OVERVIEW OF community health nursing

Community
• a group of people living in the
same place or having a particular
characteristic in common.

• a feeling of fellowship with

others, as a result of sharing
common attitudes, interests, and
goals.
Definition of health

• “it is a state of complete physical, mental and social well-being and

not merely the absence of disease or infirmity.”(WHO, 1995)

• “health is a quality of life, involving social, emotional, mental, spiritual

and biological fitness on the part of the individual, which results from
adaptations to the environment.” (Butler, 2001).
Two major fields of nursing in the Philippines

Nursing

Community
Hospital Health
Nursing

Public Health School Occupational

Nursing Nursing Nursing
 Hospital nursing
Nurses provide bedside care and have direct care to patients. They consult
with physicians and other members of the health care team about an
effective care plan.

NICU
ICU

GERIATRIC REHAB
Community Health Nursing
Definition
• It is the service rendered by a professional nurse
community, groups,
within the
families and individuals at home, in
health center, clinics, in places of work for the
promotion of health, prevention of
illness, care
of the sick at home and
rehabilitation.
 Definition of CHN
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 program for the
promotion of health, the
improvement of the conditions
in the social and physical
environment, rehabilitation of
people with illness and
disability.
-WHO Expert Committee on
Nursing
Community health
nursing
Public health nursing

School nursing Occupational health

nursing

Cruz-Earnshaw (2009)
 1. Public health
nursing

“Science and
• Winslow described Public Health as the
art of preventing disease, prolonging
life, promoting health and efficiency
through organized effort for:
• The sanitation of the environment,
• The control of communicable disease,
• The education of individuals in personal hygiene,
• The organization of medical and nursing services for the
early diagnosis and preventive treatment of disease, and
• The development of social machinery to insure everyone a
standard of living adequate for the maintenance of health.
The sanitation of the environment

MEGAN’S HEALTH TEACHING ABOUT

PROPER WASTE DISPOSAL
The control of communicable disease

JOSHUA’S HEALTH
TEACHING ABOUT
COMMUNICABLE
DISEASES
The education of individuals in personal hygiene

GRACIA’S HEALTH TEACHING

ABOUT IMPORTANCE OF
PERSONAL AND DOMESTIC
HYGIENE
The organization of medical and nursing services for the
early diagnosis and preventive treatment of disease
 The development of social machinery to insure everyone a
standard of living adequate for the maintenance of health.
Health programs for the different stages
of life: From womb to tomb
Philosophy of public
health nurse

Emphasize the worth and

dignity of man.
 2.)
Occupational
health
nursing
Occupational
health
nursing
3. School Nursing
• The school
nurse provides health education by
providing health information to individual
students and groups of students
through health education, science, and
other classes. The school nurse assists
on health education curriculum
development teams and may also provide
programs for staff, families, and the
community.
School
Nursing
School
Nursing
Community
 • Strong, mutually supportive
relationships and networks.
Qualities of a • Workplaces that are supportive of
individual and family well-being
Healthy • Wide participation of residents in
Community decision-making
• Strong local cultural and spiritual
heritage
• Protection of the natural environment
• Responsible use of resources to
ensure sustainability.
American Regime (1898-1942)
• 1898- Board of health for physician was created
• 1899- the First Commissioner of Health was appointed.
 • R.A. No. 157 of the Philippine Commission created a
1901 Board of Health of the Philippines which also acted as the
board of health for the City of Manila. Subsequently, Act.
No. 309 created Provincial and Municipal Boards of
Health.
 1912

• FAJARDO ACT (Act No. 2156)

- Created sanitary Divisions
President, Sanitary Division (forerunners of the present Municipal
Health Officers) took charge of two or three municipalities. Where
there were no physicians available, male nurses were assigned to
perform the duties of the President, Sanitary Division.
1915
• The Bureau of Health was renamed Philippine Health Services
with a Director of Health as its head.
• The Service was placed under the Department of Public
Instruction with the Vice-Governor General as the Department
Secretary.
• Reorganization Act No. 2462 created the Office of General
Inspection. The office of District Nursing was organized under
this Office. It was headed by a lady physician, Dr. Rosario Pastor
who was also a nurse.
 1916-1918

• Miss Perlita Clark took charge of the public health nursing

work. Her staff was composed of one American nurse
supervisor, one American dietitian, 36 Filipino Nurses
working in the provinces an one nurse and one dietician
assigned in two Sanitary Divisions.
 1919
• The first Filipino nurse supervisor under the
Bureau of Health, Miss Carmen del Rosario
was appointed. She Succeeded Miss Mabel
Dabbs.
First convention of nurse was held
followed by yearly conventions until
the advent of World war II.

