Public health nurses in the Philippines have made great contributions to the improvement of

health of the people for more than a century now.

 Leaders in providing quality health services to communities

 First level of health workers to be knowledgeable about new public health technologies
and methodologies
 First ones to be trained to implement new programs and apply new technologies

Public health nurses must have a good understanding of the workings of the current
health system and its political infrastructure and be sensitive to the political and social
implications of the dynamics involved.

They are adept in public relations and can relate with anybody across the social,
political, religious and economic spectrum.

They have also comprehensive grasp of the current situations that impact on the health
of the people.

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

HEALTH: “state of complete physical, mental, and social well being, not merely the absence of
disease or infirmity.

DETERMINANTS OF HEALTH
The health of the individuals and communities are, to a large extent, affected by a combination
of many factors.

WHO has listed the following factors or things that make people healthy or not.
1. Income and social status
 Higher income and social status are linked to better health.
2. Education
 Low educational levels are linked with poor health, more stress and lower self
confidence.
3. Physical environment
 Safe water and clean air, healthy workplaces, safe houses, communities and roads
all contribute to good health.
4. Employment and working conditions
 People in employment are healthier, particularly those who have more control over
their working conditions.
5. Social support networks
 Greater support from families, friends and communities is linked to better health.
6. Culture
 Customs and traditions, and the beliefs of the family and community all affect health.
7. Genetics
 Inheritance plays a part in determining lifespan, healthiness and the likelihood of
developing certain illnesses.
8. Personal behavior and coping skills
 Balanced eating, keeping active, smoking, drinking, and how we deal with life’s
stresses and challenges all affect health.

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9. Health services
 Access and use of services that prevent and treat disease influence health.
10. Gender
 Men and women suffer from different types of diseases at different ages.

The determinants of health as a concept can be explained in the Optimum Level of

Functioning (OLOF) framework of individuals, families and communities being influenced
by several factors in the ecosystem.

PUBLIC HEALTH

Classic definition (Dr. C. E. Winslow):

 “The science and art of preventing disease, prolonging life, promoting health and
efficiency through organized effort for the sanitation of the environment, control of
communicable diseases, the education of individuals in personal hygiene, the
organization of medical and nursing services for the early diagnosis and preventive
treatment of disease, and the development of the social machinery to ensure
everyone a standard living adequate for the maintenance of health, so organizing
these benefits as to enable every citizen to realize his birthright of health and
longevity.”

World Health Organization:

 “The art of applying science in the context of politics so as to reduce inequalities in
health while ensuring the best health for the greatest number.”
It points out to the fact the health public health is a core element of the government’s
attempt to improve and promote health and welfare of their citizens.

Even after half a century later, the essence of public health as defined by Winslow
remains essentially the same when applied in the context of the current events.

The core business of public health as

 Disease control
 Injury prevention
 Health protection
 Health policy including those in relation to environmental hazards such as in the
workplace, housing food, water, etc.
 Promotion of health and equitable health gain.

The core business of public health cannot be achieved without the proper delivery of essential
public health functions which Yach described as “a set of fundamental activities that address
the determinants of health, protect a population’s health and treat disease.

These public health functions represent public goods, and in this respect governments need to
ensure the provision of these essential functions, but would not necessarily have to implement
and finance them.

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They prevent and manage the major contributors to the burden of disease by using effective
technical, legislative, administrative, and behavior-modifying interventions or deterrents, and
thereby provide an approach for intersectoral action for health.

Essential Public Health Functions:

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 gains
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 services.
9. Research, development and implementation of innovative public health solutions.

A well defined, coordinated public health system or infrastructure must be put in place for
these health functions to be adequately delivered.

Government needs to ensure these essential functions are provided, but do not necessarily
have to implement or finance them themselves. Implementation may be achieved through
other governmental agencies, community and non-governmental organizations, or the private
sector, among others.
PUBLIC HEALTH NURSING:

WHO expert Committee of Nursing:

 “a special field of nursing that combines the skills of nursing, public health and some
phases of social assistance and functions as part of the total public health programme
for the promotion of health, the improvement of the conditions in the social and physical
environment, rehabilitation of illness and disability.”

 This definition is an apt description of the nature of public health Nursing in the
Philippines. The public health nurses in this country are using their nursing skills
in the application of public health functions and social assistance within the
context of public health programs designed to promote health and prevent
disease.

