Chapter 2

OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

Learning Outcomes:
At the end of the unit, you will be able to:
A. Integrate relevant principles of social, physical, social, natural, and health sciences, and
humanities is a given health and nursing situation.
B. Discuss appropriate community health nursing concepts and actions holistically and
comprehensively.
C. Assume responsibility for lifelong learning, own personal development and maintenance of
competence.

Global and National Health Situations

A. Definition and Focus
1. Public Health
2. Community Health
3. Public Health Nursing
4. Community Health Nursing (CHN)
5. Evolution of Public Health Nursing in the Philippines
6. Roles and Responsibilities of a Community Health Nurse

KEY TERMS
Public Health
 include “an effort organized by society to protect, promote, and restore the people’s health”
(Trust for America’s Health,2006, p. 27)
 the health of the population as a whole rather than medical health care, which focuses on treatment
of the individual ailment” (Public Health Data Standards Consortium, 2006, p. 120).

Community
 refers to a collection of people who interact with one another and whose common interests or
characteristics form the basis for a sense of unity or belonging. It can be a society of people
holding common rights and privileges (e.g., citizens of a town), sharing common interests (e.g., a
community of farmers), or living under the same laws and regulations (e.g., a prison community).
Allender, 2010
 place where people under usual conditions are found.

Health
 a state of complete physical, mental, and social well-being and not merely the absence of disease
or infirmity” (Ustin &Jakob, 2005)/WHO Community Health
 is the identification of needs, along with the protection and improvement of collective health,
within a geographically defined area (Allender, 2010)
 part of paramedical and medical intervention/approach which is concerned on the health of
the whole population.
 Aims:
o Health promotion
 o Disease prevention
o Management of factor affecting health

Public Health Nursing

 is the practice of promoting and protecting the health of populations using knowledge from
nursing, social, and public health sciences” (ANA, 2005, p. 10) Community Health Nursing
 is a field of nursing, combines nursing science with public health science to formulate a
community-based and population-focused practice (Anderson & McFarlane, 2004).
 The utilization of the nursing process in the different levels of clientele-individual, families,
population groups and communities, concerned with the promotion of health, prevention of
disease, and disability and rehabilitation (Maglaya, et al)

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

Historical Background
1898
 Department of Health was first established as Department of Public Works, Education and
Hygiene.

1912
 The Fajardo Act (Act No. 2156) created Sanitary Divisions.
 The President of Sanitary Division took charge of two or three municipalities. Where there are
no physicians available, male nurses were assigned to perform the duties of the President,
Sanitary Division.
 Philippine General Hospital (PGH), then under the Bureau of Health sent four nurses to Cebu
to take of mothers and their babies.
 St. Paul’s Hospital School of Nursing in Intramuros, also assigned two nurses to do home visiting in
Manila and gave nursing care to mothers and newborn babies from the outpatient obstetrical
service of the PGH.

1914
 School nursing was rendered by a nurse employed by the Bureau of Health in Tacloban, Leyte.
 Reorganization Act No. 2462 created the Office of General Inspection.
 Dr. Rosario Pastor a lady physician was headed the Office of District Nursing.
 Two graduate Filipino nurses, Mrs. Casilang Eustaquia and Mrs. Matilde Azurin were employed for
Maternal and Child Health and Sanitation in Manila under an American nurse, Mrs. G.D.
Schudder.

1919
 The first Filipino nurse Supervisor under the Bureau of Health, Miss Carmen del Rosario
was appointed. She succeeded Miss Mabel Dabbs.

1923
 Two government Schools of Nursing were established: Zamboanga General Hospital School
of Nursing in Mindanao and Baguio General Hospital in Northern Luzon. These schools were
 primarily intended to train non-Christian women and prepare them to render service among their
people.
 Four more government School of Nursing were establish: one in Southern Luzon
(Quezon Province) and three in the Visayan Islands of Cebu, Bohol and Leyte.

1927
 The Office of District Nursing under the Office of General Inspection, Philippine Health Service
was abolished and supplanted by the Section of Public Health Nursing. Mrs. Genara de
Guzman acted as consultant to the Director of Health on nursing matters.

1928
 First convention of nurses was held followed by yearly conventions until the advent of World
War II. Pre-service training was initiated as a pre-requisite for appointment.

1930
 The Section of Public Health Nursing was converted into Section of Nursing. The Section of Nursing
was transferred from the Office of General Services to the Division of Administration. This Office
covered the supervision and guidance of nurses in the provincial hospitals and the government
schools of nursing.

1933
 Reorganization Act No. 4007 transferred the Division of Maternal and Child Health of the Office
of Public Welfare Commission to the Bureau of Health.
 Mrs. Soledad A. Buenafe, former Assistant Superintendent of Nurses of the Public Welfare
Commission was appointed as Assistant Chief Nurse of the Section of Nursing, Bureau of Health.

