Community Health Nursing
Lecture, Skills, and Clinical
Community health nursing focus more on the care of
the four levels of clientele. More on the health
teaching, health promotion and prevention.
Overview of Public health nursing in the Philippines
GLOBAL AND NATIONAL HEALTH SITUATIONS
Global and Country Health Imperatives
 Public health systems are operating within a
context of ongoing changes, which exert a
number of pressures on the public health
system.
 These changes include: (Reyala, 2007)
 Shifts in demographic and epidemiological
trends in diseases, including the emergence and
re-emergence of new diseases and in the
prevalence of risk and protective factors;
 New technologies for health care,
communication and information;
 Existing and emerging environmental hazards
some associated with globalization;
 Health reforms.
GLOBAL HEALTH SITUATION(WORLD HEALTH
ORGANIZATION, 2018)
 The global population was 2.8 billion in 1955
and is 5.8 billion now. It will increase by nearly
80 million people a year to reach about 8 billion
by the year 2025.
 By the year 2025, it is expected that no country
will have a life expectancy of less than 50 years.
 By 2025, 8% of all deaths will be in the under-
5s, 3% among 5-19-year-olds,
 27% among 20-64-year-olds and 63% among
the over-65s.
 Leading causes of death from infectious
diseases were acute lower respiratory infections
(3.7 million), tuberculosis (2.9 million), diarrhea
(2.5 million), HIV/AIDS (2.3 million) and malaria
(1.5-2.7 million).
 By 2025 there will still be 5 million deaths
among children under five - 97% of them in the
developing world, and most of them due to
infectious diseases such as pneumonia and
diarrhea, combined with malnutrition.
THE PHILIPPINE PUBLIC HEALTHCARE SCENARIO
 The national budget allocation for health care is
relatively small.
 Local government units augment the national
budget to an undetermined extent.
 This scenario requires strategies that will allow
maximization of limited resources:
 Health promotion
 Disease prevention
NURSES IN PUBLIC HEALTHCARE
 Community/public health nursing is the
synthesis of nursing practice and public health
practice.
 The major goal of community health nursing is
to preserve the health of the community and
surrounding populations by focusing on health
promotion and health maintenance of
individuals, families, and groups within the
community.
 The mission of public health is SOCIAL JUSTICE,
which entitles all people to basic necessities
such as adequate income and health protection
and accepts collective burdens to make this
possible.
CONCEPTS OF HEALTH
 The variety of characterizations of the word
illustrates the difficulty in standardizing the
conceptualization of health.
 Common concepts in various definitions
include:
 Goal-directed/ purposeful actions,
processes, responses or behaviors.
 Soundness, wholeness, and/ or well-
being
CONCEPTS OF COMMUNITY
 Before 1996: definitions of community focused
on geographical boundaries, combined with
social attributes of people.
 Later part of the decade: geographical location
became a secondary characteristic in the
discussion of what defines a community.
DEFINING ATTRIBUTES OF COMMUNITIES
 1. People  Public health nursing may be defined as a field
2. Place of professional practice in nursing and in public
3. Interaction health in which technical nursing, interpersonal,
4. Common characteristics, interests or goals analytical, and organizational skills are applied
to problems of health as they affect the
TYPES OF COMMUNITIES
community.
 Geopolitical / Territorial community (example:  The practice of promoting and protecting the
Batangas City, Dumuklay) health of populations using knowledge from
 Phenomenological / Functional community nursing, social, and public health sciences.
(Example: Churh, School, chapel)
COMMUNITY-BASED NURSING
DETERMINANTS OF HEALTH AND DISEASE
 Application of the nursing process in caring for
 Income and social status individuals, families and groups where they live,
 Education work or go to school or as they move through
 Physical environment the health care system,
 Employment and work conditions
POPULATION-FOCUSED APPROACH
 Social support networks
 Culture  Focuses on the entire population
 Genetics  Is based on assessment of the populations'
 Personal behavior and coping skills health status
 Health services  Considers the broad determinants of health
 Gender  Emphasizes all levels of prevention
 Intervenes with communities, systems,
COMMUNITY HEALTH individuals, and families
 Part of paramedical and medical LEVELS OF CLIENTELE
intervention/approach which is concerned on
the health of the whole population  Individual
 Family
Aims:  Group/ Aggregate
 Health promotion  Community
 Disease prevention PRE-PAYMENT MECHANISM
 Management of factors affecting health
 Community health services and community
HEALTH PROMOTION AND DISEASE PREVENTION
health nursing services, are generally free at the
 Health promotion activities enhance resources point of care.
directed at improving well-being, whereas  The services have already been pre-paid by the
disease prevention activities protect people community/aggregate.
from disease and the effects of disease.  Taxes cover government-provided healthcare
services
LEVEL OF PREVENTION  Tuition fees cover school-health services
1. Primary: general health promotion and specific  Consumers pay for the occupational health
protection services of employees of a company.
2. Secondary: early detection and prompt
intervention
3. Tertiary: reduce the effects of disease and
injury, and restore individuals to their optimal
EMERGING FIELDS OF COMMUNITY HEALTH NURSING
level of functioning.
IN THE PHILIPPINES
DEFINITIONS OF PUBLIC HEALTH NURSING
Home health care: This practice involves providing
nursing care to individuals and families in their own
places of residence mainly to minimize the effects of
illness and disability.
Hospice home care: This is home care specifically
rendered to the terminally ill.
EntrepreNurse: This is a project initiated by the
Department of Labor and Employment (DOLE), in
collaboration with the Board of Nursing of the
Philippines, Department of Health, Philippine Nurses
Association, and other stakeholders to promote nurse
entrepreneurship.
Faith community nursing or parish nursing: This is the
practice of nursing combined with spiritual care. They
may work in either paid or unpaid positions in a variety
of religious faiths.
COMPETENCY STANDARDS IN COMMUNITY HEALTH
NURSING
 Safe and quality nursing care
 Management of resources and environment
 Health education
 Legal responsibility
 Ethico-moral responsibility
 Personal and professional development
 Quality improvement
 Research
 cords management
 Communication
 Collaboration and Teamwork
HISTORY OF PUBLIC HEALTH NURSING IN THE
PHILIPPINES
 1577: Friar Juan Clemente opened a medical
dispensary in Intramuros for the indigent.
 1690: Dominican Father Juan de Pergero
worked towards installing a water system in San
Juan del Monte (now San Juan City, Metro
Manila) and Manila.
 1805: Dr. Francisco de Balmis introduced
Smallpox vaccination.
 1876: The first medicos titulares were
appointed and worked as provincial health
officers.
HISTORY OF PUBLIC HEALTH NURSING IN THE
PHILIPPINES
 1888: The University of Santo Tomas opens a
two-year, cirujanos ministrantes course to
produce male nurses and sanitary inspectors.
 1901: The Board of Health of the Philippine
Islands was created through Act 157, which
eventually evolved into the Department of
Health (DOH)
 1912: The Fajardo Act law created sanitary
divisions made up one to four municipalities.
 1905: Asociacion de Feminista Filipina founded
La Gota de Leche: the first center dedicated to
the service of mothers and babies
 1947: The DOH was reorganized into bureaus
and the administration of city health
departments was placed at bureau level.
 1954: The congress passed R.A. 1082 or the
Rural Health Unit Act which provided an RHU in
every municipality.
 1957: R.A. 1891 was enacted to have a more
equitable distribution of health personnel.
 1958: Regional health offices were created as a
result of decentralization efforts, thus creating
the position: Regional Health Officer.
 1970: the Philippine health care delivery system
was restructured, paving the way for the health
care system that exists to this day where health
services are classified into primary, secondary
and tertiary levels.
 1991: R.A.7160 or the Local Government Code
mandated the devolution of basic services,
including health services, to local government
units and the establishment of a local health
board in every province and city or municipality.
 1999: Health Sector Reform Agenda was
launched to direct government efforts towards
comprehensive reforms.
 2005: FOURmula One (F1) for health was
launched to provide an implementation
framework to the reform agenda.
 2010: Universal Health Care was launched to
provide the necessary revisions to the F1
framework.
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.
 Provides the environment that facilitates
cooperation and sharing of resources to
promote and protect health and to resolve
health problems and alleviate their effects
 WHO constitution came into force on April 7,
1948 (World Health Day)
 Headquarters: Geneva, Switzerland
 147 country offices and 6 world regional offices
WHO CORE FUNCTIONS
Objective: the attainment by all peoples of the highest
possible level of health (WHO, 2006)

