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History of public health

Roman
Ancient Civilization Western Renaissance
Pre-Historic Greeks
Egyptians Civilization Period
Or
Middle Ages

Future 20th Century 1900s 1800s 15th Century

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 Pre-historic
SHAMANS

Medicinal Herbs
Amulets
Ceremonies

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 Pre-historic
•Trepanning

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ANCIENT EGYPT

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ANCIENT EGYPT

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 greeks

•Greek physicians were

revered by society.

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 greeks

ARISTOTLE SOCRATES PYTHAGORAS

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 greeks
Four Humors
1. Phlegm
2. Blood
3. Yellow Bile
4. Black Bile

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ROMANS

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 ROMANS
Black Plague/Bubonic Plague

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1577
• Franciscan Friar
Juan Clemente

• Medical Dispensary

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1690
• 1690- Dominican
Father Juan de
Pergero worked
toward installing a
water system in San
Juan del Monte and
Manila
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1805
Dr. Edward Jenner
• pioneered the process of
vaccination or immunization.

• Father of Immunology.

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 Colonial Period
Edwin Chadwick
• Secretary of the England’s Poor Law
Commission

• Wrote “Report on the Inquiry into

Sanitary Condition’s Study of the
Laboring Population of Great Britain

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 Colonial Period
John Snow
• Father of Epidemiology

• He elucidate how Cholera was

transmitted.

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 Florence Lilian Wald
Nightingale
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Robert Koch Louis Pasteur
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• 1876- The first Medicos
Titulares was appointed by
the Spanish Government

• 1901- The United States Philippine Commission, through Act

157, created the Board of Health of Philippine Island with a
commissioner.

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1905
• 1905- La Gota de Leche was established by the
Associacion de Feminista Filipina.

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• 1912- The Fajardo Act created Sanitary
Divisions with 1-4 municipalities.

• 1915- The PGH began to extend public

health nursing services in the homes of
patients and called it Social and Home
Service.

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• Puericulture centers, Municipal and Charity Clinics were also set up
manned by a physician, nurse or midwife.

• 1947- the DOH was reorganized into bureaus.

• 1954- Congress passed RA 1082 ( Rural Health Act)- that created the
Rural Health Unit in every Municipality.

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✓ Primary
✓ Secondary
✓ Tertiary

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• 1991- RA 7160/ Local Government
Code was enacted. Mandated
the devolution of basic health
services to LGU.

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• 1999- Launched the Health
Sector Reform Agenda for
the implementation of
FOURmula One (F1) for
health in 2005 and Universal
Health Care in 2010

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• 2000- Philippines
committed itself to
the United Nations
Millennium
Declaration.

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Questions & answers
Invite questions from the audience

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This Photo by Unknown Author is licensed under CC BY-SA

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LEVELS OF CLIENTELE

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 LEVELS OF CLIENTELE

The Family is considered the basic unit of

care in the community.

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 COMMUNITY
HEALTH NURSING
Philosophy:

worth and
Is based on the
dignity of man.
(Dr. Margaret Shetland)

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 COMMUNITY
HEALTH NURSING
Concepts:
1. The primary focus of CHN practice is on health
promotion.

2. CHN practice is extended to benefit not only the

individual but the whole family and community.

3. CH nurses are generalists.

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 COMMUNITY
HEALTH NURSING

Concepts:
4. Contact with the client and/or the family may
continue over a long period of tie which include all
ages and all types of health care.

5. The nature of CHN practice requires current

knowledge.
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 COMMUNITY
HEALTH NURSING

Concepts:
6. The dynamic process of assessing, planning,
implementing and intervening provide periodic
measurements of progress, evaluation and
continuum of the cycle until the termination of
nursing is implicit in the practice of CHN.

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 COMMUNITY
HEALTH NURSING

To help communities and families to cope

with the discontinuities in health
threats.

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 COMMUNITY
HEALTH NURSING

Objectives:
1. To participate in the development of an over-all health
plan for the community and its implementation and
evaluation.

2. To provide quality nursing services to individuals,

families and communities as basis, the standards set for
CHN practice
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 COMMUNITY
HEALTH NURSING
Objectives:
4. To coordinate nursing services with various
members of the health team, community leader
and significant others, government and non-
government agencies/organization in achieving the
aims of public health services within the
community.

