Aklan State University Community Health Nursing Module

Aklan State University
School of Arts and Sciences

Bachelor of Science in Nursing
AKLAN STATE UNIVERSTIY

SCHOOL OF ARTS AND SCIENCES
BACHELOR OF SCIENCE IN NURSING
Module 1:
Community Health Nursing
1 (Individual and Family)
(A compilation of Lecture Notes for

Students)
Developed by:
Joan Rigodon Agustin, RN, MAN

August 2020
Adapted www.monohealth.com
Community Health Nursing 1 (Individual and Family)

Preface
Public Health System in the Philippines has undergone various transformations. As it faces
the new millenium, it has to paveway for a new direction for Community Health Nurses
especially with our current condition, COVID 19 Pandemic. It has brought extraodinary
challenges and affected different sectors. In order to sustain the continuity of learning
despite limited access to computer and internet connection, new teaching and learning
mode is being adapted. Because being a nurse in the near future, one must be flexible in
adapting to change.
This module has incorporated different chapters relating to community health nursing. It
aims to provide a stimulating resource for both community nursing students and
educators in clinical practice. The module poses questions and issues for reflection,and
debate, as well as offering referenced and recommended reading to promote depth
and breadth of study.
This module was also made to continue with a 'framework' approach to education and
professional development that links social and health policy with innovation and
community nursing practice. Each chapter is cross-referenced with other chapters, which
allows the reader to gain an in-depth knowledge of particular areas and assists with
building the 'picture of nursing in a community and primary care environment'. It is also a
student-centered module wherein the students will be able to learn by themselves under
the supervision a lecturer.
Community Health Nursing 1 (Individual and Family) 1

Introduction
In the old days, health care providers traveled on horseback to the homes of their
neighbors to render medical services. These health care providers were critical to
decreasing the mortality rates within their communities. After the war, hospitals were built.
This began the enforcement of structured healthcare system. Nowadays, health care
providers practice in various settings and community health is once again re-emerging as
an important component of delivering care to everyone
Community Health Nursing in the Philippines made a great impact to the improvement of
the health of the people. It is a combination of nursing practice utilized in promoting and
preserving the health of the community. Community health suggests integration of
curative, preventive and promotional health services. The goal of community diagnosis is
the identification of community health problems. Extraordinary improvement in
community health was successful control of many communicable diseases.
Community Health Nurse have been delivering excellent health services to the
community. They are one of the first line of defense in the health care setting to be
informed with regards to the new public health issues, methodologies and technologies.
They are proficient in public relations and can easily connect with anyone across the
economic, political, religious and social scope. It is important that the Community Health
Nurse understands the country and global health issues that will later on direct public
actions and address prime concern. Nursing and medical services were reinforced to
promote positive health. At this moment more emphasis is focused on the sick to the well
person, from the individual, family and to the community.

CHAPTER I
Adapted from directorsofpublichealthnursing.wildapricot.org

OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES
Objectives
At the end of this chapter, the students must be able to:
1. Integrate relevant principles of social, physical, natural and health sciences and
humanities in a given health and nursing situation.
2. Discuss appropriate community health nursing concepts and actions holistically and
comprehensively.
A. GLOBAL AND NATIONAL HEALTH SITUATIONS

Health is a fundamental aspect of quality of life, not only because being free from illness
or injury directly affects our capacity to enjoy life, but also because health indirectly
affects our capacity to produce and consume other valuable goods and services.
What is the commonly used measure to describe population’s health?

