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PREFACE

This learning packet is designed to assists students understand the concepts, theories, and
principles, and techniques in the provision of basic care in terms of health promotion, disease
prevention, restoration and maintenance and rehabilitation at the individual and family level. It
incorporates learning activities that will help students meet the objectives with the corresponding
textbook chapter.

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NCM 104 COMMUITY HEALTH NURSING (INDIVIDUAL AND FAMILY)

Prepared by: BEGONIA C. YBOA, MAN

CONTENT
I. Overview of Public Health Nursing in the Philippines
II. Global and National Health Situations
1.1. Definition and Focus
1.2. Public Health
1.3. Community Health
1.4. Public Health Nursing
1.5. Community Health Nursing (CHN)
1.6. Standards of Public Health Nursing in the Philippines
1.7. Evolution of Public Health Nursing in the Philippines
1.8. Roles and Responsibilities of a Community Health Nurse

INSTRUCTIONS:
This COURSE is divided into 4 learning packets (2 midterm period, and 2 final Period). It is
important for the student to acquire a textbook (see requirements). Access to the internet is
advantageous but in its absence, any Maternal and Child Health Nursing book will suffice. Each
topic includes an overview about the topic, along with student learning objectives. Self-assessment
questions and activities (SAQA) are provided. It is required that students answer all SAQA and
Related Learning Experience (RLE) Activities (RLEA). Answers should be handwritten on a
separate notebook/journal. Students should acquire 4 (or more) blue cattleya notebooks/journals for
the whole semester (4learning packets/semester). It is important that students accomplish the reading
activity before proceeding with the text/discussion. All activities in SAQA should be answered since
this will be included as a summative evaluation of student’s performance. Submission of activity
notebook will be a week after posting. Students should take note of the scheduled retrieval of
notebooks/journals. Late submission is tantamount to failing or incomplete grade for the
corresponding learning packet.

GRADING SYSTEM:

Major Examination - 40%

Summative Quiz - 25%
Class Participation - 15%
Term Project/Requirements - 20%

Overview of Public Health Nursing in the Philippines:

Global and National Health Situations

On 5 August 2021, the cumulative number of COVID-19 cases globally surpassed 200
million, just six months after reaching 100 million cases. This week alone, over 4.2 million
new cases and over 65 000 new deaths were reported, a slight increase as compared to the
previous week. The largest proportionate increases in new cases were reported by the Region
of the Americas (14%) and Western Pacific Region (19%), with 1.3 million and over 375 000

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new cases reported, respectively. Additionally, a substantial increase (46%) in the number of
new deaths was reported this week in the Western Pacific Region. Of the 228 Member States
and territories, 38 (17%) reported more than a 50% increase in new cases as compared to the
previous week and 34 (15%) reported a more than a 50% increase in new deaths.

Philippines: COVID-19 as a Public health crisis

COVID-19 on South East Asia
Coronabrief | Created by Dr. RJ Naguit
The COVID-19 pandemic exacerbates the long-standing symptoms of a weak and inequitable
public health system in the Philippines. A densely populated capital, widespread socioeconomic
disparities and inept infrastructure have made the country an epidemiological disaster waiting to
happen. Like any other country whose health system has been put to the test, the Philippines, with its
relatively ill-equipped health system, is expected to be overwhelmed with the surge of COVID-19
cases. A shortage of hospital beds in regular as well intensive care, mechanical ventilators and masks
are among the most pressing issues in an archipelago country of 100 million people.

Days after the announcement of a lockdown, it became evident that action plans and
centralized power alone would not be enough to ensure social protection for all Filipinos. For civil
society groups, it was a call to take a more active role in addressing the pandemic.

