● The HNC has two (2) divisions:
Different Fields of Nursing Concept of Community
School Health Nursing
● One of the subspecialized fields in the nursing profession.
● A type of public health nursing that focuses on the promotion
of health and wellness of the pupils or students, teaching and
non-teaching personnel of the schools.
● Is determined by the characteristics of their clientele--- their
age, developmental age, and their common health problems
and concerns.
● Facilitates positive student responses to normal development,
promotes health and safety, intervenes with actual and
potential health problems, provides care or case management
services, and actively collaborates with others to build student
and family capacity for adaptation, self management, self
advocacy, and learning.
● Other Determinants:
○ Health problems of school children are the result of
economic and environmental (particularly their home
and immediate environment) factors.
○ School nursing practice which include policies and
standards of the Department of Education, Culture
and Sports and the Department of Health, and
standards of the nursing profession.
● The school nurse's role is essential to ensure coordinated care.
● There is a recognized relationship between health and learning,
as there is between school nurses availability and student
well-being and educational success.
● The role of the school nurse encompasses both health and
education goals. Students today may face family crisis,
hopelessness, immigration, poverty, and violence which
increases both their physical and mental health needs.
● School nurses perform a critical role within the school health
program by addressing the major health problem experienced
by the children.
● Health is an important requisite in education.
● School health nursing aims at promoting the health of school
children and preventing health problems that would hinder
their learning and performance of their developmental tasks.
● Although school health nursing is primarily concerned with
health concerns in the school setting, it accepts that health is
affected by factors outside the school setting such as poverty,
family dynamics, and lifestyle.
● These roles include:
○ Providing preventive and screening services, health
education and assistance with decision making about
health and immunization against preventable disease.
● School nurses are well positioned to take the lead for the school
system in partnering with the school physician, community
physician, and community organization. They facilitate access
to medic-aid and the state children health insurance program to
help families and students.
Objectives of School Nursing
● General: To promote quality nursing service to the school
population by providing comprehensive and quality nursing
care.
● The school has a unique role in provision of school health
services for children with special health needs, including
children with chronic illnesses and disabilities of various
degrees of severity.
● The HNC (Health and Nutrition Center) of the Department of
Education (DepED) is mandated to safeguard the health and
nutritional well being of the total school population.
○ Health Division
○ Nutrition Division
● The health division has four (4) sections:
○ Medical
○ Dental
○ Nursing
○ Health education sections
● The school nurse provides school education by providing
information to individual students and groups of students
through health education, science and other classes.
● The school nurse assists on health education and also to
identify or monitor the health status of those students who are
underweight and those students who have underlying medical
health problems. This is to eradicate or minimize that there
should be no longer children who are malnourished and those
with underlying medical health conditions will be given
appropriate management.
Duties and Responsibilities
1. The Individual
2. The Family
3. The Group or Aggregate
● Make up the whole population
1. Health Advocacy
● Is a direct service to the individuals or families as well as
activities that promote health and the access to health care in
communities and the larger public.
● Health advocates are best suited to address the challenge of
patient-centered care in our complex health care system.
2. Health and Nutrition Assessment
● Health screening can decrease the negative effect of health
problems on education by identifying students with potential
underlying medical problems early, and referring them to
treatment as appropriate.
3. Supervision of the health and safety of the school plant
● Provide for the safety of the environment by participating in
environmental safety monitoring, like the playgrounds, indoor
air quality and potential hazards.
4. Treatment of common ailments and attending to emergency cases
● Provides care for injuries, acute illness for all students and long
term management of students with special health care needs.
● An individualized healthcare plan is developed for students with
chronic conditions and an appropriate emergency plan is
developed to manage potential emergency events in the school
setting.
5. Referrals and follow up of pupils and personnel
● Referral to the medical home and use of appropriate
community resources, promotes optimal outcomes of health
status of individuals.
6. Home Visits
● Is a family nurse contact which allows healthcare workers to
assist the home family situation in order to provide the
necessary nursing care and health related activities.
