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Community Health Nursing: o group

o community
Definitions:  goal of improving community health involves
multidisciplinary effort
1.) World Health Organization:  CHN works not for individual patient, family, group or
a. Special field of nursing that combines skills of community. The latter are active partners, not passive-
nursing public health… recipients of care
b. Function as part of total public health program  Practice of CHN is affected by changes in society in
for: general and by developments in health field in particular
i. Promotion of health  CHN is part of community health system, which in turn is
ii. Improvement of condition part of the larger human services system
iii. Rehabilitation of illness and
disability Barangay Health Centers
2.) Jacobsen
a. Learned practice discipline with ultimate goal 1 doctor, 1 nurse, midwives, 2 barangay health workers. 1 nurse= 5000
of contributing as individuals to promote people
client’s optimum level of functioning through
teaching and delivery of care Wednesday: check-up and free immunizations
3.) Dr. Ruth B. Freeman
a. CHN is a unique blend of nursing and public
health practice aimed at developing and
enhancing health capabilities of people. It is
Roles and Functions
involved in entire spectrum of health services
for the community
4.) Tinkham and Voorhies, 1972  Planner: e.g. IMCI = Integrated management of childhood
a. CHN is a field of nursing in which family and illnesses
communities are patients  Provider of Nsg Services: direct nursing care of sick;
b. Unique blend of nursing and public health provides patient continuity of care5
practice woven into human service  Manager/Supervisor: formulates individual, family, group
c. “The hallmark of CHN is that it is population or and community centered care of plan; organize work
aggregate-focused.” force
 Coordinator of Services: coordinates with individuals,
Philosophy of CHN family, group for health related services provided by GO’s
and NGO’s
Dr. Margaret Shetland:  Trainer/health educator/counselor: identifies and
interprets training needs of RHM’s, BHW’s and hilots;
“Philosophy is based on the worth and dignity of resource speaker; IEC materials
man.”  Health Monitor: detects deviation from health of
individual, family, group and community through contact
visits with them; use of systematic and objective
Ultimate Goal
assessment
 Role model: provides good example/ model of healthful
“To raise level of health of the citizenry.”
living to public
 Change agent: motivates changes in health behavior of
Objectives of CHN
individual, family, group and community including
lifestyle to promote and maintain health. “most difficult
1.) participate…
role.”
2.) conduct researches…
 Recorder/reporter/statisticiain: prepares and submits
3.) coordinate…
records and reports
 Researcher: participates/assists in conduct of surveys
Concepts of CHN
Community Health Nursing:
 emphasis on importance of “greatest good for the greatest
number”
History:
 assessing health needs, planning, implementing and
evaluating impact of health services on population group
 Early Christian era: virgins, noblewomen and plebeians
 priority of health promotive and disease preventive
took care of sick
strategies over curative interventions
 Phoebe: 1st visiting nurse
 tools for measuring and analyzing community health
 Mr. William Rathbone:
problems
o Philanthropist who first thought of public
 application of principles of management and organization
of the delivery of health services to the community health nursing
o District nursing service in Liverpool in 1859
Basic Principles of Community Health Nursing o More emphasis on midwifery
o Forerunner of public health nursing system
 family is the unit of care, community is the patient and  In the USA:
the four levels of clientele of CHN are: o Public HN developed from visiting nursing
o individual service under missionary societies and visiting
o family nursing associations

