UNIT 1: INTRODUCTION TO “Health is the extent to which an individual or
group is able, on the one hand, to realize
COMMUNITY AND PUBLIC
HEALTH NURSING
OVERVIEW OF PUBLIC HEALTH NURSING
IN THE PHILIPPINE
HEALTH: KEY CONCEPT IN NURSING
SCIENCE
NURSING
• As a profession
‫ ־‬aimed at helping the population
achieve better health thru their own
hands
• As a science
‫ ־‬relies on an understanding the key
towards genuine development in
investing on health and healthcare of
people regardless of age, gender,
religion, and color (Sumile, 2018)
HEALTH (in nursing science)
• it is a shared, complex reality
• is multidimensional, the well-being of an
individual is determined by factors such
as biological and behavioral
characteristics, the physical and social
environment.
• is a fundamental right of every individual
regardless of race, religion,
• political belief, economic and social
condition.
DEFINITION OF HEALTH (WORLD
HEALTH ORGANIZATION)
“a state of complete, physical, mental, and
social well-being and not merely the absence of
disease or infirmity” (1958)
• Social means relating to living together in
organized groups or similar close aggregates
(American Heritage College Dictionary,
1997, p.1291)
• Refers to units of people in communities
who interact with one another
• Social health connotes community vitality
and is a result of positive interaction among
groups within the community, with an
emphasis on health promotion and illness
prevention.
aspirations and satisfy needs; and, on the other
hand, to change or cope with the environment.
Health is therefore, seen as a source for
everyday life, not the objective of living; it is a
positive concept emphasizing social and
personal resources, and physical capacities”
(1986).
HEALTH AS A HUMAN RIGHT
Health as a human right is grounded in:
1. Universal Declaration of Human Rights
(UDHR)
‫ ־‬proclaimed by the United Nations
(UN) General Assembly in Paris on
Dec. 1948
‫ ־‬it did set that fundamental human
rights be universally protected.
Article 25.1 declares: “Everyone has the
right to a standard of living adequate
for the health and well-being of himself
and of his family, including food, clothing,
housing and medical care and necessary
social services” (United Nations, UDHR,
1948)
2. International Covenant on Economic,
Social and Cultural Rights (United
Nations, CESCR)
Art.12:“ Health is a fundamental human
right indispensable for the exercise of
other human rights. Every human being is
entitled to the enjoyment of the highest
attainable standard of health conducive to
living a life in dignity.The realization of the
right to health may be pursued through
numerous, complementary approaches,
such as the formulation of health policies,
or the implementation of health
programmes developed by the World
Health Organization (WHO), or the
adoption of specific legal instruments”
(United Nations, CESCR, 2000)
‫־‬ According to the Committee on
Economic, Social and Cultural Rights,
(United Nations, CESCR, 2000) the
right to health consist of
interconnected and indispensable
components:
1) Availability -requires that
operational public health and
channels of service delivery,
products and services as well as
programs be adequate for all.
2) Accessibility - entails that
health facilities, services and
goods must be made possible
 and obtainable to everyone.
Being non- discriminatory,
physically accessible,
economically accessible
(affordable) and information
accessible are the four
intersecting features of
accessibility.
3) Acceptability - corresponds to
respect for the medical ethics,
being culturally appropriate and
gender sensitive. This clearly
define the need for health care
centers, products services and
programs to be people-centered,
able to accommodate the
specific needs of diverse
population groups and adheres
to the international standards of
medical ethics for informed
consent and confidentiality.
4) Quality - implies that the health
facilities, commodities and
services must be in accordance
with specific and medical
standards. Quality health
services need to be safe,
effective, people-centered,
timely, equitable, integrated and
efficient.
3. Article II Section 11 and 15 of the 1987
Philippine Constitution
‫ ־‬at the National Level, affirms health
as a fundamental human right and
recognizes the obligation of the
state to protect and promote the
right to health of all Filipinos
(Republic of the Philippines Official
Gazette, 1987)
Department of Health (DOH)
Leads the health sector towards assuring
quality health care in promoting and
protecting the health of all Filipinos.
MODELS OF HEALTH
Guides the nurses in understanding health
as a concept:
1. Clinical Model
‫ ־‬Health is the absence of signs and
symptoms of disease and
illness.
‫ ־‬Ex: An adult individual who is not
particular with his lifestyle choices
will only seek healthcare when
chest pain is encountered and
begins to suspect a
cardiovascular disease.
2. Role Performance Model
‫ ־‬The ability to perform societal roles
defines what health is, failure to
perform these roles means illness.
‫ ־‬Ex: An employee who reported for
work, even if he/she is febrile.
