UNIT 1: INTRODUCTION TO COMMUNITY AND PUBLIC
HEALTH NURSING
OVERVIEW OF PUBLIC HEALTH NURSING IN THE
PHILIPPINE
CHAPTER 1
HEALTH: KEY CONCEPT IN NURSING SCIENCE
NURSING
As a profession
- aimed at helping the population achieve better health
thru their own hands
As a science
- relies on an understanding the key towards genuine
development in investing on health and healthcare of
people regardless of age, gender, religion, and color
(Sumile, 2018)
HEALTH (in nursing science)
• it is a shared, complex reality
• is multidimensional, the well-being of an individual is
determined by factors such as biological and behavioral
characteristics, the physical and social environment.
• is a fundamental right of every individual regardless of
race, religion, political belief, economic and social
condition.
DEFINITION OF HEALTH (WORLD HEALTH
ORGANIZATION)
“a state of complete, physical, mental, and social well-
being and not merely the absence of disease or
infirmity” (1958)
• Social means relating to living together in organized
groups or similar close aggregates (American Heritage
College Dictionary, 1997, p.1291)
-Refers to units of people in communities who interact
with one another
• Social health connotes community vitality and is a
result of positive interaction among groups within the
community, with an emphasis on health promotion and
illness prevention.
“ Health is the extent to which an individual or group is
able, on the one hand, to realize aspirations and satisfy
needs; and, on the other hand, to change or cope with
the environment. Health is therefore, seen as a source
for everyday life, not the objective of living; it is a
positive concept emphasizing social and personal
resources, and physical capacities” (1986).
HEALTH AS A HUMAN RIGHT
Health as a human right is grounded in:
1. Universal Declaration of Human Rights (UDHR)-
proclaimed by the United Nations (UN) General
Assembly in Paris on Dec. 1948
-it did set that fundamental human rights be
universally protected.
• Article 25.1 declares: “Everyone has the right
to a standard of living adequate for the health
and well-being of himself and of his family,
including food, clothing, housing and medical
care and necessary social services” (United
Nations, UDHR, 1948)
2. International Covenant on Economic, Social and
Cultural Rights (United Nations, CESCR)
Art.12: “ Health is a fundamental human right
indispensable for the exercise of other human
rights. Every human being is entitled to the
enjoyment of the highest attainable standard of
health conducive to living a life in dignity. The
realization of the right to health may be
pursued through numerous, complementary
approaches, such as the formulation of health
policies, or the implementation of health
programmes developed by the World Health
Organization (WHO), or the adoption of specific
legal instruments” (United Nations, CESCR,
2000)
According to the Committee on Economic,
Social and Cultural Rights, (United Nations,
CESCR, 2000) the right to health consist of
interconnected and indispensable components:
• 1. Availability-requires that operational public
health and channels of service delivery,
products and services as well as programs be
adequate for all.
• 2. Accessibility- entails that health facilities,
services and goods must be made possible and
obtainable to everyone. Being
nondiscriminatory, physically accessible,
economically accessible (affordable) and
 information accessible are the four intersecting
features of accessibility.
• 3. Acceptability- corresponds to respect for
the medical ethics, being culturally appropriate
and gender sensitive. This clearly define the
need for health care centers, products services
and programs to be people-centered, able to
accommodate the specific needs of diverse
population groups and adheres to the
international standards of medical ethics for
informed consent and confidentiality
• 4. Quality-implies that the health facilities,
commodities and services must be in
accordance with specific and medical standards.
Quality health services need to be safe,
effective, people-centered,timely, equitable,
integrated and efficient.
3. Article II Section 11 and 15 of the 1987 Philippine
Constitution
-at the National Level, affirms health as a
fundamental human right and recognizes the
obligation of the state to protect and promote
the right to health of all Filipinos ( Republic of
the Philippines Official Gazette, 1987)
Department of Health (DOH)
Leads the health sector towards assuring quality
health care in promoting and protecting the
health of all Filipinos.
MODELS OF HEALTH
Guides the nurses in understanding health as a concept:
1. Clinical Model
• Health is the absence of signs and symptoms of
disease and illness. Ex: An adult individual who is not
particular with his lifestyle choices will only seek
healthcare when chest pain is encountered and begins
to suspect a cardiovascular disease.
2. Role Performance Model
• The ability to perform societal roles defines what
health is, failure to perform these roles means illness.