1941
 Bureau of Health were transferred to the new department.
 Dr. Mariano Icasiano became the first City Health Officer of Manila.
 An office of Nursing was organized with Mrs. Vicenta C. Ponce. As Chief Nurse and Mrs. Rosario A.
Ordiz as Assistant Chief Nurse.

Dec 8, 1941
 World War II broke out, public health nurses in Manila were assigned to devastated areas
to attend to the sick and the wounded.

1942
 A group of public health nurses, physicians and administrators from the Manila Health
Department went to the internet camp in Capas, Tarlac to receive sick prisoners of war
repleased by the Japanese Army.
 They were confined at San Lazaro Hospital and 68 Public Health Nurses were assigned to
help the hospital staff take care of them.
July 1942
 31 nurses who were taken prisoners of war by the Japanese army and confined at the Bilibid
Prison in Manila were released to the Director of the Bureau of Health, Dr. Eusebio Aguilar
who acted as their guarantor.
 Many public health nurses joined the guerillas or went to hide in the mountains during
World War II.

February 1946
 Post war records of the Bureau of Health showed that there were 308 public health nurses and
38 supervisors compared to pre-war when there were 556 public health nurses and 38
supervisors.
 Mrs. Genera M. de Guzman, Technical Assistant in Nursing of the Department of Health and
concurrent President of the Filipino Nurses Association recommended the creation of a
Nursing Office in the Department of Health.

Oct. 7, 1947
 Executive Order No. 94 organized government offices and created the Division of Nursing under
the Office of the Secretary of Health. This was implemented onDecember 16, 1947.
 Mrs. Genara de Guzman was appointed as Chief of the Division, with three Assistant:Miss
Annie Sand for Nursing Education; Mrs. Magdalena C. Valenzuela for Public Health Nursing and
Mrs. Patrocinio J. Montellanofor Staff Education.
 At the Bureau of Health, the Section of Nursing Supervision took over the functions of the
former Section of Nursing.
 Mrs. Soledad Buenafe was appointed Chief and Miss Marcela Gabatin, Assistant Chief.

1948
 The first training Center of the Bureau of Health was organized in cooperation with the Pasay City
Health Department. This was housed at the Tabon Health Center located in a marginalized part of
the city. It was later renamed as Doña Marta Health Center.
 Physicians and nurses undergoing pre-service and in-service training in public health/public health
nursing as well as nursing student on affiliation were assigned to the above training center.

1950
 The Rural Health Demonstration and Training Center (RHDTC) was established by the
Department of Health through the initiative of Dr. Hilario Lara, Dean, institute of Hygiene, now
College of Public Health, University of the Philippines.
 The WHO/UNICEF assisted project used health centers of the Quezon City Health
Department, which were located in the rural areas of the city.
 Dr. Amansia S. Mangay (Mrs. Andres Angara), a Doctor of Public Health Graduate from
Harvard was chosen tobe the Chief of the RHDTC.
 Dr. Antonio V. Acosta, former Physician of the Manila Health Department was Medical
Training Officer.

