SPECIALIZED

FIELDS IN
COMMUNICTY
HEALTH
NURSING
Marriane Andrei Salazar
BSN-1-2

School Health Nursing

- School health nursing is the application of nursing theories and principles in the care of the
school population.
1. School Services – maintain school clinic, screening all children-visual, hearing, scoliosis.
2. Health instruction- as health educator/ counselor
3. Health monitoring
a. Mental health- substance abuse, sexual health.
d. Environmental health- food sanitation, water supply, safe environment, safe.
c. school community linkage- as Community organizer.

Aim of the Program

The aim of school health nursing is to promote the health of school children and prevent
health problems they would hinder the learning process and performance of their
developmental task; health is considered an important requisite for education.

DepEd Health and Nutrition Center

The health and Nutrition Center (HNC)

Under Department of education has responsibility to safeguard the health and nutritional well-
being of the total school population. It has two divisions: the nutrition division and the health
division which has four sections namely: Medical, Dental, And Nursing and Health Education.

Determinants of School Health Nursing

 Characteristics of the clientele

 Policies of the department of Education
 Program of the Department of Health
 Standard of the Nursing Profession
 Objective of School Health Nursing
School health nursing aims to promote and maintain the health of the school
populace by providing comprehensive and quality nursing care. Specially, it aims to
achieve the following objectives.
Duties and Responsibilities of School Nurses

1. Health advocacy and health education ;

2. Health and nutrition assessment including screening procedures like vision and
hearing;
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 pupils and personnel,
6. Home visits
7. Community outreach like organizing school community health councils;
8. Recording and reporting of accomplishments;
9. Monitoring and evaluating of programs and projects;

Functions of the School Nurse

1. School health and nutrition program includes current health and nutritional status of school
children, status of health facilities, and actual status of health education activities being
undertaken by the teachers and health personnel;
2. Putting up a functional school clinic for the treatment of minor ailments and attendance to
emergency cases as mandated by R.A 124;
3. Health assessment involves
a. Interviewing for data-gathering
b. Through physical examination - percussion, palpation, auscultation and percussion;
c. Taking of vital signs
d. Vision acuity test/ hearing test
e. Appraisal of general physical and mental condition.
F. Recording of findings
4. The nurse looks signs of illness, physical defects and bad health habits. The corresponding
health teachings or advice must be given.
5. Standard vision testing for school children and referring child with 20/40 visual acuity or
poorer to an eye specialist. Parents should be informed ASAP.
6. Ear examination - the primary concern of the nurse is to detect hearing difficulties or
disorders as early as possible through.
a. Observation.
b. Using penlight or otoscope for visual inspection.
c. Conducting screening test like whisper test, conversation voice test, ballpen click test and the
tuning fork test.
7. Height and weight measurement and nutritional status determination - to determine the
nutritional status children, the DepEd uses weight-for-age and height-for-age indicators for
children below 10 years old while the BMI (body mass index) is used for children 10 years old
and above which is done at beginning and end of the school year.
a. School feeding programs with rice, milk or fortified noodles - are given to children with below
nutritional status for 120 days.
b. DE-worming is done prior to be feeding program and must be accompanied by parents'
consent.
8. Medical referrals- a student with an existing medical illness or condition may be riffed for
further assessment or intervention by the appropriate professional or agency.
9. Attendance to emergency cases - administers appropriate first aid measures and refers
immediately to the appropriate medical facility
10. Student health counseling- especially on matters of emotional and physical problems.
Parents and guardians should also be involved in these activities.
11. Health and nutrition education activities- the nurse can do this in both formal and informal
settings by:
a. planning and conducting training programs, seminars and workshops on health-related topics
involving the students, parents, clinic teachers and other members of the faculty.
b. Acting as a resource person on health-related activities;
c. disseminating relevant finding on health promotion and malunggay and saluyot which are
now considered as "miracle or wonder" plants.
12. Organization of school and community health and nutrition councils- where the school and
members of the community are its members. The set of officers are encouraged to sponsor or
conduct motivated to take active participation in the solution of school community health
problems.
13. Communicable disease prevention and control- this is a joint responsibility of the school,
parents, students and DepEd. if a student manifest signs of contagious or infectious disease,
he/she should be immediately referred and sent home upon notification of the parent or
guardian and shall not be permitted until school authorities are fully satisfied that the child is
well.
a. Checks the immunization status of the child and encourages compliance to immunization
requirements;
b. Aids in early detection;
c. Helps to provide parental notification and information;
d. Makes the necessary medical referrals.
14. Establishment of data bank on school health and nutrition activities
-accurate and updated school health records should contain the following:
a Treatments in the school clinic
b. Records of school visits (RHU and school health personnel)
c. Health Assessment Report of the School Health Personnel
d. Health and Nutritional Status of the students/pupils
e. Form 86 of teaching and non-teaching personnel
f. Teachers' Health profile
g. Records of emergency cases attended to
h. Records of referrals made
i. Inventory of clinic equipment and supplies
j. Health and nutrition activities in school
k. Records of accomplishments of school health services
l. Records of officers/officials of the School-community Health Council and their
accomplishments
m. Action plan
n. Performance contract
15. School plant inspection for healthy environment-in addition to the minimun standards for
schools, particular attention is given to provision and hygienic maintenance of toilets, school
clinics, water supplies, sanitation of school canteen and safety and nutritional values of foods
being served.
16. Rapid classroom inspection- is done as routine procedure and may be made immediately
after holidays and between health assessments but should not be more than once a month
except in cases of epidemics.
a. Detect cases of communicable diseases.
b. Note the corrections that have been made
c. Note if eyeglasses used by the students are correctly adjusted
d. Note the general cleanliness of the pupils
e. Note new ailments