• Ex: An employee who reported for work, even if
he/she is febrile.
3. Adaptive Model
• Health is a dynamic state. An individual is considered
to be healthy if he/she was able to adjust positively to
social, mental, and physiological. Illness exist when the
person failed to cope or become maladaptive to these
changes.
4. Eudaimonistic Model
• An elevated (exuberant) level of wellness or well-
being. Illness is reflected by a lack of vitality.
• Derived from Greek terminology, this term indicates a
model that embodies the interaction and inter-
relationships among the physical, social, psychological
and spiritual aspects of life and the environment.
• Illness is indicated by a denervation or languishing, a
wasting away, or lack of involvement with life.
5. Wellness-illness Continuum
A dichotomous depiction of the relationship between
the concepts of health and illness.
Fig 1: Wellness – Illness continuum with high-level
wellness added. Movement from the center to the left
demonstrates movement toward health, movement
from the center to the right demonstrates movement
toward illness. Moving above the line demonstrates
movement toward increasing wellness. Moving below
the line demonstrates movement toward decreasing
wellness.
• The concept demonstrates that a person can have a
terminal disease and be emotionally prepared for
death, while acting as a support for other people and
achieving high-level wellness. Highlevel wellness
involves progression towards a higher level of
functioning, an open-ended and ever-expanding future
with its challenge of fuller potential, and the integration
of the whole being.
AGENT HOST ENVIRONMENT AND HEALTH BELIEF

DETERMINANTS OF HEALTH AND DISEASE
It is essential to the community health nurse to
understand the determinants of health and recognize
the interaction of the factors that leads to disease,
death, and disability :
1. Biology
• The individual’s genetic make up, family history, and
any physical and mental health problems developed in
the course of life.
Ex: Heredity, Aging, Diet, Physical Activity, Smoking,
Stress, Alcohol or Drug Abuse, Injury, Violence, or a
Toxic on Infectious Agent
2. Behaviors
• The individual’s responses to internal stimuli and
external conditions.
3. Social Environment
• Includes interactions and relationships with family,
friends, coworkers, and others in the community.
• Has a great impact on the health of individuals,
groups, and communities.
• Complex in nature because of differing cultures and
practices.
Ex: Social institutions- law enforcement, religious
communities, schools, and government agencies are
also part of the social environment. -housing, public
transportation and availability of resources
4. Physical Environment
• Pertains to an environment that is experienced by the
senses-what is smelled, seen, touched, heard, and
tasted. Ex: Presence of infectious substances in the
environment, has negative influence on health.
5. Policies and Interventions
• Can have a profound effect on the health of
individuals, groups, and communities.
Ex: Policies Against Smoking in public places, Seatbelt
and Child restraint laws Litter Ordinances
➢Public Health Nurses must work with policy makers
and community leaders to identify patterns of disease
and death and to advocate for activities and policies
that promote health at the individual, family, aggregate,
and population levels.
SOCIAL DETERMINANTS OF HEALTH
Social Determinants of Health (SDH) are:
“ conditions in which people are born, grow, live, work
and age; might also be circumstantial elements as such
housing, work conditions and access to recreational
activities; circumstances that influence how an
individual will develop sickness, what risk factor they
are exposed to, how they access services; and is shaped
by the distribution of money, power and resources at
global, national and local levels” (CSDH, 2008)
SHD may also include:
• occupation, • circumstances affecting the way in
which people work, • Income, • Culture, • Religion, •
Education, • Racial, and • Gender discrimination
CASE SCENARIO
➢A family of seven (7), a couple with five (5) kids; living
in a depressed area in Metro Manila; both parents are
high school drop outs, father working as a construction
worker (not a regular basis), earning below the
minimum wage; mother is a full time housewife, cares
for her infant, toddler, preschooler, and two school
aged children; not even one of the children goes to
school. To satisfy their hunger, the usual foods served
every meal are salt bread “pandesal” and instant
noodles.
What are the health related problems may be identified
in the given scenario?
❑At present, public health sector is particularly
working on the social determinants of health
(Schrammer & Ramon, 2018)
❑In order to improve health equity, WHO advocated
for intersectoral actions; thus, leading to a multisectoral
approach to health
❑Aside from the health sector, other essential sectors
in the society such as the government, civil society, local
communities, business, global assemblies and
international agencies were made involved ( CSDH,
2008)
❑Consequently, a better health outcome will be
positively instrumental to the attainment of the goals of
the other sectors (UN Platform on Social Determinants
of Health)
CHAPTER 2
COMMUNITY
·a group of people with common characteristics or
interests living together within a territory or
geographical boundary
· Place where people under usual conditions are found
· Derived from a latin word “comunicas” which means a
group of people.
