UNIT I.

OVERVIEW OF THE PUBLIC HEALTH NURSING IN THE PHILIPPINES

I. Introduction

Community Health Nursing is one of the major fields of nursing in the Philippines; the
other is hospital nursing. We generally use the terms community health nursing and public health
nursing, and community health nurse and public health nurse interchangeably. Those who work
in rural health units (RHU) or health centers are community health nurses and are officially called
public health nurses (PHNs). Occupational health nurses (company nurses) and school health
nurses are classified as community health nurses.
Nursing practice in the community means different things to different nurses. Many, if not
most of us, emphasize the setting of practice; that is, community health nursing because they do
not want to go on afternoon and night shifts. Others simply prefer the pace of work in the
community. But what is the nature and essence of community health nursing? Presented in this
unit is the overview and the theories and principles of Community Health Nursing in the
Philippines.

II. Objectives/Competencies

At the end of the unit, I am able to:

1. define/discuss health and community;
2. discuss the focus of public health;
3. discuss the differences between community health nursing, public health nursing;
4. cite the distinguishing features of community health nursing/roles and functions; and
5. apply the competency standards of nursing practice in the Philippines in community
health nursing practice.

III. Pre-Test

Arrange the words to form a meaningful sentence. Write your answer on the space provided
below.

health defined Public health professional nursing organizational skills

organizational skills public technical nursing health may be practice health
analytical interpersonal problems which nursing community as a field of in
and in in and are applied to of as they affect the

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

IV. Lesson Proper

A. Global and Health Situation

Public health systems are operating within a context of ongoing changes, which exert
several pressures on the public health system.
These changes include
1. Shifts in demographic and epidemiological trends in diseases, including the
emergence and re-emergence of new diseases and in the prevalence of risk and
protective factors
2. New technologies for health care, communication and information

©2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
Page 1 of 7
including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the
institution. Unauthorized reproduction is punishable by law.
 3. Existing and emerging environmental hazards some associated with
globalization
4. Health reforms

Currently, there are various country initiatives to implement more cost-effective health
care services, the health sector reform agenda (HSRA) implemented through FOURmula ONE and
operationalized in the national objectives for health 2005 to 2010 spell out the program
imperatives of the health sector. All these are in line with the millennium development goal the
medium-term development plan of the country

B. Definition and Focus of Public Health and Community Health

Health
State of complete physical, mental, and social wellbeing, and not merely the absence of
disease or infirmity.

Social means-relating to living together in organized groups or similar close aggregates

Social health – connotes community vitality and is a result of positive interaction among
groups within the community with an emphasis on health promotion and illness prevention
'Wellbeing' refers to a positive rather than neutral state, framing health as a positive
aspiration

Factors affecting health

1. Income and social status
2. Education
3. Physical environment
4. Employment and working condition
5. Social support networks
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services
10. Gender

Indicators of health and illness

1. Mortality and morbidity data
2. Life expectancy
3. Infant mortality
4. Maternal mortality
5. Age-adjusted death rates
6. Disease incidence rates
Public Health

Public health (C.E. Winslow) as 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 of communicable infections
3. Education of the individual in personal hygiene
4. Organization of medical and nursing service for the early diagnosis and preventive treatment
of disease and
5. Development of the social machinery

Core public health functions

a. Assessment
b. Policy development
c. Assurance
Public health is dedicated to the common attainment of the highest level of physical
mental and social wellbeing and longevity (Hanlon)

©2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
Page 2 of 7
including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the
institution. Unauthorized reproduction is punishable by law.
 Community Health Nursing

In 1980, the American Nurses Association (ANA) defined Community Health Nursing as
“the synthesis of nursing practice and public health practice applied to promoting and
preserving the health of populations”. This viewpoint noted that a community health nurse
directs care to individuals, families, or groups; this care, in turn, contributes to the health of the
total population. Community health nursing is considered to be a broader and more general
specialty area that encompasses subspecialties that include public health nursing, school
nursing, occupational health nursing, and other developing fields of practice such as home health
and independent nurse practice.
Philosophy of community health nursing is based on the Worth and Dignity of Man
(Shetland)

Field of Community Health Nursing in the Philippines

a. School Nursing
b. Occupational Health Nursing
School Nursing
Type of Public Health Nursing that focuses on the promotion of health and wellness of the
pupil/students, teaching and non-teaching personnel of the school. Duties and responsibilities of
the school Nurse include the following:
1. Health advocacy
2. Health and nutrition assessment –vision and hearing
3. Supervision of the health and safety of the school plant
4. Treatment of common ailments
5. Referral and follow-up of pupils and personnel
6. Home visits
7. Community outreach like community assembly
8. Recording and reporting of accomplishment
9. Monitoring and evaluation of programs and projects

