvement of health
care.
5. To provide community health nursing personnel with
opportunities for continuing education.
Principles
The following principles of CHN were adapted
from those formulated by Mary S. Gardner and by Leahy,
Cobb, and Jones:
1. Community Health Nursing is based on recognized
needs of communities, families, groups, and individuals.
2. The community health nurse must understand fully the
objectives and policies of the agency he/she represents.
3. In Community Health Nursing, the family is the unit of
service and the unit of care. Community is the locus
(place) and focus of service and care.
-CHN must be available to all regardless of race, creed,
gender
-Health is the primary responsibility of a CHNurse
Nursing Care Plan:
-blue print in defining the patient’s health care

4. Community Health Nursing must be available to all Family Care Plan

regardless of race, creed, and socio-economic status. -blue print in defining the family’s health
problem/care
5. Health teaching is a primary responsibility of the
community health nurse. National health plan
-blue print in defining the country’s health
6. The community health nurse works as a member of the problem
health team. Ottawa Charter
7. There must be provision for periodic evaluation of “Process of enabling the person to increase control over
Community Health Nursing services. and improve heatlh.”

8. Opportunities for continuing staff education programs Concept: Health for all
for nurses must be provided by the Community Health
Nursing agency. The community health nurse also has a Bangkok Charter
responsibility for his/her own professional growth. “Process of enabling the person to increase control over
and improve health and its determinants.”
9. The community health nurse makes use of available
community health resources. Concept: All for health

10. The community health nurse utilizes the already Community Health Nursing Process
existing active organized groups in the community. Goal of Care: Individual, Family, Community

11. There must be provision for educative supervision in 1. Assessment

Community Health Nursing.
• Initiate contact
12. There should be accurate recording and reporting in • Demonstrate caring attitude
Community Health Nursing. • Mutual Trust and Confidence
• Collect Data from all possible sources
CHN IN-DEPTH • Identify health problems
• Assess coping ability
CHN: is anchored with theories • Analyze and interpret data

emphasis: on the importance of the “greatest good for the 2. Planning Nursing Action
greatest
number” • Prioritize needs
• Establish goal
priority: health promotive and disease preventive • Construct action and operation plan
strategies over curative interventions (Maglaya) • Develop evaluation parameters
• Revise plan as needed
Philosophy: worth and dignity of man (Margaret Shetland)
3. Implementation of Planned Care
goal: to raise the level of health of the citizenry (through
health • Put nursing plan to action
promotion) • Coordinate care/services
• Utilizes community resources
main activity: health teaching • Delegate
• Supervise/Monitor health services provided
focus: health promotion • Provide health education and training
• Document responses to nursing action
Principles: “BUCH”
4. Evaluation of care/ services rendered
-Based on recognized NEEDS of the clientele
-Unit of service is the family • Nursing audit
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• Care outcomes
• Performance appraisal Hanlon
• Estimate cost benefit ratio : “public health is dedicated to the common
• Assessment problems attainment of the highest level of physical,
• Identify needed alterations mental, and social well-being and longevity.”
- Revise plans as necessary
Historical Background

Several factors in the eco-system which affect the : Pre-Spanish Era – no records
level of functioning: : Spanish Regime (1591-1898)

1. Political - Bro. Juan Climente (1577) started Public Health

2. Behavioral – a person’s level of functioning is affected Services
by certain through a dispensary in Intramuros.
habits that he/she has. - Water sanitation was started.
3. Hereditary- genetically influenced disease - Small pox vaccine was introduced.
4. Health Care Delivery System - Positions such as district, provincial, national health
5. Environmental influences officer were created.
6. Socio-economic influence – Families from the lower
income : American Regime (1898-1942)
groups are the ones mostly served in public
health services and by the community health - 1898- Board of Health for Physicians was created
nurses. - 1906- The Board of Health was abolished and Bureau of
Health was created.
Levels of Clientele in Community Health Nursing
Practice - 1912- PHN was started in Cebu with four graduate
nurses who dealt primarily in MCH services.
1. Community
: A social group (best definition of community by - 1915- PHN began in Manila with two nurses who offered
WHO) follow-up care of OB patients and environmental
sanitation services.
2. Population Group
: Aggregate of people who share common - 1919- The first Filipino nurse supervisor under the
characteristics Bureau
(Clark 1995) of Health, Miss Carmen del Rosario was appointed.

3. Family - 1923- Establishment of two government Schools of

: Two or more individuals joined or related Nursing: Zamboanga General Hospital School of Nursing
together by ties of blood, marriage or adoption. in Mindanao and Baguio General Hospital in Northern
Luzon.
4. Individual
: A person - 1928- First convention of Nurses followed by yearly
conventions until the advent of World War II.
UNIT TWO
: Japanese Regime (1942-1945)
PUBLIC HEALTH NURSING AND COMMUNITY
HEALTH NURSING - PHN services were interrupted.