 The terms public health nursing and community health nursing have often been
interchangeably used in the Philippines because various foreign and local
authors also used them interchangeably.

Ruth B. Freeman

 Community Health Nursing refers to a “service rendered by a professional nurse with

communities, groups, families, individuals at home, in health centers, in clinics, in
schools, places of work for the promotion of health, prevention of illness, care of the sick
at home and rehabilitation.”

 This definition is also true to public health nursing as defined by the WHO Expert
Committee on Nursing

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  Community health nursing indicates that it is broader than public health nursing
because it encompasses “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)

A variety of titles has been used to describe the type of nursing provided in the
community setting (district nursing, health nursing, visiting nursing, public health
nursing, and community health nursing) to identify nurses who work with populations as
well as individuals and families.

The term public health nursing is used to describe the population focused practice of
nurses employed by departments of health and human services.

Public Health Nursing was coined by Lilian Wald when she was director of Henry Street
Settlement in New York City to denote a service that was available to all people. The
term public health nursing became associated with “public” or government agencies and
in turn with the care of poor people as the federal, state and local governments
increased their involvement in the delivery of health services.

The phrase community health nursing emerged out of an interest in reaffirming the
original thrust of public health nursing: nursing for the health of the entire
public/community versus nursing only for the public who are poor.

The National League of Philippine Government Nurses came up with the Standards of
Public Health Nursing in the Philippines 2005 to redefine the practice of public health nursing
in the Philippines.

The Standards differentiated public health nursing and community health nursing only in
one area: setting of work as dictated by funding.

The government is the employer of public health nurses both at the national and local
health agencies. Position title or designation given by the Civil Service Commission working in
these agencies is Public Health Nurse.

Public Health Nurses (PHNs)

 Refer to the nurses in the local/national health departments or public schools whether
their official position is Public Health Nurse, Nurse or school nurse.

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 practice in public health sector.

Public health nurses are found in various health settings and occupying various
positions in the hierarchy. They are assigned in rural health units, city health centers,
provincial health offices, regional health offices, and even in the national office of the
Department of Health. They are also assigned in public schools and in the offices of
government agencies providing health care agencies. They occupy a range of positions
from Public Health Nurse 1 to Nurse Program Supervisors to Chief Nurse in public
health settings.

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 Public Health Nurses have broad roles and functions. Their specific role and function is
dependent on the position description of the public health nurse in the hierarchy of the health
care system.

The Public Health Nurse uses various tools and procedures necessary for her to properly
practice her profession and deliver basic health services. She uses nursing process in her
practice and is adept in documenting and reporting accomplishments through records and
reports. She is also technically competent in various nursing procedures conducted in settings
where she is assigned.

Qualifications and Functions:

1. Professional competence (Professionally qualified and licensed to practice)

2. Possesses personal qualities (physical, mental & emotional strength; leadership,

resourcefulness, creativity, honesty and integrity) and “people skills” (interest, willingness
and the capacity to work with people).

3. Functions in accordance with the dominant values of public health nurses, within the ethico-
legal framework of the nursing profession and in accordance with the needs of clients and
available resources for health care.

4. Functions of the PHN are consistent with the Nursing law of 2002 and program policies
formulated by the Department of Health and local government health agencies, related to
management, supervision, provision of nursing care, collaboration and coordination, health
promotion and education training and research.

MANAGEMENT FUNCTION

This is inherent in the practice of public health nursing. The nurse has been trained to lead and
manage. Objectives set for work being done can only be achieved through the execution of
five management functions of planning, organizing, staffing, directing and controlling.

Ex. The nurse organizes the “nursing service” of the local health agency; prepares and
implements the nursing service plan as part of the overall health plan.

Program management is a function where the PHN actually excels in. The nurse is
responsible for the delivery of the package of service provided by the program to the target
clientele.

Ex. As manager of the National Tuberculosis Program (NTP), the nurse plans activities and
sets targets, organizes, directs and control activities and outputs, deploys needed manpower
and budgets resources accordingly. A report on program accomplishments is a documentation
of management skills of the nurse.

SUPERVISORY FUNCTION

Generally, the PHN is the supervisor of the midwives and other auxiliary workers in the
catchment area. This is in accordance with the agency’s policies and in a manner that
improves performance and promotes job satisfaction.

