COMMUNITY HEALTH NURSING
family is 3 times more likely to not
Bernadette Wyne Tosoc Lee RN, MAN
GLOBAL HEALTH ISSUES
 Pandemics
 Environmental Factors
 Economic Disparities and Access to
Health Care
 Political Factors
 Non-Communicable Diseases
Ex: Heart Disease, Cancer
 Animal Health, Food Sourcing and
Supply
Ex: Rabies, Monkeypox, ASF, Bird Flu,
Food Poisoning
The Philippine Public Healthcare Scenario
 The national budget allocation for
health care is relatively small.
 Local government units augment the
national budget to an undetermined
extent.
 This scenario requires strategies that
will allow maximization of limited
resources:
- Health promotion
- Disease prevention
Nurses in Public Healthcare
 Community/public health nursing is the
synthesis of nursing practice and public
health practice.
 The major goal of community health
nursing is to preserve the health of the
community and surrounding
populations by focusing on health
promotion and health maintenance of
individuals, families, and groups within
the community.
 The mission of public health is SOCIAL
JUSTICE, which entitles all people to
basic necessities such as adequate
income and health protection and
accepts collective burdens to make this
possible.
CURRENT HEALTH ISSUES IN THE PHILIPPINES
 Persistent Inequities in Health
Outcomes, as evidenced by:
- 3 out of 10 children are stunted
- Every year, around 2000 mothers
due to pregnancy-related
complications.
- A Filipino child born to the poorest
reach his 5th birthday compared to
one born to the richest family.
 Restrictive and diminishing Health care
costs
- Every year, 1.5 million families are
pressed to poverty due to health
care expenses
- Filipino delay care due to
unaffordable and changeable user
fees or co-payments.
- Php 4,000/month expenses for
health care is considered terrible
for single-income families.
 Poor quality and inappropriate care
synonymous with public clinics and
hospitals
- Filipino forego or delay cure to
prohibitive and unpredictable user
fees or co-payments
Significant changes that can be observe in the
community:
 Phil. health insurance covers 92% of
our population, inclusive already the
private health insurance
 Services for all mothers and their
children had improved.
 Infant mortality had been reduced.
 Nowadays, the increasing number of
women delivers on birthing facilities,
hence newborn is being attended well
by health workers.
 There is an improved service on
diagnostics and treatment procedures
on communicable and non-
communicable diseases
HEALTH
 Health is the state of complete physical,
mental and social well-being, not
merely the absence of disease or
infirmity. (WHO)
 Socialized Conceptualization of Health
(WHO)
The extent to which an individual or
group is able, on the one hand, to
realize aspirations and satisfy needs;
and, on the other hand, to change or
cope with the environment. Health is a
resource for everyday life, not the
objective of living.
  Health is the ability of a body to adapt Ex: LGBT Community, Health Workers, A
to new threats and infirmities. (Lancet) group of Infants for Immunization,
group of senior citizens
COMMUNITY
Determinants of Health and Disease
 A community is a group of people living
in one locality, composed of individuals,
families or group of people, who
interact with one another with common
interests or characteristics.
 Community is a group of people, who
share something in common and
interact with one another, who may
exhibit a commitment with one another
and may share a geographic boundary.
(Lundy and JaneS)