Conducting the Classroom Inspection

1. Choose a well-lighted place like the entrance to a room or corridor and stand with
your back towards the light;
2. Instruct the children to line up showing their hands, arms, hair, nose throat, ears,
neck, chest, feet and legs and carefully observe for any signs of abnormality, defect or
unhygienic practices.

3. Compare present with past findings.

4. If rapid classroom inspection is done in relation to an epidemic carefully observes for

signs and symptoms of the disease in question.

5. Record the findings in the school health examination card.

6. Follow-up:

a. Discuss the findings with the classroom teacher and the parents ASAP.

b. Any case found which requires closer and more careful examination should be seen at
the clinic and be given intervention or be referred promptly.

Some legal bases of the School Health Program

* PD 603 Child and youth welfare code:

- Art I - general principles- the child is the most important asset of a nation. Every effort
should be enacted to promote his welfare and enhance his opportunities for useful,
happy life"

- Art II - Promotion of Health - "it should be the responsibility of the health, welfare and
education entities to assist the parents in looking after the health of the child"

- Art III - The rights of the Child- "Every child has the right to a balanced diet, adequate
clothing, sufficient shelter, proper medical attention and the basis physical requirements
of a healthy and vigorous life".

* Executive Order No, 14, s.1946 - creation of the Medical and Dental Services granting
authority for the voluntary contribution of 50 centavos per pupil for the maintenance of
the service.

* RA No, 951 s.1947 - Medical inspection of school children enrolled in private schools,
colleges and universities in the Philippines.

* RA No. 847 s.1953 - Return of the Medical and Dental Services from the Department
of Health to the Department of Education.
* R.A No. 2620 s.1961 - Nationalization of the Medical and Dental services of the Bureau
of Public Schools, Department of Education.

* PD 491 s.1974 - Nutrition Act of Philippines - creation of National Nutrition Council

with DECS as a member; designation of July as Nutrition Month.

*LOI No. 764 s.1978 - declaring the School Health Program as priority program of the
national government with the aim of educating teachers and school children in the use
of medicinal plants as simple remedies for common ailments.

* E.O. No. 234 s.1987- reorganizing the National Nutrition Council - the revised functions
of member agencies like DECS have been affected.
Rei Angeline R. Suelo
BSN-1-2

Occupational Health Nursing

It is the specialty practice that focuses on the promotion, prevention, and restoration of health
within the context of a safe and healthy environment.

Occupational Health Nursing is the application of Nursing principles and procedures in

conversing the health of workers in all occupations. It aims to assist the workers in all
occupations to cope with actual and potential stresses in relation to their work environment.
The focus of occupational health nursing is on the promotion, protection, and restoration of
worker’s health within the context of a safe and healthy work environment.

