OVERVIEW OF

COMMUNITY HEALTH
NURSING/PUBLIC
HEALTH NURSING
 Overview of Community Health Nursing
• The term "community health nursing" is
composed of three major concepts:
• Community - Client
• Health - Goal
• Nursing -The means
Two Major Fields of Nursing in the Philippines:
• 1. Hospital Nursing
• 2. Community/Public Health Nursing
Definition of CHN
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 the 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 of 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
• 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 Expert Committee of Nursing
• Community health nursing practice promotes
and preserves the health of populations by
integrating the skills and knowledge relevant
to both nursing and public health. The
practice is comprehensive and general, and is
not limited to a particular age or diagnostic
group; it is continual, and is not limited
to episodic care.
• - The American Nurses Association
ANA’s definition of community health nursing
highlights the following important points:
1. The goal of professional practice is the
promotion and preservation of the health of
populations
2. The nature of practice is comprehensive, general,
continual and not episodic
3. The knowledge base comes from nursing and
public health
4. The different levels of clientele— individuals,
families, groups/aggregates and community
5. The practitioner's recognition of the primacy of
the population as a whole.
Community health nursing is a specialized field of
nursing practice. Its basic knowledge and skills are
anchored on nursing theories and important concepts
from the science of public health such as:
1. Emphasis on the importance of the "greatest good
for the greatest number"
2. Assessing health needs, planning, implementing
and evaluating the impact of health services on
population groups
3. Priority of .health-promotive and disease-
preventive strategies over curative interventions
4. Tools for measuring and analyzing community
health problems
5. Application of principles of management
and organization in the delivery of health services to the
community.
Basic Concepts and Principles of CHN:
1. The FAMILY is the unit of care, the community is
the patient and there are four levels of clientele in CHN
2. The goal of improving community health is
realized through multidisciplinary effort
3. The community health nurse works WITH and not
FOR the individual patient, family, group or
community. The latter are active partners, not passive
recipients of care
4. The practice of CHN is affected by changes in
society in general and by developments in the health
field in particular
5. CHN is part of the community health system which
in turn is part of the larger human services system
OVERVIEW OF PUBLIC HEALTH
NURSING IN THE PHILIPPINES
The Philippine Public Healthcare Scenario
• The national budget allocation for health care
is relatively small.
• Local government units augment the national
budget to an undetermined extent.
• This scenario requires strategies that will allow
maximization of limited resources:
– Health promotion
– Disease prevention
 Nurses in Public Healthcare
• Community/public health nursing is the synthesis
of nursing practice and public health practice.
major goal of CHN
-is to preserve the health of the community and
surrounding populations by focusing on health
promotion and health maintenance of individuals,
families, and groups within the community.
• The mission of public health is SOCIAL JUSTICE,
which entitles all people to basic necessities such
as adequate income and health protection and
accepts collective burdens to make this possible.
 Concepts of Health
• The variety of characterizations of the
word illustrates the difficulty in
standardizing the conceptualization of
health.
• Common concepts in various definitions
include:
– Goal-directed/ purposeful actions,
processes, responses or behaviors.
– Soundness, wholeness, and/ or well-being
 Concepts of Community
• Before 1996: definitions of community
focused on geographical boundaries,
combined with social attributes of people.
• Later part of the decade: geographical
location became a secondary characteristic in
the discussion of what defines a community.

Baldwin, et.al, 1998

Defining Attributes of Communities

1. People
2. Place
3. Interaction
4. Common characteristics, interests or
goals

Maurer and Smith, 2009

 Types of Communities
1. Geopolitical / Territorial community
2. Phenomenological / Functional
community

-Maurer and Smith, 2009

 Different Types Of Communities
• Interest. Communities of people who share the
same interest or passion.
• Action. Communities of people trying to bring
about change.
• Place. Communities of people brought together by
geographic boundaries.
• Practice. Communities of people in the same
profession or undertake the same activities.
• Circumstance