 Life expectancy
 *Historical data shows that global life expectancy has increased drastically over
the last couple of centuries, with substantial long-run improvements in all
countries around the world. However, despite recent progress towards long-run
cross-country convergence, there are still huge differences that have to be
addressed: for example, people in sub-Saharan Africa have a life expectancy of
less than 60 years, compared to 80 years in countries such as Japan.
 reductions in child mortality and maternal mortality
 observed remaining inequalities: low-income countries still have, on average,
child mortality rates that are more than ten times higher than those in
high-income
 health outcomes are highly responsive to healthcare investments
 This implies that international resources channeled through development
assistance for health, if suitably targeted and managed, have the potential of
drastically reducing global inequalities in living standards countries.
 child mortality - because the first years of life are characterized by important
health-related challenges
Adapted from health.hawaii.gov

 Consequently, life expectancy increases substantially conditional on surviving
the first years of life.
Child mortality is usually measured as the probability per 1,000 live births that a
newborn baby will die before reaching age five under current age-specific mortality
patterns.
 five most lethal infectious diseases over time
 lower respiratory infections, diarrheal diseases, malaria, measles, HIV-AIDS
 Maternal mortality - provides important information regarding
the level of health in a country
Maternal mortality is usually defined as the number of women dying from
pregnancy-related causes while pregnant, or within 42 days of pregnancy termination
(typically expressed as a ratio per 100,000 live births)
Adapted from www.niehs.nih.gov
The number of AIDS-related deaths increased throughout the 1990s and reached a peak
in 2004, 2005 when in both years 2 million people died. Since then the annual number of
deaths from AIDS declined as well and a decade later it was almost halved when 1.1
million people died in 2015.
Africa is the world region that is most affected by malaria. In 2015, the African continent
held 9 out of 10 malaria victims. Importantly, however, Africa is also the world region that
has achieved most progress: from 2000 to 2015, African deaths from malaria were
reduced from 764,000 to 395,000.
Reference: Esteban Ortiz-Ospina and Max Roser, 2016 / https://ourworldindata.org/health-meta
Retrieved
Public health systems are operating within context of ongoing changes, which exert a
number of pressures on the public health system.
These changes include:
1. 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;
2. New technologies for health care, communication and information;
3. Existing and emerging environmental hazards some associated with globalization;
4. Health reforms.

In response to above trends, the global community represented by the United Nations
General Assembly, decided to adopt a common vision of poverty reduction and
sustainable development in September 2000. this vision is exemplified by the Millenium
Development Goals (MDGs) which are based on the fundamental values of freedom,
equality, solidarity, tolerance, health, respect for nature, and shared responsibility.
Reference:
Cuevas, Frances Prescilla L, et.al (2007). Public Health Nursing in the Philippines, 10th Edition. C&E
Publishing House:Manila
The eight Millenium Development Goals are as follows:

1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development Adapted from www.un.org
Except for goals 2 and 3, all the MDGs are health or health-related. Health is essential
to the achievement of these goals and is a major contributor to the overarching goal of
poverty reduction.
In order to achieve these goals, the participation of all members of the society from
both developing and developed countries is required. Achievement of these goals by
2015 is now a priority of the global community and dictates the priority public health
programs that should be implemented.
At the country level, the Philippines has experienced considerable improvements in
its health status for the past 50 years. Yet it has also in recent years experienced declined
as shown in its poor performance in reducing infant and maternal mortality rates. The
Philippines is also experiencing an epidemiologic shift, which means that while it is still
contending with the burden of communicable diseases, it is also at same time
contending with the devastation brought about by non-communicable, chronic
lifestyle-related diseases. Currently, the country is being threatened with the devastating
effect of a “triple whammy” which will be brought about not only by this epidemiologic
shift but also by the emergence of plague-like infectious diseases such as Severe Acute
Respiratory Syndrome (SARS) and Avian Flu. With this scenario, the need to strengthen the

capability of the public health nurse to adequately respond is imperative.
Currently there are various country initiatives to implement a more cost-effective
health care services. The Health Sector Reform Agenda (HRSA) implemented through
FOURmula ONE and operationalized in the National Objectives for Health 2005 to 2010
spells out the program imperatives of the health sector. All these are in line with the
Millenium Development Goals and the Medium-Term Development Plan of the country.
Reference:
Cuevas, Frances Prescilla L, et.al (2007). Public Health Nursing in the Philippines, 10th Edition. C&E Publishing
House:Manila
HSRA – Health Sector Reform Agenda – implemented through FOURmula ONE from
2005-2010
 Vaccination
 Vitamin A
 Dental Check-Up
 Child Safety Tips
Critical Components to Start Fourmula One Implementation
1. Health Care Financing Adapted from www.google.
2. Health Regulation com/imgres?imgurl=x-raw-image

