PM1 Lesson 1 Discussion: Review of CHN Concepts
COMMUNITY HEALTH NURSING AS A FIELD OF NURSING
Amidst the growing population in the Nursing Profession, only a few
who chooses to become a community health nurse while others tend
to migrate and refuse to serve their country. There are lots of things
that are grueling in the minds of every health worker which leads
them to analyze their options whether to prioritize their needs or the
necessities of the people. Things may have changed but nurses in
the Philippines are said to be the launching pad for health workers
worldwide.
But come to think of it, why is the quality of health in our motherland
deteriorating and increased demand for affordable health services are
inaccessible? This may be a tough question that leaves to be
unanswered. Despite the fact that diseases in third world countries
like the Philippines are prominent, the Community Health Nurse still
remains steadfast to their mandated roles and responsibilities not just
to the community but also to the entire country. Their intangible
passion drives them to linger complex obligations and face all
disparities in life.
As nurses, we may not have a clear picture as to why we are
exposed to all areas of health settings. But the only thing that we
know is that we are there to become change agents by applying the
COPAR process in our community. As to the rise of challenges, we
formulate personal outcomes and sound decisions. I hope that every
aspiring Community Health Nurse or Public Health Nurse will be
skillful and hard-working in their field to endeavor. They should
appreciate and envision a clear picture of the health care delivery
system in the Philippines, and let us continue to inspire more people
and remind them that nursing is not just a work of art but also a work
of the charity.
Community Health Nursing: Context and Practice
Community Health Nursing (CHN) - one of the 2 majors in nursing in
the Philippines, the other is hospital nursing. Some people use the
terms community health nursing and public health nursing
interchangeably. However, the former is broader than the latter; it
includes public health nursing, occupational health nursing and
school nursing.
A.
PRACTICE
⦿ The hallmark of community health nursing is that it is population or
aggregate-focused
I. CHN is a synthesis of nursing and public health practice.
Emphasis on the importance of the greatest good for the greatest
number. Assessing health needs planning, implementing, and
evaluating the impact of health services on population groups. The
priority of health-promotive and disease preventive strategies over
curative interventionsTools for measuring and analyzing community
health problems; and analyzing community health problems; and
Application of principles of management and organization in the
delivery of health services to the community.
II. Basic concepts and principles of community health nursing
The family is the unit of care; the community is the patient and
there are four levels of clientele in community health nursing. The
goal of improving community health is realized through
multidisciplinary efforts. The community health nurse works with
and not for the individual patient, family, group, or community. The
latter are active partners, not passive recipients of care. The
practice of community health nursing is affected by changes in
society in general and by developments in the health field in
particular. Community health nursing is part of the community
health system, which in turn is part of the larger human services
system.
III. Roles of the nurse in caring for communities and population
groups.
IV. Brief history of community health/public health nursing
practice in the Philippines
Definitions of COMMUNITY:
➼ a group of people with common characteristics or interests living
together within a territory or geographical boundary
➼ a place where people under usual conditions are found
➼ derived from the Latin word “comunicas” which means a group of
people.
➼ In recent nursing Literature, community is defined as:
“a collection of people who interact with another and whose
common interest or characteristics form the basis for a sense of
unity or belonging”.(Allender et al., 2009) a group of people
who share something in common and interact with one another
and may share a geographic boundary (Lundy and Janes
2009)a group of people who share a common interest, who
interact with each other, and who function collectively within a
defined social structure to address common concerns (Clark,
2008) “A locality-based entity. Composed of systems of formal
organizations reflecting society’s institutions, informal groups
and aggregates (Shuster and Goeppinger,2008)
➼ Maurer and Smith (2009) further addressed the concept of
community and identified four defining attributes: (1) people (2) place,
(3) interaction (4) common characteristics, interests, or goals.
➼ Maurer and Smith (2009) noted that there are two main types of
communities: geopolitical communities and phenomenological
communities.
Geopolitical communities are defined or formed by both natural and
manmade boundaries and include barangays, municipalities, cities,
provinces, regions and nations. It may also be called territorial
communities.
Phenomenological communities refer to the relational, interactive
groups, in which the place or setting is more abstract, and people
share a group of perspective or identity based on culture, values,
history, interests and goals. Examples are schools, colleges, and
universities; churches, and mosques; and various groups and
organizations.
Other terms defined:
➼ Population is typically used to denote a group of people having
common personal and environmental characteristics. It can also refer
to all of the people in a defined community.
➼ Aggregates are subgroups or subpopulations that have some
common characteristics or concerns (Clark 2008)
Health: WHO defined as a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity.
Determinants of Health and Disease
The health status of the community is associated with a number of
factors such as health care access, economic conditions, social and
environmental issues, and cultural practices.WHO cites the social and
economic environment, physical environment, and the person’s
individual characteristics and behaviors as determinants of health.
Income and social status- higher income and social status are
linked to better health. The greater the gap between the richest and
the poorest people, the greater the differences in health. Education-
low education levels are linked with poor health, more stress and
lower selfconfidence
Physical environment- safe water and clean air, healthy
workplaces, safe houses. Communities and roads all contribute to
good health.
Employment and working conditions- people in employment are
healthier particularly those who have control over their working
conditions.
Social support networks- greater support from families, friends and
communities is linked to better health.
Culture- customs and traditions, and the beliefs of the family and
community all affect health. Genetics- inheritance plays a part in
determining lifespan, healthiness and the likelihood of developing
illnesses.
Personal behavior and coping skills- balanced eating, keeping
active, smoking, drinking and how we deal with life’s stresses and
challenges all affect health.
Health services- access and use of services that prevent and
treat disease influences health.
 Gender- men and women suffer from different type of diseases at
different ages.
Community Health - part of paramedical and medical
intervention/approach which is concerned on the health of the whole
population Aims
Health promotion disease prevention
Management of factors affecting health
Mission of CHN
Health Promotion
Health Protection
Health Balance
Disease prevention
Social Justice
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.
SCHOOL NURSING
- School health nursing focuses in the promotion of health and
wellness of the pupils/students, teaching and non-teaching personnel
of the schools.
Assist young people in making choices for a healthy lifestyle, reduce
risk-taking behaviour and focus on issues such as prevention of drug
and substance abuse, teenage pregnancy, mental health, sexually
transmitted infection, malnutrition, and communicable and non-
General Objective:
To promote and maintain the health of the school populace by
providing comprehensive and quality nursing care.
Duties and Responsibilities of SHN:
1. Health advocacy
2. Health and nutrition assessment including other screening
procedures such as vision and hearing.
3. Supervision of the health and safety of the school plant.
4. Treatment of common ailments and attending to emergency cases
5. Referrals and follow-ups of pupils and personnel.
6. Home visits
7. Community outreach like attending community assemblies and
organizing school community health councils.
8. Recording and reporting of accomplishments
9. Monitoring and evaluation of programs and projects.
Functions of SHN
1. School health and nutrition survey
~ done to provide data for evaluation & for planning purposes. Actual - parents are informed of emergencies
survey done during ‘1st visit and every year.
9. Student health counseling
2. Putting up a Functional School Clinic
10. Health & nutrition education activities
RA. 124 mandates that all schools are to provide school clinics for the
treatment of minor ailments& attendance to emergency cases. 11. Organization of school- community health &nutrition councils

