CHAPTER 1:
OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES
A. Global and National Health Situations
• Global Health Situation (World Health
Organization, 2018a)
1. Global average life expectancy increased by 5
years between 2000 and 2015, the fastest
increase since the 1960s
2. Globally, healthy life expectancy (HLE) at birth
in 2015 was estimated at 63.1 years
3. In 2015, more than 16 000 children under age
five died every day
4. 45% of deaths among children under age five
occur during the first four weeks of
5. In 2015, an estimated 2.6 million babies were
stillborn
6. 1.3 million deaths in 2015 were attributable to
hepatitis
7. Noncommunicable diseases (NCDs) caused
37% of deaths in low-income countries in 2015,
up from 23% in
8. Ischaemic heart disease and stroke killed 15
million people in 2015
9. Diabetes are among the 10 leading causes of
deaths and disability worldwide
10. Injuries claimed nearly 5 million lives in 2015
• Philippine Health Situation
These are the positive changes in the country (World
Health Organization, 2018b):
1. Health insurance covers 92% of the population.
2. Maternal and child health services have
improved.
3. Access to and provision of preventive,
diagnostic and treatment services for
communicable diseases have been better.
4. Filipinos still die from Tuberculosis, HIV, dengue,
or diseases affecting mothers and children.
B. Definition and Focus
1. Health – It is defined by the World Health
Organization as a “state of complete physical, mental,
and social well-being, not merely the absence of
disease or infirmity”.
2. Public Health – the science of protecting the safety
and improving the health of communities through
education, policy making and research for disease and
injury prevention. It is the science and art of preventing
disease, prolonging life, promoting health and efficiency
through organized community effort.
3. Community Health – is a medical specialty that
focuses on the physical and mental well-being of the
people in a specific geographic region.
4. Public Health Nursing – the practice of promoting and
protecting the health of populations using knowledge
from nursing, social, and public health sciences. Nurses
influence the well-being of patients. It is a 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 programme.
5. Public Health Nurses – These are nurses in the
Philippines who have made great contributions to the
improvement of the health of the people for more than
a century now. They have been leaders in providing
quality health services to communities.
6. Community Health Nursing (CHN) – the practice of
community health nurses or public health nurses to
identify people in need and reach out to them. CH
nurses help the community by exerting efforts to aid
vulnerable groups of people. It is a service rendered by
a professional nurse with communities, groups, families,
individuals at home, in health centers, in clinics, in
schools and in places of work.
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.
Public Health Nurses
• Must be professionally qualified and licensed to
practice in the area of public health nursing.
• Must possess personal qualities and “people skills”
that would allow her practice to make a difference in
the lives of these people.
• Functions in accordance with the dominant values of
public health nurses, within the ethico-legal framework
of the nursing profession, and in accordance with the
needs of the clients and available resources for health
care.
• Functions of PHN are consistent with the Nursing Law
2002 and program policies formulated by the DOH and
local government health agencies. They are related to
management, supervision, provision of nursing care,
collaboration and coordination, health promotion and
education training and research.
Management Function
1. The management function of the public health
nurse is inherent in her practice.
2. The nurse, in whatever setting and role has been
trained to lead and manage.
3. Objectives set for work being done can only be
achieved through the execution of the five
management functions of planning, organizing,
staffing, directing and controlling.
4. This function is performed when she organizes
the “nursing service” of the local health agency.
5. Managing the nurses and their activities.
Program management
1. This is a function where the PHN actually excels
in.
2. A program manager is responsible for the
delivery of the package of services provided by
the program to the target clientele.
3. Reports on program accomplishments is a
documentation of her management skills.
Supervisory Function
1. PHN is the supervisor of the midwives and other
auxiliary health workers in the catchment area.
2. Formulates a supervisory plan and conducts
supervisory visits to implement plan.
3. Conducts supervisory visits using a supervisory
checklist
4. During the visit the PHN identifies together with
the supervisee any issue or problem encountered
and addresses them accordingly.
5. Coaching
6. Enhancement of training for the supervisee
7. Report of the encounter is given to the supervisee
and kept in her personal file for future reference.
Nursing Function
1. An inherent function of the nurse - Her practice
as a nurse is based on the science and art of
caring
2. Public health nursing is caring for individuals,
families and communities toward health
promotion and disease prevention
3. PHN are expected to provide nursing care
4. PHN uses her knowledge and skill in the nursing
process. She does assessment, plans, and
implements care, and evaluates outcomes.
5. Establishes rapport with her client: individual,
family or community
6. Home visits
7. Referral of patients to appropriate levels of care
Collaborating and coordinating Function
1. Brings activities or group activities systematically
into proper relation or harmony with each other.
2. Care coordinators for communities and their
members
3. Actively involved both socially and politically to
empower individuals, families and communities
as an entity to initiate and maintain health
promoting environments.
4. Establishes linkages and collaborative
relationships with other health professionals,
government agencies, the private sector, NGOs,
people’s organizations to address health
problems.
5. Identifies persons, groups, organizations, other
agencies and communities whose resources are
available within and outside the community and
which can be tapped in the implementation of
individuals, family and community health care.
Health Promotion and Education Function
1. Activities goes beyond health teachings and
health information campaigns.
2. Understands that health is determined by various
factors such as physical and political
environment, socio-economic status, personal
coping skills and many other circumstances, and
it is inappropriate to blame or credit a person’s
health to himself alone because he is unlikely to
control many of these factors.
3. Understanding the multidimensional nature of
health will enable her to plan and implement
health promoting interventions for individuals
and communities.
4. Uses her skills in advocacy for the creating of a
supportive environment through policies and
reengineering of the physical environment for
healthier actions.
5. As an educator, the nurse provides clients with
information that allows them to make healthier
choices and practices.
6. Health education is a major component of any
public health program.
7. PHN are expected to teach on a daily basis as
part of their practices.
Training Function
1. Initiates the formulation of staff development and
training programs for midwives and other
auxillary workers
2. Does training needs assessment for these health
workers, designs the training program and
 conducts them in collaboration with other
resource persons.
3. Also does evaluation of training.
4. PHN participates in the training of nursing and
midwifery affiliates in coordination with the
faculty of colleges of nursing and midwifery.
5. Participates in teaching, guidance and
supervision of student affiliates for their RLEs in
the community setting.
6. Health promotion calls for the active participation
of the community.
7. Mobilize communities for health actions.
8. Community organizing is a means of mobilizing
people to solve their own problems. Through this,
people learn that their problems have social
causes and fighting back is a more reasonable,
dignified approach than passive acceptance and
personal alienation.
Research Function
• Participates in the conduct of research and
utilizes research findings. - PHN function is
disease surveillance.
Purposes of disease surveillance:
1. To measure the magnitude of the problem
2. To measure the effect of the control program
Evolution of Public Health Nursing in the Philippines
HISTORY OF PUBLIC HEALTH & PUBLIC HEALTH
NURSING (Santos, E. & Santos, H. P., 2004)
1) Spanish Regime (1565-1898)
o Bro. Juan Climente (1577) – Started Public
Health Services though a dispensary in
Intramuros
o Started water sanitation
o Introduced small pox vaccine
o Creation of position of district, provincial,
national health officers
2) American Regime (1898- 1942)
• 1898
- creation of Board of the Health for
Physician
- Department of Health was first
established as Department of Public
Works, Education and Hygiene.
• 1899 - appointment of the first commissioner of
health
• 1906 - abolition of the board of health, creation of
bureau of health
• 1912 - PHN started in Cebu (PGH Nurses), The
Fajardo Act, Sanitary Divisions (now MHOs), St.
Paul Hospital School of Nursing in Intramuros
conducted home visits.
• 1914 - School Nursing, Office of General Inspection.
- Dr. Rosario Pastor 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.
• 1915 – PHN began in Manila; began to extend PHN
services in the homes – Social & Home Care Serivice
• 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.
- Four more government schools in Quezon,
Cebu, Bohol and Leyte.
• 1927 - Section of Public Health Nursing replaced the
Office of District Nursing (under Office of General
Inspection, PH Service). 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, now under
Division of Administration.
• 1933 - Reorganization Act No. 4007. Mrs. Soledad
A. Buenafe appointed as Assistant Chief Nurse of
the Section of Nursing, Bureau of Health.
• 1941
- Dr. Mariano Icasiano became the first City
Health Officer of Manila.
- Mrs. Vicenta C. Ponce. As Chief Nurse and Mrs.
Rosario A. Ordiz as Assistant Chief Nurse in
office of Nursing
• 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 - Manila Health Department receive sick
prisoners of war released by the Japanese Army in
Capas, Tarlac to.