3. Health Service Delivery
4. Governance
Retrieved from http://docshare01.docshare.tips/files/24316/243160399.pdf
B. DEFINITION AND FOCUS

a) PUBLIC HEALTH
-”science and art of promoting health, preventing diseases, prolonging life,
promoting health and efficiency through organized community effort for the
sanitation of the environment, control of communicable diseases, 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
the social machinery to ensure everyone a standard of living adequate for the
maintenance of health, so organizing these benefits as to enable every citizen to
realize his birthright of health and longevity”
- Dr. C.E. Winslow
-”dedicated to the attainment of total well-being” - (Hanlon)

-”Art of applying science in the context of politics so as to reduce inequalities in
health while ensuring the best health for the greatest number”
-World Health Organization
It points to the fact that public health is a core element of governments’ attempts to
improve and promote the health and welfare of their citizens.
It further presented the core business of public health as:

1. Disease control
2. Injury prevention
3. Health protection
4. Health public policy including those in relation to environmental hazards such as in the
workplace, housing, food, water, etc.
5. Promotion of health and equitable health gain.
Adapted from ichef.bbci.co.uk
The following are the essential public health functions:

1. Health situation monitoring and analysis
2. Epidemiological surveillance/disease prevention and control
3. Development of policies and planning in public health
4. Strategic management of health systems and services for population health gain
5. Regulation and enforcement to protect public health
6. Human resources development and planning in public health
7. Health promotion, social participation and empowerment
8. Ensuring the quality of personal and population based health services
9. Research, development and implementation of innovative public health solutions
For these public health functions to be adequately delivered, a well defined, coordinated
public health system or infrastructure must be put in place. Governments need to ensure
these essential functions are provided, but do not necessarily have to implement or
finance them themselves. Implementation may be achieved through other
governmental agencies, community and non-governmental organizations, or the private
sector, among others.
Reference:
Cuevas, Frances Prescilla L, et.al (2007). Public Health Nursing in the Philippines, 10th Edition. C&E Publishing
House:Manila

b) COMMUNITY HEALTH
-a branch of medical and paramedical approach that aims to promote health,
prevent diseases, and manage the factors affecting health
-”refers to environmental, social, and economic resources to sustain emotional and

physical well being among people in ways that advance their aspirations and satisfy
their needs in their unique environment”
- World Health Organization
- 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 Adapted from cdn.imgbin.com
Reference: RNPedia (2020), Community Health Nursing : An Overview Retrieved from:

https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/community-health-nursin
g-overview/
c) PUBLIC HEALTH NURSING

-”special field of nursing that combines the skills of nursing, public health and some
phrases of social assistance and functions as part of the total public health
programme for the promotion of health, the improvement of the conditions in the
social and physical environment, rehabilitation of illness and disability”
- “refers to the practice of nursing in national and local government health
departments (which includes health centers and rural health units), and public
schools. It is community health nursing practiced in the public sector”.
-Public Health Nursing in the Philippines 2005
Public Health Nurses (PHNs)- refer to the nurses in the local/national health
departments or public schools whether their official position title is Public Health Nurse
or Nurse or school Nurse.

Public Health Nursing – (Philippine Setting) According to Francis T Duque III, uplift the
valuable role of public health nurses as innovators, leaders, health providers and
members of the health care team.
In spite of increasing demands of nurses abroad they (PHNS) choose to study
and serve and nurse the health of the people’s health needs. Public health nurses
provide evidence that service truly has no limits.
Retrieved from: http://docshare01.docshare.tips/files/24316/243160399.pdf, retrieved August
30, 2020
d) COMMUNITY HEALTH NURSING (CHN)