o 1877: women’s board of NY mission
established 1st visiting nurses
History of Public Health
 Babylonians
o Understood need for hygiene
o Developed medical skills
 Egyptians
o Developed variety of pharmaceutical
preparations
o Constructed earth privies and public drainage
system
 Hebrew Mosaic Law
o Maternal health, communicable disease
control, protection of food, water, waste and
sanitary disposal
 Greeks
o Linked health to environment
o Wealthy people value personal cleanliness,
exercise, diet and sanitation
 Romans
o Viewed medicine from a community health and
social medicine perspective
o Emphasized regulation of medical practice
o Provision of pure water
o Sewage systems, public food preparation
o Women visited and cared for the sick
 Christianity
o Brought idea of personal responsibility
o Started the care for the sick
 Middle Ages
o Poor sanitary conditions
o Increase in communicable diseases (cholera,
bubonic plague, smallpox)
o Religious convents and monasteries
established hospitals
o Started movement of health education and
personal hygiene
 Renaissance
o Health practices were influenced by
recognition of human dignity and worth
o Elizabeth Poor Law: established 1601,
guaranteed medical services to poor and lame
individuals
 Industrial Revolution
o Advances in transportation
o Religious women started to provide nursing
care in institutions and homes
Milestones in history of public health
 1601- Elizabeth Poor Law
 1617- Sisterhood of Dames de Charite organized by St.
Vincent de Paul
 1789- Baltimore Health Department
 1798- Marine Hospital Service, nuns visited poor
 1813- Ladies Benevolent Society of Charleston, South
Carolina founded
 1836- Lutheran deaconesses provided home visits in
Germany
 1851- Nightingale visited Kaiserwerth, 3 months of
nursing training
 1855- Quarantine Board, established in New Orleans;
beginning of tuberculosis campaign in US
 1859- district nursing established by William Rathbone
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 1860- Florence Nightingale Training School for Nurses
established in St. Thomas Hospital in London
 1864- Beginning of Red Cross
Community Health Nursing Historical Background in Philippines
 1901- Act 157, est. Board of Health of Philippines
 1905- Act 1407, est. Bureau of Health, under Department
of Interior
 1912- Fajardo Act (Act 2156) – Sanitary Division,
forerunner of present Municipal Health Offices; President
of Sanitary division took charge of 2 to 3 municipalities.
Philippine General Hospital sent 4 nurses to Cebu
 1914- School of Nursing rendered by Filipino Nurse
employed by Bureau of Health in Tacloban, Leyte
 1915- Philippine Health Service; Reorganization Act 2462
created. Office of Inspector General and Office of District
Nursing headed by Dr. Rosario Pastor, a nurse and
physician
 1915-1918- Ms. Perlita Clark took charge of Public Health
Nursing Works
 1919- 1st Filipino Nurse Supervisor was appointed, 84
PHN’s assigned in 5 health stations
 1927- Office of District Nursing abolished and changed to
Section of Public Health Nursing
 1930- Section for Nursing
 1941- Outbreak of war, PHN’s were assisted to take care
of sick and wounded
 1942- 31 nurses as POW’s at Bilibid Prison, released to
Director of Bureau and Health, Dr. Eusebio Aguilar
 1948- 1st training center of Bureau of Health organized in
cooperation with Pasay City Health Department
 1950- Rural Health Demonstration and Training Center
by DOH
 1958-1965- RA 977 abolished Division of Nursing
o Annie Sand= nursing consultant, Office of
Secretary of Health
 Founded DOH National League of
Nurses Inc.
o RA 977created 8 regional offices in country
increased to 11 then to 16
Primary Health Care (Basic Health Care)
Definition
1.) World Health Organization: “essential health
care made universally accessible to individuals
and families by means acceptable to them,
through full participation and at cost that the
community and country can afford at every
stage of development.”
Conceptual Framework
 Goal: Health for all Filipinos and Health in the hands of th
epoeple by the year 2020
 Mission: to strengthen the health care system by
increasing opportunities and supporting conditions
wherein people will manage their own health care.
 Concept: Primary Health Care (PHC) characterized by
partnership and empowerment of people shall permeate
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as core strategy in effective provision of essential health d. Community discussions done through small
services group discussions
e. Selection of community health workers by
Legal Basis community
f. Foundation of health committees
 Letter of Instruction (LOI) 949: signed on Oct. 19, 1979 by g. Establishment of community health
then Pres. Ferdinand E. Marcos organizations
 Historical Background h. Mass health campaigns and community
o 1974- WHO and UNICEF conducted a joint mobilization
study 4.) Self-reliance
o 1975- World Health Assembly passed a a. Community generates support for health care
resolution giving priority to the development b. Mobilization of health resources
of PHC c. Training of community leaders on leadership
o 1977- World Health Assembly decided that and managerial skills
d. Income-generating projects
main target of government and WHO is the
5.) Recognition of interrelation of health and development
attainment of the level of health that would
a. Convergence of health, food, nutrition, water,
allow or permit them to lead a socially and
sanitation and population services
economically productive life by year 2000
b. Integration of PHC into national, provincial,
o September 6-12, 1978- 1st International
municipal and barangay development plan
Conference on Primary Health Care in Alma
6.) Social Mobilization
Ata, USSR
a. Establishment of effective health referral
o 1979- WHA launched global strategy to attain
system
health for all
b. Multi-sectoral and inter-disciplinary linkages
o 1980- PHC endorsed for implementation by
c. Integration, Education, Communication (IEC)
respective regional community support using multimedia channels
d. Collaboration among government agencies,
Why Philippines Adopted PHC non-government organizations and community
groups
1.) magnitude of health problems 7.) Decentralization
2.) inadequate and unequal distribution of health resources a. Reallocation of budgetary resources
3.) increased cost of medical care b. Advocacy for political will and support
4.) isolation of health care activities from other c. Re-orientation of health profession
developmental activities
Strategies of PHC
Principles of PHC
1.) reorientation and reorganization by local government
1.) Accessibility, acceptability, availability, and affordability code of 1991 or RA 7160
of health services 2.) effective preparation and enabling process for health
a. Health services are delivered where people live action at all levels
and work 3.) mobilization of people to know their communities and
b. Development of indigenous or resident identify basic health needs
volunteer health workers to provide health 4.) development of utilization of technology
care with an ideal ration of 1:10-20 households 5.) organization of communities arising from needs
c. Use of low cost, appropriate technology 6.) increase opportunities
sustainable by community
d. Combined utilization of traditional medicines Essential Components of Primary Health Care
and essential drugs
2.) Partnership between community and health agencies in 1.) Multi-Sectoral Approach
provision of quality, basic and essential health services a. Intrasectoral linkages
a. Community needs and priorities are basic for b. Intersectoral linkages
planning health services and activities 2.) Community participation
b. Training curriculum of community health a. Identify problem
workers I based on community health b. Identify solution
problems and task analysis of community c. Mobilizing resources
health workers d. Barriers
c. Regular supervision and periodic evaluation of i. Lack of motivation
community health workers’ performance by ii. Indifference on part of community
health staff to community iii. Resistant to change
d. Development of promotive, preventive, iv. Bureaucracy of government
curative and rehabilitative care v. Lack of managerial skills
e. Recognition of role and traditional healers in vi. Dependence on part of community
delivery of health services 3.) Appropriate Technology
3.) Community Participation a. 6 criteria:
a. Awareness building and consciousness raising i. effectiveness and safety
on health and developmental issues ii. less complex
b. Community building and organizing iii. less costly
c. Planning, implementation, monitoring and iv. broader scope of technology
evaluation done by community v. acceptability to local culture
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vi. feasibility 10.) Promotion of dental health

