Lecture

Chapter 3: Expanding fields of community and public health nursing practice

Learning Objectives:

1. Describe Public health as field of practice

2. Enumerate the standards of Public health practice

3. Discuss nature and scope of Occupational Health Nursing

4. Explain the value of School health nursing for both students and personnel

5. Identify emerging fields of community and public health nursing

Public Health Nursing

Defined as a field of professional practice in nursing and in public health in which

technical nursing interpersonal, analytical, and organizational skills are applied to
problems of health as they affect the community. These skills are applied in concert with
those of other persons engaged in health care, through comprehensive nursing care of
families and other groups and through measures for evaluation or control of threats to
health, for health education of the public, and for mobilization of the public for health
action.

Traditionally, "public health nursing" was seen as a subspecialty nursing practice

generally delivered within "official" or governmental agencies. In contrast, "community
health nursing" was considered to be a broader and more general specialty area that
encompassed many additional subspecialties (e g. school nursing, occupational health
nursing, forensic nursing, home health).

American Nurses Association (ANA) defined community health nursing as "the

synthesis of nursing practice and public health practice applied to promoting and
preserving the health of populations" (ANA, 1980, p. 2).
American Public Health Association (APHA) Committee on Public Health Nursing
(1996). Thus, public health nursing is defined as "the practice of promoting and
protecting the health of populations using knowledge from nursing, social, and public
health sciences" (APHA, 1996, p. 5). Public health nursing practice "is population-
focused, with the goals of promoting health and preventing disease and disability for all
people through the creation of conditions in which people can be healthy" (p. 5).

Standards of Practice for Public Health Nursing

Standard 1. Assessment

Standard 2. Population Diagnosis and Priorities

Standard 3. Outcomes Identification

Standard 4. Planning

Standard 5. Implementation

Standard 5A. Coordination of Care

Standard 5B. Health Teaching and Health Promotion

Standard 5C. Consultation

Standard 5D. Prescriptive Authority

Standard 5E. Regulatory Activities

Standard 6. Evaluation

Standards of Professional Performance for Public Health Nursing

Standard 7. Ethics

Standard 8. Education

Standard 9. Evidence-Based Practice and Research

Standard 10. Quality of Practice

Standard 11. Communication

Standard 12. Leadership

Standard 13. Collaboration

Standard 14. Professional Practice Evaluation

Standard 15. Resource Utilization

Standard 16. Environmental Health

Standard 17. Advocacy

Occupational health nursing

Article 23 of the United Nations Universal Declaration of Human Rights states that,
"Everyone has the right to work, to free choice of employment, to just and favorable
conditions of work." The government, being tasked to uphold the rights of its people,
must then gather the various expertise of its members to enable itself to promote
occupational safety and health (OSH), including that of public health nurses. The
demand for highly trained and experienced occupational health nurses is on the rise as
employer search for ways to cut costs and to comply with employment laws.

In our country, the lead government agency on OSH is the Department of Labor
nursing practice and Employment (DOLE). It has been given rule-making and rule-
enforcement powers to implement stipulations of the Philippine Constitution and the
Philippine Libor Code. Through its Occupational Safety and Health Center (OSHC).

the National Profile on Occupational Safety and Health of the Philippines that
defined OSH as a discipline involved in, "the promotion and maintenance of the highest
degree of physical, mental and social well-being of workers in all occupations. " The
union of public health nurses to the thrust of the government for OSH gave rise to a
public health nursing subspecialty called occupational health nursing

American Association of Occupational Health Nurses (AAOHN) defined the OHN:

The specialty practice that focuses on the promotion, prevention, and restoration of
health within the context of a safe and healthy environment. It includes the prevention of
adverse health effects from occupational and environmental hazards. It provides for and
delivers occupational and environmental health and safety programs and services to
clients.

Nursing science—to provide the context for health care delivery and recognize the
needs of individuals, groups, and populations within the framework of prevention, health
promotion, and illness and injury care management, including the risk assessment, risk
management, and risk communication.

Medical science—specific to treatment and management of occupational health illness

and injury, integrated with nursing health surveillance activities.

Occupational health sciences—including toxicology, to recognize routes of exposure,

examine relationships between chemical exposures in the workplace

Epidemiology—to study health and illness trends and characteristics of the worker
population, investigate work-related illness and injury episodes, and apply
epidemiological methods to analyze and interpret risk data to determine causal
relationships and participate in epidemiological research.

Business and economic theories, concepts, and principles—for strategic and

operational planning for valuing quality and cost effective services, and for management
of occupational health and safety programs.

Social and behavioral sciences—to explore influences of various environments (e.g.,

work and home), relationships, and lifestyle factors on workers’ health and determine
the interactions affecting worker health.

Environmental health—to systematically examine interrelationship between the worker

and the extended environment as a basis for the development of prevention and control
strategies.
Legal and ethical issues—to ensure compliance with regulatory mandates and contend
with ethical concerns that may arise in competitive environments.