• July 1942 - Dr. Eusebio Aguilar, Director of the
Bureau of Health, guaranteed the release of 31
 o Organizes work force, resources, equipment and
supplies, and delivery of health care at local
levels
o Requisitions, allocates, distributes materials
(medicine and medical supplies, records and
reports equipment)
o Provides technical and administrative support
to Rural Health Midwife (RHM)
o Conducts regular supervisory visits and
meetings to different RHMs and gives feedback
on accomplishments/performances.
4. Community Organizer
o Responsible for motivating and enhancing
community participants in terms of planning,
organizing, and implementing and evaluating
health programs/services
o Initiates and participates in community
development activities
5. Coordinator
o Coordinates with individuals, families, and
groups for health and related health services
provided by various members of health team
and other Government Organizations (GOs)
and Non-Government Organizations (NGOs)
o Coordinates nursing program with other health
programs as environmental sanitation, health
education, dental health and mental health.
6. Trainer/Health Educator/Counselor
o Identifies and interprets training needs of the
RHMs, Barangay Health Workers (BHWs) and
hilots.
o Formulates appropriate training program
designs for RHMs,, BHWs and hilots
o Provides and arranges learning experience for
RHMs, affiliates (nursing and midwife) and other
health workers.
o Conducts training for RHMs and hilots on health
promotion and disease prevention
o Conducts pre and post consultation conferences
for clinic patients
o Facilitates training for Barangay Health Worker
o Organizes orientation/training of concerned
groups including non-government organizations
o Acts as a resource speaker/person on health
and health related services
o Participates in the development and distribution
of Information Education and Communication
(IEC) materials
o Conducts IEC orientation for selected group in
specific programs/projects
o Initiates the use of radio/TV and cinema plugs,
print ads and other indigenous resources for
health education purposes
o Conducts pre-marital counseling
Counseling
o is the process of helping a client to recognize
and cope a stressful psychological or social
problems, to develop improved intrapersonal
relationships, promote personal growth
7. Health Worker
o Detects deviation from health of individuals,
families, groups of the community through
contact/visits with them.
o Uses symptomatic and objective observation
and other forms of data gathering like
morbidity, registry, questionnaire, checklist, and
anecdo, report/ record to monitor growth,
development, and health status of individuals,
families, and communities
8. Role Model
o Provides good example/model of healthful living
in the public/community
9. Change Agent
o Motivates changes in health behavior of
individuals, families, group a community
including lifestyle in order to promote and
maintain health.
10. Recorder/Reporter/Statistician
o Prepares and submits required reports and
records
o Maintains adequate, accurate and complete
recording and reporting.
o Reviews, validates, consolidates, analyzes and
interprets all records and reports
o Prepares statistical data/charts and other data
presentation for display and pr
o esentation in staff meetings, conference,
seminars/workshops.
11. Researcher - Participates/assists in the conduct of
surveys studies and researches in nursing and
health related subjects
o Coordinates with gov’t. and non-gov’t.
organization in the implementation of
studies/research
 CHAPTER 2:
THE HEALTH CARE DELIVERY SYSTEM
A. World Health Organization (WHO)
World Health Organization (WHO) builds a better and
healthier future for people all over the world. The
organization strives to combat diseases –
communicable diseases like influenza and HIV, and
noncommunicable diseases like cancer and heart
disease. WHO also helps mothers and children survive
and thrive so they can look forward to a healthy old age
and ensures the safety of the air people breathe, the
food they eat, the water they drink – and the medicines
and vaccines they need (World Health Organization,
2019a).
• Millennium development goals (MDGs)
The United Nations Millennium Development
Goals are eight goals that all 191 UN member states
have agreed to try to achieve by the year 2015. The
United Nations Millennium Declaration, signed in
September 2000 commits world leaders to combat
poverty, hunger, disease, illiteracy, environmental
degradation, and discrimination against women. The
MDGs are derived from this Declaration, and all have
specific targets and indicators.
The Eight Millennium Development Goals are:
1. to eradicate extreme poverty and hunger;
2. to achieve universal primary education;
3. to promote gender equality and empower women;
4. to reduce child mortality;
5. to improve maternal health;
6. to combat HIV/AIDS, malaria, and other diseases;
7. to ensure environmental sustainability; and
8. to develop a global partnership for development.
The MDGs are inter-dependent; all the MDG
influence health, and health influences all the MDGs.
For example, better health enables children to learn
and adults to earn. Gender equality is essential to the
achievement of better health. Reducing poverty, hunger
and environmental degradation positively influences,
but also depends on, better health (World Health
Organization, 2019b).
• Sustainable Development Goals
In September 2015, the General Assembly adopted the
2030 Agenda for Sustainable Development that
includes 17 Sustainable Development Goals (SDGs).
Building on the principle of “leaving no one behind”, the
new Agenda emphasizes a holistic approach to
achieving sustainable development for all.
The year 2016 marks the first year of the
implementation of the SDGs. At this critical point,
#Envision2030 will work to promote the mainstreaming
of disability and the implementation of the SDGs
throughout its 15-year lifespan with objectives to
(United Nations, n.d.)
Raise awareness of the 2030 Agenda and the
achievement of the SDGs for persons with disabilities;
Promote an active dialogue among stakeholders on the
SDGs with a view to create a better world for persons
with disabilities; and
Establish an ongoing live web resource on each SDG
and disability.
The 17 sustainable development goals (SDGs) to
transform our world (World’s Largest Lesson, 2015):
GOAL 1: No Poverty - End poverty in all its forms
everywhere
GOAL 2: Zero Hunger - End hunger, achieve food
security and improved nutrition and promote
sustainable agriculture
GOAL 3: Good Health and Well-being - Ensure healthy
lives and promote well-being for all at all ages
GOAL 4: Quality Education - Ensure inclusive and
equitable quality education and promote lifelong
learning opportunities for all
GOAL 5: Gender Equality - Achieve gender equality and
empower all women and girls
GOAL 6: Clean Water and Sanitation - Ensure
availability and sustainable management of water and
sanitation for all
GOAL 7: Affordable and Clean Energy - Ensure access
to affordable, reliable, sustainable and modern energy
for all
GOAL 8: Decent Work and Economic Growth - Promote
sustained, inclusive and sustainable economic growth,
full and productive employment and decent work for all
GOAL 9: Industry, Innovation and Infrastructure - Build
resilient infrastructure, promote inclusive and
sustainable industrialization and foster innovation
GOAL 10: Reduced Inequality - Reduce inequality within
and among countries
GOAL 11: Sustainable Cities and Communities - Make
cities and human settlements inclusive, safe, resilient
and sustainable
GOAL 12: Responsible Consumption and Production -
Ensure sustainable consumption and production
patterns
GOAL 13: Climate Action - Take urgent action to
combat climate change and its impacts
GOAL 14: Life below Water - Conserve and sustainably
use the oceans, seas and marine resources for
sustainable development
GOAL 15: Life on Land - Protect, restore and promote
sustainable use of terrestrial ecosystems, sustainably
manage forests, combat desertification, and halt and
reverse land degradation and halt biodiversity loss
GOAL 16: Peace and Justice Strong Institutions -
Promote peaceful and inclusive societies for sustainable
development, provide access to justice for all and build
effective, accountable and inclusive institutions at all
levels
GOAL 17: Partnerships to achieve the Goal - Strengthen
the means of implementation and revitalize the global
partnership for sustainable development
B. Philippine Department of Health
1. Mission-Vision
• MISSION To lead the country in the
development of a productive, resilient,
equitable and people-centered health system
• VISION Filipinos are among the healthiest
people in Southeast Asia by 2022, and Asia by
2040
2. Historical Background
Americans assembled a military Board of
Health on September 10, 1898, with its formal
organization on September 29. Upon its creation, Dr.
Frank S. Bourns is assigned as president while Dr. C. L.
Mullins is assigned as assistant surgeon. The purpose of
this Board of Health was to care for injured American
troops but as the hostilities between Filipinos and
Americans waned in 1901, a civilian Board of Health was
now deemed appropriate with Dr. L. M. Maus as the
first health commissioner.
In the early 1900s, 200,222 lives including
66,000 children were lost; three percent of the
population was decimated in the worst epidemic in
Philippine health history. In view of this, the Americans
organized and erected several institutions, including the
Bureau of Governmental Laboratories, which was built
in 1901 for medical research and vaccine production.
The Americans, led by Dean Worcester built the UP
College of Medicine and Surgery in 1905, with Johns
Hopkins University serving as a blueprint, at the time,
one of the best medical schools in the world. By 1909,
nursing instruction also begun at the Philippine Normal
School. In terms of public health, the Americans
improved on the sewer system and provided a safer
water supply.