3. Adaptive Model
‫ ־‬Health is a dynamic state. An
individual is considered to be
healthy if he/she was able to
adjust positively to social, mental,
and physiological. Illness exist
when the person failed to cope or
become maladaptive to these
changes.
4. Eudaimonistic Model
‫ ־‬An elevated (exuberant) level of
wellness or well-being. Illness is
reflected by a lack of vitality.
‫ ־‬Derived from Greek terminology,
this term indicates a model that
embodies the interaction and inter-
relationships among the physical,
social, psychological and spiritual
aspects of life and the
environment.
‫ ־‬Illness is indicated by a
denervation or languishing, a
wasting away, or lack of
involvement with life.
5. Wellness-illness Continuum
‫ ־‬A dichotomous depiction of the
relationship between the concepts
of health and illness.
Fig 1: Wellness – Illness continuum with high-level wellness added.
Movement from the center to the left demonstrates movement toward
health, movement from the center to the right demonstrates
movement toward illness. Moving above the line demonstrates
movement toward increasing wellness. Moving below the line
demonstrates movement toward decreasing wellness
HEALTH ILLNESS CONTINUUM
The concept demonstrates that a person can
have a terminal disease and be emotionally
prepared for death, while acting as a support for
other people and achieving high-level wellness.
High- level wellness involves progression
towards a higher level of functioning, an open-
ended and ever-expanding future with its
challenge of fuller potential, and the integration
of the whole being.
AGENT HOST ENVIRONMENT
HEALTH BELIEF
DETERMINANTS OF HEALTH AND DISEASE
It is essential to the community health nurse to
understand the determinants of health and
recognize the interaction of the factors that
leads to disease, death, and disability :
1. Biology
‫ ־‬The individual’s genetic make up, family
history, and any physical and mental
health problems developed in the course
of life.
‫ ־‬Ex: Heredity, Aging, Diet, Physical
Activity, Smoking, Stress, Alcohol or
Drug Abuse, Injury,Violence, or a Toxic
on Infectious Agent.
2. Behaviors
‫ ־‬The individual’s responses to internal
stimuli and external conditions.
3. Social Environment
‫־‬
Includes interactions and relationships
with family, friends, coworkers, and
others in the community.
‫ ־‬Has a great impact on the health of
individuals, groups, and communities.
‫ ־‬Complex in nature because of differing
cultures and practices.
‫ ־‬Ex: Social institutions- law enforcement,
religious communities, schools, and
government agencies are also part of
the social environment.
-housing, public transportation and
availability of resources
4. Physical Environment
‫ ־‬Pertains to an environment that is
experienced by the senses-what is
smelled, seen, touched, heard, and
tasted.
‫ ־‬Ex: Presence of infectious substances in
the environment, has negative influence
on health.
5. Policies and Interventions
‫ ־‬Can have a profound effect on the health
of individuals, groups, and communities.
‫ ־‬Ex:
ͽ Policies Against Smoking in public
places,
ͽ Seatbelt and Child restraint laws
ͽ Litter Ordinances
Public Health Nurses must work with policy
makers and community leaders to identify
patterns of disease and death and to advocate
for activities and policies that promote health
at the individual, family, aggregate, and
population levels.
SOCIAL DETERMINANTS OF HEALTH
• Social Determinants of Health (SDH) are:
“conditions in which people are born, grow, live,
work and age; might also be circumstantial
elements as such housing, work conditions and
access to recreational activities; circumstances
that influence how an individual will develop
sickness, what risk factor they are exposed to,
how they access services; and is shaped by the
distribution of money, power and resources at
global, national and local levels” (CSDH, 2008)
• SHD may also include:
‫ ־‬occupation,
‫ ־‬circumstances affecting the way in
which people work,
‫ ־‬Income,
‫ ־‬Culture,
‫ ־‬Religion,
‫ ־‬Education,
‫ ־‬Racial, and
‫ ־‬Gender discrimination
• At present, public health sector is particularly
working on the social determinants of health
(Schrammer & Ramon, 2018)
• In order to improve health equity,WHO
advocated for intersectoral actions; thus,
leading to a multisectoral approach to health
• Aside from the health sector, other essential
sectors in the society such as the
government, civil society, local communities,
business, global assemblies and
international agencies were made involved (
CSDH, 2008)
• Consequently, a better health outcome will
be positively instrumental to the attainment
of the goals of the other sectors (UN
Platform on Social Determinants of Health)
COMMUNITY
• A group of people with common
characteristics or interests living
together within a territory or
geographical boundary
• Place where people under usual
conditions are found
• Derived from a Latin word “comunicas”
which means a group of people.
