MODULE 1

Community Public Health Nursing - Roles and Responsibilities

Community public health nursing is not entirely different in nursing practice with that of clinical nursing
confined in the four corners of the hospital. It also promotes wellness and prevents illness through education
and health teachings, provides comfort and care through its delicate nursing care interventions, and
emphasizes curative and rehabilitative interventions through individualized efficient approaches. But its
peculiarity involves not only caring a single client but by extending thru the whole family and the community.
It is further defined in the book of Community Health Nursing Services as a unique blend of nursing and
public health practice woven into a human service that is properly developed and applied by which has a
tremendous impact on human well being. Thus, taking this into consideration makes its roles and
responsibilities a tremendous mix of art and science, too.
Basing on the concepts of the community public health nursing, the following roles and responsibilities
are described below:
Roles and Responsibilities of a Community Health Nurse
1. The main focus of community health nurse is health promotion.
Programmer/Planner
• Identifies the needs and concerns of individuals, groups, families, and the community
• Formulates health plans, especially in the absence of a community physician
• Interprets and implements nursing plans and programs
• Assists other health team members in implementing health programs in the setting
Health Educator/Trainer/ Counsellor
• Acts as resource speaker on health and health related services
• Advocates health programs in the community through dissemination of IEC or Information Education
and Communication materials
• Conducts advocacy educations concerning premarital, breastfeeding, and immunization counsellings
• Organizes orientation/ training of concerned groups like pregnant mothers
• Identifies and interprets training needs of health team members and formulate appropriate training
program for them
• Conducts and facilitates necessary training or educational orientation to other health team members
in the community
2. The recipient of care of community public health nursing practice is extended not only the individual but
also to benefit the whole family and community.
Community Organizer
•Promotes self- reliance of community and emphasizes their involvement and participation in planning,
organizing, implementing and evaluating of health services
•Initiates and implements community development activities
Coordinator of services
Coordinates health services with concerned individuals and families through the community health
team members, government organizations and non- government organizations
Coordinates nursing plans and programs with other health programs
3. Community health nurse are generalists in terms of their practice through life's continuum.
Provider of Nursing Care
■Renders direct care to various clients with different needs, may it be at home, in school, clinics or work
settings
■Involves the family in the care of the sick or dependent individual, i.e. sick child
4. Continuity of care with the client, family or and the community extends for a longer time involving
individuals of all ages and health needs.
Health Monitor
Monitors and detects presence of health concerns in the community through contacts or home visits.
Utilizes various effective data gathering techniques in keeping an eye on the health status of all
recipients of care.
Records and reports health status and presence of health problems in the community
5. The nature of nursing practice in the community needs the knowledge of biological and social sciences,
ecology, clinical nursing, and community organizing, for it to be effective.
Researcher
Follows a systematic process of monitoring the health status of the community through the conduct of
surveys and home visits
Conducts researches concerning the health of the community
Coordinates with government and non- government organizations in the conduct and implementation
of studies
Statistician
■Records data systematically and ensures its validity through accurate and complete data gathering
Reports prepared reports to concerned organizations i.e. government organization for immediate
necessary plans or programs
Consolidates and reviews reports efficiently.
Analyzes and interprets consolidated data for monitoring the development in the health matters of the
whole community
6. This field of nursing practice utilizes a dynamic process (assessment, planning, implementation, and
evaluation) in the provision of continuous care until termination is implicit.
Change Agent
Promotes and motivates change in the community in their health practices and lifestyle behaviours for
them to promote and maintain good health, be knowledgeable and has initiative in accessing health
services
Inculcates self- reliance to brought about development and improvement in the community
My apologies for I only have included a short list of the roles and responsibilities. A community health
nursecould still develop other sorts of roles while working in the setting. It may not be evident because of its
vast and intricate tasks. What is important is the impact it produces in those individuals who needed the care
of a community health nurse.
Paper works, like the graphs and pie charts shown the community health center are not enough to say that
a nurse accomplished her work because a much bigger responsibility is laid in front of her - the community. So,
despite the short description of the roles and responsibilities of community public health nursing my hopes
are up that some of us would like to be one, too or if not, recognize the hardships and efforts of our own nurses
in the community in delving with the issues in health in the community.
Community Health Nursing Career Overview
in Nursing
A community health nursing is a specialty of nursing generally focused on providing care to the general public,
often in venues that cater to low-income people who have minimal or no health insurance.
If you become a community health nurse, you will mostly work in medical clinics or for neighborhood health
care providers who provide free care to those in need.
In addition, you will refer them to other facilities that can better handle specific issues. These referrals may be
to clinics that specialize in areas such as podiatry or pediatrics or to counseling or mental health care
organizations. If a patient cannot physically make it to a clinic, you may visit the patient's home to provide care.
You will also play the role of an educator talking to individuals and groups on the benefits of healthy living and
how to best address common problems, such as substance abuse, obesity and diseases caused by improper
food handling or lack of sanitary conditions. You will instruct communities on home nursing and childcare and,
whenever needed, you will refer patients to sources that are known to provide free or reduced cost medications.
A community health care nurse also commonly provides prenatal care to pregnant women. He is often the main
medical advisor for expectant mothers with no medical insurance who have no regular medical doctor to guide
them through their pregnancies.
In order to become a community health nurse, it is important to get a college degree in nursing so you can
become a registered nurse (R.N.).
MODULE 2
Universal health coverage means that all people have access to the health services they need, when and where
they need them, without financial hardship. It includes the full range of essential health services, from health
promotion to prevention, treatment, rehabilitation, and palliative care.
• UHC strategies enable everyone to access the services that address the most significant causes of disease and
death and ensures that the quality of those services is good enough to improve the health of the people who
receive them.
Monitoring progress towards UHC should focus on 2 things:
• The proportion of a population that can access essential quality health services (SDG 3.8 1)
• The proportion of the population that spends a large amount of household income on health (SDG 3.8.2).
Measuring equity is also critical to understand who is being left behind-where and why.
• Together with the World Bank, WHO has developed a framework to track the progress of UHC by monitoring
both categories, taking into account both the overall level and the extent to which UHC is equitable, offering
service coverage and financial protection to all people within a population, such as the poor or those living in
remote rural areas.
WHO is supporting countries to develop their health systems to move towards and sustain UHC. And to monitor
progress. But WHO is not alone.
WHO works with many different partners in differen situations and for different purposes to advance UHC
around the world.