Occupational Safety and Health (OSH)

It is a discipline involved in “the promotion and maintenance of the highest degree of physical,
mental and social well-being of workers in all occupations.”

Determinants of Occupational Health Nursing practice

1. Government policies and standards.

a. Department of Labor and employment
b. Department of Health
c. Social Security System
d. Philippine Health Insurance Corporation
e. Employees Compensation Commission
2. Professional Standards
a. Occupational Health Nurses Association
b. Philippine Nurses Association

Nursing in the Workplace

1. Focuses on promotion, protection, and restoration of worker's health within the context of a
safe and healthy work environment.
2. Aimed at optimizing health, preventing illness and injury, and deducing health hazards.
RA 1054 Occupational Health Act

RA 1054 stipulates the healthcare requirements for occupations. These are as follows:
1. For businesses with <30 employees - OHN services are provided by the PHN
2. For businesses with 30-100 employees and located within 1 km- OHN services are provided
by the PHN
3. For businesses with 30-100 employees but are located beyond 1km - an OHN is needed,
together with supplies and equipment
4. For businesses with 201-300 employees - OHN, supplies, and equipment are needed
5. For businesses with 201-300 employees - OHN, supplies, equipment, resident physician, and
dentist are needed
6. For businesses with >301 employees - OHN, supplies, equipment, physician, dentist,
permanent clinic (1:100) or accessible hospital within 2 km are required.

Key Elements of Occupational Health Programs

1. Health Protection- is composed of health risk management at work (health hazard

identification, health risk assessment and its control measures, health surveillance, information,
instruction and training and monitoring and record-keeping
2. Health Promotion - assessment of health risk associated with workplace, living environment
and lifestyle, and employee information and assistance program.

Functions of Responsibilities of the Occupational Health Nurse

PD 856, Chapter VII of the Industrial Hygiene of the sanitation Code of the Philippines stipulates
the following functions and responsibilities of occupational health nurses:
1. Works with Occupational Health Team to lend the sanitary industrial hygiene of all industrial
establishments like hospitals to find out their compliance with the sanitation code and its
implementing rules and regulations.
2. Recommends to the local Health Authority the issuance of license/business permits.
3. Coordinates with other government agencies relative to the implementation of the
implementing rules and regulations.
4. Attends to complaints of all the business establishments in the area of assignment related to
industrial hygiene and recommends appropriate measures for immediate compliance.
5. Participate to provide, install and maintain in good condition all control facilities and
protective barriers for potential and actual hazards.
6. Informs all affected workers regarding the nature of hazards and the reasons for the control
measures and protective equipment
7. Makes a periodic testing for physical examination of the workers and other health
examination related to worker’s exposure to potential or actual hazards in 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. Provides employees/ workers occupational health services/ facilities
11. Refers or elevates to higher authority all unresolved issues in relation to occupational and
environmental; health problems.
12. Prepares and submits yearly reports to the local and National Government.

DOH Occupational Health Programs

By virtue of the Sanitation Code of the Philippines, Chapter VII- industrial Hygiene(PD 856), the
department of Health is further tasked with the administration and enforcement of sanitary
requirements, environmental measures, provision of personal protective equipment and health
services applicable to all workplace.
The organization of DOH in 2000 left the occupational health program to the national center for
disease prevention and control (NCDPC) an environmental and occupational health office
(EOHO)

Objective of the Occupational Health program

1. Improve the health status of the workers.

2. Provide maximum access to the occupational services.
3. Develop the skills and aptitude of health personnel on the anticipation, recognition,
evaluation, and control of health hazards and other health and occupational concern
4. Reduce morbidity and mortality rates among workers in the workplace.
5. Reduce disability incidence due to work related illnesses, diseases and poisonings.
6. Establish a monitoring/ reporting system for occupational diseases.

Program strategies/ key result areas

1. Establish/ institutionalize regional occupational toxicology (wherein Mercury Surveillance is

Incorporated) and Poison Control Center.
2. Integration of Occupational Health Services (OHS) as part of the primary Health Approach.
3. Upgrade manpower capability of health personnel and existing facilities.
4. Preventive and promotive occupational health strategies.
5. Toxic vigilance activities.
6. Advocacy campaign through the "Healthy Workplace" initiative.
7. Research.
8/ Multi-agency linkages

Levels of Preventive Care and Occupational Health Nursing

Primary Prevention

In the area of primary prevention, the occupational health nurse is involved in both health
promotion and disease prevention.
The occupational health nurse may be in an advocacy role to negotiate with the employer for
changes in the work environment that will reduce or eliminate existing or potential
occupational exposure to risk factors.