Defining Attributes of Communities

1. People
2. Place
3. Interaction
4. Common characteristics, interests or
goals
-Maurer and Smith, 2009
Types of Communities
 Geopolitical / Territorial community
- Defined or formed by both natural
and man-made boundaries and
include barangays, municipalities,
cities, provinces, regions and
nations.
- May geographic location and may
boundaries
 Phenomenological / Functional
community
- Refer to relational, interactive
groups, in which the place or
setting is more abstract and people
share a group perspective or
identity based on culture, values,
history, interests and goals
-Maurer and Smith, 2009
Population and Aggregate
 Population is typically used to denote a
group of people having common
personal or environmental
characteristics. It can also refer to all
the people in a defined community.
 Aggregates are subgroups or
subpopulations that have common
characteristics or concerns.
Determinants of Health and Disease
 Income and social status
 Education (Ex: low educ level)
 Physical environment (Ex: Pollution)
 Employment and working conditions
(Ex: Factories)
 Social support networks (Ex: Covid)
 Culture
 Genetics
 Personal behavior and coping skills
(Ex: Lifestyle, stress eating)
 Health services
 Gender
INDICATORS OF HEALTH AND ILLNESS
 Morbidity
- Number/rate which a disease
happens in a certain situation.
 Mortality
- Number of deaths
 Life expectancy
 Infant Mortality
- Number of deaths of infant
 Maternal Mortality
- Pregnancy and childbirth delivery
death (Ex: Hemorrhage,
Postpartum)
 Age-adjusted death rates
 Disease incidence rates
PUBLIC HEALTH
 Science and art of preventing disease,
prolonging life and promoting health
and efficiency through organized
community effort for:
1. Sanitation of the environment
2. Control of communicable infections
3. Education of the individual in personal
hygiene
4. Organization of medical and nursing
services for early diagnosis and
preventive treatment of disease
5. Development of social machinery to
ensure everyone a standard of living
adequate for maintenance of health as
to enable every citizen to realize
birthright of health and longevity
CORE PUBLIC HEALTH FUNCTIONS
ASSESSMENT: Regular collection, analysis and
information sharing about health conditions,
risks and resources in a community.
POLICY DEVELOPMENT: Use of information
gathered during assessment to develop local
and state health policies and to direct resources
toward those policies.
ASSURANCE: Focuses on the availability of
necessary health services throughout the
community.
Ex: Covid 19 – government develop policies and
health regulation
9 ESSENTIAL PUBLIC HEALTH FUNCTIONS
1. Health situation monitoring and analysis
2. Epidemiological surveillance/disease
prevention and control.
3. Development of policies 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 service.
9. Research, development and
implementation of innovative public
health solutions.
COMMUNITY HEALTH
 Extends the realm of public health to
include organized health efforts at the
community level through both
government and private efforts.
Health Promotion and Disease Prevention
Health promotion activities enhance resources
directed at improving well-being
Disease prevention activities protect people
from disease and the effects of disease.
Levels of Prevention
Primary: general health promotion and specific
protection
Secondary: early detection and prompt
intervention
Tertiary: reduce the effects of disease and
injury, and restore individuals to their optimal
level of functioning
-Leavell and Clark, 1958
PRIMARY LEVEL
Directed towards individual who are at risk or
developing a disease or those who are pre-
pathogenic stage, general health promotion and
specific protection of individuals against these
risk factors
Ex: Added food supplements, tooth enamel
cleaning
SECONDARY LEVEL
Directed to individuals in the subclinical stage,
both symptomatic and asymptomatic stage;
pertains to early detection and prompt
interventions to diagnose and treat existing
health problems in order to limit disabilities.
Ex: Treatment of communicable disease,
mammography
TERTIARY LEVEL
Directed towards individual in the pathogenic
stage of the disease to reduce the effects of
disease and injury and restore individuals to
their optimal level of functioning.
Ex: Rehabilitation of post stroke patients
COMMUNITY HEALTH NURSING
  The synthesis of nursing practice and  Intervenes with communities, systems,
public health practice applied to individuals, and families
promoting and preserving the health of -Minnesota Department of Health, 2003
population (ANA)
 Encompasses subspecialties that Levels of Clientele
include public health nursing, school  Individual
nursing, occupational health nursing  Family
and other developing fields of practice  Group/ Aggregate
such as home health, hospice care and  Community
independent nurse practice.
Intervention Wheel
PUBLIC HEALTH NURSING
 Elements
 Public health nursing may be defined as 1. Population-based
a field of professional practice in 2. Contains 3 levels of practice
nursing and in public health in which (community, systems and
technical nursing, interpersonal, individual/family)
analytical, and organizational skills are 3. Identifies and defines 17 public health
applied to problems of health as they interventions
affect the community. -Freeman, 1963

 The practice of promoting and

protecting the health of populations
using knowledge from nursing, social,
and public health sciences -ANA/APHA,
1996