7. Community outreach like attending community assemblies and
organizing school community councils
● Is an activity of providing school services to any population that
might not otherwise have access to those services.
● This also builds avenues where people can try with support and
bayanihan with others.
● Being stewards of inspiration and encouragement, contribute to
building empowered stewards of change.
8. Recording and reporting of accomplishments
● This will help to assess whether a goal has been achieved or
not.
Monitoring and evaluation of programs and projects
● This is used to assess the performance of programs and projects
that are mandated by the department of health that have been
implemented.
● Its goal is to improve current and future management of
outputs, outcomes, and impact on the delivery of health care
systems on how it is being implemented.
Skills Needed by and Provided to the School Nurses to Enable Them
to Deliver Effective Health Care to School Populace
1. Assessment and Screening Skills
● One of the important skills a school nurse must possess so that
important data collection during assessment will be appropriate
as to give appropriate care according to the needs of
individuals.
2. Health Counseling Skills
● Able to empower your client and is not about providing them
with answers, but it is about empowering them with your
counseling skills to find their own solution and realizing that
exploration is necessary in truly understanding a client’s
thoughts and feelings in relation to their pressing problem.
3. Social Mobilization Skills
● Primary step of community development for recovery from
complex disasters.
● It allows people to think and understand their situation as well
as to organize and initiate action for their recovery with their
own initiative and creativity.
4. Good Oral and Written Skills
● Someone who is able to deliver clear or concise verbal or
written messages that facilitate a mutual understanding in both
parties.
5. Basic Management Skills
● Someone who has knowledge on how to respond to emergency
treatment during a crisis.
6. Life Skills
Functions of the School Nurse
● School health and nutrition survey
● Putting up a functional school clinic
● Health assessment
● Interviewing
● Nutritional assessment- height and weight measurement
● Vision acuity test/hearing test
● Four methods of physical examination (inspection, percussion,
palpation, auscultation)
● Taking vital signs
● Appraisal of general physical and mental condition
● Recording of findings
● Medical referrals
● Attendance to emergency cases
● Student health counseling
● Health and nutrition education activities
Communicable Disease Control
● One of the activities of the school nurse.
● Defined as one that is spread from one person to another
through a variety of ways that includes contact with blood and
bodily fluids, breathing in an airborne virus and by being bitten
by an insect.
Establishment of Data Bank on School Health and Nutrition
Activities
● Your regular physical activity is proven to help prevent and
manage non communicable diseases such as heart disease,
stroke, diabetes, and several cancers. It also helps prevent
hypertension, maintain healthy body weight, and can improve
mental health quality of life and well being.
School Plant Inspection For Healing Environment
● Done for the sanitation and safety requirements, thus
promoting environmental safety and precaution.
● If there are any hazardous substances, or pollution exposure in
any case in which the potential contamination at the potential
school site exists.(?)
Rapid Classroom Inspection
● Can be done for us to know if there are school children who are
having such minor illnesses that they might transmit the
infection to other children.
● To check the safety of the environment, thus preventing any
further infection and immediate management will be
implemented.
Home Visitation
● One of the essential parts of community health services
because most of the people are found in the home so as to
assist the living condition of the patient and his family and their
health practices in order to provide the appropriate health
teaching.
● Remember that home visitation is a family nurse contact which
allows the health worker to assess the home and family
situation in order to provide the necessary nursing care and
health related activities.
Occupational Health Nursing
● RA 1054 is also known as “the occupational health act”
● Aside from the number of employees, there are a number of
factors that must be considered in determining the
occupational health privilege of the worker, which they are
entitled the location of the workplace in relation to the health
facilities. This is because, based on the RA 1054, the
occupational nurse must be employed, there should be 30 to
100 employees and the workplace is more than 1 kilometer
away from the nearest health center.
● NURSING in the workplace.
● CHN focused on people in their places of work, which of course,
is part of the bigger community.
● The practice focuses on promotion, protection, and restoration
of worker’s health within the context of a safe and healthy work
environment.