ROLES AND RESPONSIBILITIES OF A COMMUNITY 1. Provide leadership and engage in partnerships

HEALTH NURSE on matters of health
2. Shape research agenda and promote
Qualifications: knowledge.
5 goals: Capacity, Priorities, Standards,
 Bachelor of Science in Nursing
Translation and Organization
 Registered Nurse of the Philippines 3. Set and monitor standards
-Planner/Programmer 4. Articulating ethical and evidenced-based policy
-Provider of Nursing Care options.
-Community Organizer 5. Provide technical support, catalyze change and
-Coordinator of Services build sustainable capacity
- Trainer
- Health Monitor MILLENNIUM DEVELOPMENTAL GOALS
- Role Model
- Change Agent  Resulted from Millennium Summit – Sept. 6-8,
- Recorder 2000
- Researcher  Collective responsibility to uphold the principles
of human dignity, equality and equity at the
THE HEALTHCARE DELIVERY SYSTEM global level
 Reduce extreme poverty and achieve seven
HEALTH SYSTEM other targets by 2015

 A health system consists of all organizations, 8 MDGS AND TARGETS OF HEALTH-RELATED MDGS
people and actions whose primary intent is to
promote, restore or maintain health. 1. Eradicate extreme poverty and hunger.
 Six building blocks or components (WHO, 2. Achieve universal primary education.
2007a): 3. Promote gender equality and empower women.
4. Reduce child mortality. Target: Reduce by two
a. service delivery thirds, between 1990 and 2015, the under-five
b. health workforce mortality rate.
c. information 5. Improve maternal health.
d. medical products, vaccines and technologies Reduce by three quarters the maternal
e. financing; mortality ratio; and
f. leadership and governance or stewardship Achieve universal access to reproductive health.

WORLD HEALTH ORGANIZATION

6. Combat HIV/AIDS, malaria and other diseases.
Targets:
A. Have halted by 2015 and begun to reverse the spread
of HIV/AIDS;
B. Achieve, by 2010, universal access to treatment for
HIV/AIDS for all those who
need it; and
C. Have halted by 2015 and begun to reverse the
incidence of malaria and other major
diseases.

7. Ensure environmental sustainability.

8. Develop a global partnership for development.