Without intending to romanticize the concept of resilience, Filipinos have always been
known to pull through environmental hazards and humanitarian crises that regularly plague the
country. This pandemic is no exception. To help mitigate the impact, decentralized arrangements
between corporations and workers have been made. Some are providing continuous payment and are
moving to flexible work schemes, while others are directly offering cash assistance to employees.
Less optimal short-term fixes, which provide immediate relief but are not certain to benefit workers
in the long run, range from releasing workers’ thirteenth-month pay to utilization of leave credits
during the period of quarantine.

Innovation and resourcefulness

In the face of the rapidly unfolding COVID-19 crisis, improvising, local initiatives and creative
innovations are the call of the hour. They are key to address the lack of personal protective
equipment (PPE), testing kits and critical infrastructure. Scientists from the National Institute for
Health developed a local antigen-based screening test kit that lowered the cost and reduced
turnaround time for results. Students from the University of the Philippines released models for
sanitary tents, which were adopted by local government units. Due to the supply shortage of PPE,
workers in the garment industry developed a design for masks, together with infectious disease
specialists, and temporarily converted their workspace into a makeshift mask factory. Local
communities in villages started assembling face shields made from everyday materials.

Social rearrangements as windows of solidarity

It is truly inspiring to see how many innovations in terms of social solidarity are emerging, which are
equally important as technological innovations. Schools, hotels and event places have opened up
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their spaces to cater to patients with mild symptoms of COVID-19. Cafes and dormitories have
opened to accommodate front-liners and people who are homeless. Various individuals have started
fundraising programmes for the relief of marginalized groups, developed databases to match donors
and those who need assistance and volunteered in government relief efforts. Professionals in
different fields are also offering free online consultations via social media platforms.

Stigma and discrimination against underpaid, overworked front-liners

While most people respond to the pandemic with a strong sense of solidarity, public anxiety over the
spread of the virus has led to the emergence of discriminating acts against front-liners. Because they
are highly susceptible to the virus, some front-liners have been evicted from their boarding house,
have been prevented from buying food and, at times, subject to violence. A nurse in the southern
Philippines was splashed with a corrosive disinfectant by five men. In Quezon City, an ambulance
driver was shot in his hand after being accused of transporting COVID-19-positive patients.

Despite the risk to their personal or family’s health and poor compensation, health care workers
bravely continue going to work.

Any public health crisis is essentially about social justice

Comprehensive health care, even in normal times, is prohibitively expensive and out of reach for
many people in the Philippines. Filipinos shoulder more than half of their total health expenses out of
pocket. An estimated 1 million people are driven into poverty every year because of health-related
expenses. And 6 out of 10 people in the Philippines die without seeing a doctor.

Social justice is at the bottom of any public health crisis. Civil society in the Philippines has taken on
much of the burden, performing tasks that urgently need to be addressed by the government, such as
fundraising for more PPE and tests, securing front-liners’ welfare and ensuring food supply and
distribution. The big gap in this crisis is yet to be filled with the State’s response. Hands-on civil
society initiatives grounded in solidarity and justice continue to be an important source of hope at
this decisive point in time. https://asia.fes.de/news/philippines-covid-19-as-a-public-health-crisis

SAQA-1
What are your perceptions/views regarding the following:
1. Government’s efforts and strategies in handling the Covid crisis in the Philippines
2. The plight of health workers.
3. Cite personal experiences about the Covid pandemic.
Criteria for rating
Ideas : 50%
Organization : 25%
Sentence and fluency : 25%

PUBLIC HEALTH
 Public health is the science of protecting and improving the health of people and their
communities. This work is achieved by promoting healthy lifestyles, researching disease and
injury prevention, and detecting, preventing and responding to infectious diseases.