COMMUNITY HEALTH
• Part of paramedical and medical
intervention / approach which is
concerned on the health of the whole
population.
AIMS
1) Health promotion
2) Disease prevention
3) Management of factors affecting health
NURSING
Both profession & a vocation. Assisting sick
individuals to become healthy and healthy
individuals achieve optimum wellness
COMMUNITY HEALTH NURSING
“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.”
(Maglaya, et al)
• Goal : “To raise the level of citizenry by
helping communities and families to
cope with the discontinuities in and
threats to health in such a way as to
maximize their potential for high-level
wellness” (Nisce, et al)
• 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 Expert Committee of Nursing)
• A learned practice discipline with the
ultimate goal of contributing as
individuals and in collaboration with
others to the promotion of the client’s
optimum level of functioning thru’
teaching and delivery of care (Jacobson)
• A service rendered by a professional
nurse to IFCs, population groups in
health centers, clinics, schools,
workplace for the promotion of health,
prevention of illness, care of the sick at
home and rehabilitation (DR. Ruth B.
Freeman)
PUBLIC HEALTH
“Public Health is directed towards assisting
every citizen to realize his birth rights and
longevity.” The science and art of preventing
disease, prolonging life and efficiency through
organized community effort for:
1) The sanitation of the environment
2) The control of communicable infections
3) The education of the individual in
personal hygiene
4) The organization of medical and nursing
services for the early diagnosis and
preventive treatment of disease
5) The development of a social machinery
to ensure everyone a standard of living,
adequate for maintenance of health to
enable every citizen to realize his birth
right of health and longevity (Dr. C.E
Winslow)
MISSION OF CHN
1) Health Promotion
2) Health Protection
3) Health Balance
4) Disease prevention
5) Social Justice
PHILOSOPHY OF CHN
“The philosophy of CHN is based on the worth
and dignity of man.” (Dr. M. Shetland)
BASIC PRINCIPLES OF CHN
1. The community is the patient in CHN,
the family is the unit of care and there
are four levels of clientele: individual,
family, population group (those who
share common characteristics,
developmental stages and common
exposure to health problems – e.g.
children, elderly), and the community.
2. In CHN, the client is considered as an
ACTIVE partner NOT PASSIVE
recipient of care
3. CHN practice is affected by
developments in health technology, in
particular, changes in society, in general
4. The goal of CHN is achieved through
multi-sectoral efforts
5. CHN is a part of health care system and
the larger human services system.
ROLES OF A PUBLIC HEALTH NURSE
• Clinician, who is a health care provider,
taking care of the sick people at home or
in the RHU
• Health Educator, who aims towards
health promotion and illness prevention
through dissemination of correct
information; educating people
• Facilitator, who establishes multi-
sectoral linkages by referral system
• Supervisor, who monitors and
supervises the performance of midwives
• Health Advocator, who speaks on
behalf of the client
• Advocator, who act on behalf of the
client
• Collaborator, who working with other
health team member
In the event that the Municipal Health Officer
(MHO) is unable to perform his duties/functions
or is not available, the Public Health Nurse will
take charge of the MHO’s responsibilities.
OTHER SPECIFIC RESPONSIBILITIES OF A
NURSE, SPELLED BY THE IMPLEMENTING
RULES AND REGULATIONS OF RA 7164
(PHILIPPINE NURSING ACT OF 1991)
INCLUDES:
• Supervision and care of women during
pregnancy, labor and puerperium
• Performance of internal examination and
delivery of babies
• Suturing lacerations in the absence of a
physician
• Provision of first aid measures and
emergency care
• Recommending herbal and symptomatic
meds…etc.