1928
 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.
• In 1933, the nursing institution have increased their requirement.
During this period, they have implemented that to enter nursing
education an applicant must be able to complete secondary
education. The first collegiate nursing graduates of the Philippines
graduated from University of the Philippines School of Public
Health Nursing in 1938.
1940
 Dec. 8. 1941
•At the outbreak of World
War II, public health nurses
in Manila were assigned to
devastated areas to attend
to the sick and the
wounded.
 Japanese regime (1942-1945)

•Public Health Nurses

services were interrupted
 June 1942

• A group of public health nurses with physicians and

administrators of the Manila Health Department went
to the internment camp in Capas, Tarlac to receive sick
prisoners of war released by the Japanese army. They
were confined at San Lazaro Hospital and sixty-eight
National Public Health Nurses were assigned to help
the hospital staff to take care of them.
 Era of the republic of the Philippines (1946-
present)
➢1947- DOH was
divided into three
bureaus
•Hospital
•Quarantine
•Health
 1948
• The first training Center of the Bureau of Health was
organized in cooperation with the Pasay City Health
Department.
• Tabon Health Center was located in a marginalized part of
the city. It was renamed as Dona Marta Health Center.
• Physicians and nurses undergoing pre-service and in-service
training in public health/public health nursing as well as
nursing students on affiliation were assigned to the above
training center.
 • As a result of the restructuring of the health
care delivery system based on findings of
Operation Research (WHO Assisted) conducted
in the province of Rizal in the early 70’s the
functions of the health team members
(Municipal Health officer, Public Health nurse,
Rural health midwife, and Rural Sanitary
1975 Inspector) were re-defined.
• The roles of the public health nurse and the
midwife were expanded. Two thousand
midwives were recruited and trained to serve in
the rural areas.
• The aim was for a ratio of one Rural Health
Midwife per 5000 population.
 The local Government Code of 1991 (R.A. 7160) was
passed and implemented.

Results in devolution, which transferred the power and

authority from the national to the local government
units.

1990-1992 It was aimed to build their capabilities for self-

government and develop them fully as self-reliant
communities.

Appointments of RHU/city health department

personnel (including nursing personnel) have to be
approved by the mayor. Material supplies of health
center have to be provided by the LGUs.
 Executive Order No. 102 was signed by
President Joseph Ejercito Estrada, redirecting
the functions and operations of the
Department of Health.

May 24, the DOH seeks to serve as the national

technical authority on health, one that will
1999 ensure the highest achievable standards of
quality health care, health promotion and
health protection, from which local
government units, non-government
organizations, other private organizations
and individual members of civil society will
anchor their health programs and strategies;
Framework for Community
Health Nursing
 Scope of practice
Factors
influencing
Policies and standards of the
the Department of Health and
organizations where the CHN works.

practice of
CHN Health needs and problems of the
people
 Health care delivery system (HCDS) with its CHN
subsystem

Components Clients (individual, family, population groups &

of macro- community.

framework of Health (goal of HCDS)

CHN
Economic, sociocultural, political, &
environmental factors that affect HCDS, practice
of community nursing & people’s health
Philippine Heart Center
Philippine Children Medical Center
Lung Center of the Philippines
National Kidney and Transplant Center
Levels of clientele of the
community health nursing
General view
Community

Population
group

Family

Individual
 Individual

A person, sick or well, regardless of age,

gender, educational status, role in the
community
 • Two or more individuals joined or
related together by ties of blood,
marriage or adoption and who
constitute a single household,
interact with each other in their
respective familial role, and create
and maintain a common culture.

Family
 According to Clark (1995), population
group is an aggregate of people who share
common characteristics, developmental
stage or common exposure to particular
environmental factors thus resulting in
common health problems.
Population
group
Population aggregates with
developmental needs and those that are
vulnerable are population group (Allender
& Spradley, 2000).
Population group examples
Developmental needs Vulnerable