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 Overall, public health is concerned with protecting the health of entire populations. These
populations can be as small as a local neighbourhood, or as big as an entire country or region
of the world.
https://www.cdcfoundation.org/what-public-health

PUBLIC HEALTH NURSING

 Is the practice of promoting and protecting the health of populations using knowledge from
nursing, social, and public health sciences.
o Public health nursing is a systematic process by which:
o The health and health care needs of a population are assessed in order to identify
subpopulations, families and individuals who would benefit from health promotion or
who are at risk of illness, injury, disability or premature death.
o A plan for intervention is developed with the community to meet identified needs that
take into account available resources, the range of activities that contribute to health
and the prevention of illness injury, disability, and premature death.
o The plan is implemented effectively, efficiently and equitably.
o Evaluations are conducted to determine the extent to which the intervention has an
impact on the health status of individuals and the population.
o The results of the process are used to influence and direct the current delivery of care,
deployment of health resources, and the development of local, regional, state, and
national health policy and research to promote health and prevent disease.

Key Concepts of Community and Public Health Nursing

1. The community as a client
 A group of people living in particular area with common beliefs, values and traditions
 Two attributes
o With geographic boundaries
o With shared belief system or culture
2. Health as a goal
 More than a state of well-being
 Multidimensional reality that includes socioeconomic, environmental, and even political
factors
3. Nursing, as a vehicle or means to achieve its aims
 A body of knowledge grounded on the works of nursing theorists or philosophers.

COMMUNITY AND PUBLIC HEALTH NURSING (CPHN)

Community Health Nursing

 Specialized field of nursing practice that renders care to individuals, families, and
communities; focusing on health promotion and disease prevention through people
empowerment
 Priorities are focused on efforts to help people reduce their risks from developing disease,
and preventive measures like vaccination and screening activities for certain diseases for
early detection.
 Includes enabling people in the community the opportunity to do things on their own to
maximize wellness.

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 The synthesis of nursing and public health practice applied to promote and protect the health
population. It combines all the basic elements of professional, clinical nursing with public
health and community service.

Fields of Community and Public Health Nursing

1. Occupational health nursing
 The practice focuses on promotion and restoration of health, prevention of illness and injury,
and protection from work-related and environmental hazards.
2. Faith community nursing
 is a specialized practice of professional nursing that focuses on the intentional care of the
spirit as well as on the promotion of holistic health and prevention or minimization of
illness within the context of a faith community
3. Correctional nursing
 Correctional nursing, sometimes called forensic nursing, is a specialized field of nursing that
involves caring for the medical and mental health needs of detainees and inmates. These
nurses work in a variety of settings such as jails, prisons, and juvenile detention centers.
4. School health nursing
 A specialized practice of professional nursing that advances the wellbeing, academic
success, and life-long achievement of students.

Characteristics and features of Community and Public health Nursing (CPHN)

1. CPHN is developmental
 Nurses in community/public health work believe that individuals, families and population of
groups are primarily responsible for their health. Health education is a primary activity that
nurses incorporate in all public health activities and interventions as an approach to help
people acquire knowledge and skills and ultimately instil health consciousness among them.
2. CPHN is multidisciplinary
 The nurse fosters collaboration with different professionals and sectors from society.
3. CPHN is ecology oriented
 Includes the subfields of community and public health nursing
 Nursing care outside of the hospital but on the field of practice is about nursing care outside
of the hospital but on the field where the people are
4. CPHN promotes social justice
 Health is a human right and all people should enjoy access to health care
 Regardless if age, sex, creed or religion people should enjoy health care services in the
community
5. CPHN values consumer involvement
 Patients are considered partners in health
 The need for patients to be responsible for their own health hence the active participation of
communities are essential in all levels at all stages
6. CPHN uses prepayment mechanism
 Services provided by public health system are not give for free. It is funded by taxes of the
people, Hence, healthcare is a basic social service that should be provided by the state to all
people.
7. CPHN focuses in preventive services

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 The community had public health nurse are in constant search of risks they make people
vulnerable to disease and implements interventions to modify and mitigate these
vulnerabilities.
8. CPHN offers comprehensive care
 This field requires the nurse to be skilled and knowledgeable on the bora dares of nursing
 Holistic care is expected in delivering health services
 The practice of the nurse in the community offers several opportunities to help individuals
families, and groups realize their birth right to health and longevity