COMMUNITY HEALTH
· Part of paramedical and medical
intervention/approach which is concerned on the
health of the whole population
AIMS:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health
NURSING
Both profession & a vocation. Assisting sick individuals
to become healthy and healthy individuals achieve
optimum wellness
COMMUNITY HEALTH NURSING
“The utilization of the nursing process in the different
levels of clientele-individuals, families, population
groups and communities, concerned with the
promotion of health, prevention of disease and
disability and rehabilitation.” ( Maglaya, et al)
Goal : “To raise the level of citizenry by helping
communities and families to cope with the
discontinuities in and threats to health in such a way as
to maximize their potential for high-level wellness” (
Nisce, et al)
 Special field of nursing that combines the skills
of nursing, public health and some phases of
social assistance and functions as part of the
total public health program for the promotion
of health, the improvement of the conditions in
the social and physical environment,
rehabilitation of illness and disability ( WHO
Expert Committee of Nursing)
 A learned practice discipline with the ultimate
goal of contributing as individuals and in
collaboration with others to the promotion of
the client’s optimum level of functioning thru’
teaching and delivery of care (Jacobson)
 A service rendered by a professional nurse to
IFCs, population groups in health centers,
clinics, schools , workplace for the promotion of
health, prevention of illness, care of the sick at
home and rehabilitation (DR. Ruth B. Freeman)
PUBLIC HEALTH
“Public Health is directed towards assisting every citizen
to realize his birth rights and longevity.”“The science
and art of preventing disease, prolonging life and
efficiency through organized community effort for:
1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for
the early diagnosis and preventive treatment of disease
5. The development of a social machinery to ensure
everyone a standard of living, adequate for
maintenance of health to enable every citizen to realize
his birth right of health and longevity (Dr. C.E Winslow)
MISSION OF CHN
1· Health Promotion
2· Health Protection
3· Health Balance
4· Disease prevention
5· Social Justice
PHILOSOPHY OF CHN
“The philosophy of CHN is based on the worth and
dignity of man.”(Dr. M. Shetland)
BASIC PRINCIPLES OF CHN
1. The community is the patient in CHN, the family is
the unit of care and there are four levels of clientele:
individual, family, population group (those who share
common characteristics, developmental stages and
common exposure to health problems – e.g. children,
elderly), and the community.
2. In CHN, the client is considered as an ACTIVE partner
NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health
technology, in particular, changes in society, in general
4. The goal of CHN is achieved through multi-sectoral
efforts
5. CHN is a part of health care system and the larger
human services system.
ROLES OF A PUBLIC HEALTH NURSE
· Clinician, who is a health care provider, taking care of
the sick people at home or in the RHU
· Health Educator, who aims towards health promotion
and illness prevention through dissemination of correct
information; educating people
· Facilitator, who establishes multi-sectoral linkages by
referral system
· Supervisor, who monitors and supervises the
performance of midwives
· Health Advocator, who speaks on behalf of the client
· Advocator, who act on behalf of the client
· Collaborator, who working with other health team
member
In the event that the Municipal Health Officer (MHO) is
unable to perform his duties/functions or is not
available, the Public Health Nurse will take charge of the
MHO’s responsibilities.
OTHER SPECIFIC RESPONSIBILITIES OF A NURSE,
SPELLED BY THE IMPLEMENTING RULES AND
REGULATIONS OF RA 7164 (PHILIPPINE NURSING ACT
OF 1991) INCLUDES:
· Supervision and care of women during pregnancy,
labor and puerperium
· Performance of internal examination and delivery of
babies
· Suturing lacerations in the absence of a physician
· Provision of first aid measures and emergency care
· Recommending herbal and symptomatic meds…etc.