 The Sentrong Sigla program has developed a Supervisory Package complete

with supervisory checklists for various programs and proved to be useful. During
the visit the PHN identifies together with the supervisee any issue or problem
encountered and addresses them accordingly.

 Coaching is instituted where there is breach in the procedure and

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 established protocol.

 Conduct of training when enhancement is identified.

NURSING CARE FUNCTION

In the provision of care, the PHN

 Uses her knowledge and skill in the nursing process (assessment, plans and
implements care, and evaluates outcomes)

 Establishes rapport with clientele to ensure good quality data and to facilitate or
enhance partnership in addressing identified health needs and problems.

 Conducts home visits which is a visible manifestation of the caring function;

“must’ activity of the PHN; devote time for those chronically ill patients who stay
at home.

 Makes referral of patients to appropriate levels of care.

COLLABORATING & COORDINATING FUNCTION

 Brings activities or group of activities systematically into proper relation or harmony with
each other.

 Care coordinators for communities and their members; actively involved both socially
and politically to empower individuals, families and communities as entity to initiate and
maintain health promoting environments.

 Establishes linkages and collaborative relationships with other health professionals,

government agencies, the private sector, non government organizations, people’s
organizations to address health problems.

 Identifies persons, groups, organizations, other agencies and communities whose

resources are available within and outside the community and which can be tapped in
the implementation of individuals, family and community health care.

HEALTH PROMOTION & EDUCATION FUNCTION

 Understanding the multidimensional nature of health will enable the PHN to plan and
implement health promoting interventions for individuals and communities.

 Uses her skills in advocacy for the creation of a supportive environment through policies
and reengineering of the physical environment for healthier actions.

 Provides clients with information that allows them to make healthier choices and
practices. Giving health education is a very important function and a basic health
service. Health education activities are a major component of any public health
program. Correct knowledge, attitude and skills should be taught and subsequently
practiced to improve the health of the individuals, family and community.

 PHN are expected to teach on a daily basis as part of their practice. They must have a
solid knowledge base about the theories and models of the teaching/learning process
as well as the general principles of teaching and learning. This knowledge base will

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 enhance the teaching relationship established with each individual, family, or group.

TRAINING FUNCTION

The PHN

 Initiates the formulation of staff development and training programs for midwives and
other auxiliary workers.

 Identify training needs of these health workers, designs the training program, conducts
them in collaboration with other resource persons and evaluates of training outcomes.

 Participates in teaching, guidance & supervision of student affiliates for their related
learning experiences in the community setting.

TRAINING FUNCTION

The PHN

 Mobilizes communities for health actions. Community organizing is a means of

mobilizing people to solve their own problems. Through CO, people learn that their
problems have social causes and fighting back is a more reasonable, dignified
approach than passive acceptance and personal alienation.

RESEARCH FUNCTION

 Participates in the conduct of research and utilizes research findings in her practice.

 Disease surveillance is a research activity of the nurses.

 Disease surveillance is a continuous collection and analysis of data of cases and

deaths.

 Purposes: to measure the magnitude of the problem and to measure the effect of
the control program. The data collected can be used to improve strategies and
thus prevent diseases from occurring.

 Surveillance is an integral part of many programs; important in monitoring the

progress of the disease reduction initiatives (poliomyelitis eradication, neonatal
tetanus elimination, measles control, NCN risk factors..)

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Public health nurses should have specific competencies and skills.

1. Community Health Nursing Process

Assessment  Initiate contact

 Demonstrate caring attitudes
 Mutual trust & confidence
 Collect data from all possible sources
 Identify health problems
 Assess coping ability
 Analyze and interpret data
Planning Nursing  Prioritize needs
Action  Establish goal based on needs and capabilities of
staff
 Construct action and operation plan
 Develop evaluation parameters
 Revise plan as needed
Implementation of  Put nursing plan to action
Planned Care  Coordinate care/ services
 Utilize community resources
 Delegate
 Supervise/monitor health services provided
 Provide health education and training
 Document responses to nursing action

Evaluation of Care  Nursing audit

and Services  Care outcome
Rendered  Performance appraisal
 Estimate cost benefit ratio
 Assessment of problems
 Identify needed alterations
 Revise plans as necessary