-A unique blend of nursing and public health which aims to promote health, prevent
diseases, and enhance the capabilities of the Individual, Family, and Community
towards the exercise of individual’s birthright of health and longevity.
-Service rendered by a professional nurse with communities, groups, families,

individuals at home, in health centers, in clinics, in schools, in places of work for the
promotion of health, prevention of illness, care of the sick at home and rehabilitation.
- Ruth B. Freeman
-Nursing Practice in a wide variety of community services and consumer advocate
areas, and in a variety of roles, at times including independent practice. Community
nursing is certainly not confined to public health nursing agencies.
- Jacobson
- 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
programme for the promotion of health, the improvement of the conditions in the
social and physical environment, rehabilitation of illness and disability.
- 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.
- Dr. Araceli Maglaya
- 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

Community health nursing is a discipline that incorporates evidenced-based research
along with advances in science and new approaches for improving the health The
practice takes into consideration the cultural and socioeconomic backgrounds of the
people in the community to ensure appropriate interaction and sensitivity when working
with them.
A community is a group of people in a specific location, which includes places where

people live, work and go to school. Most people belong to multiple types of communities.
Community health nursing is commonly practiced in geographic locations like cities and
rural areas.
The goal of community health nursing is to promote, protect and preserve the health of
the public. Community health nursing involves these basic concepts:
 Promote healthy lifestyle

 Prevent disease and health problems
 Provide direct care
 Educate community about managing chronic conditions and making healthy
choices
 Evaluate a community’s delivery of patient care and wellness projects
 Institute health and wellness programs
 Conduct research to improve healthcare
Reference: Northeastern State University (2020). Nurse Role in Community. Retrieved from:
https://nursingonline.nsuok.edu/articles/rnbsn/nurses-role-in-community-health.aspx
Mission of CHN
 Health Promotion  Disease prevention

 Health Protection  Social Justice
 Health Balance
Philosophy of CHN
“The philosophy of CHN is based on the worth and dignity 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.
e) STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

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
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
g-overview/

Adapted from img.theculturetrip.com
f) EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES
For the public health nurse to have a better understanding of how public health
nursing came about in the Philippines, there are certain concepts that must be
understood and should serve as a point of reference in the foregoing discussions.
Health
-”state of complete physical, mental, and social well being, not merely the absence
of disease or infirmity” -World Health Organization
Determinants of Health
The health of individuals and communities are, to large extent, affected by a
combination of many factors. A person’s health is determined by his circumstances
and environment. It is also important to note that in understanding the
multidimensional nature of health, the public health nurse will now be in better
position to plan and implement heath promoting interventions for individuals and
communities.
Factors or things that make people healthy or not, known as determinants of health
are listed by the World Health Organization to include:
1. Income and social status. Higher income and social status are linked to better
health.
2. Education. Low education levels are linked with poor health, more stress and lower
self confidence.
3. Physical environment. Safe water and clean air, healthy workplaces, safe houses,
communities and roads all contribute to good health.
4. Employment and working conditions. People in employment are healthier,
particularly those who have more control over their working conditions.
5. Social support networks. Greater support from families, friends and communities is
linked to better health.

6. Culture. Customs and traditions, and the beliefs of the family and community all
affect health.
7. Genetics. Inheritance plays a part in determining lifespan, healthiness and the
likelihood of developing certain illnesses.
8. Personal behaviour and coping skills. Balanced eating, keeping active, smoking,
drinking, and how we deal with life’s stresses and challenges all affect health.
9. Health services. Access and use of services that prevent and treat disease
influence health.
10. Gender. Men and women suffer from different types of diseases at different ages.
The determinants of health as a concept can be further explained in Figure 1. this

framework refers to and Optimum Level of Functioning (OLOF) of individuals, families and
communities being influenced by several factors in the eco-system.
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 Shief 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. Pnce. As Chief Nurse
and Mrs. Rosario A. Ordiz as Assistant Chief Nurse. Dec 8.
-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 on December 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. Montellano for
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 form Harvard was chosen to be the Chief of the RHDTC.
- Dr. Antonio V. Acosta, former Physician of the Manila Health Department
was Medical Training Officer.
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 Bureaus 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.
Retrieved from http://docshare01.docshare.tips/files/24316/243160399.pdf
g) ROLES AND RESPONSIBILITIES OF A COMMUNITY HEALTH NURSE
The primary role of community health nurses is to provide treatment to patients.