Some of WHO’s partnerships include:

• UHC2030
• Alliance for Health Policy and Systems Research
• P4H Social Health Protection Network
• UHC Partnership
• Primary Health-Care Performance Initiative
WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage in
countries:
1. Reproductive, maternal, newborn and child health:
• family planning
• antenatal and delivery care
• full child immunization
• health-seeking behavior for pneumonia..
2. Infectious diseases:
• tuberculosis treatment
• HIV antiretroviral treatment
• use of insecticide-treated bed nets for malaria prevention
• adequate sanitation.
3. Noncommunicable diseases:
• prevention and treatment of raised blood
• pressure prevention and treatment of raised blood glucose
• cervical cancer screening
• tobacco (non-)smoking. .
4. Service capacity and access:
• basic hospital access
• health worker density
• access to essential medicines.
• health security. Compliance with the International Health Regulations.
On 25-26 October 2018, WHO in partnership with UNICEF and the Ministry of Health of Kazakhstan hosted the
Global Conference on Primary Health Care, 40 years after the adoption of the historic Declaration of Alma-Ata.
• Ministers, health workers, academics, partners and civil society came together to recommit to primary health
care as the cornerstone of UHC in the bold new Declaration of Astana.
The Declaration of Astana aims to renew political commitment to primary health care from governments, non-
governmental organizations, professional organizations, academia and global health and development
organizations.