• Maternal • Rural clients

• Prenatal & newborn • The poor
• Infant • Migrant workers
• Toddler • Minority experiencing health
• Preschool disparities
• Mental illness
• Living with addiction
• Correctional facilities
• Long term settings
 Levels of
health
prevention
Levels of health prevention
Level 1 Level 2
Primary Prevention Secondary Prevention
Activities Activities
Prevention of problems Early detection and
before they occur intervention
Level 3
Tertiary Prevention Activities
Correction and prevention of
deterioration of a disease
state
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Primary prevention
• Primary prevention aims to prevent disease or injury before it ever occurs.
This is done by preventing exposures to hazards that cause disease or injury,
altering unhealthy or unsafe behaviors that can lead to disease or injury, and
increasing resistance to disease or injury should exposure occur. Examples
include:
• legislation and enforcement to ban or control the use of hazardous
products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use
of seatbelts and bike helmets)
• education about healthy and safe habits (e.g. eating well, exercising
regularly, not smoking)
• immunization against infectious diseases.
Secondary prevention

• Secondary prevention aims to reduce the impact of a disease or injury that has
already occurred. This is done by detecting and treating disease or injury as soon as
possible to halt or slow its progress, encouraging personal strategies to prevent
reinjury or recurrence, and implementing programs to return people to their
original health and function to prevent long-term problems. Examples include:
• regular exams and screening tests to detect disease in its earliest stages (e.g.
mammograms to detect breast cancer)
• daily, low-dose aspirins and/or diet and exercise programs to prevent further
heart attacks or strokes
• suitably modified work so injured or ill workers can return safely to their jobs.
Tertiary prevention
• Tertiary prevention aims to soften the impact of an ongoing illness or
injury that has lasting effects. This is done by helping people manage long-
term, often-complex health problems and injuries (e.g. chronic diseases,
permanent impairments) in order to improve as much as possible their
ability to function, their quality of life and their life expectancy. Examples
include:
• cardiac or stroke rehabilitation programs, chronic disease management
programs (e.g. for diabetes, arthritis, depression, etc.)
• support groups that allow members to share strategies for living well
• vocational rehabilitation programs to retrain workers for new jobs when
they have recovered as much as possible.
Factors affecting health
Health
• Health is a basic human right.
• Health is the goal of public health in general, and
community health nursing in particular.
• “it is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity.”(WHO, 1995)
• “health is a quality of life, involving social, emotional,
mental, spiritual and biological fitness on the part of
the individual, which results from adaptations to the
environment.” (Butler, 2001).
Health
• Florence Nightingale looked
into health and illness in
relation to the environment--
-ventilation, noise, light,
cleanliness, diet and restful
bed.
Sustainable Development Goals (SDG)
 Poverty & health
• Poverty is the indication of the continuing social injustice
and failure of a country’s development efforts.
• The Philippines is the 106th among he 189 countries ranked
by the United Nations Development Program in terms of
human development (2019).
• The World Bank had estimated poverty incidence in the
Philippines at 24.5 percent for 2016, 23.1 percent for 2017
and 21.9 percent for 2018. (PH poverty projected to be at
18.7% in 2021: WB Oct 2019)
• An estimated 5.2 million Filipino families found themselves
without food to eat at least once in the past three months
(Philstar,July 2020).
How does poverty affects health?
• The poor have poor health because they do not have the resources to afford the basic
requisites of health; they are not covered by health insurance; and they do not have the
capacity to effectively transact or negotiate with the health care system which seems to be
more responsive to the needs of those with necessary financial resources.
Culture & health
• Culture is a way of life; it is the totality of who we are as a
people.
• It endures over time and is passed on from one generation
to the next.
• Culture includes many things such as:
• Beliefs
• Values
• Customs or practices
• How we socialize or interact with others
• How we relax and spend our free time
• The food the we eat or do not eat
• How we prepare food
• How we treat and care for pregnant women
• How we deliver babies & take care or our new born
Filipino culture
“Culture has positive effects on health”
• Example: (Filipino culture)
• Families, relatives and friends are a major source of
financial, emotional, instrumental and social support,
especially during crisis situations.
• These close family ties among Filipinos contribute to
their sense or emotional well-being and mental
health.
 Environment &
health
• The international Physicians
for the Prevention of
Nuclear War estimates that
millions of cancer cases will
result from the nuclear
testing conducted in the
past. The WHO also
estimates about 20,000
deaths a year in the world
due to pesticides poisoning
alone (Philippine Breast
Cancer Network, 1997).
 • The state of the World’s
environment is the
direct result of the
interaction of a number
of factors such as
industrialization,
government policies,
poverty and an
uncaring attitude
towards the
environment.
Environment & health
Politics & health
• Policies reflect the priorities of
government and the value system of
policy makers.
• The health budget is the most
concrete expression of the
government’s political will.
• Many Filipinos do not have full
access to basic health goods and
services because of the severely
limited health care financing.
• In 2017, the amount spent for
health was only 4.45% of the gross
national product, lower than WHO-
recommended 5%.
Politics & health
• Almost half of health expenditures is out-of-pocket;
• Access of care is highly inequitable.
• Laws that impact on people’s health directly
• RH law (pending)
• Food fortification law
• Salt iodized Law “Sangkap Pinoy”
• Laws that impact people’s health indirectly
• Minimum wage
• Laws protecting women & children
Roles &
functions of
the public
health nurse
 Provider of
Roles & functions nursing care