In 1915, the Bureau of Health was reorganized
and renamed into the Philippine Health Service. During
the succeeding years leadership and a number of
health institutions were already being given to Filipinos,
in accordance with the Organic Act of 1916. On January
1, 1919, Dr. Vicente De Jesus became the first Filipino to
head the Health portfolio.
In 1933, after a reorganization, the Philippine
Health Service reverted to being known as the Bureau of
Health. It was during this time that it pursued its official
journal, The Health Messenger and established
Community Health and Social Centers, precursors to
today's Barangay Health Centers.
By 1936, as Governor-General Frank Murphy
was assuming the post of United States High
Commissioner, he would remark that the Philippines led
all oriental countries in terms of health status.
When the Commonwealth of the Philippines was
inaugurated, Dr. Jose Fabella was named chief of the
Bureau of Health. In 1936, Dr. Fabella reviewed the
Bureau of Health’s organization and made an inventory
of its existing facilities, which consisted of 11 community
and social health centers, 38 hospitals, 215 puericulture
centers, 374 sanitary divisions, 1,535 dispensaries and
72 laboratories.
In the 1940s, the Bureau of Health was
reorganized into the Department of Health and Public
Welfare, still under Fabella. During this time, the major
priorities of the agency were 14 tuberculosis,
malnutrition, malaria, leprosy, gastrointestinal disease,
and the high infant mortality rate.
When the Japanese occupied the Philippines,
they dissolved the National Government and replaced
it with the Central Administrative Organization of the
Japanese Army. Health was relegated to the
Department of Education, Health and Public Welfare
under Commissioner Claro M. Recto.
In 1944, President Manuel Roxas signed
Executive Order (E.O.) No. 94 into law, calling for the
creation of the Department of Health. Dr. Antonio C.
Villarama as appointed Secretary. A new Bureau of
Hospitals and a Bureau of Quarantine was created
under DOH. Under E.O. 94, the Institute of Nutrition was
created in 1948 to coordinate various nutrition activities
of the different agencies.
On February 20, 1958, Executive Order 288
provided for the reorganization of the Department of
Health. This entailed a partial decentralization of
powers and created eight Regional Health Offices.
Under this setup, the Secretary of Health passed on
some of responsibilities to the regional offices and
directors.
One of the priorities of the Marcos
administration was health maintenance. From 1975 to
the mid-eighties, four specialty hospitals were built in
succession. The first three institutions were
spearheaded by First Lady Imelda Marcos. The
Philippine Heart Center was established on February 14,
1975 with Dr. Avelino Aventura as director. Second, the
Philippine Children’s Medical Center was built in 1979.
Then in 1983, the National Kidney and Transplant
Institute was set up. This was soon followed by the Lung
Center of the Philippines, which was constructed under
the guidance of Health Minister Dr. Enrique Garcia.
With a shift to a parliamentary form of government, the
Department of Health was transformed into the
Ministry of Health on June 2, 1978 with Dr. Clemente S.
Gatmaitan as the first health minister. On April 13, 1987,
the Department of Health was created from the
previous Ministry of Health with Dr. Alfredo R. A.
Bengzon as secretary of health.
On 17th December 2016 Health Secretary
Paulyn Jean Rossel-Ubial announced that in 2017 the
government will start paying the hospital bills and
medicines of poor Filipinos. She said that the
Department of Health (DOH) is capable of taking care
of the hospital bills and medicines of poor Filipinos
owing to its bigger budget starting in 2017.
A total of ₽96.336 billion was allocated to the
DOH in the 2017 national budget, which includes funds
for the construction of additional health facilities and
drug rehabilitation centers. Ubial said poor patients in
government hospitals do not even have to present
Philhealth cards when they avail of assistance. She
added that poor patients will no longer be billed by
government hospitals.
Ubial said President Rodrigo Duterte is keen on
implementing the program to help poor Filipinos in all
parts of the country. She said Philhealth will remain a
partner of government hospitals in serving the poor.
Senator Loren Legarda, chair of the Senate committee
on finance said that the proposed ₽3.35-trillion national
budget for 2017 will provide healthcare assistance to all
Filipinos, said an additional ₽3 billion was allocated to
the Philippine Health Insurance Corporation
(PhilHealth) to ensure coverage for all Filipinos.
“The Department of Health (DOH) said there
are some eight million Filipinos still not covered by
PhilHealth. It is our duty, in serving the public, to extend
basic healthcare protection to all our people. That is
why we pushed for the augmentation of the PhilHealth’s
budget so that in 2017, we achieve universal healthcare
coverage,” she said.
Legarda said universal healthcare coverage
means that any non-member of PhilHealth will
automatically be made a member upon availment of
healthcare service in a public hospital
3. Local Health System and Devolution
of Health Services
Bureau of Local Health Systems and Development
(BLHSD) (Department of Health, 2019)
General Functions:
• Identify and assess priorities in local health systems
development;
• Develop policies, guidelines and standards on
sustainable local health systems;
• Ensure multi-stakeholder participation in local
health systems development;
• Monitor and evaluate functionality of local health
system.
Divisions
1) Health Systems Development Division (HSDD)
Specific Functions
• Identify and assess priorities in local health
systems development;
• Develop policies, guidelines and standards on
sustainable local health systems;
• Ensure multi-stakeholder participation in local
health systems development;
• Monitor and evaluate functionality of local
health system.
2) Health Systems Monitoring and Evaluation Division
(HSMED)
Specific Functions
• Develop policies, plans and standards to build
and enhance capacity for local health
leadership and governance;
• Provide technical assistance to monitor and
evaluate local health system performance;
• Promote best practices in local health systems
development for wide-spread replication.
created in 1948 to coordinate various nutrition activities
of the different agencies.
On February 20, 1958, Executive Order 288
provided for the reorganization of the Department of
Health. This entailed a partial decentralization of
powers and created eight Regional Health Offices.
Under this setup, the Secretary of Health passed on
some of responsibilities to the regional offices and
directors.
One of the priorities of the Marcos
administration was health maintenance. From 1975 to
the mid-eighties, four specialty hospitals were built in
succession. The first three institutions were
spearheaded by First Lady Imelda Marcos. The
Philippine Heart Center was established on February 14,
1975 with Dr. Avelino Aventura as director. Second, the
Philippine Children’s Medical Center was built in 1979.
Then in 1983, the National Kidney and Transplant
Institute was set up. This was soon followed by the Lung
Center of the Philippines, which was constructed under
the guidance of Health Minister Dr. Enrique Garcia.
With a shift to a parliamentary form of government, the
Department of Health was transformed into the
Ministry of Health on June 2, 1978 with Dr. Clemente S.
Gatmaitan as the first health minister. On April 13, 1987,
the Department of Health was created from the
previous Ministry of Health with Dr. Alfredo R. A.
Bengzon as secretary of health.
On 17th December 2016 Health Secretary
Paulyn Jean Rossel-Ubial announced that in 2017 the
government will start paying the hospital bills and
medicines of poor Filipinos. She said that the
Department of Health (DOH) is capable of taking care
of the hospital bills and medicines of poor Filipinos
owing to its bigger budget starting in 2017.
A total of ₽96.336 billion was allocated to the
DOH in the 2017 national budget, which includes funds
for the construction of additional health facilities and
drug rehabilitation centers. Ubial said poor patients in
government hospitals do not even have to present
Philhealth cards when they avail of assistance. She
added that poor patients will no longer be billed by
government hospitals.
Ubial said President Rodrigo Duterte is keen on
implementing the program to help poor Filipinos in all
parts of the country. She said Philhealth will remain a
partner of government hospitals in serving the poor.
Senator Loren Legarda, chair of the Senate committee
on finance said that the proposed ₽3.35-trillion national
budget for 2017 will provide healthcare assistance to all
Filipinos, said an additional ₽3 billion was allocated to
the Philippine Health Insurance Corporation
(PhilHealth) to ensure coverage for all Filipinos.
“The Department of Health (DOH) said there
are some eight million Filipinos still not covered by
PhilHealth. It is our duty, in serving the public, to extend
basic healthcare protection to all our people. That is
why we pushed for the augmentation of the PhilHealth’s
budget so that in 2017, we achieve universal healthcare
coverage,” she said.
Legarda said universal healthcare coverage
means that any non-member of PhilHealth will
automatically be made a member upon availment of
healthcare service in a public hospital
3. Local Health System and Devolution
of Health Services
Bureau of Local Health Systems and Development
(BLHSD) (Department of Health, 2019)
General Functions:
• Identify and assess priorities in local health systems
development;
• Develop policies, guidelines and standards on
sustainable local health systems;
• Ensure multi-stakeholder participation in local
health systems development;
• Monitor and evaluate functionality of local health
system.