2. Nursing procedures during clinic and home visits

 Clinic visit
 Blood pressure measurement
 Home visit
 Bag technique
 Nursing care in the home/ isolation technique in the home

3. Community organizing

 Community analysis
 Design and initiation
 Implementation
 Program maintenance-consolidation
 Dissemination-reassessment

4. Health promotion and education

5. Surveillance

 Epidemiology
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  Vital statistics

6. Records and reports

 Field Health Services and Information System (FHSIS)

 Family treatment record

 Target client list
 Reporting forms
 Output reports

SCHOOL NURSING

The Health and Nutrition Center (HNC) of the Department of Education (DepEd) is mandated
to safeguard the health and nutritional well-being of the total school population. The HNC has
two divisions: Health and Nutrition. The Health Division has four sections, Medical, Dental,
Nursing and Health Education sections.

School nursing focuses on the promotion of health and wellness of the pupils/students,
teaching and non-teaching personnel of the schools. School nurses also assist young people
in making choices for a healthy lifestyle, reduce risk taking behavior and focus on issues such
as prevention of drug and substance abuse, teenage pregnancy, sexually transmitted infection,
malnutrition, and communicable and non-communicable disease.

OBJECTIVES:
General: To promote and maintain health the health of the school populace by providing
comprehensive and quality nursing care

Specific:
1. Provide quality nursing service to the school population;
2. Create among awareness among school children, personnel and administrators on the
importance of the promotive and preventive aspects of health through health education;
3. Encourage the provision of standard functional facilities;
4. Provide nursing personnel with opportunities for continuing education and training;
5. Conduct and participate in researches related to nursing care;
6. Establish/strengthen linkages with government and non-government
organizations/agencies for school community health work

DUTIES
1. Health advocacy
2. Health and nutrition assessment (vision & hearing screening procedures)
3. Supervision of the health and safety of the school plant
4. Treatment of common ailments and attending to emergency cases
5. Referrals and follow-up of pupils and personnel
6. Home visits
7. Community outreach (attending in community assemblies and organizing school
community health councils)
8. Recording and reporting of accomplishments
9. Monitoring and evaluation of programs and projects

Skills needed by and provided to the school nurses to enable them to deliver effective
health acre to the school populace:
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  Assessment and Screening skills
 Health Counseling skills
 Social Mobilization skills
 Good Oral and Written Communication skills
 Basic Management skills
 Life skills

FUNCTIONS:

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. Health and Nutrition Education Activities
11. Organization of School-Community health and Nutrition Councils
12. Communicable Disease Control
13. Establishment of Data Bank on School Health and Nutrition Activities
14. School Plant Inspection for health Environment
15. Rapid classroom Inspection
16. Home Visitation

OCCUPATIONAL HEALTH NURSING

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 In the Philippines, the health of 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 develops certain patterns on the job that affect their health.

Functions of Public Health Nurse as an Occupational Health Nurse

(Referenced from PD 856, chapter VII-Industrial Hygiene of the Sanitation Code of the
Philippines)

1. Work with the Occupational health team to lead the sanitary and industrial hygiene of all
industrial establishments including hospitals to determine their compliance with the
sanitation code and its implementing rules and regulations.

2. Recommends to Local Health Authority the issuance of license/business permits and

suspensions and revocations of the same for any violation of the condition upon which said
licenses or permits had been issued, pursuant to existing rules and regulations.

3. Coordinates with other government agencies relative to the implementation of the

implementing rules and regulations.

4. Attends to complaints of all establishments in the area of assignments related to industrial

hygiene and recommends appropriate measures for immediate compliance.

5. Participates to provide, install and maintains in good condition all control facilities and
protective barriers for potential and actual health hazards.

6. Informs all affected workers regarding the nature of hazards and the reasons for the control
measures and protective equipment.

7. Makes periodic testing for physical examination of the workers and other health
examinations related to worker’s exposure to potential and actual health hazards in the
workplace.

8. Provides control measures to reduce noise, dust, health and other hazards.

9. Ensures strict compliance on the regular use and proper maintenance of Personal
Protective Equipment (PPE).

10. Provide employees and workers an occupational health services and facilities.

11. Refers or elevates to higher authority all unsolved issues in relation to occupational and
environmental health problems.

12. Prepares and submits yearly reports to the Local and national Government.

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