A. CONCEPT OF PUBLIC HEALTH : Era of the Republic of the Philippines (1946 to

1. Definition of Public Health
: Winslow, “science and art of preventing
disease,
prolonging life, promoting health and efficiency
through organized community effort.”
: birthright of health and longevity.
2. Philosophy of Public Health
: Emphasizes the worth and dignity of man.
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present)
- 1947- DOH was divided into 3 Bureaus: Hospital,
Quarantine, and Health
- 1958 – 1965- Miss Annie Sand was appointed Nursing
Consultant under the Office of the Secretary of Health.
- The Department of Health National League of Nurses,
Inc. was founded by Miss Annie Sand in 1961. She
became its first President and Adviser.
- 1975- Formulation of the National Health Plan and the
restructured Health Care Delivery System
- 1992- Devolution led to the transfer of authority to the
LGUs by virtue of the local government code.
3. Principles of Public Health
a. Education concerning prevailing health problems
b. Promotion of food supply and proper sanitation
c. Adequate supply of safe water and basic sanitation
d. Maternal and child health care; including family
planning
e. Immunization against major infectious diseases
f. Prevention and control of locally endemic diseases
g. Appropriate treatment of common diseases and
injuries
h. Provision of essential drugs
4. Roles and Functions of Public Health Nurse
a. Planner/programmer
: Identifies needs, priorities
: Formulates Municipal Health Plan
: Interprets and implements nursing care plan,
program
policies
: Provides technical assistance to rural health
midwives
b. Provider of Nursing Care
: Provides direct nursing care
: Develops the family’s ability to take care of the
sick.
c. Manager/supervisor
: Formulates individual, community-centered
plan.
: Interprets and implements programs, policies
: Organizes work force, resources
d. Community Organizer
: Motivates and enhances community
participation
: Initiates and participates in community
development
activities.
e. Coordinator of Services
: Coordinates with individuals, families for health-
related
services
: Coordinates nursing program with other health
programs like environmental sanitation
f. Trainer/Health Educator
: Identifies and interprets training needs
: Conducts trainings
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g. Health Monitor
: Detects deviation from health
practices/behaviour of
individuals
h. Role Model
: Provides good example
i. Change Agent
: Motivates changes in health behaviour
j. Recorder/reporter/statistician
: Prepares/submits reports
: Prepares statistical data/chart
k. Researcher
: Participates in the conduct of survey studies
B. CONCEPT OF COMMUNITY HEALTH NURSING
1. Definition and Philosophy –
Community Health Nursing (CHN)
: Refers to “the utilization of the nursing process in the
different level of clientele concerned with the promotion of
health, prevention of disease and disability, and
rehabilitation. (Maglaya, 2006)
: Aims to achieve the highest possible level of community
health.
: The ultimate goal of CHN is to improve/raise the level of
health among Filipinos.
3. Nursing Theories related to CHN
: Nightingale’s Theory of Environment
- Involves the nurse’s initiative to configure environmental
settings appropriate for the gradual restoration of the
patient’s health.
: Orem’s Self-Care Model
- States that an individual is self-caring if he/she can
manage effectively the maintenance of normal growth
and development.
: Neumann’s Health Care System Model
- Provides a comprehensive, flexible, holistic, and
system-based perspective for nursing.
: Roger’s Model of the Science and Unitary Man
- States that the purpose of the nurses is to promote
health and well-being for all persons and groups
wherever they are.
: Pender’s Health Promotion Model (HPM) 6. Specialized Fields in Community and Public Health
Nursing
- Persons have the capacity for self-awareness, including
assessment of their own competencies. : School Health Nursing

: Roy’s Adaptation Model - Aims to maximize potential for learning by promoting

health of school-age children and adolescents.
- States that nursing is the science and practice that
expands adaptive abilities and enhances person and Roles of School Health Nurse:
environment transformation.
- Educator
4. Concepts and Principles of Community Health - Consultant/Researcher
Nursing - Student, family, and staff advocate/change agent
- Health screener
: Equitable distribution of health - Healthcare provider
: Active community participation and involvement in the
planning, implementation, and evaluation of health School Health Triad
services.
- Service
: The use of appropriate technology in the delivery of - Education
health care services. - Environment

: Focus on health promotion and disease prevention : Occupational Health Nursing

: A multi-sectoral approach to community health - Refers to the application of nursing principles and
development procedures
- Aims to assist, maintain, and promote positive health of
5. Standards in Community Health Nursing laborers and employees

: Theory – applies theoretical concepts as basis for : Community Mental Health Nursing
decisions in practice.
- Promotion of mental health
: Data collection - gathers comprehensive, accurate
data UNIT THREE
systematically.
PUBLIC HEALTHCARE DELIVERY SYSTEM
: Diagnosis – analyses collected data to determine the
needs/health problems A. THE DEPARTMENT OF HEALTH

: Planning – develops plans that specify nursing actions - The principal health agency in the Philippines.