Divisions
1) Health Systems Development Division (HSDD)
Specific Functions
• Identify and assess priorities in local health
systems development;
• Develop policies, guidelines and standards on
sustainable local health systems;
• Ensure multi-stakeholder participation in local
health systems development;
• Monitor and evaluate functionality of local
health system.
2) Health Systems Monitoring and Evaluation Division
(HSMED)
Specific Functions
• Develop policies, plans and standards to build
and enhance capacity for local health
leadership and governance;
• Provide technical assistance to monitor and
evaluate local health system performance;
• Promote best practices in local health systems
development for wide-spread replication.
performs highly specialized procedures on an out-
patient basis. Examples are, but not limited to, the
following.
1. Dialysis Clinic;
2. Ambulatory Surgical Clinic;
3. In-Vitro Fertilization Center;
4. Stem Cell Facility;
5. Oncology Chemotherapeutic Center/Clinic;
6. Radiation Oncology Facility;
7. Physical Medicine and Rehabilitation • Investing in People
Center/Clinic. • Protection Against Instability
• Universal Health Coverage
5. Philippine Health Agenda 2016 – 2022 • Strengthen Implementation of RPRH Law
All for Health towards Health for All (Philippine Health • War against Drugs
Agenda 2016 – 2022: Healthy Philippines 2022) • Additional Funds from PAGCOR

I. ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE

Services for Both the Well & the Sick
II. SERVICE DELIVERY NETWORK
Functional Network of Health Facilities
III. UNIVERSAL HEALTH INSURANCE
Financial Freedom when Accessing Services
A - Advance quality, health promotion and primary
care
1. Conduct annual health visits for all poor families
and special populations (NHTS, IP, PWD, Senior
Citizens)
2. Develop an explicit list of primary care
entitlements that will become the basis for
licensing and contracting arrangements
3. Transform select DOH hospitals into mega-
hospitals with capabilities for multi-specialty
training and teaching and reference laboratory
4. Support LGUs in advancing pro-health
resolutions or ordinances (e.g. city-wide smoke-
free or speed limit ordinances)
5. Establish expert bodies for health promotion and
surveillance and response
C - Cover all Filipinos against health-related financial
risk
1. Raise more revenues for health, e.g. impose
health-promoting taxes, increase NHIP premium
rates, improve premium collection efficiency.
2. Align GSIS, MAP, PCSO, PAGCOR and minimize
overlaps with PhilHealth.
3. Expand PhilHealth benefits to cover outpatient
diagnostics, medicines, blood and blood products
aided by health technology assessment.
4. Update costing of current PhilHealth case rates to
ensure that it covers full cost of care and link
payment to service quality.
5. Enhance and enforce PhilHealth contracting
policies for better viability and sustainability
H - Harness the power of strategic HRH development
1. Revise health professions curriculum to be more
primary care-oriented and responsive to local
and global needs.
2. Streamline HRH compensation package to
incentivize service in high-risk or GIDA areas.
3. Update frontline staffing complement standards
from profession-based to competencybased.
4. Make available fully-funded scholarships for HRH
hailing from GIDA areas or IP groups.
5. Formulate mechanisms for mandatory return of
service schemes for all heath graduates.
I - Invest in Health and data for decision-making
1. Mandate the use of electronic medical records in
all health facilities.
2. Make online submission of clinical, drug
dispensing, administrative and financial records
a prerequisite for registration, licensing and
contracting.
3. Commission nationwide surveys, streamline
information systems, and support efforts to
improve local civil registration and vital statistics.
4. Automate major business processes and invest in
warehousing and business intelligence tools.
5. Facilitate ease of access of researchers to
available data
E - Enforce standards, accountability and transparency
1. Publish health information that can trigger better
performance and accountability.
2. Set up dedicated performance monitoring unit to
track performance or progress of reforms
V - Value all clients and patients, especially the poor,
marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all
health programs and support them in nondirect
health expenditures.
6. A DOH licensed tertiary clinical laboratory with
standing equipment/reagents/supplies necessary for
the performance of histopathology examinations;
7. A DOH licensed level 3 imaging facility with
interventional radiology.
2. Specialty Hospitals
Examples of these hospitals are Lung Center of
the Philippines, Philippine heart Center, National Kidney
and Transplant Institute, a hospital dedicated to
treatment of eye disorders.
3. Trauma Capability of Hospitals The trauma capability
of hospitals shall be assessed in accordance with the
guidelines formulated by the Philippine College of
Surgeons (PCS)
a. Trauma-Capable Facility – a DOH licensed
hospital designated as a Trauma Center
b. Trauma-Receiving Facility – a DOH licensed
hospital within the trauma service area which
receives trauma patients for transport to the
point of care of a trauma center.
2) CLASSIFICATION OF OTHER HEALTH FACILITIES
Rule V. B. 1. A. on ‘Classification of Hospitals According
to Ownership’ shall also apply to ‘Other Health
Facilities’ in the following categories.
a. Category A: Primary Care Facility – a first-contact
healthcare facility that offers basic services including
emergency service and provision for normal deliveries.
It is subdivided into:
1. With In-patient beds – a short stay facility when a
short (average of one to three days) length of time is
spent by patients before discharge. Examples are, but
not limited to, the following
a. Infirmary;
b. Birthing Home- a homelike facility that provides
maternity service on pre-natal and post-natal care,
normal spontaneous delivery, and care of newborn
babies. Staff shall be trained in Essential
Intrapartum and Newborn Care (EINC) in
accordance with DOH A.O. No. 2009- 0025 entitled
“Adopting Policies and Guidelines on Essential
Newborn Care” and Basic Emergency Obstetrics
and Newborn Care (BEmONC) in accordance DOH
A.O. No. 2011 -0014 regarding “Guidelines on the
Certification of Health Facilities with Basic
Emergency Obstetrics and Newborn Care”. Birthing
facilities shall comply with licensing requirements
(Annex C) and planning and design guidelines/
Reference Plan (Annex D) of DOH.
2. Without beds – a facility where medicine, medical
and/or dental examination/treatment is dispensed.
Examples are, but not limited to, the following:
a. Medical Out-patient Clinic;
b. Medical Facility for Overseas Workers and
Seafarers (OFW clinic);
c. Dental Clinic.
b. Category B: Custodial Care Facility – a health facility
that provides long term care, including basic human
services like food and shelter to patients with chronic or
mental illness, patients in need of rehabilitation owing
substance abuse, people requiring ongoing health and
nursing care due to chronic impairments and a reduced
degree of independence in activities of daily living.
Examples of such facilities are, but not limited to, the
following:
1. Custodial Psychiatric Care Facility;
2. Substance/Drug Abuse Treatment and
Rehabilitation Center;
3. Sanitarium/Leprosarium;
4. Nursing Home.
c. Category C: Diagnostic/Therapeutic Facility – a
facility that examines the human body or specimens
from the human body (except laboratory for drinking
water analysis) for the diagnosis, sometimes treatment
of diseases. The test covers the pre-analytical, and
postanalytical phases of examination.
1. Laboratory Facility, such as, but not limited to, the
following:
a. Clinical Laboratory;
b. Human Immunodeficiency Virus (HIV) Testing
Laboratory;
c. Blood Service Facility;
d. Drug Testing Laboratory;
e. Newborn Screening Laboratory;
f. Laboratory for Drinking Water Analysis.
2. Radiologic Facility, such as, but not limited to, the
following:
a. Ionizing Machines as X-Ray, CT scan,
mammography and others.
b. Non-Ionizing Machines as MRI, ultrasound and
others.
3. Nuclear Medicine Facility – a facility, presently
regulated by PNRI, embracing all applications of
radioactive materials in diagnosis, treatment or in
medical research, with the exception of the use of
sealed radiation sources in radiotherapy.
d. Category D: Specialized Out-Patient Facility – a
facility with highlight competent and trained staff that
performs highly specialized procedures on an out-
patient basis. Examples are, but not limited to, the
following.