Acc. To Richard Millington

Determinants of Health and Disease
• Income and social status
• Education
• Physical environment
• Employment and work conditions
• Social support networks
• Culture
• Genetics
• Personal behavior and coping skills
• Health services
• Gender
 Health promotion and Disease
prevention
• Health promotion activities enhance resources
directed at improving well-being, whereas
disease prevention activities protect people
from disease and the effects of disease.
 Level of Prevention
1. Primary: general health promotion and
specific protection
2. Secondary: early detection and prompt
intervention
3. Tertiary: reduce the effects of disease and
injury, and restore individuals to their
optimal level of functioning
-Leavell and Clark, 1958
Definitions of Public Health Nursing
• Public health nursing may be defined as a
field of professional practice in nursing and
in public health in which technical nursing,
interpersonal, analytical, and
organizational skills are applied to
problems of health as they affect the
community.
-Freeman, 1963
• The practice of promoting and protecting
the health of populations using knowledge
from nursing, social, and public health
sciences
-ANA/APHA, 1996
 Community-Based Nursing
• Application of the nursing process in
caring for individuals, families and
groups where they live, work or go to
school or as they move through the
health care system.
-McEwen and Pullis, 2008
 Population-Focused Approach
• Focuses on the entire population
• Is based on assessment of the populations'
health status
• Considers the broad determinants of health
• Emphasizes all levels of prevention
• Intervenes with communities, systems,
individuals, and families
-Minnesota Department of Health, 2003
 Levels of Clientele
• Individual
• Family
• Group/ Aggregate
• Community
 Pre-payment Mechanism
• Community health services and
community health nursing services, are
generally free at the point of care.
• The services have already been pre-paid
by the community/aggregate.
– Taxes cover government-provided
healthcare services
– Tuition fees cover school-health services
– Consumers pay for the occupational health
services of employees of a company.
 Emerging Fields
of Community Health Nursing in the Philippines
Home health care
This practice involves providing nursing care to
individuals and families in their own places of
residence mainly to minimize the effects of illness
and disability.
• Hospice home care: This is home care
specifically rendered to the terminally ill.
 Emerging Fields
of Community Health Nursing in the Philippines
• EntrepreNurse
• This is a project initiated by the Department
of Labor and Employment (DOLE), in
collaboration with the Board of Nursing of the
Philippines, Department of Health, Philippine
Nurses Association, and other stakeholders to
promote nurse entrepreneurship.
 Emerging Fields
of Community Health Nursing in the Philippines
• Faith community nursing or parish nursing
-This is the practice of nursing combined with
spiritual care.
-They may work in either paid or unpaid
positions in a variety of religious faiths.
 Competency Standards
in Community Health Nursing
• Safe and quality nursing care
• Management of resources and environment
• Health education
• Legal responsibility
• Ethico-moral responsibility
• Personal and professional development
• Quality improvement
• Research
• Records management
• Communication
• Collaboration and Teamwork
 History of Public Health Nursing
in the Philippines
• 1577: Friar Juan Clemente opened a medical
dispensary in Intramuros for the indigent.
• 1690: Dominican Father Juan de Pergero
worked towards installing a water system in
San Juan del Monte (now San Juan City,
Metro Manila) and Manila.
• 1805: Dr. Francisco de Balmis introduced
Smallpox vaccination.
• 1876: The first medicos titulares were
appointed and worked as provincial health
officers.
• 1888: The University of Santo Tomas opens a
two-year, cirujanos ministrantes course to
produce male nurses and sanitary inspectors.
• 1901: The Board of Health of the Philippine
Islands was created through Act 157, which
eventually evolved into the Department of
Health (DOH)
• 1905: Asociacion de Feminista Filipina
founded La Gota de Leche: the first center
dedicated to the service of mothers and
babies
• 1912: The Fajardo Act law created sanitary
divisions made up one to four municipalities.
1919
• Act # 2808 (Nurses Law was created) –
Carmen del Rosario, 1st Filipino Nurse
supervisor under Bureau of Health
Oct. 22, 1922
• Filipino Nurses Organization (Philippine
Nurses’ Organization) was organized.
• 1923
▪ Zamboanga General Hospital School of Nursing & Baguio General
Hospital were established; other government schools of nursing were
organized several years after.
• 1928
▪ 1st Nursing convention was held
• 1940
▪ Manila Health Department was created.
• 1941
▪ Dr. Mariano Icasiano became the first city health officer; Office of
Nursing was created through the effort of Vicenta Ponce (chief nurse)
and Rosario Ordiz (assistant chief nurse)
• Dec. 8, 1941
▪ Victims of World War II were treated by the nurses of Manila.
• July 1942
▪ Nursing Office was created; Dr. Eusebio Aguilar helped in the release
of 31 Filipino nurses in Bilibid Prison as prisoners of war by the
Japanese.
• Feb. 1946
▪ Number of nurses decreased from 556 – 308.
• 1948
▪ First training center of the Bureau of Health was organized by the
Pasay City Health Department. Trinidad Gomez, Marcela Gabatin,
Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and Zenaida Nisce
composed the training staff.
• 1950
▪ Rural Health Demonstration and Training Center was created.
• 1947: The DOH was reorganized into bureaus and
the administration of city health departments
was placed at bureau level.
• 1953 :The first 81 rural health units were
organized.
• 1954: The congress passed R.A. 1082 or the Rural
Health Unit Act which provided an RHU in every
municipality.
• 1957: R.A. 1891 was enacted to have a more
equitable distribution of health personnel.
• 1958: Regional health offices were created as a
result of decentralization efforts, thus creating
the position: Regional Health Officer.
• 1957
▪ RA 1891 amended some sections of RA 1082 and created the eight
categories of rural health unit causing an increase in the demand for
the community health personnel.
• 1958-1965
▪ Division of Nursing was abolished (RA 977) and Reorganization Act
(EO 288)
• 1961
▪ Annie Sand organized the National League of Nurses of DOH.
• 1967
▪ Zenaida Nisce became the nursing program supervisor and
consultant on the six special diseases (TB, leprosy, V.D., cancer,
filariasis, and mental health illness).
• 1970: the Philippine health care delivery
system was restructured, paving the way for
the health care system that exists to this day
where health services are classified into
primary, secondary and tertiary levels.
• 1991: R.A.7160 or the Local Government
Code mandated the devolution of basic
services, including health services, to local
government units and the establishment of a
local health board in every province and city
or municipality.
• 1975
▪ Scope of responsibility of nurses and midwives became wider due to restructuring of the
health care delivery system.
• 1976-1986
▪ The need for Rural Health Practice Program was implemented.
• 1990- 1992
▪ Local Government Code of 1991 (RA 7160)
• 1993-1998
▪ Office of Nursing did not materialize in spite of persistent recommendation of the officers,
board members, and advisers of the National League of Nurses Inc.
• Jan. 1999
▪ Nelia Hizon was positioned as the nursing adviser at the Office of Public Health Services
through Department Order # 29.
• May 24, 1999
▪ EO # 102, which redirects the functions and operations of DOH, was signed by former
President Joseph Estrada.
• 1999: Health Sector Reform Agenda was
launched to direct government efforts
towards comprehensive reforms.
• 2005: FOURmula One (F1) for health was
launched to provide an implementation
framework to the reform agenda.
• 2010: Universal Health Care was launched
to provide the necessary revisions to the
F1 framework.
Community Public Health Nursing in
the Philippine Islands
GEORGE C. DUNHAM, M.D., F.A.P.H.A. *
Major, Medical Corps, U. S. Army, Army Medical School, Washington, D. C.
AMERICAN Journal of Public health volume 26,1936

