ARETÉ REVIEW & TUTORIAL CENTER - TACURONG

COMMUNITY HEALTH NURSING

ARETE-REVIEW & TUTORIAL CENTER
MODULAR LEARNING
Part 1 Definition of Terms
Part 2 Basic Principles of CHN
Part 3 Roles and Functions of the PHN
Part 4 Levels of Care
Part 5 Levels of Clientele
Part 6 Health Care Delivery System
Part 7 Primary Health Care
Part 8 Ten Herbal Plants Recommended by the DOH
Part 1 Definition of Terms
A. Public Health
 Science and Art of Preventing Disease, Prolonging Life, Promoting Health and efficiency
through organized community 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 social machinery to ensure everyone a standard of living adequate for the
maintenance of health, so organizing these benefits as to Enable Every Citizen to Realize His
Birthright to Health and Longevity
Dr. C.E. Winslow
-
 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
WHO
-
B. Public Health Nursing
 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 program for the promotion of
health, the improvement of the conditions in the social and physical environment, rehabilitation
of illness and disability.
WHO
-
C. Community Health Nursing
 Service 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
-
 The utilization of the Nursing Process in the Different Levels of Clientele-Individuals, Families,
Population Groups and Communities, concerned with the Promotion of Health, Prevention of
Disease and Disability and Rehabilitation
- Dr. Araceli Maglaya

Part 2 Basic Principles of CHN

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A. Brief History of Nursing
 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 a passive recipient of care.
 CHN Practice is affected by developments in Health Technology, in Particular, Changes in
Society, in General.
 The goal of CHN is achieved through Multi-Sectoral Efforts
 CHN is a part of the Health Care System and the larger Human Services System
B. Philosophy of CHN
 A philosophy is defined as a system of beliefs that provides a basis for a guides action. A
philosophy provides the direction and describes the whats, the whys, and the hows of activities
within a profession.
 CHN Practice is guided by the following beliefs:
Humanistic values of the nursing profession upheld
Unique and distinct component of health care
Multiple factors of health considered
Active participation of clients encouraged
Nurse considers availability of resources
Interdependence among health team members practiced
Scientific and up-to-date
Tasks of CHN vary with time and place
Independence or self-reliance of the people is the end goal
Connectedness of health and development regarded
Part 3 Roles and Functions of the Public Health Nurse
A. Roles of the CHN
 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
 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
 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
 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
 Leader and Change Agent: influences people to participate in the overall process of community
development
 Manager: organizes the nursing service component of the local health agency or local government unit;
also, as program manager, the PHN is responsible for the delivery of the package of services provided by
the health program to target clientele
 Researcher: participates in the conduct of research and utilizes research findings in practice
B. Responsibilities of the CHN
 Be a 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
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 Provide opportunities for professional growth and continuing education for staff development
C. Specialized Fields of CHN
 Community Mental Health Nursing: a unique clinical process which includes an integration of concepts
from nursing, mental health, social psychology, psychology, community networks, and the basic sciences
 Occupational Health Nursing: the application of nursing principles and procedures conserving the health
of workers in all occupation
 School Health Nursing: the application of nursing theories and principles in the care of the school
population
Part 4 Levels of Care
A. The Three Levels of Health Care Services
 Primary Level of Care: devolved to the cities and municipalities and is the first contact
between the community people and the different levels of health facility; refers to health care
provided by the health center staff
 Secondary Level of Care: rendered by physicians with basic health training in district hospitals,
provincial hospitals, and city hospitals; these facilities are capable of basic surgical procedures
and simple laboratory examinations; serves as referral center of primary health facilities
 Tertiary Level of Care: rendered by specialists in medical centers, regional hospitals and
specialized hospitals like the Lung Center of the Philippines; serves as the referral center of
secondary health facilities
B. Three levels of Health Care Services and the Two-Way Referral System

National Health
Services, Medical
Centers, Tertiary TERTIARY
Teaching and Training
Hospitals