Philosophical and Ethical Underpinnings

 The practice of CPHN is anchored on the primacy of worth and dignity of man (Margaret
Shetland)
 Respects of people’s inherent value regardless of their background and beliefs are edified in
the universal bioethical principles
 The right to health of all people ( UN declaration of 1948)
 The responsibility for health rests primarily on people and not agencies or professionals

SAQA-2
Explain the principle stated below (100 words or more). Criteria for rating.
Ideas : 50%
Organization : 25%
Sentence and fluency : 25%

“A fundamental commitment of community and public health nurse is to adhere to the tenets
of social justice.”

Roles of the Community and Public Health Nurse

1. Healthcare Provider
 The use of the nursing process applied in the natural environment of the client
pertains to this role
2. Health Educator
 Communicating information to help patients make an informed choice regarding their
health is a key activity in public health work
3. Program Implementer
 Nurses working under local government units deliver healthcare to the grassroots.
This also requires that programs initiated by the national government thru the
Philippine department of Health (DOH).
4. Community Organizer
 Working with people in communities and providing them ownership of their
healthcare needs and to act collectively on their issues is best captured by this role of
the nurse in public health
5. Manager/Leader
 The nurse employs principles of management to maximize resources effectively and
efficiently
6. Researcher/Epidemiologist

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 The nurse is regarded as the health monitor of the community

 Together with the rural midwife, they keep track of the illnesses encountered in their
areas of jurisdiction and submits reports to health authorities as required by law
7. Client Advocate
 The community/public health nurse takes a proactive stance in ensuring that the right
to health of the population he/she works with is realized and protected.

Levels of Clientele in Community and Public Health Nursing

1. Individuals
2. Families
3. Groups
4. Communities

SAQA- 3
Explain the basic principle in Community Health Nursing.
Criteria for rating
Ideas : 50%
Organization : 25%
Sentence and fluency : 25%

Public Health
 “The science and art of preventing disease, prolonging life, and promoting physical and
mental health and efficiency through organized community efforts for the sanitation of the
environment, the control of community infections, the education of the individual in
principles of personal hygiene, the organization of medical and nursing service for the early
diagnosis and preventive treatment of disease, and the development of the social machinery,
which will ensure to every individual in the community a standard of living adequate for the
maintenance of health (Winslow, 1920).
 The purpose of public health is to improve the health of the public by promoting healthy
lifestyles, preventing disease and injury, and protecting the health of communities.

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Standards of Public Health Nursing In the Philippines

The National League of Philippine Government came up with Standards of Public Health Nursing in
the Philippines 2005.
 Qualifications and Functions
o The standards of Public Health Nursing in the Philippines developed by the National
League of Philippine government Nurses in 2005 described the qualification and
functions of a Public Health Nurse

Evolution of Public Health Nursing in the Philippines

 Public Health Nursing Development: 1931 – 1941

o In 1933, the nursing institution have increased their requirement. During this period,
they have implemented that to enter nursing education an applicant must be able to
complete secondary education. The first collegiate nursing graduates of the
Philippines graduated from University of the Philippines School of Public Health
Nursing in 1938.

SAQA-4 : READ
Community Public Health Nursing in the Philippine Islands
By GEORGE C. DUNHAM, M.D., F.A.P.H.A. *
Major, Medical Corps, U. S. Army, Army Medical School, Washington, D. C
https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.26.8.771

Answer the following:

1. Compare the community health services rendered during the Commonwealth
Government and in the present day. What are the similarities (if any) and
differences?
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2. Considering the absence of present-day technology during the Commonwealth

Government, what suggestions can you give to improve their health services?