In the care of the families:
· Provision of primary health care services
· Developmental/Utilization of family nursing care plan
in the provision of care
In the care of the communities:
· Community organizing mobilization, community
development and people empowerment
· Case finding and epidemiological investigation
· Program planning, implementation and evaluation
· Influencing executive and legislative individuals or
bodies concerning health and development
RESPONSIBILITIES OF CHN
be a part in developing an overall health plan, its
implementation and evaluation for communities
· provide quality nursing services to the three levels of
clientele
· maintain coordination/linkages with other health team
members, NGO/government agencies in the provision
of public health services
· conduct researches relevant to CHN services to
improve provision of health care
· provide opportunities for professional growth and
continuing education for staff development
STANDARDS OF CHN (9)
1. Theory
· Applies theoretical concepts as basis for decisions in
practice
2. Data Collection
· Gathers comprehensive, accurate data systematically
3. Diagnosis
· Analyzes collected data to determine the needs/
health problems of IFC
4. Planning
· At each level of prevention, develops plans that specify
nursing actions unique to needs of clients
5. Intervention
· Guided by the plan, intervenes to promote, maintain
or restore health, prevent illness and institute
rehabilitation
6. Evaluation
· Evaluates responses of clients to interventions to note
progress toward goal achievement, revise data base,
diagnoses and plan
7. Quality Assurance and Professional Development
· Participates in peer review and other means of
evaluation to assure quality of nursing practice
· Assumes professional development
· Contributes to development of others
8. Interdisciplinary Collaboration
· Collaborates with other members of the health team,
professionals and community representatives in
assessing, planning, implementing and evaluating
programs for community health
9. Research
· Indulges in research to contribute to theory and
practice in community health nursing
LEVELS OF CLIENTELE IN COMMUNITY AND PUBLIC
HEALTH NURSING (CPHN)
➢ The Philippine Nursing Law of 2002 ( RA 9173)
states that…
“ A person shall be deemed to be practicing nursing
within the meaning of this Act when he/she singly or in
collaboration with another, initiates and performs
nursing services to individuals, families and
communities in any health care setting. It includes, but
not limited to, nursing care during conception, labor,
delivery, infancy, childhood, toddler, pre-school, school
age, adolescence, adulthood and old age.”
➢Furthermore …
”As independent practitioners, nurses are primarily
responsible for the promotion of health and prevention
of illness. As members of the health team, nurses shall
collaborate with other health care providers for the
curative, preventive, and rehabilitative aspects of care,
restoration of health, alleviation of suffering, and when
recovery is not possible , towards a peaceful death”
ONE HEALTH CONCEPT: A FRAMEWORK FOR
COMMUNITY AND PUBLIC HEALTH NURSING
❑The world in the present times, is faced with
immense challenges for health.
❑Jones, et al., 2008 reported the appearance of 335
infectious disease among human population between
1940 and 2004
❑COVID 19 immergence in the past 2 years and still
occurring at the present.
❑Emerging infectious diseases (EIDs) are a matter of
importance to a great extent if there is a rapid increase
in cases and high incidences of deaths cased by these
diseases (Petrosillo, 2019)
❑The most effective way to act in response to the
threats of EIDs is the One Health Approach-recognizing
the connection between human, animal, and
environmental health (Johnson et al., 2019)
❑ consolidated interaction between human
health, veterinary medicine, and public and
environmental health professionals, clinicians,
researchers, and agencies functioning hand in
hand for a worthwhile and sustainable health
interventions in addressing worldwide and
environmental health challenges. The reciprocal
actions may occur at several levels which is
from management of zoonotic infectious
disease outbreaks to consolidated policy-
making and funding resolution (Day, 2011)
One Health Approach Activities example includes:
 National Rabies Prevention and Control
Program (NRPCP)
 Avian Influenza Protection Program (AIPP)
 Philippines Inter-agency Committee on
 ❑Integrated approach-One Health Concept, is vital for
an effective action to decrease the incidence of
emerging infectious disease.

SUMMARY
❑Health is multidimensional. The well-being of an
individual is determined by factors such as the
biological and behavioral characteristics, the physical,
and social environment, and of the policies and
interventions related to health.
❑Health is a fundamental right of every individual.
❑The social determinants of health are interconnected
and have an influence on the health of the individual,
family and community.
❑Community/Public Health Nursing is a specialized
field of practice that focuses on health promotion and
disease prevention
❑Health as a shared reality requires comprehensive
and collaborative interventions built on partnership.
❑Nurses in the community deal with individuals,
families, groups, and communities but the family
remains to be his/her unit of services.
❑Protecting and promoting the worth and dignity of
man is the philosophy of community/public health
nursing and ensuring the common good is his/her
framework in practice.
❑ Nursing practice should be guided by principles of
bioethics that spells out obligation of professionals
when dealing with population groups.