 ● It is a field within the nursing disciple that involves developing
industrial health and safety programs or observing workers who
have been injured on the job.
● Help improve the health and safety of the workers.
● Is autonomous, and occupational health nurses make
independent nursing judgments in providing occupational
health services.
● Which emphasizes on optimizing health, preventing illness and
injury, and reducing health hazards to cope with actual and
potential stresses in relation with their work and work
environment.
● Primary Focus:
○ The mission of occupational health and safety is “to
assure as far as possible every working man and
woman in the country is safe and in healthful working
conditions.”
● Occupational health and safety should be considered an
integral part of all health services.
○ Thus to ensure the welfare of the employee to their
safety and security.
Determinants of Occupational Nursing Practice
1. Government policies and standards (e.g. DOLE, DOH, SSS)
● The company must follow the mandated policy and the
standards in implementing the health benefits of the employee
for their own welfare.
2. The PHN can be an occupational nurse who is in a prime position
to assess the needs of the working population and design working
interventions.
● It is our responsibility to fully comply with those stipulated
policies to provide health care assistance in times the
employees are in a crisis situation.
Professional Goals
● There are 11 different goals for occupational health and safety
to provide a good working condition, not only through
environment safety, but also in other aspects, so that optimum
level of functioning will be achieved.
● Professionals from multiple disciplines work cooperatively to
achieve the goals of occupational health and safety:
● Occupational health nurses’ central mission is to promote and
maintain the health and safety of workers through a systemic
process of assessment, planning, intervention, and evaluation.
Occupational Physicians
● The one focused on the prevention, detection, and treatment of
work related diseases and injuries.
Industrial Hygienists
● Recognizes, evaluates, controls toxic exposure and hazards in
the work environment.
Safety engineers and other safety professionals
● Focus on the prevention of occupational injuries and the
maintenance or creation of safe workplaces and safe work
practices.
Epidemiologists
● Study and describe the natural history of occupational diseases
and injuries in the population group.
Toxicologists
● Study and describe the toxic properties of agents used in the
work application to which workers may be exposed.
Industrial Engineers
● Designed the tools, equipment, and machines used in
manufacturing and other work applications.
Ergonomist
● Study, design and promote the healthy interfairs of humans,
their tools, and their work.
Health Educators
● Promote workers healthy lifestyle and work practices.
Environmental Engineers
● Concentrate on environmental control to limit the
environmental population and achieve a healthy environment.
Essential Components of This Specialty Practice
1. Health promotion and prevention principles
● As a company nurse, health promotion should always take place
in giving health education to the worker.
2. Worker or workplace health hazard assessment and surveillance
● It is our accountability to oversee the environmental workplace
of our employees. It should be free from any hazardous
substances.
3. Injury and illness investigation, analysis and prevention
● If there are more cases reported in any form of cause of an
injury of every worker, it entails that the implementation of the
health protocol and safety are not fully imposed. That will
greatly affect the prevention of getting injured.
4. Primary Care
● It is the vital aspect of the nurse that we should know the
management and treatment under the primary care system, so
that immediate care can be given to anyone who gets sick or
injured.
5. Case Management
● A collaborative process that assesses, plans, implements,
coordinates, monitors and evaluates the option in services
required to meet the clients help and human services needs.
6. Counseling
● It is a collaborative process that involves the development of
confidential professional relationships that focus on personal
problems.
● The objective of the counseling is to help you clarify issues, gain
insights with your feelings and thoughts, and deals effectively
with problems.
7. Management and Administration
● It is our responsibility to oversee if the management and
administration is considering your health plan program for the
welfare of your employee.
● Since then the management is the one organizing and
administering organization by a group of people. They are
working together to achieve the well- being of the employee.
8. Legal and Ethical Monitoring
● This is to gain employee trust and maintain transparency in your
company. There are two ethical consequences of employee and
personal data. This reduces employees' moral entrust ?!?!!?