1898
 Department of Health was first established as Department of Public Works, Education and
Hygiene.
1912
 The Fajardo Act (Act No. 2156) created Sanitary Divisions.
 The President of Sanitary Division took charge of two or three municipalities. Where there
are no physicians available, male nurses were assigned to perform the duties of the President,
Sanitary Division.
 Philippine General Hospital (PGH), then under the Bureau of Health sent four nurses to Cebu
to take of mothers and their babies.
 St. Paul’s Hospital School of Nursing in Intramuros, also assigned two nurses to do home
visiting in Manila and gave nursing care to mothers and newborn babies from the outpatient
obstetrical service of the PGH.
1914
 School nursing was rendered by a nurse employed by the Bureau of Health in Tacloban,
Leyte.
 Reorganization Act No. 2462 created the Office of General Inspection. Dr. Rosario Pastor a
lady physician was headed the Office of District Nursing.
 Two graduate Filipino nurses, Mrs. Casilang Eustaquia and Mrs. Matilde Azurin were
employed for Maternal and Child Health and Sanitation in Manila under an American nurse,
Mrs. G.D. Schudder.
1919
 The first Filipino nurse Supervisor under the Bureau of Health, Miss Carmen del Rosario was
appointed. She succeeded Miss Mabel Dabbs.

1923
 Two government Schools of Nursing were established: Zamboanga General Hospital School
of Nursing in Mindanao and Baguio General Hospital in Northern Luzon. These schools were
primarily intended to train non-Christian women and prepare them to render service among
their people.
 Four more government School of Nursing were establish: one in Southern Luzon (Quezon
Province) and three in the Visayan Islands of Cebu, Bohol and Leyte.
1927
 The Office of District Nursing under the Office of General Inspection, Philippine Health
Service was abolished and supplanted by the Section of Public Health Nursing. Mrs. Genara
de Guzman acted as consultant to the Director of Health on nursing matters.
1928
 First convention of nurses was held followed by yearly conventions until the advent of World
War II. Pre-service training was initiated as a pre-requisite for appointment.
1930
 The Section of Public Health Nursing was converted into Section of Nursing. The Section of
Nursing was transferred from the Office of General Services to the Division of
Administration. This Office covered the supervision and guidance of nurses in the provincial
hospitals and the government schools of nursing.
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1933
 Reorganization Act No. 4007 transferred the Division of Maternal and Child Health of the
Office of Public Welfare Commission to the Bureau of Health. Mrs. Soledad A. Buenafe,
former Assistant Superintendent of Nurses of the Public Welfare Commission was appointed
as Assistant Shief Nurse of the Section of Nursing, Bureau of Health.
1941
 Bureau of Health were transferred to the new department. Dr. Mariano Icasiano became the
first City Health Officer of Manila. An office of Nursing was organized with Mrs. Vicenta C.
Ponce. As Chief Nurse and Mrs. Rosario A. Ordiz as Assistant Chief Nurse.
Dec 8. 1941
 World War II broke out, public health nurses in Manila were assigned to devastated areas to
attend to the sick and the wounded.
1942
 A group of public health nurses, physicians and administrators from the Manila Health
Department went to the internet camp in Capas, Tarlac to receive sick prisoners of war
repleased by the Japanese Army. They were confined at San Lazaro Hospital and 68 Public
Health Nurses were assigned to help the hospital staff take care of them.
July 1942
 31 nurses who were taken prisoners of war by the Japanese army and confined at the Bilibid
Prison in Manila were released to the Director of the Bureau of Health, Dr. Eusebio Aguilar
who acted as their guarantor. Many public health nurses joined the guerillas or went to hide
in the mountains during World War II.
February 1946
 Post war records of the Bureau of Health showed that there were 308 public health nurses and
38 supervisors compared to pre-war when there were 556 public health nurses and 38
supervisors. Mrs. Genera M. de Guzman, Technical Assistant in Nursing of the Department
of Health and concurrent President of the Filipino Nurses Association recommended the
creation of a Nursing Office in the Department of Health.