Regional Health Services,

Regional Medical Centers
and Training Hospital

Provincial/City Health Services, Provincial /City SECONDARY

Hospitals

Emergency / District Hospitals

Rural Health Units, Community Hospitals and Health Centers,

Puericulture centers
PRIMARY
Barangay Health Station

REFERRAL from the COMMUNITY

*There are TWO LEVELS OF PRIMARY HEALTH CARE WORKERS, namely:

1. Village or Barangay Health Workers: refers to trained community health workers or health
auxiliary volunteers or traditional birth attendants or healers
2. Intermediate Level Health Workers: refers to general medical practitioners or their assistants,
public health nurse, rural sanitary inspectors, and midwives.

C. Types of Primary Health Workers

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Village / Grassroots Health Intermediate Level Health Personnel of
Workers First-Line Hospitals
E - trained community -general medical -physicians
X -health worker practitioners -nurses
A -auxiliary health -public health nurses -dentists
M volunteer -midwives
P -traditional birth
L attendant
E
C -initial link, first contact -first source of professional -establishes close contact
H of the community health care with the village and
A intermediate level health
R -works in liaison with the -attends to health problems workers to promote the
A local health service beyond the competence of continuity of care from
C workers village health workers hospital to community to
T home
E -provides elementary -provides support to the
R curative and preventive frontline health workers in -provides back-up health
I health care measures terms of supervision, services for cases
S training, referral services requiring hospital or
T and supplies thru linkages diagnostic facilities not
I with other sectors available in health care
C
S
Part 5 Levels of Clientele
*Four Levels of Clientele in the Community Setting
A. Individual
B. Family
C. Community
D. Population Groups
A. Individual
-basic approaches in looking at the individual
 Atomistic: the whole is equal to the sum of its parts
 Holistic: the whole is NOT equal to the sum of its parts; traces man’s relationship in the
suprasystem of society

B. Family
-defined by Murray and Zentner is a small social system and primary reference group made up of
two or more persons living together who are related by blood, marriage or adoption or who are living
together by arrangement over a period of time.

C. Population Groups
- a group of people sharing the same characteristics, developmental stage or common exposure to
particular environmental factors thus resulting in common health problems
* Vulnerable groups:
 Infants and young children
 School age
 Adolescents
 Mothers
 Males
 Older People

D. Community
-a group of people sharing common geographic boundaries and/or common values and interests
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Part 6 Health Care Delivery System

HEALTH CARE DELIVERY SYSTEM

-the totality of all policies, facilities, equipment, products, human resources and services which
addresses the health need, problems and concerns of the people. It is large, complex, multi-level and multi-
disciplinary

MAJOR PLAYERS
 Public Sector- largely financed thru tax-based budgeting system at both the national and local levels
and where health care is generally given free at the point of service
a. National Level – Department of Health as lead agency
b. Local Health system run by local government units

 Private Sector- largely market-oriented and where health care is paid through user fees at the point of
service

A. THE PUBLIC SECTOR

1. Department of Health (UPDATED based on National policies and guidelines 2017-2022)
 Vision: Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by
2040
 Mission: To lead the country in the development of a productive, resilient, equitable and
people-centered health system.
 Roles and Functions: Executive Order 102 has identified the DOH as the national health
authority providing technical and other resource assistance to concerned groups. It has three
specific roles in the health sector and several functions under each role.
 LEADERSHIP IN HEALTH
Functions:
a. LEADER in the formulation, monitoring and evaluation of national health policies,
plans and programs
b. ADVOCATE in the adoption of health policies, plans and programs to address
national and sectoral concerns
c. NATIONAL POLICY AND REGULATORY INSTITUTION where local
government units, nongovernmental organizations and other members of the health
sector involved in social welfare and development anchor their thrusts and directions
for health.