Additionally, community health nurses offer education to community members about
maintaining their health so that they can decrease the occurrence of diseases and
deaths. They plan educational assemblies, hand -out fliers, conduct health screenings,
dispense medications and administer immunizations.
Nurses also may distribute health-related items like condoms and pregnancy tests.
Examples of some health issues that community health nurses try to control or eliminate
are:
 Infectious and sexually transmitted diseases

 Obesity
 Poor nutrition
 Substance abuse
 Smoking
 Teen pregnancy
Reference: Northeastern State University (2020). Nurse Role in Community. Retrieved from:
Roles of the PUBLIC HEALTH NURSE Adapted from www.purdueglobal.edu
 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
g-overview/
The Public Health Nurse
Public Health Nurses
Adapted from i.pinimg.com
 Made great contributing to the improvement of the health of the people

 Readers in providing quality health services to communities
 First level health workers knowledgeable about new public health technologies
and methodologies.
 First to be trained to implement new programs and apply new technologies.
 Leaders in health promotion and advocacy
 Make a difference in the health outcomes of individuals, families and
communities cared for.
Public Health Nurses
- Are found in various health settings and occupying various positions in the hierarchy. -
Are assigned in rural health units, city health centers, provincial health offices, regional
health offices, and evening the national office of the Department of Health.
- Are also assigned in public schools and in the offices of government agencies providing
health care services.
- Occupy a range of positions from Public Health Nurse I to Nurse Program Supervisors to
Chief Nurse in public health settings.

- Uses various tools and procedures necessary for her to properly practice her profession
and deliver basic health service.
- Uses nursing process in her practice and is adept in documenting and reporting
accomplishments through records and reports.
- Technically competent in various nursing procedures conducted in settings where she is

assigned
Qualifications and Functions
The standards of Public Health Nursing in the Philippines developed by the National
League of Philippine government Nurses in 2005 described the qualification and functions
of a Public Health Nurse.
Public health nurse
- must be professionally qualified and licensed to practice in the area of public health
nursing.
- Must possess personal qualities and “people skills” that would allow her practice to make
a difference in the lives of these people.
- Functions in accordance with the dominant values of public health nurses, within the
ethico-legal framework of the nursing profession, and in accordance with the needs of
the clients and available resources for health care.
- Functions of PHN are consistent with the Nursing Law 2002 and program policies
formulated by the DOH and local government health agencies. They are related to
management, supervision, provision of nursing care, collaboration and coordination,
health promotion and education training and research.
 Management Function
Adapted from www.myamericannurse.com

- the management function of the public health nurse is inherent in her practice.
- The nurse, in whatever setting and role has been trained to lead and manage.

- Objectives set for work being done can only be achieved through the execution of the
five management functions of planning, organizing, staffing, directing and controlling.
- This function is performed when she organizes the “nursing service” of the local health
agency.
- Managing the nurses and their activities
- Program management. This is a function where the PHN actually excels in.
- A program manager is responsible for the delivery of the package of services provided
by the program to the target clientele.
- Reports on program accomplishments is a documentation of her management skills.
 Supervisory Function
- PHN is the supervisor of the midwives and other auxiliary health workers in the catchment
area.
- Formulates a supervisory plan and conducts supervisory visits to implement plan.
- Conducts supervisory visits using a supervisory checklist
- During the visit the PHN identifies together with the supervisee any issue or problem
encountered and addresses them accordingly.
- Coaching
- Enhancement of training for the supervisee Adapted from

maureenvolkerrn.files.wordpress.com
- Report of the encounter is given to the supervisee and kept in her personal file for future
reference.
 Nursing Function
- An inherent function of the nurse