UNIVERSAL HEALTH CARE LAW

• Was signed on February 20, 2019
• REPUBLIC ACT No. 11223. Universal Health Care Act
The fund sources that can be tapped to finance the implementation of the UHC Act:
a. Increasing revenues from tobacco, alcohol, sugar-sweetened beverages taxes
b. Funds from Philippine Charity Sweepstakes Office (PCSO), Philippine Amusement and Gaming Corporation
(PAGCOR), and Department of Health Medical. Assistance Program (DOH MAP), etc.
c. Annual appropriations of the DOH
d. Proposed increased premium rates and collection efficiency in Philhealth
e. Supplemental funding
The 3 C’s of Universal Health Care Coverage
1. Centeredness Patient’s families and communities with:
• Equitable access to needed services by overcoming financial, physical, information and sociocultural barriers
in access
• Information, skills and knowledge to enable informed decision-making and control over own health and health
care (health literacy)
• Acceptable care of appropriate quality by serving the whole person, ensuring privacy/confidentiality, safety
and efficacy of care.
For example, through:
• Assessments that unpack community health needs and related barriers to services
• Prioritizing accessible and acceptable modalities of service delivery through outreach, mHealth, peer services
and integration of traditional practitioners
• Service organization to ensure convenience e.g. opening times
• Providing a safe and welcoming physical environment supportive of diversity, privacy and dignity
 2. Continuity
Health Organization with:
• Well-defined and targeted service delivery packages that incorporate needs and preference of disadvantaged
groups (e.g. diseases of the poor)
• Modalities of service delivery that facilitate continuity of care for disadvantaged groups e.g. action to address
loss to follow up
• Referral pathways in all directions (up, down, across) that take into account barriers faced by disadvantaged
groups
For example, through:
• Monitoring pathways to identify barriers faced by disadvantaged groups
• Mechanisms for participatory planning (systematic engagement of patients, families and communities in
health service development)
• Mechanisms to work with other sectors on the social determinants of health equity
• eHealth solutions to facilitate equity-focused integration of services,e.g electronic medical records
• Strengthening appropriate connections between health financing and other social protection schemes

3. Competence
• Health workers with: Technical/ clinical competence in diseases affecting disadvantaged groups, in ethical and
legal obligations when addressing issues related to disadvantaged groups etc.
• Social competence (communication, team work with other health workers/programmes and other sectors to
ensure care coordination and continuity, non discrimination, sensitivity to gender, age, ethnicity)
• Understanding of a holistic approach to health care; respect for patients and their decisions at the clinical level
and respect for communities at the population health level
• Skills to build partnerships with communities, to engage and build peer support networks
For Example, through: • Access to pre- and in-service training that aims to strengthen the above competences
• Employment and remuneration conditions, staff performance evaluations and career progression that
incentivize equity-enhancing behaviour and skill
• Organizational leadership that set the expectation for respectful care
• Upgrading provider skills to reflect the changing health needs, or introduction of new cadres of health care
workers, or integration of village community health workers.
How can decentralization work for UHC?
• Need to clearly identify the role delineation between national and local governments
• Need to consolidate local governments to reduce inefficiencies and transactions cost in health through referral
systems, pooling of resources, complementation with other social services
• Need to adequately license, regulate, supervise and engage private sector providers
• Need to support the devolution of powers and functions with adequate financing (intergovernmental
transfers)
• Need to institutionalize accountability mechanisms
MODULE 3
Family Health Assessment
In the family health nursing, this involves a set of actions by which the nurse measures the status of the family
as a client, its ability to maintain itself as a system and functioning unit, and its ability to maintain wellness,
prevent, control and resolve problems in order to achieve health and well-being among its members.
Data about the present condition or status of the family are compared against norms or standards of personal,
social and environmental health, system integrity and ability to resolve system problems.
These norms or standards are arrived from values, beliefs, principles, rules or expectation.
Nursing Assessment includes data collection, data analysis or interpretation and problem definition or nursing
diagnosis.
These are:
1. First-level assessment is a process whereby existing and potential health conditions or problems are
categorized as:
a. Wellness state
b. Health threats
c. Health deficit
d. Stress points or foreseeable crisis situation
2. Second-level assessment is defines the nature or type of nursing problems that the family encounters in
performing the health tasks with respect to a given health condition or problems and etiology or barriers to the
family’s assumption of these task.