 ADMINISTRATOR OF SPECIFIC SERVICES

Functions:
a. MANAGE selected health facilities and hospitals
b. ADMINISTER direct services for emergent health concerns that require new
complicated technologies
c. PROVIDE emergency health response services including referral and networking
system for trauma, injuries and catastrophic events, and, in cases of epidemic
widespread public danger upon the direction of the President and in consultation with
the concerned LGU
d. ADMINISTER special components of specific programs like tuberculosis, HIV-
AIDS, etc.

 CAPACITY BUILDER AND ENABLER

Functions:

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a. ENSURE highest achievable standards of quality health care, health promotion and
health protection
b. INNOVATE new strategies in health to improve the effectiveness of health programs
c. INITIATE public discussion on health issues and disseminate policy research outputs
to ensure informed public participation in policy decision-making
d. OVERSEE implementation, monitoring and evaluation of national health plans,
programs and policies

 Goal of DOH: National Policy on Universal Health Care

 Framework for the implementation of the HSRA: FOURmula ONE Plus (F1
Plus)
 3 Strategic Thrusts:
o Better Health Outcomes
o More responsive health system
o More equitable health care financing
a. This is directed towards ensuring accessible, affordable quality health care especially
for the more disadvantaged and vulnerable sectors of the population
b. This strategy has FIVE ELEMENTS
1. FINANCING – secure sustainable investments to improve health outcomes and
ensure efficient and equitable use of health resources.
2. SERVICE DELIVERY - ensure the accessibility of essential quality health
services and affordable levels of care
3. REGULATION – to ensure high quality and affordable health products, devices,
facilities and services of health goods and services
4. GOVERNANCE – strengthen leadership and management capacities,
coordination and support mechanisms necessary to ensure functional, people-
centered and participatory health systems
5. PERFORMANCE ACCOUNTABILITY – USE MANAGEMENT SYSTEMS
TO DRIVE BETTER EXECUTION OF POLICIES AND PROGRAMS IN THE
DOH WHILE ENSURING RESPONSIBILITIES TO ALL STAKEHOLDERS.

2. Local Government Units

-the Local Government Code of 1991 or RA 7160 transformed local government units into self-
reliant communities and active partners in the attainment of national goals through a more
responsive an accountable government structure instituted through a system of decentralization

GOVERNOR

Provincial Level Provincial Health Board

Provincial Health Office

Provincial Hospital District Hospital Other health and medical facilities

MAYOR 6
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Municipal Level Municipal Health Board

 Municipal Health Office

ARETÉ REVIEW & TUTORIAL CENTER - TACURONG

Rural Health Unit/ Health Center Barangay Health Station

B. The Private Sector

- composed of both commercial and business organizations with its market or profit orientation and non-
business organizations with its service orientation
Part 7 Primary Health Care

Primary Health Care – is essential health care made universally accessible to individuals and families
in the community by means acceptable to them, through their full participation and at a cost that the
community and country can afford at every stage of development

 Conceptual Framework:
a. Health is a fundamental human right
b. Health is both an individual and collective responsibility
c. Health should be an equal opportunity to all
d. Health is an essential element of socio-economic development

 Translated into action, the PHC APPROACH focuses on:

Partnership with the community
Equitable distribution of health resources
Organized and appropriate health system infrastructure
Prevention of disease and promotion of health as focus
Linked multisectorally
Emphasis on appropriate technology

 PHC GOAL (1978): Health for all by the year 2000

 PHC was declared in Alma-Ata, USSR during the First International Conference on
PHC held on September 6-12, 1978 through the sponsorship of WHO and UNICEF