Secondary Prevention

Secondary prevention strategies are aimed at early diagnosis, early treatment interventions,
and attempts to limit disability. The focus at this level is on identification of health needs,
health problems, and employees at risk.

Tertiary Prevention

On the tertiary level, the occupational health nurse plays a key role in the rehabilitation and
restoration of the worker to an optimal level of functioning based on the limitations imposed by
the disability or illness
Name: Jonamae C. Ramos

COMMUNITY HEALTH NURSING

Community health nursing

Community health nursing involves several basic concepts, including the promotion of healthy living,
prevention of disease and health problems, medical treatment, rehabilitation, evaluation of community
health nursing care delivery and prevention systems, and research to further community health nursing
and wellness.
A community nurse can serve direct care, educate individuals or the public, advocate for health
improvements and perform research in community health. It is the job of a community health nurse to
help and keep the community health problems under control.

Characteristics of Community Health Nursing:

There are six important characteristics of community nursing; those are mentioned in the following:

 It is a specialty field of nursing.

 Its practice combines public health with nursing.
 It is population based.
 It emphasizes on wellness and other than disease or Illness.
 It includes inter-disciplinary collaboration.
 It amplifies client’s responsibility and self-care.

Functions of Community Health Nursing:

The four core functions of community health nursing practices are described in the below:

i. Identification of community culture and resources that lead as a key factor in the
community health care delivery system.
ii. Evaluate community health conditions, health risks and problems to identify the health-care
demands of the people.
 iii. Plan and implementation of comprehensive community health interventions, care, services and
programs.
iv. Develop health policy at the local community level to drive policies/agreements at the state and
national levels for collaborative endeavors and actions.

Functions of Community Health Nurse:

There are seven major functions of community health nurse; those are mentioned in the following:

1. Clinician,
2. Educator,
3. Advocate,
4. Managerial,
5. Collaborator,
6. Leader,
7. Researcher.

Roles and Responsibilities of Community Health Nurse:

Some key roles and responsibilities of community health nurse have discussed in the below:

1. Clinician Role or Direct care provider:

The clinician role in the community health nurse means, the nurse ensures health care services, not just
to individuals and families but also to groups and population of the community. For community health
nurses the clinician role involves certain emphasis different from basic nursing, i.e. – Holism, health
promotion, and skill expansion

2. Educator Role:
It is widely recognized that health teaching is a part of good nursing practice and one of the major
functions of a community health nurse (Brown, 1988). Assesses the knowledge, attitudes, values, beliefs,
behaviors, practices, stage of change, and skills of the community people and provide health education
according to knowledge level.

3. Advocate Role:
The issue of clients’ rights is important in health care today. Every patient or client has the right to
receive just equal and human treatment. Community health nurse is an advocate of patient’s rights in
relation to their care. They encourage the individuals to take right food for maintaining health, right
drugs for the treatment and right services at right place where ever needed.

4. Managerial Role:
As a manager the nurse exercises administrative direction towards the accomplishment of specified
goals by assessing clients’ needs, planning and organizing to meet those needs, directing and controlling
and evaluating the progress to assure that goals are met.
5. Collaborator Role:
Community health nurses seldom practice in isolation. They must work with many people including
clients, other nurses, physicians, social workers and community leaders, therapists, nutritionists,
occupational therapists, psychologists, epidemiologists, biostaticians, legislators, etc. as a member of
the health team (Fairly 1993, Williams, 1986).

6. Leader Role:
Community health nurses are becoming increasingly active in the leader role. As a leader, the nurse
instructs, influences, or persuades others to effect change that will positively affect people’s health. The
leadership role’s primary function is to useful change of health policy based on community people
health; thus, the community health nurse becomes an agent of change.

7. Research Role:
In the researcher role community health nurses engage in systematic investigation, collection and
analysis of data for the purpose of solving problems and enhancing community health nursing practice.
Based on the research result community nurse improve their service quality and improve community
people health.
References

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