COMMUNITY-BASED NURSING

 Application of the nursing process in

caring for individuals, families and
groups where they live, work or go to
school or as they move through the
health care system Public Health Interventions
-McEwen and Pullis, 2008  Surveillance
 Disease and other health event
COMMUNITY-BASED NURSING VS.
investigations
COMMUNITY HEALTH NURSING
 Outreach
 Screening
 Case finding
Ex: may tuberculosis sputum exam
 Referral and follow-up
Ex: respiratory mode of transmission
pwede mag chest x-ray
 Case Management
 Delegated functions
Population-Focused Approach
Ex: May tumataas ang BP delicate BP
 Focuses on the entire population monitoring on barangay health care
 Is based on assessment of the worker
populations' health status  Health teaching
 Considers the broad determinants of  Counseling
health  Consultation
 Emphasizes all levels of prevention  Collaboration
 Coalition building
  Community organizing
 Advocacy
 Social marketing
 Policy development and enforcement
Pre-payment Mechanism
 Community health services and
community health nursing services, are
generally free at the point of care.
 The services have already been pre-paid
by the community/aggregate.
- Taxes cover government-provided
healthcare services
- Tuition fees cover school-health
services
- Consumers pay for the
occupational health services of
employees of a company.
Emerging Fields of Community Health Nursing
in the Philippines
Home health care: This practice involves
providing nursing care to individuals and
families in their own places of residence mainly
to minimize the effects of illness and disability.
Hospice home care: This is home care
specifically rendered to the terminally ill.
EntrepreNurse: This is a project initiated by the
Department of Labor and Employment (DOLE),
in collaboration with the Board of Nursing of
the Philippines, Department of Health,
Philippine Nurses Association, and other
stakeholders to promote nurse
entrepreneurship.
Faith community nursing or parish nursing:
This is the practice of nursing combined with
spiritual care. They may work in either paid or
unpaid positions in a variety of religious faiths.
Competency Standards in Community Health
Nursing
 Safe and quality nursing care
 Management of resources and
environment
 Health education
 Legal responsibility
 Ethico-moral responsibility
 Personal and professional
development
 Quality improvement
 Research
 Records management
 Communication
 Collaboration and Teamwork
History of Public Health Nursing
in the Philippines
 1577: Friar Juan Clemente opened a
medical dispensary in Intramuros for
the indigent.
 1690: Dominican Father Juan de
Pergero worked towards installing a
water system in San Juan del Monte
(now San Juan City, Metro Manila) and
Manila.
 1805: Dr. Francisco de Balmis
introduced Smallpox vaccination.
 1876: The first medicos titulares were
appointed and worked as provincial
health officers.
 1888: The University of Santo Tomas
opens a two-year, cirujanos
ministrantes course to produce male
nurses and sanitary inspectors.
 1901: The Board of Health of the
Philippine Islands was created through
Act 157, which eventually evolved into
the Department of Health (DOH)
 1912: The Fajardo Act law created
sanitary divisions made up one to four
municipalities.
 1905: Asociacion de Feminista Filipina
founded La Gota de Leche: the first
center dedicated to the service of
mothers and babies
 1947: The DOH was reorganized into
bureaus and the administration of city
health departments was placed at
bureau level.
 1954: The congress passed R.A. 1082 or
the Rural Health Unit Act which
provided an RHU in every municipality.
 1957: R.A. 1891 was enacted to have a
more equitable distribution of health
personnel.
 1958: Regional health offices were
created as a result of decentralization
efforts, thus creating the position:
Regional Health Officer.
 1970: the Philippine health care delivery
system was restructured, paving the
way for the health care system that
exists to this day where health services
 are classified into primary, secondary
and tertiary levels.
 1991: R.A.7160 or the Local
Government Code mandated the
devolution of basic services, including
health services, to local government
units and the establishment of a local
health board in every province and city
or municipality.
 1999: Health Sector Reform Agenda was
launched to direct government efforts
towards comprehensive reforms.
 2005: FOURmula One (F1) for health
was launched to provide an
implementation framework to the
reform agenda.2010: Universal Health
Care was launched to provide the
necessary revisions to the F1
framework.
Universal Health Care
 Aims to achieve the health system goals
of:
- better health outcomes,
- sustained health financing and
- a responsive health system that
will provide equitable access to
health care.
 It is deliberately focused on
economically disadvantaged Filipinos to
ensure that they are given risk
protection through enrollment in
PhilHealth (Philippine Health Insurance
Corporation) and that they are able to
access affordable and quality health
services.
Roles of the Community Health Nurse
Health monitor- Detecting deviations from
health in individuals, families, specific
population groups and the community as a
whole.
Provider of nursing care to the sick and
disabled
Health teacher – Health education is one of the
most used interventions by the nurse.
Counselor –Giving appropriate advice and
broadening a client’s insights about a problem
so that appropriate decisions are made.
Client/Patient advocate – Advocate is on who
intercedes and pleads the cause of another;
promote and defend the rights of
clients/patients.
Change agent – Changing individual, family,
group or community behavior, including
lifestyle and the environment, in order to
promote and maintain health.
Community organizer – Nurse stimulates and
enhances the community’s participation in
planning, organizing, implementing and
evaluating health programs and services,
initiates community development activities and
strengthens the community’s capabilities to
recognize and manage health and health
related-problems
Team member – Community health nurse is a
member of a health team that includes
traditional health care providers, community
health workers and volunteers as well a
professional in the health field and intersectoral
teams.
Trainer, supervisor – Formulate staff
development. Participate in training, the
guidance of affiliated students. Schedule and
assign staff for training on particular programs.
Manager – Objectives can be done through
planning, organizing, staffing, directing and
controlling
Coordinator of health and related services –
Coordinate services provided by various
members of health and related intersectoral
teams.
Researcher – Planning and conduct of nursing
and related studies that contribute to the
improvement of nursing and health services.
Role model – Nurse is called upon to provide a
good example of healthful living to the
community, to practice and demonstrate what
she preaches.
Duties and Responsibilities of a Community
Health Nurse
1. Participate in the development of an
overall health plan.
2. Provides quality nursing care to the four
clientele.
3. Maintain coordination/linkages with
other health teams, government and
non-government agencies.
4. Initiates and conduct researches.
5. Undertakes human resource training for
professional growth and development
6. Guide and supervise student’s affiliates.