9. Research
10. Community Orientation
Community Mental Health Nursing
Mental health nurses (RMN) work with:
● Children, adults and older people suffer from various types of
mental health problems.
● RMN work in:
○ Homes, residential units, National Health Service
(NHS) or in private specialist hospital services and
secure units.
● Also known as psychiatric nursing. This is a specialized field of
nursing practice that involves the care of individuals with a
mental health disorder to help them recover and improve their
quality of life.
● Started in the US (1960) with the belief that a person gets
better faster if he or she is placed in an environment familiar to
him or her.
● The patient does not need to be hospitalized away from home
and community.
● Mental illnesses can affect individuals of any age, ethnic origin,
or socioeconomic status. For this reason, a mental health nurse
may need to work with many different individuals from various
backgrounds.
● Advantage:
○ Less expensive and intervention in a familiar
surroundings.
● Disadvantage:
● Homelessness is linked to deinstitutionalization.
○ Emphasize work on mental health promotion.
● Help people to recover from their illness or come to terms with
it in order to maximize their life potential.
● Mental health nurses liaise with psychiatrists, occupational
therapists, GPs, social workers and other health professionals to
plan and deliver care using a multidisciplinary client-centred
approach.
● The nurse provides an important link between the hospital and
the community. He or she ensures that people living in
hospitals continue to receive the right care after discharge.
The Roles of The Community Mental Health Nurse
1. Coordinating the care of patients
● Care coordination involves deliberately organizing the patient’s
care activities and sharing information among all of the
participants concerned with patients care to achieve safer and
more effective care.
2. Liaising with patients, relatives and fellow professionals in the
community treatment team and attending regular meetings to
review and monitor patients' care plan
● Improve the way we communicate with our patients, their
relatives, and to raise concern about the current condition of
our patients.
3. Visiting patients in their home to monitor progress
● Can be a valuable strategy to improve care transitions from
patients and to be able to identify, assess the patient’s status
and level of knowledge and capability to manage their diseases.
Assessing patients' behavior and psychological needs
● Psychological assessment measures can support qualified
clinicians in making a formal diagnosis for mental health
problems.
Identifying if and when a patient is at risk of harming themselves or
others.
● A risk assessment should identify key factors that indicate a
pattern or harming or if they need to protect the public.
Community
● Is a group of people sharing common geographic boundaries or
values and interests.
● A group of people living in the same place or having particular
characteristics that are common such as norms, religion, values,
or identity.
● 1996 – definition focused on geographical boundaries & social
attributes of people.
● There is also a group of people who differ from one another
through their physical environment.
● No two communities are alike
● Recent Literature: a collection of people who interact with one
another and whose common interests or characteristics form
the basis for a sense of unity or belonging
● A group of people who share something in common and
interact with others who may exhibit a commitment with one
another and may share a geographic boundary and who
function collectively within a defined social structure to address
common concern and locality, base entity, composed of system
and formal organization, reflecting society institution in formal
groups and aggregates. (ywa na sentence)
4 Defining Attributes of a Community (Maurer and Smith, 2009)
1. People
● The attitude of the people living in the community will greatly
affect the implementation of such health programs and
activities.
2. Place
● If the geographical location where the people living in the
community is far flung areas from where the health care center
is located, then you will expect that those people will not
participate in activities. That could lead to a problem source
which can be identified.
3. Interaction
● Is one of the important aspects in dealing with a community of
people. By letting them see that you are showing them
empathy towards their community concern.
4. Common characteristics. Interests, values and goals
● Anyone of this aspect that the community of people will not
show their interest then your implementation will be affected.
This is interrelated and can be seen by the people living in the
community that they must this characteristic combining the
ideas and the concept of community is seen as a group or
collection of locality, base individuals interacting in social units
and sharing common interests, characteristic values and goals.
(mas better if dli nani nimo i read. Murag grade 2 ang ga sulat)
Types of Community (Maurer and Smith, 2009)
1. Geopolitical
● Natural & man-made boundaries (barangays, municipalities,
cities, provinces, regions).