4.) Community involvement 11.) Elderly and disabled’s physical and mental health
a. Involvement level:
i. Individual The Philippine Healthcare Delivery System
ii. Family-monitor growth and
development of child and able to  Health Care System- organized plan of health services
address to problems in government  Health Care Delivery- rendering services to people
iii. Community- organizations formed  Health Care Delivery System- network of health facilities
to promote health development and personnel which carries out task of rendering health
care to people
Concepts of Primary Health Care  Philippine Health Care System- complex set of
organizations interacting to provide an array of health
1.) PHC represents supplementary health system services
2.) Equip community with capability to solve its own  RA 7160
problems by conducting trainings o Local Gov’t Code of 1991
3.) Come into being only when community recognizes and o Provides for decentralization
accepts problems o Places in local gov’ts to manage health care
4.) Government officials don’t work in place of community system
and vice versa
5.) Community involvement is the heart and soul of PHC
Levels of Health Care Facilities
6.) Good health is related to living conditions and lifestyle
7.) Provide opportunity to underprivileged majority to
1.) Primary level
develop to an acceptable level
a. Composed of barangay, municipal and
a. Basic minimalistic needs:
medicare health facilities
i. Food
b. 1st contact emergency care
ii. Clothing
c. rural health units, chest clinics, malaria
iii. Shelter and clean environment
eradication units, schistosomiasis control units,
iv. Health
puericulture units, private clinics, company
v. Education and information
clincis
vi. Security of life
d. early symptomatic stage
vii. Means of livelihood
2.) Secondary level
8.) Community must take its role and responsibility to
a. Consists of district health care institutions with
develop basic needs
capabilities and facilities for cases with
9.) PHC activities must be in harmony with existing
hospitalization
institution
b. Smaller non-departmentalized hospitals
10.) PHC activities must be flexible in its application
including emergency and regional hospitals
11.) Must be related to public health services and technical
3.) Tertiary level
support levels of public…
a. Highly technological and sophisticated services
b. Specialized centers, regional health care
Elements of Primary Health Care
institutions and provincial health care centers
1.) Education
Multi-Sectoral Approach to Health
2.) Locally Endemic Diseases
a. Filariasis
b. Schistosomiasis  Intersectoral
3.) Essential basic drugs o Sectors most closely related to health
a. Cotrimoxazole o Agriculture, education, public works, local
b. Amoxicillin governments, social welfare, population
c. Rifampicin control, private sectors
d. Isoniazid  Intrasectoral
e. Ethambutol
f. Paracetamol Restructured Healthcare Delivery System
g. Pyrazinamide
h. Oresol Rationale
i. Nifedipine
4.) Maternal and Child Health Care  healthcare system serves only small portion of rural
5.) Expanded program of immunization population
a. BCG- bacillus calmette guerin  diseases do not require sohphistication
b. OPV- oral polio vaccine  some problems can be handled by other postiions besides
c. AMV- anti-measles vaccine MHO (Municipal Health Officer)
d. DPT- dyptheria pertussis tetanus
e. Anti-Hep B Solutions
6.) Nutrition
a. IDD- iodine deficiency disorder  3 levels of health care provided by RHU (rural health unit)
b. IDA- iron deficiency anemia staff, with referral and supervisory system support
c. PEM- protein energy malnutrition  redefinition of roles and relationships among RHU staff
7.) Treatment of common diseases  establishment of satellite health centers in selected
8.) Safe water supply and sanitation barangays
9.) Prevention and control of leading communicable diseases
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Features of DOH reorganization strength to deal with problems