 LEGAL BASIS OF PHC IN THE PHILIPPINES- Letter of Instruction(LOI) 949

signed in October 19, 1979 by former President Ferdinand E. Marcos

 UNDERLYING THEME of the Philippine implementation of PHC: Health in the

Hands of the People by 2020
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 5A’s of Health Care according to PHC
a. Available
b. Accessible
c. Affordable
d. Acceptable
e. Attainable
*PHC as a service delivery policy of the DOH permeates all strategies and thrusts of government health
programs from the national to the local and community levels
Dimension Commercialized Health Care Primary Health Care
Goal Absence of disease for the Prevention of disease
individual Socio-economic development
Focus of Care Sick Sick and well individuals
Setting for Services Hospital-based Satellite Health Centers
Urban-Centered Community Health Centers
Rural-Based
Accessible only to a few people Accessible to all
People Passive recipients of health care Active participants in health care
Structure Health is isolated from other Inter- and intra- sectoral linkaging
sectors of society allows health to be integrated with
over-all socio-economic
development efforts
Process Decision-making from top-down Decision-making from bottom-top
Technology Curative services based on Promotive and preventive services
modern medicine and blend traditional medicine with
sophisticated technology modern medicine
Physician dominated Appropriate technology for
frontline health care
Outcome Reliance on health professionals People empowerment or self-
reliance

 Four Cornerstones or Pillars of PHC

Use of appropriate technology
Support mechanism made available
Active community participation
Intra- and inter-sectoral linkage
a. APPROPRIATE TECHNOLOGY implies the use of methods, procedures,
techniques, equipment or materials that are not only scientifically sound but also
provides a socially and environmentally acceptable service or product at the least
economic cost
CRITERIA used in determining the appropriateness of technology:
Acceptability: measured in terms of the degree of utilization of the people
Complexity: should be simple and easy to apply under local conditions
Cost: should be affordable
Effectiveness: should produce the desired effect
Safety: effect of utilization should produce no harm
Scope of Technology: serves a variety of purposes
Feasibility: compatible with local conditions

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b. MULTISECTORAL APPROACH recognizes intersectoral and intrasectoral
linkages in health. With intersectoral linkages, PHC recognizes the integration of
health plans with other sectors for TOTAL community development.

 Elements/ Components of Primary Health Care

Communicable disease control
Health education
Expanded program on immunization
Locally endemic disease treatment
Environmental Sanitation
Maternal and child health and family planning
Essential drugs provision
Nutrition and adequate food provision
Treatment of emergency cases and provision of medical care

Part 8 Ten Herbal Plants Recommended by DOH

10 Medicinal Plants (LUBBY SANTA)

Lagundi
 Indications: cough, asthma, fever, muscle pain
 Preparation: decoction or syrup
Ulasimang Bato
 Indications: lowers serum uric acid in cases of gouty arthritis
 Preparation: Salad or decoction
Bawang
 Indications: lowers serum cholesterol
 Preparations: may be roasted, soaked in vinegar or used for sautéing
Bayabas
 Indications: its antiseptic properties is best used for wound cleansing, as mouthwash in
cases of oral cavity infections and gingivitis
 Preparation: decoction
Yerba Buena
 Indications: for muscle pain
 Preparation: decoction
Sambong
 Indications: its diuretic effect is good for edema and against urolithiasis
 Preparation: decoction
Ampalaya
 Indications: for diabetes mellitus or non-insulin dependent diabetes
 Preparation: decoction or steamed
Niyug-niyogan
 Indications: for intestinal infestation with ascaris lumbricoides
 Preparation: prepare dried, mature niyug-niyugan seeds
Tsaang gubat
 Indications: stomachache

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 Preparation: decoction
Akapulko
 Indications: ringworm, tinea flava, athlete’s foot and other types of fungal infection
 Preparation: poultice or Ointment
*GUIDELINES
 Chemical pesticides or insecticides may leave toxic residues on plants. These should not
be used on herbal plants
 Use palayok or clay pots and wooden spoon when cooking herbal medicines, Remove the
pot cover when the herbal preparation starts to boil
 Use only the plant part recommended
 Use the appropriate herbal plant for each sign and symptom observed
 Watch out for allergic reactions. STOP the use of herbal plant preparation when allergic
and untoward reactions are observed
 Always keep the herbal medicine containers properly labeled
 Always keep the herbal preparations out of reach of children
 RA 8423: utilization of medicinal plants as alternative for high cost medications
Policies:
 The indications/uses of plants
 The part of plant to be used
 Preparation of herbal medicines

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