Researcher Manager

Coordinator of
Leader
services

community
Change Community
Agent organizer

Role Model Health

monitor
Trainer &
Health
Educator
 Planner/programmer

Identifies needs, priorities, Formulates municipal

and problems of individuals, health plan in the absence
families & communities. of a medical doctor.

Interprets and implements

Provides technical nursing plan, program
assistance to rural health policies, memoranda, and
midwives in health matters. circular for the concerned
staff personnel.
Provider of nursing care
• Provides direct nursing
care to sick or disabled
in the home, clinic,
school, or workplace.
• Develops the family’s
capability to take care
of the sick, disabled, or
dependent member.
 Manager/supervisor
• Formulates individual, family
group, and community-centered
plan.
• Interprets and implements
programs, policies, memoranda,
and circulars.
• Organizes work force, resources,
equipment, and supplies at the
local level.
 Community organizer

• Motivates and enhances

community participation in terms
of planning organizing,
implementing, and evaluating
health services.
• Initiates and participates in
community development
activities.
 Coordinator of services
• Coordinates with individuals,
families, & groups for health-
related services provided by
various members of the
health team.
• Coordinates nursing program
with other health programs
like environmental
sanitation, health education,
dental health, and mental
health.
 Health monitor

• Detects deviation from

health
practices/behavior of
individuals, families,
groups, &
communities through
contacts/visits with
them.
Provides good
example of
healthful living to
the member of
the community.

Role model
 Change agent
• Motivates changes in health
behavior lifestyles of
individuals, families, groups,
and communities in order
to promote & maintain
health.
Recorder/reporter/statistician

Prepares & submit required reports & records.

Maintains adequate, accurate, & complete

recording & reporting

Prepares statistical data/chart & other data

presentation

Reviews, validate, consolidates, analyzes, and

interprets all records & reports.
 Trainer/health educator
• Identifies & interpret training needs
of the Rural Health Midwives
(RHMs), Barangay Health Workers
(BHWs), and hilots.
• Conducts training for midwives and
hilots on the health promotion and
disease prevention.
• Conducts pre- and post-consultation
conferences for clinic clients.
• Acts as a resource speaker on health
& health related services.
Principles of
health
Education
 • Consider the health status of the
people, which is determined by the
economic and social conscience of the
country.
• It is a process whereby people learn to
Principles improve their personal habits &
attitudes, to work responsibly for the
improvement of health conditions of
of health the family, community, and nation.
• It involves motivation, experience,

Education change in conduct & thinking, while

stimulating active interest.
• It develops & provides experience
for change in people’s attitudes
customs, and habits in relation to
health and everyday living.
 • It takes place in the home, in the school,
and in the community.
• It is a cooperative effort requiring all
categories of health personnel to work

Principles together in close teamwork with

families, groups, and the community.
• It meet the needs, interests, and
of health problems of the people affected.
• It is a slow, continuous process that

education involves constant changes and revisions

until objectives are achieved.
• It makes use of supplementary aids
and devices to help with the verbal
instructions.
 • It utilizes community
resources by careful
Principles evaluation of the different
services and resources found
of health in the community.
• It aims to help people make
education use of their own efforts and
education to improve their
conditions of living.
 Goals & objective of CHN
• Community health nursing aims to achieve the highest possible level
of community health by developing & enhancing the capabilities of
individuals, families, various population groups and the community as
a whole to take care of their own health and effectively cope with
health.

ULTIMATE GOAL OF CHN

IMPROVE/RAISE LEVEL OF HEALTH AMONG FILIPINOS

references

Cuevas, F.L. (Ed.) (2007). Public health nursing in the Philippines

(10th ed.).National League of Philippine Government Nurses,
Incorporated.

Famorca, Z.U., Nies, M.A., and McEwen, M.A. (2013). Nursing

care in the community: a comprehensive text on community and
public health nursing in the Philippines.

Maglaya, A. (2009). Nursing Practice in the Community (5th ed.).

Marikina city: Argonauta Corporat