Western Mindanao State University

COLLEGE OF NURSING
Zamboanga City

COMMUNITY HEALTH NURSING 1

Overview of Public Health Nursing in the Philippines

A HANDOUT

SHIRLEY M. NOLLEDO, R.N.,M.N.

Level 2 Faculty
I. Global and National Health Status

Global Health Status -Studies describe the state of global health by measuring the burden of
disease – the loss of health from all causes of illness and deaths worldwide. .
- WHO 2018

Collecting and comparing health data from across the globe is a way to describe health
problems, identify trends and help decision-makers set priorities.

Studies describe the state of global health by measuring the burden of disease – the loss
of health from all causes of illness and deaths worldwide. They detail the leading causes of
deaths worldwide and in every region, and provide information on more than 130 diseases and
injuries across the world.

Top 10 Most Common Health Issues in the Philippines

 Physical Activity and Nutrition
 Overweight and Obesity
 Tobacco
 Substance Abuse
 HIV / AIDS
 Mental Health
 Injury and Violence
 Environmental Quality
 Immunization
 Access to Health Care

1. Physical Activity and Nutrition

Research indicates that staying physically active can help prevent or delay certain diseases,
including some cancers, heart disease and diabetes, and also relieve depression and improve
mood. Inactivity often accompanies advancing age, but it doesn't have to. Check with your local
churches or synagogues, senior centers, and shopping malls for exercise and walking programs.
Like exercise, your eating habits are often not good if you live and eat alone. It's important for
successful aging to eat foods rich in nutrients and avoid the empty calories in candy and sweets.

2. Overweight and Obesity

Being overweight or obese increases your chances of dying from hypertension, type 2 diabetes,
coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory
problems, dyslipidemia and endometrial, breast, prostate, and colon cancers. In-depth guides and
practical advice about obesity are available from the National Heart Lung and Blood Institute of
the National Institutes of Health.

3.Tobacco

Tobacco is the single greatest preventable cause of illness and premature death in the U.S.
Tobacco use is now called "Tobacco dependence disease." The Centers for Disease Control and
Prevention (CDC) says that smokers who try to quit are more successful when they have the
support of their physician.
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4. Substance Abuse

Substance abuse usually means drugs and alcohol. These are two areas we don’t often associate
with seniors, but seniors, like young people, may self-medicate using legal and illegal drugs and
alcohol, which can lead to serious health consequences. In addition, seniors may deliberately or
unknowingly mix medications and use alcohol. Because of our stereotypes about senior citizens,
many medical people fail to ask seniors about possible substance abuse.

5. HIV/AIDS

Between 11 and 15% of U.S. AIDS cases occur in seniors over age 50. Between 1991 and 1996,
AIDS in adults over 50 rose more than twice as fast as in younger adults. Seniors are unlikely to
use condoms, have immune systems that naturally weaken with age, and HIV symptoms (fatigue,
weight loss, dementia, skin rashes, swollen lymph nodes) are similar to symptoms that can
accompany old age. Again, stereotypes about aging in terms of sexual activity and drug use keep
this problem largely unrecognized. That’s why seniors are not well represented in research,
clinical drug trials, prevention programs and efforts at intervention.

6. Mental Health

Dementia is not part of aging. Dementia can be caused by disease, reactions to medications,
vision and hearing problems, infections, nutritional imbalances, diabetes, and renal failure. There
are many forms of dementia (including Alzheimer’s Disease) and some can be temporary. With
accurate diagnosis comes management and help. The most common late-in-life mental health
condition is depression. If left untreated, depression in the elderly can lead to suicide. Here’s a
surprising fact: The rate of suicide is higher for elderly white men than for any other age group,
including adolescents.

7. Injury and Violence

Among seniors, falls are the leading cause of injuries, hospital admissions for trauma, and deaths
due to injury. One in every three seniors (age 65 and older) will fall each year. Strategies to
reduce injury include exercises to improve balance and strength and medication review. Home
modifications can help reduce injury. Home security is needed to prevent intrusion. Home-based
fire prevention devices should be in place and easy to use. People aged 65 and older are twice as
likely to die in a home fire as the general population.

8. Environmental Quality

Even though pollution affects all of us, government studies have indicated that low-income,
racial and ethnic minorities are more likely to live in areas where they face environmental risks.
Compared to the general population, a higher proportion of elderly are living just over the
poverty threshold.

9. Immunization

Influenza and pneumonia and are among the top 10 causes of death for older adults. Emphasis on
Influenza vaccination for seniors has helped. Pneumonia remains one of the most serious
infections, especially among women and the very old.
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10. Access to Health Care

Seniors frequently don't monitor their health as seriously as they should. While a shortage of
geriatricians has been noted nationwide, URMC has one of the largest groups of geriatricians and
geriatric specialists of any medical community in the country. Your access to health care is as
close as URMC, offering a menu of services at several hospital settings, including the VA
Hospital in Canandaigua, in senior housing, and in your community.