3. Health Assessment 12. Communicable disease control

Aims to discover the signs of illness & physical defects in order to 13. Establishment of data bank on school health & nutrition activities
correct them, check on the health habits of pupils & prevent the 14. School plant inspection for healthy environment
progress of those which cannot be corrected.
15. Rapid classroom inspection
Health assessment should include:
16. Home visit
a. Interviewing for information gathering
b. Nutritional assessment - height & wt.
SCHOOL NURSING
c. Vision acuity test/hearing test
1. PD 603 Child & Youth welfare Code
d. IPPA
2. 1986 Constitution of the Philippines Article Vill-Social Justice &
e. V/S taking
Human Rights
f. appraisal of the general physical and mental conditioning
3. EO No. 14s. 1946-Creation of the Medical & Dental Services
g. record findings granting authority for the voluntary contribution of 50 centavos per
pupil for the maintenance of the service.

4, Standard vision testing for school children-screen students with 4. RA No. 951s. 1947 - medical inspection of school children enrolled
poor visual acuity/identify ocular problems/referral in private schools, colleges, & universities in the Phil.

5. Ear examination 5. RA No. 847 s. 1953 - Return of the Medical & Dental Services from
the Dept.of Educ.
6. Height & weight measurements/ nutritional status
6. RA No. 1082 s. 1954 - An act strengthening health & dental service
- students with existing conditions be referred for further in the rural areas & providing funds thereof.
assessment/treatment
7. RANo. 2620 s. 1961 - Nationalization of the Medical & Dental
7. Medical referrals Service of theBureau of Public Schools, Dept. Ed.
- students with existing conditions be referred for further 8. PD No. 255s. 1967 - Observance of National Health Education
assessment/treatment Week on Oct.10-16 of every year
8. Attendance to emergency cases 9. Article V. Sec. 29 s. 1972 Dangerous Drug Act - Integration of
Drug Education concept in the School Curriculum
10. PD No. 491s. 1974 - designated July as Nutrition Month for the
purpose of creating greater awareness among the people on the
importance of nutrition.
1. PD 603 Child & Youth welfare Code
2. 1986 Constitution of the Philippines Article VIII-Social ©
Justice & Human Rights
3. EO No. 14s. 1946-Creation of the Medical & Dental Services
granting authority for the voluntary contribution of 50 centavos
per pupil for the maintenance of the service.
4. RA No. 951s. 1947 - medical inspection of school children
enrolled in private schools, colleges, & universities in the Phil. © 7
5. RA No. 847 s. 1953 - Return of the Medical & Dental Services
from the Dept.of Educ.
6. RA No. 1082 s. 1954 - An act strengthening health & dental *
service in the rural areas & providing funds thereof.
7. RA No. 2620 s. 1961 - Nationalization of the Medical & Dental
Services of the Bureau of Public Schools, Dept. Ed.
8. PD No. 255 s. 1967 - Observance of National Health Education,
Week on Oct.10-16 of every year
9. Article V. Sec. 29 s. 1972 Dangerous Drug Act - Integration of
Drug Education concept in the School Curriculum
10. PD No. 491s. 1974 - designated July as Nutrition Month for
the purpose of creating greater awareness among the people on
the importance of nutrition.
11. PD No. 491s. 1974 - Nutrition Act of the Phil. -creation of a
National Nutrition Council w/ DECS as amember
12. RA No. 856 s. 1975-Code of Sanitation
13. LOI No. 441s. 1976 - mandated the Integration of Nutrition Educ.
In the school curriculum.
14. LOI No. 764 s. 1977 - Creation of school Health Guardian
Program. Its concept was focused on the training of the teachers to
assume responsibilities in providing school health services in the
absence of school health personnel.
15. LOI No. 764 1978-Declaring the School Health Program a priority
of the national government w/ the aim of educating teachers & school
children in the use of medicinal plants as simple remedies for
common ailments.
16. Sec. 938 of the Revised Administrative Code - Provides that the
Bureau of Public Schools shall have specified powers regarding
heath teaching physical education & to prescribe rules on personal
hygiene W, the public school premises.
17. E.0. no. 234, s. 1987-Reorganizing the National Nutrition Council 4. Health assessment can be done by trained nurses to answer
- The revised function of member agencies like DECS have been shortage of physicians in the field
affected.
5. Health inspection can be delegated to teachers
18. P.D. No. 335 s. 198 - Observance of DrugAbuse Prevention
Control Week every 3rd week of November It is therefore assumed that with implementation of RASHN [DECS
1987]
19. Rep. Act 7624, s. 1992 An act Integrating Drug Prevention &
Controlin the Intermediate & Secondary Curricula as well as in Non-
Formal, Informal In 1987, Department of Education Culture and There will be:
Sports [DECS] introduced the Redirected Approach in School Health
Nursing [RASHN] utilizing the concept on Primary Health Care[PHC]. 1. Increase in number of schools given quality& comprehensive
health service
Activities of the Program:
2. More ailments can be discovered &attended to
1. School health survey-basis for evaluation performance
3. Improvement in academic performance of school children with
2. Functional school clinic improved health
3. Comprehensive pupil health assessment 4. Improvement in monitoring & reports will be completed
4. Referral of cases Primary Prevention
5. School plant inspection - Nutrition education
6. Attending to emergency cases - Immunizations
7. Organize & reactivating school community health council - Safety Health education
8. Intensify health education activities Secondary Prevention
