Introduction To CHN

Introduction to
Community
Health
Nursing
Introduction to Community Health Nursing
Lesson 1.1: Overview of Public Health Nursing in the Philippines

Lesson 1.2: Definition and Focus
Lesson 1.3: Standards of Public Health Nursing in the Philippines
Lesson 1.4: Evolution of Public Health Nursing
Lesson 1.5: Roles and Responsibilities of Community Health Nurse
Objectives/Competencies
Learners are expected to:
1. Explain the current global and country health imperatives that dictate public health
priorities and actions
2. Describe the Nature of Public Health Nursing in the context of the Philippine Health
care delivery system
3. Understand the common terminologies in Community Health Nursing
4. Apply competency standards of Nursing Practice in the Philippines in Community Health
Nursing practice.
5. Discuss how Public Health Nursing came about in the Philippines and its concepts.
6. Identify roles and responsibilities of a Community Health Nurse
Overview of Public Health Nursing in the Philippines
The Department of Health and the Public Health System have evolved into what is
now in response to the challenges of the times, so has Public Health Nursing
practice been influenced by the changing global and local health trends. These
global and country health imperatives brought Public Health Nursing into new
frontiers and have positioned nurses to emerge as leaders in health promotion
and advocacy.
This perception has been validated by a World Health Organization (WHO) report
acknowledging the significant contribution of the nursing workforce to the
achievement of health outcomes, particularly that of the Millennium Development
Goals (MDG).
Changes in the Public Health System:
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
3. Existing and emerging environmental hazards some associated
with globalization
4. Health reforms
In response to above trends, the global community, represented by the United Nations General
Assembly, decided to adopt a common vision of poverty reduction and sustainable development in
September 2000. This vision is exemplified by the Millennium Development Goals (MDG’s) which are
based on the fundamental values of freedom, equality, solidarity tolerance, health, and respect for
nature and shared responsibility.
The Eight Millennium Development Goal are as follows:
1. Eradicate extreme poverty and hunger

2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDs, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
At the country level, The Philippines has experienced considerable improvements
in its health status for the past 50 years, yet it has also in recent years experienced
decline as shown in its poor performance in reducing infant and maternal
mortality rates. The Philippines is also experiencing an epidemiologic shift, which
means that while it is contending with the burden of communicable diseases,
chronic lifestyle diseases. Currently the country is being threatened with the
devastating effect of a “triple whammy’ which will be brought about not only by
this epidemiologic shift but also by the emergence of plaque like infectious
diseases such as Severe Acute Respiratory Syndrome (SARS) and avian Flu. With
these scenarios, the need to strengthen the capability of the public health
infrastructure including the public health nurse to adequately respond is
imperative.
Currently there are various country initiatives to implement a more
cost-effective health care service. The Health Sector Reform Agenda
(HSRA) implemented through FOURmula ONE for Health and
Operationalized in the National Objectives for Health 2005 to 2010 spells
out the program imperatives of the Health Sector. All these are in line with
the Millennium Development Goals and the Medium Development Plan of
the country.
Community
❏ “a collection of people who interact with one and whose common interests or characteristics
form the basis for a sense of unity or belonging” ‘(Allender et al,2009, p.6)
❏ “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 a geographic boundary “(Lundy
andJanes,2009, p.16)
❏ “a group of people who share common interests who and who function collectively within a
define social structure to address common concerns “(Clark,2008, p.27)
❏ “a locality base entity, composed of systems of formal organizations reflecting society’s
institution, informal groups and aggregates “(Shuster and Goeppinger, 2008p.344)
Health
❏ A state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity (WHO,1958, p1)
Nursing
❏ Assisting sick individuals to become healthy and healthy
individuals achieve optimum wellness.
Community Health
● Part of paramedical and medical intervention/ approach which is
concerned on the health of the whole population.
● Aims of Community Health
○ Health promotion
○ Disease prevention
○ Management of factors affecting health
Community Health Nursing
❏ The utilization of the Nursing Process in the different level of Clientele- Individual,
Families, Population Groups and Communities, concerned with the Promotion of Health,
Prevention of Disease and Disability and Rehabilitation (Dr. Araceli Maglaya,et al).
❏ Services rendered by a professional nurse with communities, groups, families,
individuals at home, in health centers, in clinics, in schools, in places of work for the
promotion of health, prevention of illness, care of the sick at home and rehabilitation.
(Ruth B. Freeman).
❏ Nursing practice in a wide variety of community services and consumer advocate areas
and in a variety of roles at times including independent practice…. community nursing is
certainly not confined to public health nursing agencies (Jacobson 1975).
Public Health Nursing