2. Top 8 Most Common Health Issues in the World (WHO)

https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019

1. Global influenza pandemic

The world will face another influenza pandemic – the only thing we don’t know is when it will
hit and how severe it will be. Global defences are only as effective as the weakest link in any
country’s health emergency preparedness and response system.

WHO is constantly monitoring the circulation of influenza viruses to detect potential pandemic
strains: 153 institutions in 114 countries are involved in global surveillance and response.

Every year, WHO recommends which strains should be included in the flu vaccine to protect
people from seasonal flu. In the event that a new flu strain develops pandemic potential, WHO
has set up a unique partnership with all the major players to ensure effective and equitable access
to diagnostics, vaccines and antivirals (treatments), especially in developing countries.

2. Fragile and vulnerable settings

More than 1.6 billion people (22% of the global population) live in places where protracted
crises (through a combination of challenges such as drought, famine, conflict, and population
displacement) and weak health services leave them without access to basic care.

Fragile settings exist in almost all regions of the world, and these are where half of the key
targets in the sustainable development goals, including on child and maternal health, remains
unmet.

WHO will continue to work in these countries to strengthen health systems so that they are better
prepared to detect and respond to outbreaks, as well as able to deliver high quality health
services, including immunization.

3. Antimicrobial resistance

The development of antibiotics, antivirals and antimalarials are some of modern medicine’s
greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the
ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us
back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis,
gonorrhoea, and salmonellosis. The inability to prevent infections could seriously compromise
surgery and procedures such as chemotherapy.

Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease that causes around
10 million people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000 cases of
tuberculosis were resistant to rifampicin – the most effective first-line drug – and 82% of these
people had multidrug-resistant tuberculosis.

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Drug resistance is driven by the overuse of antimicrobials in people, but also in animals,
especially those used for food production, as well as in the environment. WHO is working with
these sectors to implement a global action plan to tackle antimicrobial resistance by increasing
awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.

4. Ebola and other high-threat pathogens

In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of which
spread to cities of more than 1 million people. One of the affected provinces is also in an active
conflict zone.

This shows that the context in which an epidemic of a high-threat pathogen like Ebola erupts is
critical – what happened in rural outbreaks in the past doesn’t always apply to densely populated
urban areas or conflict-affected areas.

At a conference on Preparedness for Public Health Emergencies held last December, participants
from the public health, animal health, transport and tourism sectors focussed on the
growing challenges of tackling outbreaks and health emergencies in urban areas. They called for
WHO and partners to designate 2019 as a “Year of action on preparedness for health
emergencies”.

WHO’s R&D Blueprint identifies diseases and pathogens that have potential to cause a public
health emergency but lack effective treatments and vaccines. This watchlist for priority research
and development includes Ebola, several other haemorrhagic fevers, Zika, Nipah, Middle East
respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome
(SARS) and disease X, which represents the need to prepare for an unknown pathogen that could
cause a serious epidemic.

5. Weak primary health care

Primary health care is usually the first point of contact people have with their health care system,
and ideally should provide comprehensive, affordable, community-based care throughout life.

Primary health care can meet the majority of a person’s health needs of the course of their life.
Health systems with strong primary health care are needed to achieve universal health coverage.

Yet many countries do not have adequate primary health care facilities. This neglect may be a
lack of resources in low- or middle-income countries, but possibly also a focus in the past few
decades on single disease programmes. In October 2018, WHO co-hosted a major global
conference in Astana, Kazakhstan at which all countries committed to renew the commitment to
primary health care made in the Alma-Ata declaration in 1978.

In 2019, WHO will work with partners to revitalize and strengthen primary health care in
countries, and follow up on specific commitments made by in the Astana Declaration.
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6. Vaccine hesitancy

Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines –
threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one
of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a
year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.

Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are
complex, and not all of these cases are due to vaccine hesitancy. However, some countries that
were close to eliminating the disease have seen a resurgence.

The reasons why people choose not to vaccinate are complex; a vaccines advisory group to
WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are
key reasons underlying hesitancy. Health workers, especially those in communities, remain the
most trusted advisor and influencer of vaccination decisions, and they must be supported to
provide trusted, credible information on vaccines.

In 2019, WHO will ramp up work to eliminate cervical cancer worldwide by increasing coverage
of the HPV vaccine, among other interventions. 2019 may also be the year when transmission of
wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30 cases were
reported in both countries. WHO and partners are committed to supporting these countries to
vaccinate every last child to eradicate this crippling disease for good.

7. Dengue

Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal and kill up to
20% of those with severe dengue, has been a growing threat for decades.