9. Establishing data in school health activities - Screening
Concepts & Procedure - Treatment
The approach as premised on the following concepts: - Case-finding
1. Quality of service in school nursing is possible only if a - Home visits
considerable amount of time is allotted for every school visit
Tertiary prevention
2. Comprehensive service is possible only if all aspects of school
children can be made through health assessment instead of just plain - Referral of student for substance abuse or behavior problems
health inspections
- Prevention of complications & adverse effects
3. Early detection of common ailments &diseases among children can
be made through health assessment instead of just health plan © - Faculty & staff monitoring society
SPECIALIZED FIELD IN COMMUNITY AND PUBLIC HEALTH
Nursing
 School Health Nurse
 Provide health supervision and nursing interventions to
school children
 Conduct home visits or home follow-up
 Identifies cases needing immediate medical attention
and makes the necessary referrals as needed.
 school health Nursing
- is the application of nursing theories and principles in the care of
the School population.
 WHO expert committee on school health services noted:
 “to learn effectively, children need good health”
 eight components of school health program
 School Health Services
 DepEd order no. 43, . 2011
 INTEGRATED SCHOOL HEALTH AND NUTRITION
PROGRAM ( ISHNP)
 Is designed to maintain and improve the health of
school children by preventing disease and by
promoting health-related knowledge, skills and
practices.
 GOALs
1. To expand early childhood care and education
2. To improve the quality of education
3. To provide learning and life skills to young people and adults
 INTEGRATED SCHOOL HEALTH AND NUTRITION
PROGRAM activities intended to address
(MDG Goals)
1. To eradicate extreme poverty and hunger
2. To reduce child mortality rate
3. To combat HIV/AIDs, malaria, and other disease
4. To ensure environmental sustainability
 Duties and responsibilities of school Nurse
 1. Health advocacy and health education
 2. Health and nutrition assessment
 3. Supervision of the health and safety of the school plant
 4. Treatment of common ailment and attending to emergency
cases
 5. Referral and follow-up of pupils and personnel
 6. Home visits
 Duties and responsibilities of school Nurse
 7. Community outreach like organizing school community
health council
 8. Recording and reporting of accomplishment
 9. Monitoring and evaluation of programs and projects
 Functions of School nurse
 1. School Health and Nutrition program
 2. Putting up of a functional school clinic for the treatment of
minor ailments and emergency cases as mandated by R.A.
124.
 3. Health assessment
 4. The nurse looks for signs of illness, physical defects an bad
health habits.
 5. Standard vision screening
 6. Ear examination
  Functions of School nurse 4. Use of traditional and alternative health care in
the management of common health conditions
 7. Height and weight measurement an nutritional status
determination  Other areas of concern
 8. medical referrals 1. Oral hygiene
 9. attendance in emergency cases 2. Injury prevention and developing safety conscious behavior in
the use of the school playground (sports, MAPEH)
 10. student health counseling
3. Tobacco use
 11. Health and nutrition education activities
4. Substance abuse – use of alcohol
 12. organization of school and community health and nutrition
councils 5. HIV/ AIDs
 Functions of School nurse  School health services
 13. Communicable disease prevention and control 2. PHYSICAL EDUCATION
 14. Establishment of data bank on school health and nutrition - Should focus on activities that children can continue into their adult
activities year Such a walking, Swimming, biking and jogging.
 15. School Plant Inspection for healthy environment  School health services
 16. Rapid classroom inspection 3. HEALTH SERVICES
 School health services -health care provided in schools such a preventive service a
health screening. Including screening for completeness of
1. HEALTH EDUCATION immunization, such a measles and vaccine.
 Health concept are introduce accdg. to the  3. health services
developmental level of school children.
a. HEALTH SCREENINGS
 The health education concepts are integrated in the
curriculum from K – K12.  Annual individual health assessment
1. Nutrition  Height and weight measurement
2. Personal and oral hygiene, including WASH  Rapid classroom inspection ex:(sore eyes)
(water, sanitation and hygiene)
 3. health services
3. Prevention of soil-borne helminthiasis,
mosquito – borne disease and other b. EMERGENCY CARE
communicable disease like acute respiratory - basic first aid equipment should be available in school
infections, diarrheal disorders and tuberculosis
 3. health services
 c. CARE OF THE ILL CHILD  Physical , psychological, and social environment that
Is developmentally oriented and culturally appropriate
- the school nurse Is responsible for monitoring the health of all and that enable student to achieve their potential;
students.
 Healthy organizational culture within the school
 3. health services
 Productive interaction between the school and the
d. STUDENT RECORDS community
- health record should be maintained for all student accdg to  School health services
the policies of the Dep Ed
7. HEALTH PROMOTION FOR SCHOOL STAFF
 School health services
 The school nurse can assist the faculty and staff by
4. NUTRITION SERVICES giving workshop on exercise and nutrition, screening
- identifying nutritional problem, counseling and making for increase blood pressure and establishing weight
appropriate referral are impt. in the school setting. management programs.