1. Dialysis Clinic;
2. Ambulatory Surgical Clinic;
3. In-Vitro Fertilization Center;
4. Stem Cell Facility;
5. Oncology Chemotherapeutic Center/Clinic;
6. Radiation Oncology Facility;
7. Physical Medicine and Rehabilitation • Investing in People
Center/Clinic. • Protection Against Instability
• Universal Health Coverage
5. Philippine Health Agenda 2016 – 2022 • Strengthen Implementation of RPRH Law
All for Health towards Health for All (Philippine Health • War against Drugs
Agenda 2016 – 2022: Healthy Philippines 2022) • Additional Funds from PAGCOR

I. ALL LIFE STAGES & TRIPLE BURDEN OF DISEASE

Services for Both the Well & the Sick
II. SERVICE DELIVERY NETWORK
Functional Network of Health Facilities
III. UNIVERSAL HEALTH INSURANCE
Financial Freedom when Accessing Services
A - Advance quality, health promotion and primary
care
1. Conduct annual health visits for all poor families
and special populations (NHTS, IP, PWD, Senior
Citizens)
2. Develop an explicit list of primary care
entitlements that will become the basis for
licensing and contracting arrangements
3. Transform select DOH hospitals into mega-
hospitals with capabilities for multi-specialty
training and teaching and reference laboratory
4. Support LGUs in advancing pro-health
resolutions or ordinances (e.g. city-wide smoke-
free or speed limit ordinances)
5. Establish expert bodies for health promotion and
surveillance and response
C - Cover all Filipinos against health-related financial
risk
1. Raise more revenues for health, e.g. impose
health-promoting taxes, increase NHIP premium
rates, improve premium collection efficiency.
2. Align GSIS, MAP, PCSO, PAGCOR and minimize
overlaps with PhilHealth.
3. Expand PhilHealth benefits to cover outpatient
diagnostics, medicines, blood and blood products
aided by health technology assessment.
4. Update costing of current PhilHealth case rates to
ensure that it covers full cost of care and link
payment to service quality.
5. Enhance and enforce PhilHealth contracting
policies for better viability and sustainability
H - Harness the power of strategic HRH development
1. Revise health professions curriculum to be more
primary care-oriented and responsive to local
and global needs.
2. Streamline HRH compensation package to
incentivize service in high-risk or GIDA areas.
3. Update frontline staffing complement standards
from profession-based to competencybased.
4. Make available fully-funded scholarships for HRH
hailing from GIDA areas or IP groups.
5. Formulate mechanisms for mandatory return of
service schemes for all heath graduates.
I - Invest in Health and data for decision-making
1. Mandate the use of electronic medical records in
all health facilities.
2. Make online submission of clinical, drug
dispensing, administrative and financial records
a prerequisite for registration, licensing and
contracting.
3. Commission nationwide surveys, streamline
information systems, and support efforts to
improve local civil registration and vital statistics.
4. Automate major business processes and invest in
warehousing and business intelligence tools.
5. Facilitate ease of access of researchers to
available data
E - Enforce standards, accountability and transparency
1. Publish health information that can trigger better
performance and accountability.
2. Set up dedicated performance monitoring unit to
track performance or progress of reforms
V - Value all clients and patients, especially the poor,
marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all
health programs and support them in nondirect
health expenditures.
nature, relates them with each other and determines
patterns or recurring themes among the data, and
compares these data with norms and standards.
2. Family Data Analysis
Utilizing the data generated from the tool on Initial Data
Base in Family Nursing Practice, the nurse goes through
data analysis. The nurse sorts out and classifies or
groups data by type or nature (e.g. which are wellness
states, threats, deficits or stress points/foreseeable
crises), relates them 41 with each other and determines
patterns or reoccurring themes among the data, and
then compares these data and the patterns or
reoccurring themes with norms and standards.
• Socio – Economic and Cultural Characteristics
• Home Environment
• Family Health Status
• Family Values and Health Practices
Family Nursing Diagnosis
• The end result of the second-level assessment is a
set of family nursing problems for each health
condition or problem.
• A wellness condition is a nursing judgment related
with a client’s capability for wellness.
• A health condition or problem is a situation which
interferes with the promotion and/or maintenance
of health and recovery from illness or injury.
• The Nursing Diagnosis in Family Nursing Practice is
the Wellness State or Health Condition / Problem
when it is stated as the family’s failure to perform
adequately specific health tasks to enhance the
wellness state or manage health problems.
Family Nursing Care Plan
• the blueprint of the care that the nurse designs to
systematically minimize or eliminate the identified
health and family nursing problems through
explicitly formulated outcomes of care (goals and
objectives) and deliberately chosen set of
interventions, resources and evaluation criteria,
standards, methods, and tools.
Features:
1. Focuses on Actions which are designed to solve
or minimize existing problems.
2. Product of a deliberate systematic process.
3. Relates to the future.
4. Based upon the identified health and nursing
problems.
5. Means to an end, not an end in itself.
6. Continuous Process, not a one-shot deal.
Qualities:
1. It should be based on clear, explicit definition of
the problem/s.
2. It is realistic.
3. It is prepared jointly with the family
4. Most useful in Written Form.
The Family Nursing Care Plan / Implementation Plan
Priority Setting
1. Nature of the condition or problem presented
2. Modifiability of the condition or problem
3. Preventive Potential
4. Salience
• Nature of the condition or problem presented –
categorized into wellness state/potential, health threat,
health deficit and foreseeable crisis:
• Modifiability of the condition or problem – refers to
the probability of success in enhancing the wellness
state, improving the condition, minimizing, alleviating
or totally eradicating the problem through intervention;
• Preventive Potential – refers to the nature and
magnitude of future problems that can be minimized or
totally prevented if intervention is done on the condition
or problem under consideration;
• Salience – refers to the family’s perception and
evaluation of the condition or problem in terms of
seriousness and urgency of attention needed or family
readiness.
Establishing Goals and Objectives
Goal- a general statement of the condition or state to
be brought about by a specific course of action
Objectives – a more specific statement of the desired
result or outcomes of care.
Selecting Appropriate Family Nursing Interventions /
Strategies
• Involves selection of appropriate nursing
interventions based on the formulated goals and
objectives.
• Take into consideration nurse-family contact as
well as resources
Implementing Family Care Plan
Categories of Intervention
PROMOTIVE
→Health Promotion allows individuals to increase
control over their own health. Its extensive range of
5) Environmental Sanitation and Promotion of Safe
Water Supply
• Environmental Sanitation is defined as the
study of all factors in the man’s environment,
which exercise or may exercise deleterious
effect on his well- 26 being and survival. Water
is a basic need for life and one factor in man’s
environment. Water is necessary for the
maintenance of healthy lifestyle. Safe Water
and Sanitation is necessary for basic promotion
of health.
6) Nutrition and Promotion of Adequate Food Supply
• One basic need of the family is food. And if food
is properly prepared then one may be assured
healthy family. There are many food resources
found in the communities but because of faulty
preparation and lack of knowledge regarding
proper food planning, Malnutrition is one of the
problems that we have in the country.
7) Treatment of Communicable Diseases and Common
Illness
• The diseases spread through direct contact
pose a great risk to those who can be infected.
Tuberculosis is one of the communicable
diseases continuously occupies the top ten
causes of death. Most communicable diseases
are also preventable. The Government focuses
on the prevention, control and treatment of
these illnesses.
8) Supply of Essential Drugs
• This focuses on the information campaign on
the utilization and acquisition of drugs.
• In response to this campaign, the GENERIC ACT
of the Philippines is enacted. It includes the
following drugs: Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine, Rifampicin, INH
(isoniazid) and Pyrazinamide, Ethambutol,
Streptomycin, Albendazole, Quinine.
6. Principles and Strategies
Principles of Primary Healthcare
1) 4 A’s = Accessibility, Availability, Affordability &
Acceptability, Appropriateness of health services.
• The health services should be present where
the supposed recipients are. They should make
use of the available resources within the
community, wherein the focus would be more
on health promotion and prevention of illness.
2) Community Participation
• heart and soul of PHC
3) People are the center, object and subject of
development.
• Thus, the success of any undertaking that aims
at serving the people is dependent on people’s
participation at all levels of decision-making;
planning, implementing, monitoring and
evaluating. Any undertaking must also be based
on the people’s needs and problems (PCF, 1990)
• Part of the people’s participation is the
partnership between the community and the
agencies found in the community; social
mobilization and decentralization.
• In general, health work should start from where
the people are and building on what they have.
Example: Scheduling of Barangay Health
Workers in the health center
Barriers of Community Involvement
• Lack of motivation
• Attitude
• Resistance to change
• Dependence on the part of community people
• Lack of managerial skills
4) Self-reliance
• Through community participation and
cohesiveness of people’s organization they can
generate support for health care through social
mobilization, networking and mobilization of
local resources. Leadership and management
skills should be develop among these people.
Existence of sustained health care facilities
managed by the people is some of the major
indicators that the community is leading to
self-reliance.
5) Partnership between the community and the health
agencies in the provision of quality of life.
• Providing linkages between the government
and the nongovernment organization and
people’s organization.
6) Recognition of interrelationship between the health
and development
• Health - Is not merely the absence of disease.
Neither is it only a state of physical and mental
well-being. Health being a social phenomenon
recognizes the interplay of political, socio-
cultural and economic factors as its
determinant. Good Health therefore, is
manifested by the progressive improvements in
the living conditions and quality of life enjoyed
by the community residents.
social and environmental interventions benefits and
protects individual people’s health and quality of life.