❂PERSPECTIVES
STUDENT VOICES
I was really terrified when I got to my community
health rotation and found that I had to go to people’s
homes and knock on their doors! I was going to
graduate in a few months, and I felt really comfortable
in the hospital......I knew the routines and the
machines well. Now, I had to actually find houses and
apartments in an area of the city I would normally
never venture into! And, it wasn’t clear to me what I
was supposed to do! I didn’t have much equipment—a
baby scale, a blood pressure cuff, a stethoscope,
thermometer, and a paper tape measure—that was
all! I was told to go visit this 16-year-old mother who
had a 4-month-old baby, and to monitor the baby’s
progress. I don’t even have children! What can I tell
her? And, besides, she is a teenager who “knows it
all.” My clinical instructor told me to “build a
relationship with her” and to “gain trust and rapport.”
That is hard to do when you are scared to death! I was
afraid of her responses, of being out in that part of the
city alone, and of trying to answer questions without
anyone there to turn to. But, I wanted to get through
nursing school, so I drove over there and knocked on
her door. I was shocked to see the condition of the
apartment building in which she lived. Peeling paint,
loud music, trash everywhere, and strange characters
at every turn. When she answered the door, she
seemed uninterested—or maybe a little defensive. I
told her who I was and why I was there, and she
motioned me inside and pointed toward the baby,
propped up on the tattered couch. I spent the next 15
weeks visiting Anna and her baby; weighing and
measuring the baby, doing a Denver II and sharing the
results with Anna, helping her schedule appointments
for immunizations, listening to Anna’s story of abuse
and abandonment, and realizing that what I was doing
was actually exciting and rewarding. By the end of my
rotation,
I was truly going to miss Anna and little José! He
always smiled at me, and I enjoyed “playing” with him
as I instructed her about baby-proofing her apartment,
finding resources for food and clothing, and getting
birth control. We even talked about how she could
finish high school. I thought about Anna and José
occasionally, when young mothers would bring their
babies into the emergency department, where I
worked after graduation. I learned from my
community health nursing rotation that I needed to
look beyond the bravado of a teenage mother and try
to “connect” with her in order to assure that she
would follow through with the antibiotics and
antipyretics we were prescribing for her baby’s
dangerously high fever and serious infection. A year
and a half after I graduated, one day when it had been
particularly hectic but was now calming down, I
glanced up to see Anna and José. She looked so
relieved to see me! She was frantic with worry about
the serious burn José had on his right hand. The other
nurses were mumbling about “child abuse” and how
“irresponsible teen mothers always were.” I learned
that Anna had left José with a neighbor for an hour
while she visited a nearby high school to see about
getting her GED. The older neighbor was not used to
dealing with a busy toddler, and she had left the
handle of a pan of refried beans where José could
reach it. The team treated José’s burn, and I gave Anna
instructions for follow-up care. The bond we had
developed was still there. She trusted me, and I knew
that she would follow
through with the instructions. I also knew that the
other nurses who were making comments about her
did not know Anna’s circumstances. I feel that I am a
more effective ER nurse because of the things I learned
in community health. Someday, when I get tired of the
hospital, I may try working as a Public Health Nurse.
You never know!
Courtney, Age 25
1953
 The Office of Health Education and Personnel Training was established with Dr. Trinidad Gomez as
Chief
 Philippine Congress approved Republic Act No. 1082 or the Rural Health Law. It created the
first 81 Rural Health Units.

1957
 Republic Act 1891 was approved amending Sections Two, Three, Four, Seven and Eight of R.A.
1082 : Strengthening Health and Dental Services in the Rural Areas and Providing Funds thereto.”

1958-1965
 Republic Act 977 passed by Congress in 1954 was implemented. This abolished the Division of
Nursing. However, it created nursing positions at different levels in the health organization. Miss
Annie Sand was appointed Nursing Consultant under the Office of the Secretary of Health.
 The Department of Health National League of Nurses, Inc. was founded by Miss Annie Sand in
1961. She became its first President and Adviser.
 The Reorganization Act with implementing details embodied in Executive Order 288, series of
1959 de-centralized and integrated health services.
 The reorganization of 1959 also merged two Bereaus in the Department of Health. The Bureau
of Health was merged with the Bureau of Hospitals to form the Bureau of Health and Medical
Services.

1967
 In the Burea of Disease Control, Mrs. Zenaida Panlilio – Nisce was appointed as Nursing Program
Supervisor and served as consultant on the nursing aspects of the 5 special diseases: TB,
Leprosy, Venereal Disease, Cancer, Filariasis, and Mental Health.

1974
 The Project Management Staff was organized as part of Population II of the Philippine
Government with Dr. Francisco Aguilar as Project Manager.

1975
 The roles of the public health nurse and the midwife were expanded. 2000 midwives
were recruited and trained to serve in the rural areas.

1987-1989
 Executive Order No. 119 reorganized the Department of Health and created several offices and
services within the Department of Health.

1990-1992
 Department Order No. 29 designated Mrs. Neila F. Hizon, Nurse VI, then President of the National
League of Philippine Government Nurses, as Nursing Adviser. She was detailed at the Office Public
Health Services. As Nursing Adviser, matters affecting nurses and nursing are referred to her.
May 24, 1999
 Executive Order No. 102 was signed by President Joseph Ejercito Estrada, redirecting the functions
and operations of the Department of Health.

2005-2006
 The development of the Rationalization Plan to streamline the bureaucracy further was
started and is in the last stages of finalization. The Philippine Health Care Delivery System

ROLES OF COMMUNITY HEALTH NURSES

1. Clinician Role
- the nurse ensures health services are provided not just to individuals and families, but also to groups
and populations.

Holistic Practice
- In community health, however, a holistic approach means considering the broad range of
interacting needs that affect the collective health of the “client” as a larger system (Dossey,
Keegan, & Guzzetta, 2005)
- Holistic nursing care encompasses the comprehensive and total care of the client in all areas,
such as physical, emotional, social, spiritual, and economic.
- e. g. physical condition of teenage pregnancy and childbirth

Focus on Wellness
-Effective services include seeking out clients who are at risk for poor health and offering
preventive and health-promoting services, rather than waiting for them to come for help after
problems arise.
- The community health nurse identifies people, programs, and agencies interested in achieving a
higher level of health, and works with them to accomplish that goal and to sustain the expected
changed behavior (Pender, Murdaugh, & Parsons,2005).
- Examples include immunization of preschoolers, family planning programs, cholesterol
screening, and prevention of behavioral problems in adolescents.