• In the care of the families:
‫ ־‬Provision of primary health care
services
‫ ־‬Developmental/Utilization of family
nursing care plan in the provision of
care
• In the care of the communities:
‫ ־‬Community organizing mobilization,
community development and people
empowerment
‫ ־‬Case finding and epidemiological
investigation
‫ ־‬Program planning, implementation and
evaluation
‫ ־‬Influencing executive and legislative
individuals or bodies concerning health
and development
RESPONSIBILITIES OF CHN
• be a part in developing an overall health
plan, its implementation and evaluation
for communities
• provide quality nursing services to the
three 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
STANDARDS OF CHN (9)
1. Theory - Applies theoretical concepts as
basis for decisions in practice
2. Data Collection - Gathers
comprehensive, accurate data
systematically
 3. Diagnosis - Analyzes collected data to
determine the needs/ health problems of
IFC
4. Planning - At each level of prevention,
develops plans that specify nursing
actions unique to needs of clients
5. Intervention - Guided by the plan,
intervenes to promote, maintain or
restore health, prevent illness and
institute rehabilitation
6. Evaluation - Evaluates responses of
clients to interventions to note progress
toward goal achievement, revise data
base, diagnoses and plan
7. Quality Assurance and Professional
Development
‫ ־‬Participates in peer review and
other means of evaluation to
assure quality of nursing practice
‫ ־‬Assumes professional
development
‫ ־‬Contributes to development of
others
8. Interdisciplinary Collaboration
Collaborates with other members of the
health team, professionals and
community representatives in
assessing, planning, implementing and
evaluating programs for community
health
9. Research - Indulges in research to
contribute to theory and practice in
community health nursing
LEVELS OF CLIENTELE IN COMMUNITY
AND PUBLIC HEALTH NURSING(CPHN)
➢ The Philippine Nursing Law of 2002 (RA
9173) states that…
“A person shall be deemed to be practicing
nursing within the meaning of this Act when
he/she singly or in collaboration with another,
initiates and performs nursing services to
individuals, families and communities in any
health care setting. It includes, but not limited to,
nursing care during conception, labor, delivery,
infancy, childhood, toddler, pre-school, school
age, adolescence, adulthood and old age.”
➢ Furthermore …
“As independent practitioners, nurses are
primarily responsible for the promotion of health
and prevention of illness. As members of the
health team, nurses shall collaborate with other
health care providers for the curative,
preventive, and rehabilitative aspects of
care, restoration of health, alleviation of
suffering, and when recovery is not possible,
towards a peaceful death”
Clients of Community Health Nursing
composed of different levels of clientele:
• Individual
• Family
• Population group
• Community
ONE HEALTH CONCEPT: A FRAMEWORK
FOR COMMUNITY AND PUBLIC HEALTH
NURSING
• The world in the present times, is faced
with immense challenges for health.
• Jones, et al., 2008 reported the
appearance of 335 infectious disease
among human population between 1940
and 2004
• COVID 19 immergence in the past 2
years and still occurring at the present.
• Emerging infectious diseases (EIDs)
are a matter of importance to a great
- extent if there is a rapid increase in
cases and high incidences of deaths
cased by these diseases (Petrosillo,
2019)
• The most effective way to act in
response to the threats of EIDs is the
One Health Approach-recognizing the
connection between human, animal,
and environmental health (Johnson et
al., 2019)
• consolidated interaction between human
health, veterinary medicine, and public
and environmental health professionals,
clinicians, researchers, and agencies
functioning hand in hand for a
worthwhile and sustainable health
interventions in addressing worldwide
and environmental health
challenges.The reciprocal actions may
occur at several levels which is from
management of zoonotic infectious
disease outbreaks to consolidated
policy-making and funding resolution
(Day, 2011)
• One Health Approach Activities example
includes:
‫ ־‬National Rabies Prevention and
Control Program (NRPCP)
‫ ־‬Avian Influenza Protection
Program (AIPP) Philippines Inter-
agency Committee on Zoonoses
• Thus, guided by this framework, nurses
in communities can better promote
awareness of people on how all these
factors impact wellness and spawn
collective action for better health.
HIERARCHY OF NURSING PRACTICE obligation of professionals when dealing
FIELDS with population groups.
ͽ Integrated approach-One Health
Concept, is vital for an effective action
to decrease the incidence of emerging
infectious disease.

REFERENCES:
• https://sebhau.edu.ly/suj/paper/Health.
Amer.pdf
• https://pdfcoffee.com/community-
health-nursing-9-pdf-free.html
• https://slideplayer.com/slide/10167952/
FIELDS OF COMMUNITY AND PUBLIC • Famorca et al (2019), Nursing Care of
HEALTH NURSING the Community, Singapore: Elsevier
• Sumile, Earl Francis R., (2020),
Community and Public Health Nursing
2nd Ed, Singapore, Elsevier,

SUMMARY
ͽ Health is multidimensional. The well-
being of an individual is determined by
factors such as the biological and
behavioral characteristics, the physical,
and social environment, and of the
policies and interventions related to
health.
ͽ Health is a fundamental right of every
individual.
ͽ The social determinants of health are
interconnected and have an influence on
the health of the individual, family and
community.
ͽ Community/Public Health Nursing is a
specialized field of practice that focuses
on health promotion and disease
prevention
ͽ Health as a shared reality requires
comprehensive and collaborative
interventions built on partnership.
ͽ Nurses in the community deal with
individuals, families, groups, and
communities but the family remains to
be his/her unit of services.
ͽ Protecting and promoting the worth and
dignity of man is the philosophy of
community/public health nursing and
ensuring the common good is his/her
framework in practice.
ͽ Nursing practice should be guided by
principles of bioethics that spells out