These interventions address and prevent the origin of ill
health, not just focusing on treatment and cure.
PREVENTIVE
→Preventive care refers to measures that aim to avoid
or reduce injuries and diseases, their sequelae and
complications. Prevention is based on a health
promotion strategy that involves a process to enable
people to improve their health through the control over
some of its immediate determinants. This includes a
wide range of expected outcomes, which are covered
through a diversity of interventions, organized as
primary, secondary and tertiary prevention levels.
CURATIVE
→Curative care encompasses health care contacts
during which the principal intent is to relieve symptoms
of illness or injury, to reduce the severity of an illness or
injury, or to protect against exacerbation and/or
complication of an illness and/or injury that could
threaten life or normal function.
REHABILITATIVE
→Rehabilitation is an integrative strategy with the
purpose of empowering persons with health conditions
who are experiencing or are likely to experience
disability so that they can achieve and maintain
optimal functioning, a decent quality of life and
inclusion in the community and society.
→While curative services mainly emphasize the health
condition, rehabilitation services focus on the
functioning associated with the health condition.
Rehabilitation services stabilize, improve or restore
impaired body functions and structures, compensate
for the absence or loss of body functions and structures,
improve activities and participation, and prevent
impairments, medical complications and risks.
Tools of Public Health Nurse (Cuevas, 2007)
• THE BAG TECHNIQUE The bag technique is a tool by
which the nurse, during her visit will enable her to
perform a nursing procedure with ease and deftness, to
save time and effort, with the end view of rendering
effective nursing care to clients. 45
The public health bag is an essential and indispensable
equipment of a public health nurse/ CHN Nurse which
she/he has to carry along during her home visits. It
contains basic medications and articles which are
necessary for giving care.
Principles of bag technique
1. Performing the bag technique will minimize, if not
prevent the spread of infection.
2. It saves time and effort in the performance of
nursing procedures.
3. The bag technique should show the effectiveness
of total care given to an individual or family.
4. The bag technique can be performed in a variety
of ways depending on the agency’s policy, the
home situation, or as long as principles of
avoiding transfer of infection is always observed.
Important points to consider in the use of the bag
1. The bag should contain all the necessary articles,
supplies and equipment that will be used to answer
emergency needs.
2. The bag and its contents should be cleaned very
often, the supplies replaced, and ready to use
anytime.
3. The bag and its contents should be well protected
from contact with any article in the patient’s home.
Consider the bag and its contents clean and sterile,
while articles that belong to the patients as dirty
and contaminated.
4. The arrangement of the contents of the bag should
be the one most convenient to the user, to facilitate
efficiency and avoid confusion.
Contents of Public Health Bag
• Paper lining
• Extra paper for making waste bag
• Plastic/linen lining
• Apron
• Hand Towel
• Soap in a soap dish
• Thermometers (oral and rectal)
• 2 pairs of scissors (surgical and bandage)
• 2 pairs of forceps (curved and straight)
• Disposable syringes with needles (g. 23 and 25)
• Hypodermic needles g. 19, 22, 23, 25
• Sterile dressing
• Cotton balls (dry and with alcohol)
• Cord clamp
• Micropore plaster
• Tape measure
• One pair of sterile gloves
• Baby’s scale
• Alcohol lamp
• 2 test tubes
• Test tube holders
• Solutions of: Betadine, Zephiran Solution, Spirit of
ammonia, Acetic Acid, 70% Alcohol, Hydrogen
peroxide, Ophthalmic ointment, Benedict’s solution
• Sphygmomanometer and stethoscope are carried
separately.
 Individual needs and group needs find natural
balance:
• The need for self-expressions not over shadow
consideration for others
• Power is equitably distributed
• Independence is permitted to flourish
5. The family relates to the community
• Family develops a stance with respect to the
community:
1. The relationship between the families is
wholesome and reciprocal; the family utilizes
the community resources and in turn,
contributes to the improvement of the
community.
2. There are families who feel a sense of isolation
from the community.
o Families who maintain proud, “We
keep to ourselves” attitude.
o Families who are entirely passive
taking the benefits from the
community without either contributing
to it or demanding changes to it.
6. The family has a growth cycle
• Families pass through predictable development
stages.
Stages of Family Growth Cycle:
Stage 1: Marriage and the Family
Stage 2: Early Childbearing Family
Stage 3: Family with Pre-School Children
Stage 4: Family with School Age Children
Stage 5: Family with Adolescent Children
Stage 6: The Launching Center Family
Stage 7: Family of Middle Years
Stage 8: Family in Retirement / Older Age
Stage 9: Period from Retirement to Death of
both spouses
STAGES:
Stage 1: MARRIAGE & THE FAMILY
o Involves merging of values brought into the
relationship from the families of orientation.
o Includes adjustments to each other’s routines
(sleeping, eating, chores, etc.), sexual and
economic aspects.
o Members work to achieve 3 separate
identifiable tasks:
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of
orientation
3. If applicable, engage in reproductive life
planning
Stage 2: EARLY CHILDBEARING FAMILY
o Birth or adoption of a first child which requires
economic and social role changes
o Oldest child: 2-1/2 years
Stage 3: FAMILY WITH PRE-SCHOOL CHILDREN
o This is a busy family because children at this
stage demand a great deal of time related to
growth and development needs and safety
considerations.
o Oldest child: 2-1/2 to 6 years old
Stage 4: FAMILY WITH SCHOOL AGE CHILDREN
o Parents at this stage have important
responsibility of preparing their children to be
able to function in a complex world while at the
same time maintaining their own satisfying
marriage relationship.
o Oldest child: 6-12 years old
Stage 5: FAMILY WITH ADOLESCENT CHILDREN
o A family allows the adolescents more freedom
and prepare them for their own life as
technology advances-gap between generations
increases
o Oldest child: 12-20 years old
Stage 6: THE LAUNCHING CENTER FAMILY
o Stage when children leave to set their own
household-appears to represent the breaking of
the family
o Empty nests
Stage 7: FAMILY OF MIDDLE YEARS
o Family returns to two partners nuclear unit
o Period from empty nest to retirement
Stage 8: FAMILY IN RETIREMENT/OLDER AGE
Stage 9: PERIOD FROM RETIREMENT TO DEATH OF BOTH
SPOUSES
Family as a System (Dr. Murray Bowen)
• Individuals cannot be understood in isolation from
one another, but rather as part of their family, as
the family is an emotional unit.
• Families are systems of interconnected and
interdependent individuals, none of whom can be
understood in isolation from the system.
• A family is a system in which each member has a
role to play and rules to respect.
• The change in roles may maintain the stability in
the relationship, but it may also push the family
towards a different equilibrium.
Functions Developmental Stages
According to Ackermann:
1. Ensure the physical survival of the species
2. Transmit culture, thereby ensuring man’s
humanness
 • Physical functions of the family are met
through parents providing food, clothing and
shelter, protection against danger, provision
for bodily repairs after fatigue or illness, and
through reproduction.
• Affectional function – the family is the primary
unit in which the child tests his emotional
reactions.
• Social functions – include providing social
togetherness, fostering self-esteem and a
personal identity tied to family identity,
providing opportunity for observing and
learning social and sexual roles, accepting
responsibility for behavior and supporting
individual creativity and initiative.
According to Doode:
Universal Function of the Family
• REPRODUCTION – for replacement of members of
society: to perpetuate the human species
• STATUS PLACEMENT of individual in society
• BIOLOGICAL and MAINTENANCE of the young
and dependent members
• SOCIALIZATION and CARE of the children
• SOCIAL CONTROL
Family Health Task
• Health task differ in degrees from family to family
• TASK - is a function, but with work or labor
overtures assigned or demanded of the person
7. Placement of members into larger society –consists
of selecting community activities such as church,
school, politics that correlate with the family beliefs and
values
8. Maintenance of motivation and morale– created
when members serve as support people to each other
5 Family Health Tasks (Maglaya, A., 2004)
1. Recognizing interruptions of health development
33
2. Making decisions about seeking health care/ to
take action
3. Dealing effectively health and non-health
situations
4. Providing care to all members of the family
5. Maintaining a home environment conducive to
health maintenance
Characteristics of a Healthy Family (Stone-Clemen,
Eigsti, McGuire 1991)
• Can engage in flexible role patterns
• Responsive to the needs of individual members
• Have dynamic problem-solving mechanisms
• Have the ability to accept help
• Observes open communication patterns
• Involves the experience of trust and respect in a
warm and caring atmosphere
• Capable to create and maintain constructive
relationships with broader neighborhood and
community

8 Essential Task for a Family to Function as a Unit

(Duvall and Miller)
1. Physical maintenance- provides food shelter, clothing,
and health care to its members being certain that a
family has ample resources to provide
2. Socialization of Family– involves preparation of
children to live in the community and interact with
people outside the family.