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 COMMUNITY
HEALTH NURSING
Objectives:
4. To participate in and/or conduct researches relevant to
community health and CHN services and disseminate
their results for improvement of health care.

5. To provide CHN personnel with opportunities for

continuing education and professional growth through
staff development.
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 COMMUNITY
HEALTH NURSING

Basic Principles:
1. The community is the patient in CHN. The family is the unit of
care.
2. In CHN, the client is considered as an Active partner not
Passive recipients of care.
3. CHN practice is affected by developments in health technology.
4. The goal of CHN is achieved through multi-sectoral efforts.
5. CHN is a part of health care system and the large human
services system.
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 COMMUNITY
HEALTH NURSING
Roles of the PHN:
1.Clinician
2.Health Educator
3.Facilitator
4.Supervisor
5.Heath Advocate
6.Collaborator
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 COMMUNITY
HEALTH NURSING

Specific Responsibilities of a Nurse:

• IRR of RA 7164 (Philippine Nursing Act of 1991):
• Supervision and care of women during pregnancy,
labor and puerperium.
• Performance of IE and delivery of babies
• Suturing lacerations in the absence of s physician.
• Provision of first aid measure and emergency care
• Recommending herbal an symptomatic medicines.
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 COMMUNITY
HEALTH NURSING

In the care of the families:

• Provision of primary health care services
• Developmental/Utilization of family
nursing care plan in the provision of care.

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 COMMUNITY
HEALTH NURSING

In the care of the communities:

• Community Organizing mobilization, community
development and people empowerment.
• Case finding and epidemiological investigation
• Program planning, implementation and
evaluation.
• Influencing executive and legislative individuals or
bodies concerning health and development.
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 COMMUNITY
HEALTH NURSING

Responsibilities of CHN:
• Be a part in developing an overall health plan, it’s
implementation and evaluation for communities.
• Provide quality nursing services to the levels of
clientele.
• Maintain coordination or linkages with other health
team members, NGO, government agencies in the
provision of public health services.
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 COMMUNITY
HEALTH NURSING

Responsibilities of CHN:
• Conduct researches relevant to CHN services to
improve provision of health care.
• Provide opportunities for professional growth and
continuing education for staff development.

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 VITAL STATISTICS
Birth Rate 20.377 births/1,000 people

Death Rate Number of death/1,000 people

Neonatal Mortality Rate Number of neonatal deaths/1,000 births

Infant Mortality Rate Number of infant deaths/1,000 live

births
Child Mortality Rate Number of child deaths/1,000 live births

Maternal Mortality Rate Number of maternal deaths/100,000

live births
Life Expectancy 71.1 years
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In 2006, the country’s total fertility rate was at 3 births
per woman, a slight decline from the 2003 rate of 3.5
(FPS 2006). However, of the three million pregnancies
that occur each year, half were unplanned, of which, one-
third end in abortions. Young women accounted for 17
percent of this (Allan Guttmacher Institute). Induced
abortion is one of the leading causes of maternal deaths
in the country.

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 INTRODUCTION

•The term, “Community Health Nursing” is

composed of 3 major concepts:
Community Client
Health Goal
Nursing the means

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 COMMUNITY

• A collection of people who interact with one another and whose

common interests or characteristics form the basis for a sense of unity
or belonging. ( Allender et al 2009)

• A group of people who share something in common and interact

with one another, who may exhibit a commitment with one another
and may share a geographic boundary. ( Lundy and Janes, 2009)

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 COMMUNITY
• A group of people who share common interests, who interact with
each other, and who function collectively within a defined social
structure to address common concerns. (Clark, 2008)

• A locality-based entity, composed of systems of formal organizations

reflecting society’s institutions, informal groups and aggregates. (
Shuster and Goeppinger, 2008)

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 COMMUNITY

4 Defining Attributes( Maurer and Smith, 2009)

1. People
2. Place
3. Interaction
4. Common Characteristics, Interests or Goals

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 2 TYPES OF COMMUNITY

Geopolitical

Phenomenological

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 COMMUNITY

• Population- Refer to all the people in a defined

community.