A high number of cases occur in the rainy seasons of countries such as Bangladesh and India.
Now, its season in these countries is lengthening significantly (in 2018, Bangladesh saw the
highest number of deaths in almost two decades), and the disease is spreading to less tropical and
more temperate countries such as Nepal, that have not traditionally seen the disease.

An estimated 40% of the world is at risk of dengue fever, and there are around 390 million
infections a year. WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.

8. HIV

The progress made against HIV has been enormous in terms of getting people tested, providing
them with antiretrovirals (22 million are on treatment), and providing access to preventive
measures such as a pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take
antiretrovirals to prevent infection).

However, the epidemic continues to rage with nearly a million people every year dying of
HIV/AIDS. Since the beginning of the epidemic, more than 70 million people have acquired the
infection, and about 35 million people have died. Today, around 37 million worldwide live with
HIV. Reaching people like sex workers, people in prison, men who have sex with men, or
transgender people is hugely challenging. Often these groups are excluded from health services.
A group increasingly affected by HIV are young girls and women (aged 15–24), who are
particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa despite
 being only 10% of the population.

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This year, WHO will work with countries to support the introduction of self-testing so that more
people living with HIV know their status and can receive treatment (or preventive measures in
the case of a negative test result). One activity will be to act on new guidance announced In
December 2018, by WHO and the International Labour Organization to support companies and
organizations to offer HIV self-tests in the workplace.

Activity : Ask the student to make a reaction on a certain issues related on global and
national health status.

II. Definition and Focus

A. Terms
Community
 is a social unit with commonality such as norms, religion, values, customs, or
identity. Communities may share a sense of place situated in a given
geographical area or in virtual space through communication platforms.

- Wikipedia
 The definition of community is all the people living in an area or a group or
groups of people who share common interests.

- Webbster Dictionary

Health
 is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.
- WHO
 the state of being free from illness or injury.
- Dictionary
Nursing
 encompasses autonomous and collaborative care of individuals of all ages,
families, groups and communities, sick or well and in all settings. It includes the
promotion of health, prevention of illness, and the care of ill, disabled and dying
people.
- WHO
 the profession or practice of providing care for the sick and infirm.
- Dictionary
Public Health
 Science and Art of Preventing Disease, 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 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
Birth right to Health and Longevity
- Dr. C.E. Winslow

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 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
- WHO

Public Health Nursing

 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 illness and disability.
- WHO
Community Health Nursing
 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

 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

III. The Standards of Public Health Nursing in the Phillipines

A. 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
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B. Qualifications and Functions of A Public Health Nurse

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.

 Qualifications :
 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

 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.

1. Management Function

 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.

2. Supervisory Function

 PHN is the supervisor of the midwives and other auxillary 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
 Report of the encounter is given to the supervisee and kept in her personal file for future
reference.
3. Nursing Function
 An inherent function of the nurse
 Her practice as a nurse is based on the science and art of caring

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 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

4. 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.

5. 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.

6. Training Function

 Initiates the formulation of staff development and training programs for midwives and
other auxillary 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.

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IV. Basic Principles of CHN

A. Evolution of Nursing

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

Education and Hygiene.

1912  The Fajardo Act (Act No. 2156) created Sanitary Divisions.
 The President of Sanitary Division took charge of two or three
municipalities. Where there are no physicians available, male nurses were
assigned to perform the duties of the President, Sanitary Division.
 Philippine General Hospital (PGH), then under the Bureau of Health sent
four nurses to Cebu to take of mothers and their babies.
 St. Paul’s Hospital School of Nursing in Intramuros, also assigned two
nurses to do home visiting in Manila and gave nursing care to mothers and
newborn babies from the outpatient obstetrical service of the PGH.
1914 - School nursing was rendered by a nurse employed by the Bureau of Health in
Tacloban, Leyte.
- Reorganization Act No. 2462 created the Office of General Inspection.
- Dr. Rosario Pastor a lady physician was headed the Office of District Nursing.
- Two graduate Filipino nurses, Mrs. Casilang Eustaquia and Mrs. Matilde
Azurin were employed for Maternal and Child Health and Sanitation in Manila
under an American nurse, Mrs. G.D. Schudder.

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

1923 - Two government Schools of Nursing were established: Zamboanga General

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

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

1928 - First convention of nurses was held followed by yearly conventions until the
advent of World War II. Pre-service training was initiated as a pre-requisite for
appointment.
 1930 - The Section of Public Health Nursing was converted into Section of Nursing.
The Section of Nursing was transferred from the Office of General Services to
the Division of Administration. This Office covered the supervision and
guidance of nurses in the provincial hospitals and the government schools of
nursing.

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

1941 - Bureau of Health were transferred to the new department.

- Dr. Mariano Icasiano became the first City Health Officer of Manila.
- An office of Nursing was organized with Mrs. Vicenta C. Pnce. As Chief
Nurse and Mrs. Rosario A. Ordiz as Assistant Chief Nurse.