3. Allocation of Resources- determines which family
needs will be met and their order of priority.
4. Maintenance of Order– task includes opening an
effective means of communication between family
members, integrating family values and enforcing
common regulations for all family members.
5. Division of Labor – who will fulfill certain roles e.g.,
family provider, home manager, children’s caregiver
6. Reproduction, Recruitment, and Release of family
member
 CHAPTER 4
FAMILY NURSING PROCESS
Family Health Assessment
1. Tools for Assessment
Assessment – this involves a set of actions by which
a nurse measures the states of a family as a client, its
ability to maintain itself as a system and functioning
unit and its ability to maintain wellness, prevent, control
or resolve problems in order to achieve health and well-
being among its members.
Defining Health and Family Nursing Problems
INITIAL DATA BASE FOR FAMILY NURSING PROCESS
(RNPedia, 2019c)
What do we need to Assess:
1. Family Structure Characteristics and Dynamics
2. Socio-Economic and Cultural Characteristics
3. Home Environment
4. Health Status of Each Family Member
5. Values, Habits, Practices on Health Promotion,
Maintenance and Disease Prevention
TYPOLOGY OF NURSING PROBLEMS IN FAMILY
NURSING PRACTICE (RNPedia, 2019d)
First Level Assessment
A. Presence of Wellness Condition - stated as
potential or Readiness-a clinical or nursing
judgment about a client in transition from a
specific level of wellness or capability to a
higher level.
B. Presence of Health Threats - conditions that are
conducive to disease and accident, or may
result to failure to maintain wellness or realize
health potential.
C. Presence of Health Deficits - instances of failure
in health maintenance.
D. Presence of Stress Points/ Foreseeable Crisis
Situations - anticipated periods of unusual
demand on the individual or family in terms of
adjustment/family resources.
Second Level Assessment
A. Inability to recognize the presence of the
condition or the problem
B. Inability to make decisions with respect to
taking appropriate health action
C. Inability to provide adequate nursing care to
the sick, disabled, dependent, or vulnerable / a
t risk member of the family
D. Inability to provide a home environment
conducive to health maintenance and personal
development
E. Failure to utilize community resources for
health care
FAMILY COPING INDEX
• the best tool used in the community to assess the
family’s ability to take care of the sick member and
to maintain an environment conducive to healing.
• purpose is to provide a basis for estimating the
nursing needs of a particular family.
Coping - dealing with problems associated with health
care with reasonable success.
*When the family is unable to cope with one or another
aspect of health care, it may be said to have a “coping
deficit”.
Family Coping Index has 9 areas to be evaluated:
1. Physical Independence
2. Therapeutic Independence
3. Knowledge of Health Condition
4. Application of Principles of General Hygiene
5. Health Attitude
6. Emotional Competence
7. Family Living Pattern
8. Physical Environment
9. Use of Community Facility
Family Coping Index Level of Competence
0 - No Problem
1 - No Competence
3 - Moderate Competence
5 - Complete Competence
Remember:
It is the coping capacity of the family, not the individual
members and underlying problems, which is rated
In summary, the Tools for Assessment Are:
1. Initial Database and Characteristics of the Family
2. Typology of Nursing Problems
3. The Family Coping Index Level of Competence:
Remember:
After Assessment, data should be analyzed. The nurse
sorts out and classifies or groups data by type or
nature, relates them with each other and determines
patterns or recurring themes among the data, and
compares these data with norms and standards.
2. Family Data Analysis
Utilizing the data generated from the tool on Initial Data
Base in Family Nursing Practice, the nurse goes through
data analysis. The nurse sorts out and classifies or
groups data by type or nature (e.g. which are wellness
states, threats, deficits or stress points/foreseeable
crises), relates them 41 with each other and determines
patterns or reoccurring themes among the data, and
then compares these data and the patterns or
reoccurring themes with norms and standards.
• Socio – Economic and Cultural Characteristics
• Home Environment
• Family Health Status
• Family Values and Health Practices
Family Nursing Diagnosis
• The end result of the second-level assessment is a
set of family nursing problems for each health
condition or problem.
• A wellness condition is a nursing judgment related
with a client’s capability for wellness.
• A health condition or problem is a situation which
interferes with the promotion and/or maintenance
of health and recovery from illness or injury.
• The Nursing Diagnosis in Family Nursing Practice is
the Wellness State or Health Condition / Problem
when it is stated as the family’s failure to perform
adequately specific health tasks to enhance the
wellness state or manage health problems.
Family Nursing Care Plan
• the blueprint of the care that the nurse designs to
systematically minimize or eliminate the identified
health and family nursing problems through
explicitly formulated outcomes of care (goals and
objectives) and deliberately chosen set of
interventions, resources and evaluation criteria,
standards, methods, and tools.
Features:
1. Focuses on Actions which are designed to solve
or minimize existing problems.
2. Product of a deliberate systematic process.
3. Relates to the future.
4. Based upon the identified health and nursing
problems.
5. Means to an end, not an end in itself.
6. Continuous Process, not a one-shot deal.
Qualities:
1. It should be based on clear, explicit definition of
the problem/s.
2. It is realistic.
3. It is prepared jointly with the family
4. Most useful in Written Form.
The Family Nursing Care Plan / Implementation Plan
Priority Setting
1. Nature of the condition or problem presented
2. Modifiability of the condition or problem
3. Preventive Potential
4. Salience
• Nature of the condition or problem presented –
categorized into wellness state/potential, health threat,
health deficit and foreseeable crisis:
• Modifiability of the condition or problem – refers to
the probability of success in enhancing the wellness
state, improving the condition, minimizing, alleviating
or totally eradicating the problem through intervention;
• Preventive Potential – refers to the nature and
magnitude of future problems that can be minimized or
totally prevented if intervention is done on the condition
or problem under consideration;
• Salience – refers to the family’s perception and
evaluation of the condition or problem in terms of
seriousness and urgency of attention needed or family
readiness.
Establishing Goals and Objectives
Goal- a general statement of the condition or state to
be brought about by a specific course of action
Objectives – a more specific statement of the desired
result or outcomes of care.
Selecting Appropriate Family Nursing Interventions /
Strategies
• Involves selection of appropriate nursing
interventions based on the formulated goals and
objectives.
• Take into consideration nurse-family contact as
well as resources
Implementing Family Care Plan
Categories of Intervention
PROMOTIVE
→Health Promotion allows individuals to increase
control over their own health. Its extensive range of
social and environmental interventions benefits and
protects individual people’s health and quality of life.
These interventions address and prevent the origin of ill
health, not just focusing on treatment and cure.
PREVENTIVE
→Preventive care refers to measures that aim to avoid
or reduce injuries and diseases, their sequelae and
complications. Prevention is based on a health
promotion strategy that involves a process to enable
people to improve their health through the control over
some of its immediate determinants. This includes a
wide range of expected outcomes, which are covered
through a diversity of interventions, organized as
primary, secondary and tertiary prevention levels.
CURATIVE
→Curative care encompasses health care contacts
during which the principal intent is to relieve symptoms
of illness or injury, to reduce the severity of an illness or
injury, or to protect against exacerbation and/or
complication of an illness and/or injury that could
threaten life or normal function.
REHABILITATIVE
→Rehabilitation is an integrative strategy with the
purpose of empowering persons with health conditions
who are experiencing or are likely to experience
disability so that they can achieve and maintain
optimal functioning, a decent quality of life and
inclusion in the community and society.
→While curative services mainly emphasize the health
condition, rehabilitation services focus on the
functioning associated with the health condition.
Rehabilitation services stabilize, improve or restore
impaired body functions and structures, compensate
for the absence or loss of body functions and structures,
improve activities and participation, and prevent
impairments, medical complications and risks.
Tools of Public Health Nurse (Cuevas, 2007)
• THE BAG TECHNIQUE The bag technique is a tool by
which the nurse, during her visit will enable her to
perform a nursing procedure with ease and deftness, to
save time and effort, with the end view of rendering
effective nursing care to clients. 45
The public health bag is an essential and indispensable
equipment of a public health nurse/ CHN Nurse which
she/he has to carry along during her home visits. It
contains basic medications and articles which are
necessary for giving care.
Principles of bag technique
1. Performing the bag technique will minimize, if not
prevent the spread of infection.
2. It saves time and effort in the performance of
nursing procedures.
3. The bag technique should show the effectiveness
of total care given to an individual or family.