Occupational health nursing in the Philippines traces its roots to Mrs. Magdalena
Valenzuela of the Department of Health (DOH). She instituted the Industrial Nursing
Unit (INU) of the Philippine Nurses Association (PNA) on November Il, 1950. Ms. Peria
Gorres of the Philippine Manufacturing Company (PMG,) served as the first
chairperson.

On August 19, 1964, Ms. Anita Santos of Jardine Davies was elected as first
president. She organized several continuing education programs and strived for the
passing of the constitution and by-laws governing the association, which was
approved on November 12, 1966. It paved way to the modification in name of the
organization to Occupational Health Nurses Association of the Philippines (OHNAP)
Inc.

Occupational health strategies: assessment and control of hazards in the workplace

Health hazards are the elements in the work environment that can cause work-related
disease to the worker. Safety hazards are the unsafe conditions or unsafe acts that
significantly increase the risk of worker to be injured.

1. Administrative control refers to the development and implementation of policies,

standards, trainings, job design, and the like. For example, a workplace where a
substantial level of noise is involved may need to implement job rotation policies to be
able to assure that no worker is exposed to the threshold limit (i.e., 85 decibels per 8-
hour shift) in any given work day.

2. Engineering refers to the adaptation of physical, chemical, or technological

improvements to limit the exposure of workers to hazards of the workplace. Noise-
emitting machines can be isolated with sound-proof walls, and dangerous tough
materials. Toxic chemicals could be substituted with alternatives, and their handling
could be automated as well.
3. Material provision refers to providing the workers with supplies or supplements
that can decrease their exposure or susceptibility to occupational hazards. Personal
protective equipment (PPE), immunization, and vitamin

4. Supplementation are some examples of these. Health care and laboratory

workers could be provided with masks, eye shields. and daily doses of multivitamins to
decrease the exposure and increase the resistance to infections.

Framework and scope of occupational health nursing practice

Only on-site health care professional, the occupational health nurse collaborates with
workers, employers, and other professionals to identify health problems or needs,
prioritize interventions, develop and implement programs, and evaluate services
delivered.

Expected duties and functions to be performed by occupational health nurses, as

follows:

1. Organizing and administering a health service program integrating occupational

safety in the absence of a physician; otherwise, these activities of the nurse shall be in
accordance with the physician.

2. Providing nursing care to injured or ill workers.

3. Participating in health maintenance examination. If a physician is not available,

performing work activities that are within the scope allowed by the nursing profession,
and if more extensive examinations are needed, referring the same to a physician.

4. Participating in the maintenance of occupational health and safety by giving

suggestions in the improvement of working environment affecting the health and
wellbeing of the workers

5. Maintaining a reporting and records system and. if a physician is not available,

preparing and submitting an annual medical report, using the prescribed form to the
employer as required by this standard.
School health nursing

School-aged children and adolescents face increasingly difficult challenges related to

health. Many of today's health challenges are different from those of the past and
include behaviors and risks linked to the majority of the leading causes of death, such
as heart disease, injuries, and cancer. The use of tobacco, alcohol, and drugs; poor
nutritional habits; inadequate physical activity; irresponsible sexual behavior; violence;
suicide; and reckless driving are examples of behaviors that often begin during youth
and increase the risk for serious health problems.

World Health Organization (WHO) Expert Committee on School Health Services noted
that, "to learn effectively, children need good health.

Teachers, who also serve as school health guardians, provide primary care as
necessary, such as detection of obvious health problems and administration of first aid.
Thus, the school nurse is responsible for planning and conducting training programs for
teachers on health and nutrition (DECS- I-INC, 1997).

There is a need for mental and physical health services for students of all ages in an
effort to improve both academic performance and sense of well-being.

School health programs were defined as covering:

1. School health services,

2. School health education, and

3. A healthy school environment to include both physical and psychosocial aspects

of environment (WHO, 1997).

Additional to the first three programs.

1. Health promotion for school personnel,

2. School-community projects and outreach,

3. Nutrition and food safety,

4. Physical education and recreation, and

5. Mental health, counseling, and social supports.

8 Components of School Health

The Eight-Component Model

CDC Model. The Centers for Disease Control and Prevention (CDC) eight-component

model of a comprehensive school health program consists of the following interactive

components.

1. Health Education

2. Physical Education

3. Health Services

4. Nutrition Services

5. Health Promotion for Staff

6. Counseling, Psychological, and Social Services

7. Healthful School Environment

8. Parent and Community Involvement

The following is a summary of CDC’s definitions and descriptions of each component of

a comprehensive school health program.

Key Features of a Comprehensive School Health Program

Component/Definition Description

Health Education - A planned, sequential, K-12 curriculum that addresses the physical,

mental, emotional, and social dimensions of health.

♦ Designed to motivate and assist students to maintain and improve their health,
prevent disease, and reduce health related risk behaviors.

♦ Allows students to develop and demonstrate increasingly sophisticated health-related

knowledge, attitudes, skills, and practices.