Dec 8. 1941 - World War II broke out, public health nurses in Manila were assigned to
devastated areas to attend to the sick and the wounded.
1942 - A group of public health nurses, physicians and administrators from the
Manila Health Department went to the internet camp in Capas, Tarlac to
receive sick prisoners of war repleased by the Japanese Army.
- They were confined at San Lazaro Hospital and 68 Public Health Nurses were
assigned to help the hospital staff take care of them.
-
July 1942 - 31 nurses who were taken prisoners of war by the Japanese army and confined
at the Bilibid Prison in Manila were released to the Director of the Bureau of
Health, Dr. Eusebio Aguilar who acted as their guarantor.
- Many public health nurses joined the guerillas or went to hide in the
mountains during World War II.
February - Post war records of the Bureau of Health showed that there were 308 public
1946 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, - Mrs. Genara de Guzman was appointed as Chief of the Division, with three
1947 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.
- 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 tobe 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 Bereaus in the Department of
Health. The Bureau of Health was merged with the Bureau of Hospitals to form
the Bureau of Health and Medical Services.
 1967 - In the Burea of Disease Control, Mrs. Zenaida Panlilio – Nisce was appointed
as Nursing Program Supervisor and served as consultant on the nursing aspects
of the 5 special diseases: TB, Leprosy, Venereal Disease, Cancer, Filariasis,
and Mental Health.

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

1975 - The roles of the public health nurse and the midwife were expanded. 2000
midwives were recruited and trained to serve in the rural areas.
1987-1989 - Executive Order No. 119 reorganized the Department of Health and created
several offices and services within the Depratment 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.

B. Philosophy of CHN

 A philosophy is defined as a system of beliefs that provides a basis for a guides

action. A philosophy provides the direction and describes the whats, the whys,
and the hows of activities within a profession.

 CHN Practice is guided by the following beliefs:

Humanistic values of the nursing profession upheld
Unique and distinct component of health care
Multiple factors of health considered
Active participation of clients encouraged
Nurse considers availability of resources
Interdependence among health team members practiced
Scientific and up-to-date
Tasks of CHN vary with time and place
Independence or self-reliance of the people is the end goal
Connectedness of health and development regarded

 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
 In CHN, the client is considered as an Active Partner, not a passive recipient of
care.
 CHN Practice is affected by developments in Health Technology, in Particular,
Changes in Society, in General.
  The goal of CHN is achieved through Multi-Sectoral Efforts
 CHN is a part of the Health Care System and the larger Human Services System

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V. Roles of the Public Health Nurse

A. Roles of the CHN

 Clinician or Health Care Provider: utilizes the nursing process in the care of the
client in the home setting through home visits and in public health care facilities;
conducts referral of patients to appropriate levels of care when necessary
 Health Educator: utilizes teaching skills to improve the health knowledge, skills
and attitude of the individual, family and the community and conducts health
information campaigns to various groups for the purpose of health promotion and
disease prevention
 Coordinator and collaborator: establishes linkages and collaborative
relationships with other health professionals, government agencies, the private
sector, non-government organizations and people’s organizations to address
health problems
 Supervisor: monitors and supervises the performance of midwives and other
auxiliary health workers; also initiates the formulation of staff development and
training programs for midwives and other auxiliary health workers as part of their
training function as supervisors
 Leader and Change Agent: influences people to participate in the overall process
of community development
 Manager: organizes the nursing service component of the local health agency or
local government unit; also, as program manager, the PHN is responsible for the
delivery of the package of services provided by the health program to target
clientele
 Researcher: participates in the conduct of research and utilizes research findings
in practice

B. Responsibilities of the CHN

 Be a part in developing an overall health plan, its implementation and evaluation
for communities.
 Provide quality nursing services to the four levels of clientele
 Maintain coordination/linkages with other health team members, NGO/
government agencies in the provision of public health services
 Conduct researches relevant to CHN services to improve provision of health care
 Provide opportunities for professional growth and continuing education for staff
development

C. Specialized Fields of CHN

 Community Mental Health Nursing: a unique clinical process which includes an
integration of concepts from nursing, mental health, social psychology,
psychology, community networks, and the basic sciences
 Occupational Health Nursing: the application of nursing principles and
procedures conserving the health of workers in all occupation
  School Health Nursing: the application of nursing theories and principles in the
care of the school population

References:

Maglaya, A.S., Nursing Practice in the Community, 5th Edition, Argonauta Corporation, 2009.
https://www.who.int/news-room/facts-in-pictures/detail/state-of-global-health
https://www.urmc.rochester.edu/senior-health/common-issues/top-ten.aspx
https://www.slideshare.net/csteve21/updated-community-health-nursing
https://www.slideshare.net/MarkFredderickAbejo/community-health-nursing

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