4. The bag technique can be performed in a variety
of ways depending on the agency’s policy, the
home situation, or as long as principles of
avoiding transfer of infection is always observed.
Important points to consider in the use of the bag
1. The bag should contain all the necessary articles,
supplies and equipment that will be used to answer
emergency needs.
2. The bag and its contents should be cleaned very
often, the supplies replaced, and ready to use
anytime.
3. The bag and its contents should be well protected
from contact with any article in the patient’s home.
Consider the bag and its contents clean and sterile,
while articles that belong to the patients as dirty
and contaminated.
4. The arrangement of the contents of the bag should
be the one most convenient to the user, to facilitate
efficiency and avoid confusion.
Contents of Public Health Bag
• Paper lining
• Extra paper for making waste bag
• Plastic/linen lining
• Apron
• Hand Towel
• Soap in a soap dish
• Thermometers (oral and rectal)
• 2 pairs of scissors (surgical and bandage)
• 2 pairs of forceps (curved and straight)
• Disposable syringes with needles (g. 23 and 25)
• Hypodermic needles g. 19, 22, 23, 25
• Sterile dressing
• Cotton balls (dry and with alcohol)
• Cord clamp
• Micropore plaster
• Tape measure
• One pair of sterile gloves
• Baby’s scale
• Alcohol lamp
• 2 test tubes
• Test tube holders
• Solutions of: Betadine, Zephiran Solution, Spirit of
ammonia, Acetic Acid, 70% Alcohol, Hydrogen
peroxide, Ophthalmic ointment, Benedict’s solution
• Sphygmomanometer and stethoscope are carried
separately.

Types of Family Nurse Contact
1. Clinic Visit
2. Home Visit
3. Group Conference
4. Telephone Calls
5. Written Communication
6. School Visit or Conference
7. Industrial Plant or Job Site Visit
• CLINIC VISIT (Cuevas, 2007)
The patient visits the Health Center/clinic to avail of the
services thereto offered by the facility primarily for
consultation on matters that ailed them physically.
Pre-consultation conference
• A pre-clinic lecture is usually conducted prior to
the admission of patients, which is one way of
providing health education.
• Done by a nurse or a health frontliner before
admission needed.
Standard procedures performed during clinic visits
1. Registration/Admission
• Greet the client upon entry and establish
rapport.
• Prepare the family record of new patients or
retrieve records of old clients.
• Elicit and record the client’s chief complaint
and clinical history.
• Perform physical examination on the client and
record it accordingly.
2. Waiting time
• Give priority numbers to clients.
• Implement the “first come, first served” policy
except for emergency/urgent cases.
3. Triaging
• Manage program-based cases.
(Certain programs of the DOH like the IMCI
utilize an acceptable decision to which the
nurse has to follow in the management of a
simple case).
Example – for control of diarrheal diseases
(CDD), assess if the child has diarrhea
- If he has, for how long – is there a blood in
the stool?
-Assess the child’s general condition – sleepy,
difficult to awaken, restless and irritable
-Observe for sunken eyes
-Offer fluid. Is he able to drink or is he drinking
regularly, thirsty
- Pinch skin of the abdomen – does it go back
very slowly?
• Refer all non-program based cases to the
physician. For all other cases which has no
potential danger, treatment/management is
initiated by the nurse and she decides to do her
own nursing diagnosis and then refer to the
physician for medical management.
• Provide first-aid treatment to emergency cases
and refer when necessary to the next level
care.
4. Clinical Evaluation
• Validate clinical history and physical
examination.
• The nurse arrives at evidence-based diagnosis
and provides rational treatment based on DOH
programs.
a. identify the patient’s problem
b. formulate/write the nursing diagnosis and
validate
c. give/perform the nursing intervention
d. evaluate the intervention if it has enabled
the patient to achieve the desired
outcome.
• Inform the client on the nature of the illness, the
appropriate treatment and prevention and
control measures.
5. Laboratory and other diagnostic examinations
• Identify a designated referral laboratory when
needed.
6. Referral System
• Refer the patient if he/she needs further
management following the two-way referral
system (BHS to RHU, RHU to RHU, RHU to
Hospital)
• Accompany the patient when an emergency
referral is needed.
7. Prescription/Dispensing
• Give proper instructions on drug intake
8. Health Education
• Conduct one-on-one counseling with the
patient.
• Reinforce health education and counseling
messages.
• Give appointments for the next visit.
• HOME VISIT (Cuevas, 2007)
The home visit is a family-nurse contact which allows
the health worker to assess the home and family
situations in order to provide the necessary nursing
care and health related activities. In performing this
activity, it is essential to prepare a plan of visit to meet
the needs of the client and achieve the best results of
desired outcomes.
Purpose of home visit
1. To give nursing care to the sick, to a post partum
mother and her newborn with the view to teach a
responsible family member to give the
subsequent care.
2. To assess the living condition of the patient and
his family and their health practices in order to
provide the appropriate health teaching
3. To give health teachings regarding the prevention
and control of diseases
4. To establish close relationship between the health
agencies and the public for the promotion of
health
5. To make use of the inter-referral system and to
promote the utilization of community services.
Principles involved in preparing for a home visit
1. A home visit must have a purpose or objective.
2. Planning for a home visit should make use of all
available information about the patient and his
family through family records.
3. In planning for a visit, we should consider and
give priority to the essential needs of the
individual and his family.
4. Planning and delivery of care should involve the
individual and family.
5. It should be flexible.
Guidelines to consider regarding the frequency of home
visits
1. The physical needs, psychological needs and
educational needs of the individual and family
2. The acceptance of the family for the services to
be rendered, their interest and the willingness to
cooperate
3. The policy of a specific agency and the emphasis
given towards their health programs
4. Take into account other health agencies and the
number of health personnel already involved in
the care of a specific family
5. Careful evaluation of past services given to a
family and how the family avail of the nursing
services
6. The ability of the patient and his family to
recognize their own needs, their knowledge of
available resources and their ability to make use
of their resources for their benefits
Steps in conducting home visits
1. Greet the patient and introduce yourself
2. State the purpose of the visit
3. Observe the patient and determine the health
needs
4. Put the bag in a convenient place then proceed to
perform the bag technique
5. Perform the nursing care needed and give health
teachings
6. Record all important data, observation and care
rendered
7. Make appointment for a return visit
• GROUP CONFERENCE (EX: HEALTH CLASSES)
The clinic or office conference is less expensive for the
nurse and provides the opportunity to use equipment
that cannot be taken to the home. In some cases, the
other team members (group) in the clinic may be
consulted or called upon to provide additional service.
The clinic or office conference also emphasizes to the
family the importance of empowerment and assuming
responsibility for self-help.
• TELEPHONE CALLS (Maglaya, 2009) The telephone
conference may be effective, efficient and appropriate if
the objectives and outcomes of care require immediate
access to data, given problems on distance or travel
time. Such data include monitoring of health status or
progress during the acute phase of an illness state,
change in schedule of visit or family decision, and
updates on outcomes or responses to care or
treatment.
• WRITTEN COMMUNICATION (MAIL, LETTERS) The
written communication is another less time- consuming
option for the nurse in instances when there are many
priority families needing follow-up on top of problems of
distance and travel time. If the family is motivated and
independent enough such that the nurse can use the
advantage of placing responsibility for action on the
family, sending a letter, note (as reminder, follow up on
medication/treatment or update on progress or referral
and learning materials) are appropriate, effective and
efficient options.

• SCHOOL VISIT OR CONFERENCE A school visit or

conference provides an opportunity to work with the
family and school authorities on how to determine the
degree of vulnerability of and work out interventions to
help children and adolescents on specific health risks,
hazards or adjustment problems.

• INDUSTRIAL PLANT OR JOB SITE VISIT An industrial

plant or job site visit is done when the nurse and the
family need to make an accurate assessment of health
risks or hazards, and work with employer or supervisor
on what can be done to improve on provisions for
health and safety of workers.

Evaluation of the Family Care Plan

Evaluation Phase
• It is a planned, ongoing, purposeful activity in which
the nurse and the client-partner determine the
client’s progress toward achievement
• of goals and outcomes.
• It involves examining the other steps of the nursing
process.
• It identifies if the steps of the process should be
terminated, continued, changed
• It is done while or immediately after implementing
the plan

What do we evaluate:
• Input - the important resources the program
cannot do without (e.g., Iron and Vitamin A for a
nutrition program and vaccines for an
immunization program).
• Process - important activities of the program.
• Outcomes
o Output – specific products or services
which an activity is expected to produce
from its inputs to achieve its objectives.
o Effects - the results of the use of project
outputs.
o Impact - the outcome of program effects
and is an expression of broader, long-
range program objectives.