confronting them
 1958- RA 1082 ii. Spiritual, physical and psychological care
o 1st Rural Health Act iii. Acts:
o employment of more physicians, dentists, 1. Pastoral counseling
nurses, midwives and sanitary inspectors 2. Stress reduction
assigned to RHU’s 3. Parenting
o 1st 81 rural health units 4. Dietary conditioning
 1972- RA 5435 b. Faith Healing
o defined authorities of regional directors for i. Believes that disease is a state of mind so
one can alter his state of mind so he will
more meaningful decentralization
be healed
o 13 regional health offices
c. Chiropractic
 1974
i. System of manipulation treatment which
o IBRD- RHCDS implemented RHM were sent to
teaches that all diseases are caused by
BHS to man BHS impringement on spinal column and
o Midwives were trained and roles expanded corrected by spinal adjustment
 1982- EO 851 ii. Daniel Palmer- founder
o integrated public health and hospital systems d. Acupuncture
with emphasis on importance of putting i. Insertion of needles into selected body
together promotive, preventive, curative and parts to control pain
rehabilitative components of health care e. Acupressure
o utilization of BHW i. Finger pressure to control pain in body
o implementation of DOH impact programs parts
f. Kinesiology
Role of Society in RHCDS i. Study of movement which applies
principles of anatomy to movement
 participation in information drive of HCDS g. Reflexology
 identifying problems i. Systematic massage of soles of feet
 identify sources ii. Applies same principles as applied in
acupressure
Local Health Board h. Massage
i. Relieves tension, enhances flexibility and
 propose annual budget creates coordination between mind and
 identify problems body
i. Homeopathy
 identify what programs
i. Use of variety of herbs, drugs and
 Chairman, vice-chairman, chairman of committee on
chemicals that when used in small
health, DOH representative, NGO representative
quantities can cure or prevent disease
caused by same substance in larger doses
Two-way referral system