• American Governor-General, an American cabinet member, and an American

technical adviser.
-more than 35 Years of supervision in Public health and welfare work during
the entire period of American occupation.
- Prior to 1934,no nursing service was available for the slum population of
Manila, and there was no other agency by which instruction in health
matters could be given to these people in their own homes.
- No progress was being made in the control of the ff.
1. Tuberculosis
2. Malnutrition
3. intestinal parasitism.
4. Infant mortality rate
As only very meager facilities were available for the promotion of maternal
and child health work among the member
• The Bureau of Health of the Philippine Government has maintained a public
health nursing service for a number of years, but prior to 1933 the bureau
was so organized that such service was entirely inadequate.
• However, a reorganization of the health and welfare activities of the
government which became effective on January 1, 1933, made it possible for
public health nursing service of the bureau to be extended and coordinated
with the other activities of the bureau.
Reorganization
• studies and surveys were made which showed that under the conditions
existing in Manila a combined public health nursing service and social service
offered the most feasible method of solving the public health problem
discussed above.
• Consequently, the Bureau of Health developed a program of public health
nursing and social service to meet the urgent need for health work in the
homes of the poor people living in the congested districts of the city.
• The basic functions of a community health-social center
1. operation of clinics at the center
2. home visiting service.

• There is a general clinic for the treatment of all kinds of cases

1. postnatal and prenatal clinics
2. a tuberculosis clinic
3. clinics for infants, and well baby clinics.

-These are held daily or at scheduled intervals.

-All service is free
Home visiting by nurses is considered to be the most important activity of a community health-social
center, because the fundamental function of the center is to carry health and social services into the
homes of the people.
The clinics conducted at the center are secondary in importance to home visiting.
• community health centers were established in the
affected districts, known as community health-
social centers.
• is an agency designed to provide a combined health
and social service, with the family as the unit
served.
• The nursing and social service personnel consists of
nurses trained in public health nursing and in social
work.
• The clinics are conducted by physicians, each of
whom has had special training in the particular
work concerned.
Effectiveness of Home visit operation services
• the quality rather than the volume of the work performed is
emphasized.
• Follow-up work is essential to success and the nurse must visit a
home many times in order to obtain the desired results.
• Ignorance is rife and many conditions favorable to the spread of
disease prevail in the homes.
• Customs inimical to health must be changed.
• the mother rules the Filipino family in all matters that pertain to the
home, and the mother must be taught in her own home how to
protect the health of her family.
• district served by a center is limited geographically to that which can
be covered efficiently by the nurses available.
• Each nurse is assigned to a zone within this district and she is
responsible for the home visiting work within that zone.
• The case load for a nurse is limited to the number of families
• The centers are also utilized for the dissemination of instruction in
health matters to groups, especially to mothers.
• Group instruction in prenatal and postnatal care and in the care of
infants is given to pregnant women by trained workers.
• Cooking classes are held at regular intervals where practical
instruction is given not only in cooking, but also in other phases of
nutrition.
 Universal Health Care
• Aims to achieve the health system goals of:
– better health outcomes,
– sustained health financing and
– a responsive health system that will provide
equitable access to health care.
• It is deliberately focused on economically
disadvantaged Filipinos to ensure that they
are given risk protection through enrollment
in PhilHealth (Philippine Health Insurance
Corporation) and that they are able to
access affordable and quality health
services.
Thank You!!!