Steps in family Nursing Assessment

There are three major steps in nursing assessment as applied to family nursing practice Data collection for first
level assessment involves gathering of five types of data which will generate the categories of health conditions
or problems of the family. These data include.
1. Family structure, characteristics and dynamic include the composition, demographic data or the members of
the family/household, their interaction relationship to the head and place of residence, the type of, and family
/communication and decision-making patterns and dynamics
2. Socio-economic and cultural characteristic include occupation, place of work and income of each working
member; educational attainment of each family member; ethnic background and religious affiliation; significant
others and the role they play in the family’s life. The relationship of the family to the larger community
3. Home environment included information on housing and sanitation facilities; kind of neighborhood and
availability of social, health, communication and transportation facilities in the community
4. Health status of each member includes current and past significant illness; beliefs and practices conducive to
health and illness; nutritional and development status; physical assessment findings and significant results of
laboratory/diagnostics/screening procedures
5. Values and practices on health promotion/maintenance and disease prevention include use of preventive
services; adequacy of rest/sleep, exercise. Relaxation activities. Stress management of other healthy lifestyle
activities, and immunization status of at-risk family members.

Second-level assessment data include:

1. Specify or describe the family’s realities
2. Perceptions about and attitudes
3. Performance of health task on each health condition or problem identified during the first level assessment
Data Gathering Methods and Tools
There are several methods of data gathering that the nurse can select from depending on the availability of
resources such as materials, manpower, time and facilities.
The critical point in the choice is concern for validity, reliability and adequacy of assessment data. Poor quality
inaccurate and inadequate data can lead to inaccurately defined health and nursing problems which, in turn,
lead to a poorly designed family nursing care plan.
The following are brief description of common methods of gathering data about a family, its status and state of
functioning;
1. Observation- this method of data collection is done through the use of the sensory capacities sight, hearing,
smell and touch. Through direct observation the nurse gathers information about family’s state of being and
behavioral responses. The family’s health status can be inferred from the signs and symptoms of the problem
areas reflected in the followings
a. Communication and interactions pattern expected, used and tolerated by family members
b. Role perceptions/task assumptions by each member, including decision making patterns
c. Conditions in the home and environment
2. Physical Examination- significant data about health status of individual family members can be obtained
through direct examination. This is done through inspection, palpation, percussion, auscultation, measurement
of specific body parts and reviewing the body system. It is essential for the nurse to have the skills in performing
physical assessment / appraisal in order to help the family be aware of the health status of its member.
3. Interview – another major method of data gathering is the interview.
a. One type of interview is completing a health history for each family member.
b. Second type interview is collecting data by personally asking significant family members or relatives questions
regarding health, family life experiences and home environment to generate data on what wellness condition
and health problems exist in the family (first level and second level of assessment)

4. Record Review- the nurse may gather information through reviewing existing records and reports pertinent
to the client. These include the individual clinical records of the family members, laboratory and diagnostic
reports, immunization records, report about home and environmental conditions or similar sources.
5. Laboratory /Diagnostic Test- another method of data collection is through performing laboratory tests,
diagnostic procedures or other tests of integrity and function carried out by the nurse herself and for other
health workers.
Data Analysis
Utilizing the data generated from the tool on initial base in family nursing practice, the nurse goes through data
analysis. She sort out and classify or group data by type or nature (e.g., which are wellness states, threats,
deficits or stress points/foreseeable crisis. She relates them with each other and determines patterns or
reoccurring themes among data. She then compares these data and the patterns or reoccurring themes with
norms or standards.
Data Analysis involves several sub-steps:
1 Sorting of data for broad categories such as those related with health status or practices of family members
or data about home and environment
2. Clustering of related cues to determine relationships between and among data
3. Distinguishing relevant from irrelevant data to decide what information is pertinent to understanding the
situation at hand and what information is immaterial.
4. Identifying patterns such as physiologic function, developmental, nutritional /dietary, coping/adaptation or
communication pattern and lifestyle
5. Comparing patterns with norms or standards of health, family functioning and assumption of health task
6. Interpreting results of comparisons to determine signs, symptoms or cues of specific wellness state. Health
deficit, health threats or foreseeable crisis/s/stress point and their underlying causes or associated factors
7. Making inferences or drawing conclusions about the reasons for the existence of the health condition or
problems or risks for non-maintenance of wellness state which can be attributed to non performance of family
health tasks.