❏ Refers to the practice of nursing in national and local government
health departments (which includes health centers and rural
health units) and public schools. It is Community Health Nursing
Practiced in the Public Sector (Standards of Public Health
nursing in the Phils,2005)
❏ Is a science and art of 3P’s: Prevention of disease; Prolonging life;
Promotion of health and efficiency through organized community
effort
PHILOSOPHY OF CHN
“The philosophy of CHN is based on the worth and dignity on the

worth and dignity of men.”
- (Dr. M. Shetland as cited by Castro, 2012)
This philosophy is based on the belief that care focused first to the
individual, the family, and the group contributes to the health care of
the people in the community.
GOAL OF THE COMMUNITY HEALTH NURSING
To assist the individual, family and community in attaining their

highest level of holistic health which is attained through multi-sectoral
efforts and to promote equally supportive relationship between
people and their physical and social environment.
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
● CHN practice is affected by developments in health technology, in
particular, changes in society, in general
● CHN is a part of health care system and the larger human services
system.
MISSION OF CHN
❏ Health Promotion
❏ Health Protection
❏ Health Balance
❏ Disease prevention
❏ Justice
Lesson 1.3: Standards of Public Nursing Practice
Profession (Robles and Dionesio 2001)
❏ In the past, only applicable to law, medicine and theology/divinity

(learned profession)
❏ Implies professed attainments in special knowledge higher
education and skills and governs by its own code of ethics
❏ Essential for employment or vocation(employment)
Professional Nursing
❏ To put the patient in the best condition for nature to act upon him”
Florence Nightingale
❏ Approach: Humanistic and Holistic care
❏ The performance for a fee, salary or other reward or compensation of
professional nursing services to individuals, families and community and
various stages development toward the promotion of health, prevention
of illness, restoration of health and alleviation of suffering. (Philippine
Nursing Act)
General Classification of Nurses:
1. Institutional Nurse – employed in hospital or institution

2. Public Health Nurses- employed in a community (together with school nurse,
occupational/industrial nurse, maternal and child health nurse and tuberculosis
nurse)
3. Nurse Educators- employed in teaching and administrative staff of a
school/nursing/ educational institution for nurses.
The classification of nurses varies whether they are in government /private sector.
The budget on Commission created R.A no.1241 - all nursing position in the government
service have been placed on group called” Nursing Group”
Categories of Nurse in Public Health

1. Public Health Nursing Supervisor
2. Regional Nursing Supervisor
3. Regional Public Health Nurse
4. Supervising Public Health Nurse II
5. Supervising Public Health Nurse I
6. Senior Public Health Nurse
7. Public Health Nurse
Standards of Public Health Nursing in the Philippines
Scope and Standards of Public Health Nursing Practice American Nurses

Association 200
➔ Standard 1. Assessment - The public health nurse collects

comprehensive data pertinent to the health status of population.
➔ Standard 2. Population Diagnosis and Priorities - The health nurse
analyses the assessment data to determine the population diagnoses and
priorities.
➔ Standard 3. Outcomes Identification - The public health nurse identifies
expected outcomes for a plan that is based on population diagnoses and
priorities.
➔ Standard 4. Planning - The public health nurse develops a plan that

reflects best practices by identifying strategies, action plans and
alternatives to attain expected outcomes.
➔ Standard 5. Implementation - The public health nurse implements the
identified plan by partnering with others.
➔ Standard 5 A. Coordination - The public health nurse coordinates
programs, services, and other activities to implement the identified plan.
➔ Standard 5B. Health Education and Health Promotion - The public

health nurse employs multiple strategies to promote health, prevent
disease, and ensure a safe environment for populations.
➔ Standard 5C Consultation - The public health nurse provides
consultation to various community groups and officials to facilitate the
implementation of [programs and services
➔ Standard 5D. Regulatory Activities - The public health nurse identifies,
interprets, and implements public health laws, regulations, and policies.
➔ Standard 6 Evaluation - The public health nurse evaluates the health
status of the population.
Evolution of Public Health Nursing in the Philippines
History of Public health in the Philippines based on Socio-Political periods
I. Pre-American Occupation till 1898
A. Pre-American Occupation › 1577- Public health began at the old Franciscan Convent
in Intramuros where Fr. Juan Clemente put up dispensary for treating indigents in
Manila. – San Juan de Dios Hospital.
B. During Spanish Time