 A. EATING DISORDER  School health services

 Binge eating 8. FAMILY AND COMMUNITY INVOLVEMENT

 anorexia  School nurses are often asked to provide health

content to families, parent and communities on a variety of
 bulimia topic, such a sexuality, STI, HIV, communicable disease.
B. OBESITY  sChool nursing practice
C. NUTRITIONAL EDUCATION PROGRAM 1. school nurses need education in specific areas

- must include parents, teachers and the child 2. Masters degree level
3. Function in many roles

 School health services 4. Conduct research

5. COUNSELING, PSYCHOLOGICAL AND SOCIAL SERVICE  Future issue affecting the school nurse

- the mental health of the child and adolescent is affected by  Issues:

physical, economic, social, psychological and environmental
factors.  Ethical dilemmas

 School health services  Use of information and technology ( ICT) in health care

6. HEALTHY SCHOOL ENVIRONMENT  Environmental threat brought about by climate change

Consist of:  Threat of new and emerging infectious disease

  Increase in antibiotic-resistant disease
 Occupational health nursing
 Occupational health nurse
 Provides health supervision and nursing intervention to worker
in factories or workplace especially in area where they are
exposed to certain health hazard; institutes appropriate health
preventive and promotive measures in order to prevent
disease and accidental injuries an does the necessary
referrals
 Occupational health nursing
 Is the application of nursing principles and procedures in
conserving the health of worker in all occupations.
 It aims to assist the workers in all occupations to cope with
actual and potential stresses in relation to their work
environment.
 The focus of OHN Is on the promotion, protection, and
restoration of worker’s health within the context of a safe and
healthy work environment
 Determinants of OHN Practice
 1. government policies and standards
 A. Department of labor and employment
 B. Department of health
 C. social security system
 D. Philippine health insurance corporation
 E. Employees Compensation Commission
 2. professional standards
 A. Occupational Health Nurses Association
 B. Philippine Nurses Association
 Nursing in the workplace
 Focuses on promotion, protection, and restoration of worker
health within the context of a safe and healthy work
environment.
 Aimed at optimizing health, preventing illness and injury, and
reducing health hazard.
 RA 1054 Occupational health Act
RA 1054 stipulates the healthcare requirements for
occupations.These are as follow:
1. For businesses with <30 employees
• - OHN services are provided by the PHN
2.For businesses with 30-100 employees and located within 1 km
• -OHN services are provided by the PHN
3. For businesses with 30-100 employees but are located beyond 1
km
• -OHN I needed, together with supplies and equipment
4. For businesses with 101 -200 employees
• – OHN, supplies, and equipment are needed
5. For businesses with 201 -300 employees
– OHN, supplies, equipment , resident physician and dentist are
needed
6. For businesses with >301 employees
- OHN, supplies, equipment , physician and dentist, permanent clinic
(1:100) or accessible hospital within 2 km are required
 Key elements of OHN
 1. health protection
 Composed of health risk management at work (
health hazard identification, health risk assessment
and it’ s management and it’ s control measures,
 health surveillance , information, instruction and 4. Reduce morbidity and mortality rate among worker in the
training and monitoring and record-keeping. workplace.
 2. health promotion 5. Reduce disability incidence due to work-related illness, disease
and poisonings.
 assessment of health risk associated with the
workplace, living environment and lifestyle, and 6. establish a monitoring/ reporting system for occupational diseases.
employee information and assistance program
 Occupational health strategies: assessment and control of
 Functions and responsibilities of OHN hazard in the workplace
 PD 856, chapter VII of the industrial hygiene of the sanitation  Health Hazards
code of the Philippines….
 are the elements n the work environment that can
1. Works with the OHT cause work-related diseases to the workers.
2. Recommends to the local Health authority  Safety Hazards
3. Coordinate with other government agencies  Are the unsafe conditions or unsafe acts that
significantly increase risk of a worker to be injured.
4. Attends to complaints of all business establishment
 Health Hazards
5. Participates to provide, install and maintain in good condition in the workplace
6. Informs all affected workers 1. Biological –infectious Hazards:
7. Makes a periodic testing for physical exam 2. Chemical Hazards
8. Provide control measures 3. Environmental Hazards
9. Ensure strict compliance 4. Physical hazards