2. Phenomenological
● relational or interactive groups, in which the setting is more
abstract & people share a perspective or identity based on
culture, values, interests, goals, history (e.g. schools, churches,
mosques, org).
Characteristics of a Healthy Community
● Shared sense of being a community based on history
and values.
● Empowerment and control over matters that affect
the community as a whole.
● Existing structures that allow subgroups within the
community.
● The ability to cope with change, solve problems, and
manage conflicts.
● Open channels of communication and cooperation
among members.
● Equitable and efficient use of community resources.
● According to the WHO in 2002, the characteristics of a
healthy community includes a clean and safe physical
environment that promotes social harmony and
actively involves everyone with the community.
environment that needs and basic needs and
understanding of local health and environmental
concern.
● A community that participates in identifying local
health solutions and local issues.
● A community whose members have access to buried
experiences, means of interaction and
communication accessible to appropriate health
services and facilities.
● The promotion and celebration of historical, cultural
heritage.
● A diverse and innovative economy and sustainable
use of health resources for all.
Location of the Community
● The health of the community is affected by both
natural and manmade variables, related to location
and natural factors. Consists of geographical features,
climate, and flora and fauna.
● Community boundaries: Urban and Rural
● Presence of open spaces
● Quality of soil, air and water
● Location of health facilities
● Geographic features: Land and water forms
○ Influence food sources and prevalent
occupation in the community.
Factors Affecting Health of the Community
Urban
● Higher population density
● Concentrated poverty and slum formation
● Greater exposure to health risks and hazards
○ Leading to violence, traffic injuries and obesity.
Rural
● Wide open spaces and low population density
○ But in equities and resources of economic
opportunities hinders rural development, health
facility, and health workers concentrated mainly in
urban areas. (wtf)
● Poverty is more prevalent – 80%
● Outdoor air pollution (air, water, & soil pollution)
○ Poses health hazard.
○ Attributed to the transport and manufacturing which
occur in concentration in urban areas.
● Indoor pollution (use of solid fuel).
○ More prevalent among the low income household in
the rural areas.
Social System
● Patterned series of interrelationships existing between
individuals, groups, and institutions and forming a coherent
whole. (Merriam-Webster Online Dictionary,2012)
● Family
● Economic
● Educational
● Communication
● Political
● Legal
● Religious
● Recreational
● Health systems
● Organizations within the social system:
○ Formal
■ Ex. Gov’t. agency, Bank and School
○ Informal
■ Ex. Neighborhood friends, Volunteers,
barangay clean up drive
○ Subsystems
■ Ex. Health center, private clinics, hospitals,
health laboratories, and drugstores
Roles and Activities of Community Health Nurse
1. Care Provider
● Or clinician
● Uses the nursing process to provide direct nursing intervention
to individuals, families, or population groups.
2. Educator
● Facilitates learning for positive health behavior change.
3. Advocate
● The one who speaks or act in behalf of the client who cannot do
it for himself.
4. Manager
● Community health nurses like all nurses engage in the role of
managing health services.
● As a manager, the nurse exercises administrative directions
towards the accomplishment of specified goals by assessing
clients needs, planning and organizing to meet those needs,
controlling and evaluating the progress to ensure that goals are
met.
● The nurse serves as a manager when overseeing clients care as
a case manager.
● Supervising the staff, running clinics, conducting community
health needs assessment projects.
5. Collaborator
● Community health nurses seldom practice in isolation, they
must work with many people, including with the other health
care team members.

6. Leader
● CHN are becoming increasingly active in the leadership role.
This role focuses on affecting change and lets the nurse become
an agent of change.
● As a leader, community health nurses seek to initiate change
that positively affects people's health.

7. Researcher
● Community health nurses engage in a systematic investigation,
collection, analysis of data for solving problems and enhancing
community health practice.
● Follows a systematic practice of monitoring the health status of
the community through the conduct of surveys and home visits.
● Conducting research concerns the health of the community.