1. Creation of Vaccinators to prevent smallpox
2. Creation of Board of Health
3. First medical school in the Philippines- UST
4. School of Midwifery
5. Public Health Laboratory
6. Forensic Medicine
C. Hospital before the Americans came to Philippines
❏ General Hospitals
● San Juan de Dios Hospital
● Chinese General Hospital
● Hospicio de San Jose in Cavite
● Casa dela Caridad in Cebu
● Enfermeria de Sta. Cruz in Laguna
❏ Contagious Hospitals
● San Lazaro Hospital
● Hospital de Palestina in Camarines Sur
● Hospital delos Lesporosos in Cebu
● Hospital de Argencina in Manila for smallpox and cholera
II. American Military Government
a. Control of epidemics such as cholera, smallpox and plague
b. Fight against communicable diseases such as common cold, Hepa A-D, chickenpox,
SARS, flu, mumps, malaria, herpes, STD, measles
c. Projects and activities:
1. Garbage crematory
2. First sanitary ordinance and rat control
3. Cholera vaccine was first tried
4. Confirmed that plague in man comes from infected rat
5. Opened the UP College of Medicine
6. Establishes Bureau of Science
III. Philippine Assembly
A. Hygiene and Physiology were included in curriculum of public
elementary school
B. Anti-TB campaign was started
C. Philippine Tuberculosis Society was organized
D. Opening of PGH (Phil. Gen. Hospital)
E. Use of anti-typhoid vaccine was initiated
F. Dry vaccine against small pox was first use
IV. Jones Law Years
A. Retrogression rather than progression in so far as the health
was concern
1. Increase Clinical data registry (CDR)
2. Increase Infant Mortality Rate (IMR)
3. Increase Morbidity
B. Increase deaths from smallpox, cholera, typhoid, malaria and
TB
C. Re-organized happened (reorganized the health service and encouraged effective
supervision)
1. Study the cause and prevalence of typhoid fever
2. Schick test was used to determine the causes of diphtheria
3. Campaign against Hookworm was launched
4. Anti-dysentery vaccine was first tried
5. First training course for sanitary inspector was given. Women and child labor law
was passed.
6. Re-organized happened (reorganized the health service and encouraged effective
supervision)
7. Study the cause and prevalence of typhoid fever
8. Schick test was used to determine the causes of diphtheria
9. Campaign against Hookworm was launched
10. Anti-dysentery vaccine was first tried
V. Commonwealth Period
A. The epidemiology of life threatening disease was studied- diphtheria, yaws,
dengue
B. Research in the field of health was promoted
C. UP School of Public Health was established
D. Development of Maternal and Child Health (MCH)
E. 1939 – Creation of Dept. of Public Health and Welfare - Dr. Jose Fabella as
the First secretary
F. 1940- Bureau of Census and Statistics was created to gather vital statistics
G. In spite of development
1. Inequitable distribution of health services remained a problem
2. 80% of those who died were never given medical attention
VI. Japanese Occupation/World War II
A. During this time, all public health activities were practically
paralyzed.
B. Increase incidence of TB, venereal diseases, malaria, leprosy
and malnutrition.
VII. Post World War II
A. Philippine Independence
B. Completion of a research on Dichlorodiphenyltricholorothanel (DDT-as
larvicidal/insecticide to control malaria
C. Introduction of one-infection method for gonorrhea with penicillin
D. Manila was selected as Headquarters for World Health Organization
(WHO) Western Pacific Office
E. Strengthening Health and Dental services in rural areas (per
municipalities with 5,000-10,000 population) 1 Municipal Health
Officer; 1 Public Health Nurse; 1 Midwife; 1 Sanitary Inspector
VIII. Martial Law Years
A. Creation of National Economic Development Authority
B. Department of Health was renamed as Ministry of Health (MOH)
C. Accomplishments during this period:
1. Formulation of National Health Plan › Construction of Tertiary Hospital o
Philippine Heart Center o Lung Center o Kidney Center o Lungsod ng Kabataan
/ Phil. Childrens Medical Center › Adaptation of the Primary Health Care o Phil
was the first country to implement PHC › Launching of Operation Timbang and
Mothercraft o Nationwide program providing supplementary food for infants,
pre-school and school children. NUTRIBUN- bread with vitamins
2. Progress in Public Health research RITM- Research Institute for Topical
Medicine PCHRD- Philippine Council for Health Research and Development
IX. EDSA Revolution
❏ From Ministry of Health, it was renamed again as Dept. of
Health
❏ Increase in life expectancy slowed down
❏ Increased incidence of malnutrition
❏ Declined practice of family planning
X. Aquino Administration
❏ 1987 Constitution- more provisions on health making comprehensive
health care available
❏ Major activities:
1. Milk code- required the marketing of breast feed milk substitute
2. Universal child and mother immunization
3. RA. 6725- Act prohibiting discrimination against women
4. NESS- National Epidemic Surveillance System
5. RA. 6675- National Drug Policy and Generics Act
6. RA. 7170- Organ Donation Act
XI. Ramos Administration
“Health in the Hands of People” and “Let‟s DOH it” –by Sen Juan Flavier
Memorable initiative during leadership of Flavier
National Immunization Day
BCG (Bacille Calmette-Guérin (BCG) is a live strain of Mycobacterium bovis
developed by Calmette and Guérin for use as an attenuated vaccine to prevent
tuberculosis and other mycobacterial infections.)
DPT (diphtheria, pertussis(whooping cough) and tetanus)
OPV –Oral Polio Vaccine
MMR- Immunization shot against measles, mumps, and rubella (also called
German measles)
(Memorable initiative during leadership of Flavier)
(Memorable initiative during leadership of Flavier)
1. Promotion of Traditional Medicine- Herbal Medicine
2. Yosi Kadiri
3. Araw ng Sangkap Pinoy - aimed to prevent Vitamin A, Iron and
Iodine deficiency
4. Voluntary Blood Donation Program
5. Kung Sila‟y Mahal Mo Magplano- Family Planning Program
6. Doctors to the Barrio
❏ Laws:
1. EO 39 - which created the Philippines National AIDS Council as a
national policy and advisory body in the prevention and control
of HIV-AIDS
2. RA 7719 - the National Blood Services Act of 1994, this to
promote voluntary blood donation
3. RA 8172 - Salt Iodization Nationwide (ASIN), providing salt
iodization nationwide approved in 1996 and renamed FIDEL
(Fortified for Iodine Elimination)
Evolution of Public Health Nursing
COMMUNITY HEALTH NURSING IN THE PHILIPPINES