10. Provides employees/ workers OH services 5. Psychosocial hazards
11. Refers or elevates to higher authority all  TYPICAL Control Measures for Occupational Hazards
Unresolved issues 1. Administrative control
12. Prepares an submit yearly report to the local and national gov. 2. Engineering
 Objectives of the OH Program 3. Materials provision
1. improve the health status of the workers.  Community mental health nursing
2. Provide maximum access to the occupational services  Community mental health nurse
3. develop the skills and aptitude of health personnel on the  Assess the environment in the home and the community to
anticipation, recognition, evaluation and control of health hazards and identify factors which may aggravate or trigger mental illness.
other health and occupational concerns.
 Psychiatric nursing Is concerned with the promotion on mental
health, prevention of mental disorders and the nursing care of
patients during mental illness and rehabilitation.
 Mental health
 (WHO)A state of social well-being in which every individual
realizes his or her own potential (self-image) can cope with
the normal stresses of life (resiliency), can work productively
and fruitfully (productivity and creatvity), and is able to make a
contribution to her or his community (sense of purpose).
 The emotional adjustment that a person can involve the
promotion of a healthy state of mind among the whole
population through:
 Developing positive outlook in life
 strengthening coping mechanism
 Factors that affect mental Health
 Socioeconomic
 Genetics
 Poverty
 Low levels of education
 Poor living conditions
 stresses
 In the environment of children such a time of disaster and
natural calamities, disintegration of the value, structure and
function of the family and urbanization, migration, drugs, and
physical and sexual abuse and poverty have direct effect on
physical and mental health.
 Trend in mental health
 The modern trend in the care of the mental ill Is usually home
care management.
 Acute cases are referred to NCMH or hospitals with facilities
for psychiatric care
 Vulnerable group
 Women
 street children
 Victims of torture or violence
 Internal refugee
 Victims of armed conflicts
 Victim of natural and man-made disasters
 Conditions THAt can lead to mental illness
 1. stressful life events like death of a loved one, financial
problems, marital conflict, and violence.
 2. difficult family background :e.g. history of neglect and
violence may result to unhappy childhood.
 3. brain diseases like mental retardation and brain infections,
AIDs, head injuries, epilepsy, and stroke.
 4. Heredity may be a factor ; however this is also influenced
by environmental factors
 5. Medical problems like kidney and liver failure or medicine
taken can alter process.
 Community mental health nursing
 Is a unique process which includes an integration of concepts
from nursing, mental health, social psychology, psychology,
community networks and the basic sciences.
 The focus of CMHN is on the mental health promotion
 Components of MHP
 Stress management
 Drugs and alcohol abuse rehabilitation
 Treatment and rehabilitation of mentally-ill patients
 special project for vulnerable groups
  Mental health legislation and policy What type of housing they have in the community?
 There Is no mental health law in the phils. Are there enoug housing facilities?
 Nursing responsibilities and functions Housing laws and regulations
1. Mental health Promotion Subsystems of the Community
 Health education COMMUNICASTION
 Organize parents’ classes Systems, types of communication existing, forms of communication,
be it formal or informal
 Discuss the role of parents
Factors affecting the health of the community
2. Prevention and Control
Physical Factors
 conduct case finding
● include the influences of geography, the environment,
 Be aware of the sign and symptoms of developing community size, and industrial development.
 Encourage verbalization ● Geography- a community’s health problems can be directly
 Help the family influence by its altitude, latitude, and climate. (in tropical
countries where warm, humid temperatures and rain prevail,
3. Rehabilitation parasitic and infectious diseases are a health problem.

 Encourage patient’ s participation ● Environment- the quality of our environment is directly related
to the quality of our stewardship over it.
 Advise the family
● Community Size- the larger the community, the greater its
4. Research and epidemiology range of health problems and the greater its number of health
resources.
 participate actively
● Industrial Development- provides a community with added
resources for community health programs, but it may bring
Concept of Community with it environmental pollution and occupational illnesses.