Functions of School Nurse

1. School Health and Nutrition Survey
2. Putting up a Functional School Clinic
3. Health Assessment
4. Standard Vision testing for School Children
5. Ear examination
6. Height and Weight Measurement and Nutritional status Determination
7. Medical referrals
8. Attendance to emergency cases
9. Student Health Counseling
10. Home Visitation

Occupational Health Nursing

In the Philippines, the health of the people in the workplace is another important focus for
community health nursing practice, it is in the work setting that many individuals spend a quarter
to almost a third of their working lives each working person faces certain conditions and develop
certain patterns on the job that affect their health.
The public health nurse can be an occupational health nurse who is in a prime position to
assess the health needs of the working population and design healthful working intervention. The
integration of public health theory and principles with the roles of occupational health nurses

Public Health Nursing

Public Health Nursing has frequently been described as the synthesis of public health
nursing practice. Freeman (1963) provided a classic definition of public health nursing:
Public health nursing may be defined as a field of professional practice in nursing
and in public health in which technical nursing, interpersonal, analytical, and
organizational skills are applied to problems of health as they affect the community.
These skills are applied in concert with those of other persons engaged in
health care, through comprehensive nursing care of families and other groups

©2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
Page 3 of 7
including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the
institution. Unauthorized reproduction is punishable by law.
 and through measures for evaluation or control of threats to health, for health
education of the public, and for mobilization of the public for health action.

Standards of Public Health Nursing in the Philippines

Community and public health nurses practice disease prevention and health promotion.
It is important to note that community health nursing practice is collaborative and is based on
research and theory. It applies the nursing process to the care of individuals, families, aggregates,
and communities. Table 1 presents the standards for Public Health Nursing as formulated by the
ANA (2007).

Table 1. Standards of Public Health Nursing Practice

Standards of Care
Standard 1. Assessment Collects comprehensive data
Standard 2. Population diagnosis and Analyzes assessment data
priorities
Standard 3. Outcomes Identification Identifies expected outcomes
Standard 4. Planning Develops a plan that reflects best practices
Standard 5. Implementation Implements identified plan
a. Coordination
b. Health education and
health promotion
c. Consultation
d. Regulatory activities
Standard 6. Evaluation Evaluates health status of the population
Standards of Professional Performance
Standard 7. Quality of practice Systematically enhances quality and
effectiveness
Standard 8. Education Attains knowledge and competency
Standard 9. Professional practice Evaluates own nursing practice
evaluation
Standard 10. Collegiality and professional Establishes collegial partnerships
relationships
Standard 11. Collaboration Collaborates with representatives of
population
Standard 12. Ethics Integrates ethical provision
Standard 13 Research Integrates research findings
Standard 14. Resource utilization Considers factors related to safety,
population effectiveness, cost and impact
Standard 15. Leadership
Public health nurse
1. Must be professionally qualified and licensed to practice in the area of public health
nursing.
2. Must possess personal qualities and “people skills” that would allow her practice to make
a difference in the lives of these people
3. Functions following the dominant values of public health nurses, within the ethico-legal
framework of the nursing profession, and under the needs of the clients and available
resources for health care

Functions of PHN are consistent with the Nursing Law 2002 and program policies
formulated by the DOH and local government health agencies and they are related to:
1. Management function
2. Supervisory function
3. Nursing care function
4. Collaborating and coordinating function
5. Health promotion and education function
6. Training and research

Evolution of Public health nursing in the Philippines

©2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
Page 4 of 7
including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the
institution. Unauthorized reproduction is punishable by law.
 Records of public health service in the Philippines date back to the Spanish regime, in 1577 –
Francisca Friar Juan Clemente opened a medical dispensary in Intramuros (the old walled
city of Manila) for the indigent

1901- The United States Philippine Commission, through Act 157, created the board of health
of the Philippine Island with a commissioner of Public Health as its chief executive officer.

The board of health eventually evolved into what is now the Department of Health,
subsequently provincial and municipal boards of health were formed.

1912- The Fajardo act created a sanitary division made up to one to four municipalities; each
sanitary division has a president who had to be a physician, sometimes a nurse.

1915- The Philippine general hospital began to extend public health nursing service in the
home of patients by organizing a unit called social and home care service, with two nurses as
staff.

1947-The department of health was reorganized into bureaus

1. Quarantine Hospitals took charge of the municipal and charity clinic and health with
sanitary divisions under it
2. The reorganization also placed the administration of city health departments at the
bureau level

1954- Congress passed RA 1082 or the rural health act that provided for the creation of a
rural health unit in every municipality.