❏ 1901 – Act No. 157 of the Philippines Commission created
the Board of Health of the Philippine Board of Health for
Manila while Act 309 created the provincial and municipal
Boards of Health.
❏ 1905 – Act No. 1407 (Reorganization Act) abolished the
Board of Health and was replaced by the Bureau of Health
under the Department of Interior.
❏ 1912 – The Philippine General Hospital, under the Bureau of Health, sent 4 nurses to
Cebu to take care of mothers and babies while the St. Paul’s Hospital School of Nursing
in Intramuros assigned 2 nurses to perform home visiting in Manila and gave nursing
care to outpatient mothers and newborn at PGH.
❏ 1915 – The Reorganization Act 2462 created the Office of District Nursing headed by a
lady physician who was also a nurse, Dr. Rosario Pastor. This office was created due to
the increasing demands of nurses to work outside the hospital, in the homes, and the
need for direction, supervision and guidance of public health nurses.
❏ 1919 – The first Filipino nurse supervisor under the Bureau of Health, Ms. Carmen del
Rosario, was appointed with a staff of 84 PHNs, assigned in 5 health stations.
❏ 1990-1992 – The Local Government Code of 1991 (RA 7160) was passed
and implemented which resulted to “devolution” or the transferring of
power and authority from the national to the local government units. It
was aimed to build the capacities for self government units (LGUs) as fully
self-reliant communities.
❏ Jan. 1999 – Department Order No. 29 designated Mrs. Nelia F. Hizon,
Nurse V1, as Nursing Adviser. She was detailed at the Office of Public
Health Services with Undersecretary Milagros Fernandez as Chief
Assistant Nursing Adviser, matters affecting nurses and nursing are
referred to her.
❏ May 24, 1999 – EO No. 102 was signed by then President Joseph E.
Estrada redirecting the functions and operations of the Department of
Health. Based on this EO most of the nursing positions at the Central
Office were either transferred or devolved to other offices and services.
❏ 1999-2004 – The Health Sector Reform Agenda (HSRA) was developed to
describe major strategies, organizational and policy changes, and public
investments to improve how health care delivery is delivered, regulated
and financed.
❏ 2005 – A plan to rationalize or streamline the bureaucracy which includes
the Department of Health was developed.
Lesson 1.5 Roles of Community Health Nurse
1. CLINICIAN or HEALTH CARE PROVIDER
Utilizes the nursing process in the care of the client in the home setting
through home visits and in public health care facilities, conducts referral of
patients to appropriate levels of care when necessary.
2. HEALTH EDUCATOR
Utilizes teaching skills to improve the health knowledge, skills and attitude
of the individual, family and the community and conducts health
information campaigns to various groups for the purpose of health
promotion and disease prevention
Roles of Community Health Nurse
3. COORDINATOR and COLLABORATOR