Characteristics of a healthy community Social and Cultural Factors

Subsystems of the Community ● Social factors are those that arise from the interaction of
individuals or groups within the community.
EDUCATION
● Cultural factors arise from guidelines (both explicit and
Includes laws, regukations, facilities, activities affecting education, implicit) that individuals “inherit” from being a part of a
ratio of health educators to learners particular society.
HOUSING ● “Culture teaches us what to fear, what to respect, what to
value, what to regard as relevant in our lives”.
 ● Beliefs, Traditions, and Prejudices- Beliefs, traditions and
prejudices of community member can affect the health of the
community.
○ Example: beliefs (such as exercise and smoking),
traditions (specific ethnic groups), prejudices (ethnic or
racial groups).
● Economy
● Politics
● Religion
● Social Norms- the accepted behavior that an individual is
expected to conform to in a particular group, community, or
culture
● Socioeconomic Status (SES)
Community Organizing
● The way in which a community is able to organize its
resources directly influences its ability to intervene and solve
problems, including health problems.
● It is a process through which communities are helped to
identify common problems or goals, mobilize resources, and
in other ways develop and implement strategies for reaching
their goals they have collectively set.
Individual Behavior
● The behavior of an individual community members contributes
to the health of the entire community.
● It takes the concerted effort of many if not most of the
individuals in a community to make a program work
Roles and activities of Community Health Nurse
Clinician / Direct Care Provider
● Ensure that health services are provided, not just to
individuals and families but also to groups and population
● Involves certain emphasis different from basic nursing, i.e. –
holism, health promotion, and skills expansion
● Expanded skills- physical care skills, skills in observation,
listening, communication, and counselling
Roles and activities of Community Health Nurse
Educator
● Health teaching is a part of good nursing practice and one of
the major functions of a community health nurse.
● The educator role is especially useful in promoting the public’s
health for at least two reasons:
○ Has the potential for finding greater receptivity and
providing higher yield results.
○ Is significant because wider audience can be reached.
Roles and activities of Community Health Nurse
Advocate
● The issue of client’s rights is important in health care today.
Every patient or client has the right to receive just equal and
humane treatment.
● Community health nurse must often act as advocate for clients
pleading the cause or acting on behalf of client group.
Roles and activities of Community Health Nurse
Clinician / Direct Care Provider
● Ensure that health services are provided, not just to
individuals and families but also to groups and population
● Involves certain emphasis different from basic nursing, i.e. –
holism, health promotion, and skills expansion
● Expanded skills- physical care skills, skills in observation,
listening, communication, and counselling
Roles and activities of Community Health Nurse
Managerial role
Roles and activities of Community Health Nurse
Managerial role
CONCEPT OF COMMUNITY
Community comes from the Old French word “communite”
which is derived from the Latin “communitas” (cum, means
“with/together” + munus, means “gift”), a broad term for fellowship or
organized society.
A community is a group of people who:
 Have common interest or characteristic
 Interact with one another
 Have common sense of unity or belonging
 Functions collectively within a defined social structure
to address common concerns
 A group of people sharing common geographic boundaries
and/or common values and interest.
 Functions within a particular socio-cultural context, which
means that no two communities are alike.
 The physical environment varies , and so the people’s way of
behaving and coping.
TYPES OF COMMUNITY
RURAL COMMUNITIES
 Open lands, often agricultural in nature which is more
spacious and less densely populated.
URBAN COMMUNITIES
 Often known as city or cities which are non-agricultural by
nature, are densely populated, and marked by industrial
products and technology; Central business Districts are found
here.
 SUBURBAN OR RURBAN OR THE CAPITALS
 Usually the administrative capital of a province characterized
by a unique mix of agriculture and industry.
 CHARACTERISTICS OF A COMMUNITY
1. It is defined by its geographic boundaries within certain identifiable
characteristics:
a. It is made up of institutions organized into a social system with the
institutions and organizations linked in a complex network having a
formal and informal power structure and a communication system.
b. A common or shared interest that binds the members together
exists.
c. It has an area with fluid boundaries within which a problem can be
identified and solved.
d. It has a population aggregate concept.
2. A community is regard as an “organism” which has it’ s own stage
of development( Mature fast or slow) and responses to problem may
be adequate, inadequate, inappropriate or delayed.
 ELEMENTS OF HEALTHY COMMUNITY
1. Awareness that “we are a community
2. Conservation of natural resources
3. Recognition of, and respect for the existence of subgroups
4. Participation of subgroups in community affairs
5. Preparation to meet crises
6. Ability to solve problems
7. Communication through open channels
8. Resources available to all
9. Settling of disputes through legitimate mechanisms
10. Participation by citizens in decision-making
11. Wellness of a high degree among its members
 Conditions in the community affecting health  A professional face-to-face contact made by a nurse to the
patient or the family in order to provide necessary health care
3 features/fACTORs activities and further attain an objective of the agency.
 1. People PURPOSES:
 2. Location 1. Gather all available information regarding the family’s health
 3. Social system status.