: Intervention – guided by the plan, intervenes to
promote,
maintain or restore health, prevent illness and institute
rehabilitation
: Evaluation – evaluates responses of clients to
interventions
: Quality assurance and professional development –
participates in peer review and other means of evaluation
to assure quality of nursing practice.
Roles and functions of DOH: (EO 102)
1. Leadership in health: regulate, formulate, advocate
2. Enabler and capacity builder: Innovate, monitor &
evaluate, ensure standards
3. Administrator of specific services: Administer, manage
Primary function of DOH: Program planner
Goal of DOH: HSRA (Health Sector Reform Agenda) by
GMA year 2006

: Interdisciplinary collaboration – collaborates with
other members of the health team
: Research – indulges in research to contribute to theory
and practice in community health nursing
Overriding goal of DOH: AHA (Aquino Health Agenda)
Framework for Implementation of Goal: FOURmula One
for health
Objectives of FOURmula ONE:

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a. Better health outcomes
b. Equitable health care financing
c. More responsive health systems
Elements of FOURmula one: (3H + 1G)
1. Health financing – money, investments, insurance
Example:
PhilHealth – National Health Insurance Program (NHIP)
- Key feature of FOURmula one
- RA 7875 (National Health Insurance Act of
1995)
2. Health Regulation – Quality, affordability
- Quality Assurance Program: by means of SSM
or Sentrong Sigla Movement
3. Health Service Delivery – Accessibility, availability
- Distance of BHC to main RHU: within 3-5 kms
- 1 BHC: 5000 population
- Ideal traveling time from home to BHC: within
30 mins
4. Good Governance – Transparency, enhancement of
performance/health sectors
RA 7160 – “Devolution Act” (local gov’t code)
- Promotes decentralization: transfer of
responsibility from Nat’l gov’t to LGU.
Goal of RA 7160 – to empower LGU, to empower system
of LGU, making LGU a self-reliant.
Vision by 2030
A Global Leader for attaining better health outcomes,
competitive and responsive health care systems, and
equitable health financing.
Mission
To guarantee equitable, sustainable and quality health for
all Filipinos, especially the poor, and to lead the quest for
excellence in health.
National Objectives:
1. Improve the general health status of the population
(reduce infant mortality rate, reduce child mortality rate,
reduce maternal mortality rate, reduce total fertility rate,
increase life expectancy and the quality of life years).
2. Reduce morbidity, mortality, disability, and
complications from Diarrheas, Pneumonia, TB, Dengue,
Intestinal Parasitism, STDs, Hepatitis B, Accident and
Injuries, Dental Caries, Cardiovascular Diseases, Cancer,
Diabetes, Asthma and Chronic Obstructive Pulmonary
Diseases, Nephritis and Chronic Kidney Diseases, Mental
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Disorders, Protein Energy Malnutrition, Iron Deficiency
Anemia, and Obesity.
3. Eliminate the following diseases as public health
problems: schistosomiasis, malaria, filariasis, leprosy,
rabies, measles, tetanus, diphtheria and pertussis,
vitamin A deficiency and iodine deficiency disorders.
4. Eradicate poliomyelitis.
5. Promote healthy lifestyle through healthy diet and
nutrition, physical activity and fitness, personal hygiene,
mental health and less stressful life and prevent violent
and risk-taking behaviors.
6. Promote the health and nutrition of families and special
populations through child, adolescent and youth, adult
health, women’s health, health of older persons, health of
indigenous people, health of migrant workers and health
of different abled persons and health of the rural and
urban poor.
7. Promote environmental health and sustainable
development through the promotion and maintenance of
healthy homes, school, workplaces, establishments, and
communities towns and cities.
Four Millennium Implementation Components
1. Health Financing
2. Health Regulation
3. Health Service Delivery
4. Good Governance in Health
Millennium Development Goals
- World’s time-bound and quantified targets for
addressing
extreme poverty.
Goal 1: Eradicate extreme hunger and poverty
Goal 2: Achieve universal primary education
Goal 3: Promote Gender Equality and Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve maternal Health
Goal 6: Combat HIV/AIDS Malaria, and other Diseases
Goal 7: Ensure Environmental Sustainability
Goal 8: Develop a Global Partnership for Development
Levels of Healthcare Facilities
: Tertiary Level
1. National Health Services
2. Medical Regional Health Centers Services
3. Medical Regional Centers and Training Hospitals
: Secondary Level
1. Emergency/District Hospitals
2. Provincial/City health Services
3. Provincial/City Hospitals

: Primary Level

1. RHU
2. Community Hospitals and Health Centers
3. Private Practitioners/Puericulture Centers

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