- Her practice as a nurse is based on the science and art of caring
- Public health nursing is caring for individuals, families and communities toward health
promotion and disease prevention
- PHN are expected to provide nursing care
- PHN uses her knowledge and skill in the nursing process. She does assessment, plans, and
implements care, and evaluates outcomes.
- Establishes rapport with her client: individual, family or community
- Home visits
- Referral of patients to appropriate levels of care
 Collaborating and coordinating Function
- Brings activities or group activities systematically into proper relation or harmony with
each other.
- Care coordinators for communities and their members
- Actively involved both socially and politically to empower individuals, families and
communities as an entity to initiate and maintain health promoting environments.
- Establishes linkages and collaborative relationships with other health professionals,

government agencies, the private sector, NGOs, people’s organizations to address
health problems.
- Identifies persons, groups, organizations, other agencies and communities whose

resources are available within and outside the community and which can be tapped in
the implementation of individuals, family and community health care. Health
 Promotion and Education Function
- Activities goes beyond health teachings and health information campaigns.

- Understands that health is determined by various factors such as physical and political
environment, socio-economic status, personal coping skills and many other
circumstances, and it is inappropriate to blame or credit a person’s health to himself
alone because he is unlikely to control many of these factors.
- Understanding the multidimensional nature of health will enable her to plan and
implement health promoting interventions for individuals and communities.
- Uses her skills in advocacy for the creating of a supportive environment through policies
and reengineering of the physical environment for healthier actions.
- As an educator, the nurse provides clients with information that allows them to make
healthier choices and practices.
- Health education is a major component of any public health program.
- PHN are expected to teach on a daily basis as part of their practices.
 Training Function Adapted from Fus.123rf.com
- Initiates the formulation of staff development and training programs for midwives and
other auxiliary workers
- Does training needs assessment for these health workers, designs the training program
and conducts them in collaboration with other resource persons.
- Also does evaluation of training.
- PHN participates in the training of nursing and midwifery affiliates in coordination with
the faculty of colleges of nursing and midwifery.
- Participates in teaching, guidance and supervision of student affiliates for their RLEs in
the community setting.
-Health promotion calls for the active participation of the community.
- Mobilize communities for health actions.

- Community organizing is a means of mobilizing people to solve their own problems.
Through this, people learn that their problems have social causes and fighting back is a
more reasonable, dignified approach than passive acceptance and personal alienation.
 Research Function
- Participates in the conduct of research and utilizes research findings.
- PHN function is disease surveillance.
Purposes of disease surveillance:
o To measure the magnitude of the problem Adapted from info.athenacareers.edu
o To measure the effect of the control program
- It is important in monitoring the progress of the disease reduction initiatives: Poliomyelitis,

Neonatal Tetanus Elimination, Measles Control, NCD risk factors, etc.
Retrieved from http://docshare01.docshare.tips/files/24316/243160399.pdf,
Adapted from wpengine.netdna-ssl.com

ACTIVITY 1
A. Write your answer in the space provided.

Determinants of Health Components
1. Socioeconomic
2. Political
3. Health Care Delivery System
4. Heredity
5. Behavioral
6. Environmental
B. Matching Type. Match Column A with Column B.

A B
1. Public Health A. Reduce Child Mortality
2. Eight Millenium Development Goals B. Vaccination
3. Health Sector Reform Agenda C. Art of applying science in the context of
4. Community Health politics so as to reduce inequalities in health
5. Health while ensuring the best health for the
6. The Fajardo Act greatest number
7. Republic Act 1891 D. Created Sanitary Divisions
8. Reorganization of the Department of E. Nursing Practice in a wide variety of
Health community services and consumer
9. Community Health Nursing advocate areas, and in a variety of roles,
10. Republic Act 1082 at times including independent practice.
F. Aims disease prevention
G. A state of complete physical, mental,
and social well-being, not merely the
absence of disease or infirmity.
H. Rural Health Law
I. Strengthening Health and Dental Services
in the Rural Areas and Providing Funds
J. Executive Order No. 119
K. Created Division of Nursing
L. Abolished the Division of Nursing

C. Essay. Write at least 3 sentences.
1. What’s so important about Community Health Nursing?

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
2. Discuss the roles of the community health nurse do in the community setting.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
3. Why is there a need to strengthen the capability of the community health nurse to
respond to the current pandemic?
______________________________________________________________________________________
______________________________________________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Congratulations for completing Module 1 of Community Health Nursing 1. I hope that

the lessons that you’ve learned from this module will help you become an effective and
competent community health nurse in the future.
Mark 9:23 Jesus said to him, If you can believe, all things are possible to him that
believes.