 ROLES AND FUNCTIONS OF THE COMMUNITY HEALTH 2. Confirm all data gathered during the home visit
NURSE (CHN) 3. Prioritize the needs which have been identified by the family
1. CLINICIAN- provides nursing care to the sick and disabled in 4. Involve the individual and family from the assessment to the
order to reduce disease, discomfort, disability, and premature implementation phases.
death, among others.
PHASES:
2. ADVOCATE- speaks or acts for those who cannot speak/act
for themselves. 1. PREPARATORY PHASE
3. COLLABORATOR- brings together strengths and 2. HOME VISIT PHASE
weaknesses of people involved toward a common goal.
3. POST-VISIT PHASE
4. CONSULTANT- catalyst to bring change , helping people
understand processes and actions, and assisting them in making PREPARATORY PHASE- Activities:
decisions.  Clarify source of referral for visit
5. COUNSELOR- listens and provides feedbacks and information,  Clarify purpose of visit
strengthens and guides people’s own decision making skills, and
explores feelings and attitudes for people understand themselves and  Share information on reason and purpose of home
their decisions.
visit
6. EDUCATOR- acts as a health educator which is one of her most
important roles as CHN.  Initiate contact with family

7. RESEARCHER- utilizes data to predict future phenomenon and  Establish shared perception of purpose with family
modify interventions.
 Determine family’s willingness for home visit
8. CASE MANAGER- coordinates care system that is made up of
 Review referral & family record
many different programs which has different policies, services and
missions in order to avoid gaps in services and breakdown in the HOME VISIT PHASE: Activities:
care system.
Introduction of self
 ACTIVITIES OF THE CHN NURSE
 Establish nurse client relationship
 1. HOME VISIT
 Implement the nursing process
POST-VISIT PHASE: Activities
Record the visit
Review the visit
Plan for the next visit
 STEPS IN A HOME VISIT
1. Greet client and introduce yourself.
2. Explain the purpose of the visit.
3. Inquire about the health and welfare.
4. Place bag in a convenient place.
5. Wash hand and wear apron.
6. Perform physical assessment and nursing care.
7. Give the necessary health teaching.
8. Wash hand and close bag.
9. Record findings
10. Make appointment for clinic or home visit.
 BAG TECHNIQUE
 The bag technique is a tool using a public health bag which is
used by the nurse during a home visit. It allows the nurse to
perform nursing procedures with ease and deftness. It is also
helps the nurse save time and effort in view of rendering
effective nursing care.
 The use of bag technique should minimize, if not totally
prevent, the spread of infection.
 It should save time and effort in the performance of nursing
procedures.
 It should not overshadow concern for the patients.
 It shows the effectiveness of total care given to individual or
family.
 It should contain all necessary articles and equipment.
 The bag and its contents should be cleaned as often as
possible.
 It should be protected from contact with any article in the
home of the patient.
 The arrangement of the bag contents should be convenient .
 Hand washing should be done frequently.
 When used in a communicable case, the PHN bags, should
be thoroughly cleaned and disinfected before keeping and re-
using.
HEALTH STATISTICS AND
EPIDEMIOLOGY
Health statistics are numbers that summarize information
related to health. Researchers and experts from government,
private, and non-profit agencies and organizations collect health
statistics. They use the statistics to learn about public health
and health care.
Importance of Health Statistics
By identifying statistical trends and trails, health care providers
can monitor local conditions and compare them to state,
national, and international trends. Health statistics provide
empirical data to assist in the allocation of public and
private funds and help to determine how research efforts
should be focused.
Epidemiology is the study (scientific, systematic, and data-
driven) of the distribution (frequency, pattern) and
determinants (causes, risk factors) of health-related states
and events (not just diseases) in specified populations
Is the study of the distribution and determinants of health-
related states or events in specified populations, and the
application of this study to the control of health problems.
Purpose of Epidemiology
Epidemiology identifies the distribution of diseases, factors
underlying their source and cause, and methods for their
control; this requires an understanding of how political, social
and scientific factors intersect to exacerbate disease risk, which
makes epidemiology a unique science.
TOOLS
Demography- the statistical study of human populations
especially with reference to size and density, distribution, and
vital statistics.
Is the study of human populations – their size, composition and
distribution across space – and the process through which
populations change. Births, deaths and migration are the ‘big
three’ of demography, jointly producing population stability or
change.
“Demos” means people, “grapho” means to write. This word
was coined by John Grunt.
Scope of Demography
Demography is the science of population which is a set of
people who live in a specific land area; a commune, a district, a
country or a continent, etc.
Sources of Data:
Sources of Demographic Data:
1. Survey
2. Census
Types:
DE JURE - Data from place of origin
DE FACTO - Registration where it happened
Ex. If death happened at PGH, report in Manila regardless of
place of residency—report to that place
1. Sample survey
2. Continuing Population Registers- used computers to
monitor their birth record.
3. Other records & registration systems
Sources of Data On Health
1. Vital Registration Records
RA 3753 ( Civil Registry Law ) registration of
births, deaths to local registrars (city health officer or municipal
treasurer)
Problem: Under registration & de facto registration
Unreported birth- unreported death
2. Weekly reports from field health personnel RA 3573 ( Law
on reporting of Notifiable Diseases)
 Report to provincial & duty health office
 Midwife reports – under supervision of the nurse
2 Diseases to be reported within 24H –Measles & Polio  Can be measured
 Discrete- whole number or integral values
3 Disease to be reported w/n a week- Tetanus Neonatorum,  Continuous- fractions, decimals, can attain any decimal
Severe & acute diarrhea, HIV