Ra 1082 provided for the employment of Physicians as a municipal health officer, Public
health nurses, midwives, and sanitation inspectors in the rural health units.

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 in primary,
secondary, tertiary levels.

The Department of Health has directed efforts toward comprehensive reforms in

health care with the health sector reform agenda launched in 1999 its implementation
1. Framework FOURmula One for health
2. Universal health care in 2010

Universal health care- aims to achieve the health system goals of better health
outcomes, sustained health financing, and a responsive health system that will provide
equitable access to health care. It is an approach to health reform implementation
deliberately focused on economically disadvantages Filipinos to ensure that they are given
risk protection through enrollment in PHILHEALTH (Philippine health insurance
Corporation) and that they can access affordable and quality health services

Roles and function of the community health nurse (CHN)

1. Clinician- Focus on the health of the population
2. Advocate – speaks or act for those who cannot speak
3. Collaborator- work with people in the community
4. Consultant – catalyst to bring change, helping people understand process and action
5. Counselor – listen and provides feedback and information
6. Educator – provides SKA needed by the community member
7. Researcher -
8. Case Manager – coordinates care in the system that is made up of many different programs
which has different policies

©2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
Page 5 of 7
including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the
institution. Unauthorized reproduction is punishable by law.
 V. Reflection

***Refer to google form link***

VI. Post Test

***Refer to google form link***

VII. References

Zenaida U. Famorca, Mary A. Nieves, Melanie McEwen (2013).Nursing Care of the Community.
Elsevier Singapore

Araceli S. Maglaya (2004). Nursing Practice in the Community. 4thEdition. Argonauta

Corporation Philippines

Frances Prescilla l. Cuevas (2007). Public Health Nursing in the Philippines 10th edition.
National League of Philippine Government Nurses, Incorporated. Philippines

VIII. Additional Readings

Evolution of Public health nursing in the Philippines

1577 Francisca Friar Juan Clemente opened a medical dispensary in Intramuros (the old
walled city of Manila) for the indigent.
1690 Dominican Father Juan de Pergero worked toward installing a water system in San
Juan del Monte (now San Juan City, Metro Manila).
1805 Smallpox vaccination was introduced by Dr. Franciso de Balmis, the personal
physician of King Charles IV of Spain
1876 The first medicos titulares were appointed by the Spanish government; medicos
titulares worked as provincial health officers
1888 A 2-year course consisting of fundamental medical and dental subjects was first
offered in the University of Santo Tomas; graduates of this course known as
cirujanos ministrantes served as male nurses and sanitation inspectors
1901 The United States Philippine Commission, through Act 157, created the board of
health of the Philippine Island with a commissioner of Public Health as its chief
executive officer.

The board of health eventually evolved into what is now the Department of Health,
subsequently provincial and municipal boards of health were formed.
1912 Act #2156 or the Fajardo act created a sanitary division made up to one to four
municipalities; each sanitary division has a president who had to be a physician,
sometimes a nurse.
1915 The Philippine general hospital began to extend public health nursing service in
the home of patients by organizing a unit called social and home care service, with
two nurses as staff.

Puericulture Centers was organized by women’s clubs and other community

organizations which provided maternity and infant care. It is staffed by a nurse or
midwife, assisted by a part-time physician.

©2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
Page 6 of 7
including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the
institution. Unauthorized reproduction is punishable by law.
 La Gota de Leche founded by Asociacion Feminista Filipina in 1905 was the first
center dedicated to the service of mothers and babies.
1947 The department of health was reorganized into bureaus.
3. Quarantine Hospitals took charge of the municipal and charity clinic and
health with sanitary divisions under it
4. The reorganization also placed the administration of city health
departments at the bureau level.
1954 Congress passed RA 1082 or the rural health act that provided for the creation of
a rural health unit in every municipality.

RA 1082 provided for the employment of Physicians as a municipal health officer,

Public health nurses, midwives, and sanitation inspectors in the rural health units.
1957 For a more equitable distribution of health personnel, RA 1891, enacted in 1957,
amended certain provisions in the Rural Health Act. This law created eight
categories of rural health units corresponding to the population size of the
municipalities.
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
in primary, secondary, tertiary levels.

1991 RA 7160 or the Local Government Code was enacted; the law mandated 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.
2000 The Philippines is a signatory to the United Nations Millennium Declaration
adopted during the World Summit.

The member nations committed themselves to the attainment of the 8 Millennium

Development Goals (MDGs). On its part, the DOH has committed to the attainment
of the health MDGs to reduce child mortality, to improve maternal health, and to
combat HIV/AIDS, malaria and other diseases.

©2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
Page 7 of 7
including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the
institution. Unauthorized reproduction is punishable by law.