Establishes linkages and collaborative relationships with other health
professionals, government agencies, the private sector, non-government
organizations and people’s organizations to address health problems.
4. SUPERVISOR
Monitors and supervises the performance of midwives and other auxiliary
health workers, also initiates the formulation of staff development and
training programs for midwives and other auxiliary health workers as part
of their training function as supervisors
Roles of Community Health Nurse
5. LEADER and CHANGE AGENT

Influences people to participate in the overall process of community
development.
6. MANAGER
Organizes the nursing service component of the local health agency or
local government unit.
7. RESEARCHER
Participates in the conduct of research and utilizes research findings in
practice.
RESPONSIBILITIES OF THE CHN
❏ Be part in developing an overall health plan, its implementation
and evaluation for communities.
❏ Provide quality nursing services to the four levels of clientele
❏ Maintain coordination/linkages with other health team members,
NGO/government agencies in the provision of public health
services.
❏ Conduct researches relevant to CHN services to improve provision
of health care.
❏ Provide opportunities for professional growth and continuing
education for staff development
OTHER SPECIFIC RESPONSIBILITIES OF A CHN
❏ Supervision and care of women during pregnancy, labor and puerperium.

❏ Performance of internal examination and delivery of babies.
❏ Suturing lacerations in the absence of a Physician
❏ Provision of first aid measures and emergency care.
❏ Recommending herbal and symptomatic medications, etc.
OTHER SPECIFIC RESPONSIBILITIES OF A CHN
IN THE CARE OF THE FAMILIES

❏ Provision of primary health care services
❏ Development or Utilization of family nursing care plan in the provision of
care
IN THE CARE OF THE COMMUNITIES

❏ Community organizing, mobilization, community development and
people empowerment.
❏ Case finding and epidemiological investigation
❏ Program planning, implementation and evaluation.
❏ Influencing executive and legislative individuals or bodies concerning
health and development.

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Introduction To CHN

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Introduction to

Lesson 1.1: Overview of Public Health Nursing in the Philippines

Learners are expected to:

The Eight Millennium Development Goal are as follows:

1. Eradicate extreme poverty and hunger

Community Health Nursing

Public Health Nursing

“The philosophy of CHN is based on the worth and dignity on the

To assist the individual, family and community in attaining their

Profession (Robles and Dionesio 2001)

❏ In the past, only applicable to law, medicine and theology/divinity

General Classiﬁcation of Nurses:

1. Institutional Nurse – employed in hospital or institution

Categories of Nurse in Public Health

Scope and Standards of Public Health Nursing Practice American Nurses

➔ Standard 1. Assessment - The public health nurse collects

➔ Standard 4. Planning - The public health nurse develops a plan that

➔ Standard 5B. Health Education and Health Promotion - The public

History of Public health in the Philippines based on Socio-Political periods

I. Pre-American Occupation till 1898

B. During Spanish Time

COMMUNITY HEALTH NURSING IN THE PHILIPPINES

3. COORDINATOR and COLLABORATOR

5. LEADER and CHANGE AGENT

❏ Supervision and care of women during pregnancy, labor and puerperium.

IN THE CARE OF THE FAMILIES

IN THE CARE OF THE COMMUNITIES

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