• Aggregate- are subgroups or subpopulations that

have common characteristics or concerns.

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 HEALTH

•A state of complete physical,

mental, and social well being and
not merely the absence of disease
or infirmity. (WHO, 1958)

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DETERMINANTS OF HEALTH

1. Genetics
2. Gender
3. Personal behavior
and coping skills
4.Education
5. Income and Social
Status
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 DETERMINANTS OF HEALTH

6. Culture
7. Health Services
8. Employment and
Working conditions
9. Physical Environment
10.Social Support
Network
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 INDICATORS OF
HEALTH AND ILLNESS

•Disease Incidence Rates

•Infant Mortality Rate
•Maternal Mortality Rate
•Leading Causes of Morbidity
•Leading Causes of Mortality
•Life Expectancy
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NURSING

Nursing is the interaction

and relationship of person
with the environment to
attain health and improve
human well-being.
-Imogene King-
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 NURSING

“A significant, therapeutic,
interpersonal process. It functions
cooperatively with other human
processes that makes health
possible for individuals in
communities”
( Hildegard Peplau)
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 PUBLIC HEALTH

Is the science and art of preventing disease,

prolonging life and promoting health and
efficiency through organized community effort.

(C.E. Winslow)

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 PUBLIC HEALTH

“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.”
-WHO

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 OBJECTIVES OF
PUBLIC HEALTH

1. Control Communicable Diseases

2. Organization of Medical and Nursing Services
3. Development of Social Machinery
4.Education
5. Sanitation of the Environment

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PUBLIC HEALTH

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 PUBLIC HEALTH
NURSING

• PHN was coined by Lilian Wald.

• The term Public Health Nursing

became associated with “public” or
government agencies and in turn
with the care of the poor people.

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 PUBLIC HEALTH
NURSING

“A special field of nursing that combines 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 -

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 PUBLIC HEALTH
NURSING
• Public Health Nurses (PHNs) refer to the nurses in the
local/national health departments or public schools whether their
official position title is PHN/Nurse /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). It is the community health nursing
practiced in the public sector.

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 COMMUNITY
HEALTH NURSING

“A 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)

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 COMMUNITY
HEALTH NURSING

“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.”
Magalaya, et al.
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 COMMUNITY
HEALTH NURSING

The synthesis of nursing practice and public health

practice applied to promoting and preserving the
health of the population.
(ANA, 1980)

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 COMMUNITY
HEALTH NURSING

“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)
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 COMMUNITY
HEALTH NURSING
Sub-Specialities of CHN:
• Public Health Nursing
• School Health Nursing
• Occupational Health Nursing
• Home Health
• Hospice Care

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 FIELDS OF COMMUNITY
HEALTH NURSING

• Home Health Care •Hospice Home Care

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 COMMUNITY
HEALTH NURSING

GOAL:
To preserve the health of the community by
focusing on health promotion, health maintenance
and disease prevention of individuals, families and
groups within the community.

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 COMMUNITY
HEALTH NURSING

1. Health Promotion- behavior that is motivated by the desire to

increase well-being and to reach the best possible health potential.

2. Health Maintenance- behavior that maintain current wellness

state.

3. Disease Prevention- activities/ behavior that protect people from a

disease and the effects of the disease.

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 COMMUNITY
HEALTH NURSING
LEVELS OF PREVENTION:

1. Primary Prevention- activities directed at preventing a problem

before it occurs.

2. Secondary Prevention- refers to early detection and prompt

intervention during the period of early disease pathogenesis.

3. Tertiary Prevention- targets population that have experienced

disease or injury and focuses on limitation of disability and rehabilitation.
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 COMMUNITY
BASED NURSING
• Community Based Nursing is setting-specific, and the
emphasis is on acute and chronic care and includes
practice areas such as home health nursing and
nursing in outpatient or ambulatory settings.

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 FEATURES OF
CHN PRACTICE

1. Hallmark of CHN is that it is population or

aggregate focused.
2. Approach to health is preventive and
promotive.
3. Nurses care for different levels of clientele.
4.Developmental in nature.
5. Synthesis of Nursing and Public Health
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