♦ Includes a variety of topics, such as personal health, family health, community health,
consumer health, environmental health, sexuality education, mental and emotional
health, injury prevention and safety, nutrition, prevention and control of disease, and
substance use and abuse.

♦ Qualified, trained teachers provide health education.

Physical Education - A planned, sequential K-12 curriculum that provides cognitive

content and learning experiences in a variety of activity areas.

♦ Promotes each student’s optimum physical, mental, emotional, and social

development through a variety of planned physical activities.

♦ Promotes activities and sports that all students enjoy and can pursue throughout their
lives.

♦ Includes such activities as basic movement skills; physical fitness; rhythms and
dance; games; team, dual, and individual sports; tumbling and gymnastics; and
aquatics.

♦ Qualified, trained teachers teach physical activity.

Health Services provided for students to appraise, protect, and promote health.

♦ Designed to ensure access or referral to primary health care services or both.

♦ Fosters appropriate use of primary health care services.

♦ Prevents and controls communicable disease and other health problems.

♦ Provides emergency care for illness or injury.

♦ Promotes and provides optimum sanitary conditions for a safe school facility and
school environment.

♦ Provides educational and counseling opportunities for promoting and maintaining

individual, family, and community health.

♦ Qualified professionals (such as physicians, nurses, dentists, health educators, and

other allied health personnel) provide these services.

Nutrition Services - Access to a variety of nutritious and appealing meals that

accommodate the health and nutrition needs of all students.

♦ Reflects the U.S. Dietary Guidelines for Americans and other criteria to achieve
nutrition integrity.

♦ Offers students a learning laboratory for classroom nutrition and health education.

♦ Serves as a resource for linkages with nutrition-related community services.

♦ Qualified child nutrition professionals provide these services.

Health Promotion for Staff - Opportunities for school staff to improve their health status

through such activities as health assessments, health education, and health-related

fitness activities.

♦ Encourages school staff to pursue a healthy lifestyle that contributes to their improved
health status, improved morale, and a greater personal commitment to the school’s
overall comprehensive health program.
♦ Personal commitment often transfers into greater commitment to the health of
students and creates positive role modeling.

♦ Improves staff productivity.

♦ Decreases staff absenteeism.

♦ Reduces health insurance costs

Counseling and Psychological/Social Services - provided to improve students’ mental,

emotional, and social health.

♦ Includes individual and group assessments, interventions, and referrals.

♦ Organizational assessment and consultation skills of counselors and psychologists

contribute not only to the

health of students but also to the health of the school environment.

♦ Professionals (such as certified school counselors, psychologists, and social workers)

provide these services.

Healthful School Environment - The physical and aesthetic surroundings and the
psychosocial climate and culture of the school.

♦ Factors that influence the physical environment include the school building and the
area surrounding it, any biological or chemical agents that are detrimental to health, and
such

physical conditions as temperature, noise, and lighting.

♦ Psychological environment includes the physical, emotional, and social conditions that
affect the well-being of students and staff.

Parent/Community Involvement - An integrated school, parent, and community

approach for enhancing the health and well-being of students.

♦ Builds support for school health program efforts through school health advisory
councils, coalitions, and broadly based constituencies for school health.
♦ Schools should actively solicit parent involvement and engage community resources.

Emerging fields of community and public health nursing in the Philippines

The increasing prevalence and long-term effects of chronic and non-communicable

diseases. such as diseases of the heart and the vascular system, cancer, diabetes, and
pulmonary and renal conditions, inflict a heavy burden on the client and the health care
system.

To provide for the needs of patients such as this, the nurse may engage in:

• Home health care: This practice involves providing nursing care to individuals and
families in their own places of residence mainly to minimize the effects of illness and
disability. Home health care allows a patient to remain at home and still receive care
instead of staying in a hospital or health institution for recovery or rehabilitation.
Examples of patients who may benefit from home health care are the chronically ill,
convalescent patients, the elderly, the disabled who require custodial care, and high-risk
pregnant women.

• Hospice home care:

This is home care specifically rendered to the terminally ill. It is intended to provide
comfort to the terminally ill patient, improve his/her quality of life, and provides support
to the patient and the family as they go through the processes of dying and grieving.
Palliative care is particularly important in hospice care.

• Faith community nursing or parish nursing is the practice of the art and science of
nursing combined with spiritual care. They may work in either paid or unpaid positions in
a variety of religious faiths.

• Correctional Nursing is a specialized subset of forensic nursing. It requires a

significant amount of knowledge as well as an understanding and awareness of the
unique needs and perspectives of the clients served. Several issues specific to
correctional nursing include maintenance of a safe environment, promotion of health
among inmates, and dealing with both acute and chronic conditions.
• Entrepreneurship in Nursing is recently gaining momentum in the field of healthcare
practice among nurses. This focuses on encouraging nurses to pursue independent
practice and establish singly or in collaboration, healthcare related business
establishments.