Oct. 7, 1947
 Executive Order No. 94 organized government offices and created the Division of Nursing
under the Office of the Secretary of Health. This was implemented on
December 16, 1947.
 Mrs. Genara de Guzman was appointed as Chief of the Division, with three Assistant: Miss
Annie Sand for Nursing Education; Mrs. Magdalena C. Valenzuela for Public Health Nursing
and Mrs. Patrocinio J. Montellano for Staff Education.
 At the Bureau of Health, the Section of Nursing Supervision took over the functions of the
former Section of Nursing. Mrs. Soledad Buenafe was appointed Chief and Miss Marcela
Gabatin, Assistant Chief.
1948
 The first training Center of the Bureau of Health was organized in cooperation with the Pasay
City Health Department. This was housed at the Tabon Health Center located in marginalized
part of the city. It was later renamed as Doña Marta Health Center. Physicians and nurses
undergoing pre-service and in-service training in public health/public health nursing as well
as nursing student on affiliation were assigned to the above training center.
1950
 The Rural Health Demonstration and Training Center (RHDTC) was established by the
Department of Health through the initiative of Dr. Hilario Lara, Dean, institute of Hygiene,
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now College of Public Health, University of the Philippines. The WHO/UNICEF assisted
project used health centers of the Quezon City Health Department, which were located in the
rural areas of the city. Dr. Amansia S. Mangay (Mrs. Andres Angara), a Doctor of Public
Health Graduate form Harvard was chosen tobe the Chief of the RHDTC. Dr. Antonio V.
Acosta, former Physician of the Manila Health Department was Medical Training Officer.

1953
 The Office of Health Education and Personnel Training was established with Dr. Trinidad
Gomez as Chief Philippine Congress approved Republic Act No. 1082 or the Rural Health
Law. It created the first 81 Rural Health Units.
1957
 Republic Act 1891 was approved amending Sections Two, Three, Four, Seven and Eight of
R.A. 1082: Strengthening Health and Dental Services in the Rural Areas and Providing Funds
thereto.”
1958-1965
 Republic Act 977 passed by Congress in 1954 was implemented. This abolished the Division
of Nursing. However, it created nursing positions at different levels in the health
organization. Miss Annie Sand was appointed Nursing Consultant under the Office of the
Secretary of Health. The Department of Health National League of Nurses, Inc. was founded
by Miss Annie Sand in 1961. She became its first President and Adviser. The Reorganization
Act with implementing details embodied in Executive Order 288, series of 1959 de-
centralized and integrated health services. The reorganization of 1959 also merged two
Bureaus in the Department of Health. The Bureau of Health was merged with the Bureau of
Hospitals to form the Bureau of Health and Medical Services.
1967
 In the Bureau of Disease Control, Mrs. Zenaida Panlilio – Nisce was appointed as Nursing
Program Supervisor and served as consultant on the nursing aspects of the 5 special diseases:
TB, Leprosy, Venereal Disease, Cancer, Filariasis, and Mental Health.

1974
 The Project Management Staff was organized as part of Population II of the Philippine
Government

SAQA-5
As a nursing student, how can you will your barangay/community during the pandemic?

References:

 Community and Public Health Nursing 2nd ed., Mary A. Nies, Melanie McEwen, Earl Francis
R. Sumile
 Nursing Care of the Community. Zenaida U. Famorca, Mary A Nies, Melanie McEwen
 David, Erlinda S. (2009). Community Health Nursing An Approach to Families and
Population Groups .
 Maglaya, Araceli (2004). Nursing Practice in the Community 4th Edition. Argonauta
Corporation.

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 Pillitteri, Adele (2003). Maternal and Child Health Nursing 4th Edition Lippincott Williams
and Wilkins
 https://www.cdcfoundation.org/what-public-health
 http://docshare01.docshare.tips/files/24316/243160399.pdf
 https://www.news-medical.net/health/Roles-of-a-Nurse.aspx

Acknowledgement
The information contained in this learning packet were taken from the references
above.

Disclaimer: No copyright infringement is intended.

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