Expanded Skills
-The clinician role in population-based nursing requires skills in collaboration with consumers and
other professionals, use of epidemiology and biostatistics, community organization and
development, research, program evaluation, administration, leadership, and effecting change
(ANA, 2000; ANA, 2006).Clinician, who is a health care provider, taking care of the sick people at
home or in the RHU.

2. Educator Role
-Health teaching, a widely recognized part of nursing practice, is legislated through nurse practice
acts in a number of states and is one of the major functions of the community health nurse (ANA,
2004;ANA, 2007c)
- Information is shared with clients both formally and informally.
- the nurse has the opportunity and mandate to develop educational programs based on community
needs that seek a community-wide impact. Community-wide antidrug campaigns, dietary
 improvement programs, and improved handwashing efforts among children provide useful models
for implementation of the educator role at the population level and demonstrate its effectiveness in
reaching a wide audience (Redman, 2007).
--For example, a nurse may teach parents and teachers at a parent–teacher meeting about signs of
mood modifying drug and alcohol abuse, discuss safety practices with a group of industrial
workers, or give a presentation on the importance of early detection of child abuse to a health
planning committee considering funding a new program.
- e.g. Teaching a middle-aged man after a heart attack ; Couples with young children

3. Advocate Role
- The community health nurse often acts as an advocate for clients, pleading their cause or acting on
their behalf. Clients may need someone to explain which services to expect and which services they
ought to receive, to make referrals as needed, and to write letters to agencies or health care
providers for them. They need someone to guide them through the complexities of the system, and
assure the satisfaction of their needs. This is particularly true for minorities and disadvantaged
groups (Sequist, Cullen, & Ayanian, 2005; Traeger,Thompson, Dickson, & Provencio, 2006) and
especially the poor, those without health insurance, and people with language barriers.

Advocacy Goals
1. To help clients gain greater independence or self-determination. Until they can research the
needed information and access health and social services for themselves, the community
health nurse acts as an advocate for the clients by showing them what services are
available, those to which they are entitled, and how to obtain them.
2. To make the system more responsive and relevant to the needs of clients. By calling
attention to inadequate, inaccessible, or unjust care, community health nurses can
influence change.

Advocacy Actions
The advocate role incorporates four characteristic actions:
a. being assertive,
b. taking risks,
c. communicating and negotiating well, and
d. identifying resources and obtaining results.

4. Manager Role
- As a manager the nurse exercises administrative direction toward the accomplishment of specified
goals by assessing clients’ needs, planning and organizing to meet those needs, directing and
controlling and evaluating the progress to assure that goals are met. Nurses serve as managers when
they oversee client care, supervise ancillary staff, do case management, manage caseloads, run clinics
or conduct community health needs assessment projects.
- who monitors and supervises the performance of the midwives
Management Behaviors
Decision-Making Behaviors
Transfer of Information Behaviors
Interpersonal Behaviors
 Case Management
Case management refers to a systematic process by which the nurse
assesses clients’ needs, plans for and co-ordinates services, refers to other
appropriate providers, and monitors and evaluates progress to ensure that
clients multiple service needs are met.

5. Collaborator Role
- Community health nurses seldom practice in isolation; they must work with
many people, including clients, other nurses, physicians, social workers and
community leaders, therapists, nutritionists, occupational therapists,
psychologists, epidemiologists, biostaticians, legislators, etc. As a member of the
health team (Fairly 1993; Williams,’ 1986), the community health nurse assumes
the role of collaborator, which means to work jointly in a common endeavor, to
co-operate as partners.

6. Leadership Role
- Community health nurses are becoming increasingly active in the leader role. As
a leader, the nurse directs, influences, or persuades others to effect change that
will positively affect people’s health. The leadership role’s primary function is to
effect change; thus the community health nurse becomes an agent of change.
They also seek to influence people to think and behave differently about their
health and the factors contributing to it. The nurse as a facilitator, who
establishes multi-sectoral linkages by referral system.

7. Researcher Role
- In the researcher role community health nurses engage in systematic
investigation, collection and analysis of data for the purpose of solving problems
and enhancing community health practice. Research literally means to search
and/or to investigate, discover, and interpret facts. All research in community
health from the simplest inquiry to the most epidemiological study uses the
same fundamental process.

The research process involves the following steps:

1. Identifying an area of interest
2. Specify the research question or statement
3. Review of literature
4. Identifying the conceptual frame work
5. Select research design

The community health nurse identifies a problem or question, investigates,

by collecting and analyzing data, suggests and evaluates possible solutions and
selects and or rejects all solutions and starts the investigative process over again. In
one sense, the nurse in gathering data for health planning, investigates health
problems in order to design wellness – promoting and disease prevention for the
community