References:
1. Cuevas, Frances Prescilla, et.al (2007). Public Health Nursing in the Philippines, 10th
Edition. C&E Publishing Inc.
2. Schneider, Mary-Jane. (2011). Introduction to Public Health, 3rd Edition. Jones and
Bartlett Publishers.
3. Maglaya, Araceli S. (2005). Nursing Practice in the Community, 4th Edition. Argonauta
Corporation
4. Northeastern State University (2020). Nurse Role in Community. Retrieved from:
5. RNPedia (2020), Community Health Nursing : An Overview Retrieved from:
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/communit
y-health-nursing-overview/

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Aklan State University

School of Arts and Sciences

AKLAN STATE UNIVERSTIY

(A compilation of Lecture Notes for

Joan Rigodon Agustin, RN, MAN

Community Health Nursing 1 (Individual and Family)

Community Health Nursing 1 (Individual and Family) 1

Community Health Nursing 1 (Individual and Family) 2

Adapted from directorsofpublichealthnursing.wildapricot.org

A. GLOBAL AND NATIONAL HEALTH SITUATIONS

What is the commonly used measure to describe population’s health?

Adapted from health.hawaii.gov

Community Health Nursing 1 (Individual and Family) 3

Community Health Nursing 1 (Individual and Family) 4

The eight Millenium Development Goals are as follows:

Community Health Nursing 1 (Individual and Family) 5

2. Health Regulation com/imgres?imgurl=x-raw-image

B. DEFINITION AND FOCUS

Community Health Nursing 1 (Individual and Family) 6

It further presented the core business of public health as:

The following are the essential public health functions:

Community Health Nursing 1 (Individual and Family) 7

-”refers to environmental, social, and economic resources to sustain emotional and

Reference: RNPedia (2020), Community Health Nursing : An Overview Retrieved from:

c) PUBLIC HEALTH NURSING

Community Health Nursing 1 (Individual and Family) 8

d) COMMUNITY HEALTH NURSING (CHN)

-Service rendered by a professional nurse with communities, groups, families,

Community Health Nursing 1 (Individual and Family) 9

A community is a group of people in a specific location, which includes places where

 Promote healthy lifestyle

 Health Promotion  Disease prevention

Community Health Nursing 1 (Individual and Family) 10

e) STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

Community Health Nursing 1 (Individual and Family) 11

Adapted from img.theculturetrip.com

f) EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

Community Health Nursing 1 (Individual and Family) 12

The determinants of health as a concept can be further explained in Figure 1. this

1898 - Department of Health was first established as Department of Public Works,

Community Health Nursing 1 (Individual and Family) 13

Community Health Nursing 1 (Individual and Family) 14

Community Health Nursing 1 (Individual and Family) 15

Community Health Nursing 1 (Individual and Family) 16

g) ROLES AND RESPONSIBILITIES OF A COMMUNITY HEALTH NURSE

The primary role of community health nurses is to provide treatment to patients.

 Infectious and sexually transmitted diseases

Community Health Nursing 1 (Individual and Family) 17

Roles of the PUBLIC HEALTH NURSE Adapted from www.purdueglobal.edu

Other Specific Responsibilities of a Nurse, spelled by the implementing rules and

 Supervision and care of women during pregnancy, labor and puerperium

 Provision of primary health care services

Community Health Nursing 1 (Individual and Family) 18

 Community organizing mobilization, community development and people

The Public Health Nurse

Public Health Nurses

Adapted from i.pinimg.com

 Made great contributing to the improvement of the health of the people

Public Health Nurses

Community Health Nursing 1 (Individual and Family) 19

- Technically competent in various nursing procedures conducted in settings where she is

Qualifications and Functions

Public health nurse