Referral- intervention to direct client to another healthcare facility to

continue his/her treatment

Population
Health Promotion, Health Maintenance, and Disease Prevention
BHS Midwife BHS
BHW Health Promotion

Sanitary Inspectors RHU Midwife  Defintion

PHN o WHO- “Health promotion includes encouraging
healthy lifestyles, creating supportive
Physician environments for health, strengthening
community action, reorienting health services
Secondary Health Care Facility to place primary focus on promoting health
and preventing disease, and building healthy
Tertiary Health Care Facility public policy.”
o Pender, 1996- “Health promotion is a behavior
motivated by the desire to increase well being
and actualize human health potential.”
Types of Health Care Systems  Health promotion includes any activity that helps people
to change or maintain lifestyles that support a state of
optimal health or balance of physical, emotional, social,
1.) Traditional
spiritual and intellectual health.
a. E.g. client provider
2.) Non-Traditional  Prominence of health promotion came about as a result of
a. Holistic Health Centers changing patterns of health and corresponding emphasis
i. Believes that time, space and on “lifestyle” as a factor.
encouragement can help people find
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 PHE (Public Health Education) can only have impact on  Changing patterns of life; work and
PH only if joined other sectors and brought multiples leisure leave a significant impact on
social forces to bear. health
 Green- “Behavioral changes that health education is able  Systematic assessment of health
to effect can only be maintained if supportive impact of rapidly changing
environment were provided via: political, economic, environment, especially in areas of
social, biological and other sectors.” technology, works, energy
 1st use of term, health promotion- 1945, Henry E. Sigerist production and urbanization
o Defined 4 major tasks of medicine o Strengthen Community Action
 Promotion of health  Setting priorities, making decisions,
 Prevention of illness planning strategies and
 Restoration of the sick implementing
 Rehabilitation  Heart of this process is
o Sigerist: “Health is promoted by providing a Empowerment of communities
good labor condition, education, physical  Community development helps to
culture and means of rest and recreation.” enhance self-help and social support,
 Concepts used and found in Ottawa to develop flexible system for
Charter for Health Promotion which strengthening public participation in
occurred 40 years later and direction of health matters
 1986, WHO, Health and Welfare Canada and Canadian o Develop Personal Skills
Public Health Association organized an International  Through providing information,
Conference on Health Promotion education for health and enhancing
o later known as Ottawa Charter life skills
o Guiding principle in health promotion efforts  Enabling people to learn throughout
currently life, to prepare themselves for all of
its stages and to cope with chronic
Ottawa Charter for Health Promotion illnesses and injuries
o Reorient Health Services
 “Process of enabling people to increase control over and  Health services are shared among
to improve their health” individuals; community groups,
health service institutions and
 To reach a state of complete physical, mental and social
government
well-being , an individual or group must be able to
identify and to realized aspiration; to satisfy needs and to
change and cope with environment
 Health promotion is not just a responsibility of the health
sector, but goes beyond healthy lifestyles to well-being.
 Prerequesite for Health
o Peace
o Shelter
o Education
o Food
o Income
o A stable eco-system
o Sustainable resources
o Social Justice
o Equity
 In order to operationalize the concept of Health
Promotion, the Charter recommended the following
areas.
o Build Health Public Policy
 Coordinated action that leads to
health, income and social policies
that foster greater equity
o Create Supportive Environment
 Societies are complex and
interrelated
 Overall guiding principle is the need
to encourage reciprocal
maintenance to take care of each
other, our communities and our
natural environment
 Conservation of natural resources
throughout world should be
emphasized as a global
responsibility