 Problems: under reporting- crisis oriented, concept in health,

symptoms, diagnosis, syndromic approach. 1. Population Size- is the number of units (inhabitants) in the
population
3. Population Census- should have interval, accurate 2. Composite distribution- is the arrangement of the
estimation population in a given time, geographically or among various
4. Individual Health records/ family records types of residential areas.
 Birth cert., school clinic records, employment records, health HEALTH INDICATORS:
center records, hospital records, health facility, logbooks,
death certificate 1. Fertility Rate
2. Crude Birth Rate- is the ratio of the number of births during
5. Publications a specified period (e.g., one year) to the total number of
persons in the mid-period population or July 1 of the same
Types of Data: year then multiplied by 1,000.
1. Constant- value remains the same from person to person, Formula:
time to time, place to place
Crude Birth Rate = Number of Births in a Specified
Ex. Minutes/ hour, speed Period X 1,000

2. Variable- varies from person to person, time to time, place Total # of Persons in the mid-period
to place population or July 1 of same year
CBR= B/P X1,000
Ex. Temperature
Qualitative- categories are simply used to label to distinguish & 2. General Fertility Rate- is the number of registered live
group to another, births for a specified geographic area (nation, state, county,
etc.) during a specified period (usually a calendar year)
rather than a basis for saying that 1 group is greater, higher divided by the female population age 15-44 years (usually
than the other. estimated for a mid-year) for that area, and the resulting
fraction multiplied by 1,000
Ex. Sex, Religion, Color
Quantitative- numerical
Formula: area (for a specified time period, usually a calendar year)
and multiplied by 1,000.
General Fertility Rate = Number of registered live
births X 1,000 Formula:
Number of females age 15-44 years Neonatal Mortality Rate= Number of registered neonatal
deaths X 1,000

Mortality Rates Number of registered live births

1. Crude Death Rate- the ratio of the number of deaths
occurring within one year to the mid-year population
expressed per 1,000 population.
Formula:
Crude Death Rate= Number of Deaths within a year
1,000
NMR= D (0-28 days/LB X 1,000
4. Maternal Mortality Rate- The maternal mortality ratio
(MMR) is defined as the number of maternal deaths related
to pregnancy, delivery, & puerperium during a given time
period per 100,000 live births during the same time period.
X
Formula:

Total mid-year population Maternal Mortality Rate= Maternal Deaths ____X 100,000

CDR= D/P X 1,000 Number of Live Births

MMR= MD/LB X 100,000
2. Infant Mortality Rate- the probability of dying between birth
and age one, expressed as the number of infant deaths or 5. Cause-specific Death Rate - is the number of deaths from
deaths occurring before reaching 12 months of life in a a specified cause per 1,000 person-years at risk.
given period per 1,000 live births.
Formula:
Formula:
Cause-specific Death Rate= No. of deaths from specific
Infant Mortality Rate= Number of deaths in the first year of cause X 1,000
life X 1,000
Total Population
Number of live births
CSDR= D/P X 1,000
IMR= ID/LB X 1,000
6. Proportionate Mortality - death from a particular group
3. Neonatal Mortality Rate- is the number of registered over total deaths x 100
newborns in a specified geographic area (country, state,
county, etc.) dying at less than 28 days of age divided by
the number of registered live births for the same geographic
Ex. PMR of males = deaths of males x 100
total deaths LEADING CAUSES OF MORTALITY/ MORBIDITY
Context of CHN: Health situation
PROPORTIONATE MORTALITY INDICATOR Nutrition- Under nut of 0-6 y/o
Swaroop's index - is the proportion of deaths aged 50 Commerciogenic malnutrition
years and above. The higher the Swaroop's index of a
population, the greater the proportion of the deaths who were Mortality- the frequency of death in a population
able to reach the age of at least 50 years, i.e., more people Morbidity- the rate of disease in a population
grew old before they died.
SI = death of 50 yrs & up x 100
total deaths 10 Leading Causes of 10 Leading Causes of
Morbidity Mortality

Relative importance of a killer (TB, heart disease, diarrhea) 1. Disease of the heart
Death due to TB/ total deaths x 100 2. Diseases of the vascular
1. Pneumonia --bacterial
PMR = 30% Ex. TB --In every 100 deaths, 30 are due to TB system
2. Diarrhea
Case Fatality Rate (CFR)- How is survival rate, how strong is 3. Malignant neoplasm
3. Bronchitis
killing power, 4. Pneumonia
4. Influenza -respiratory
Prognosis 5. Accidents
5. HPN
CFR= death due to particular cause/ total cases x 100 6. TB –all forms
6. TB respiratory
Cause-of-death Rate (mortality rate) 7. COPD
7. Diseases of the heart
 rank as a killer 8. Conditions originating in
8. Malaria perinatal
C of DR= death due to particular cause/ total population x 9. Chickenpox period
100,000
10. Measles 9. DM
Incidence Rate
10. Nephritis, nephritic syndrome
IR= Number of new cases/ Number of pop at risk X 100,000
 - Study of distribution of disease or physiologic condition among
human pop & the factors affecting such distribution.
LIFE EXPECTANCY OF THE FILIPINOS (2021)
- Distribution means the frequency of diseases & physiologic
The current life expectancy for Philippines in 2021 is 71.41 condition in terms of who gets sick where & when.
years, a 0.18% increase from 2020. The life expectancy for
Philippines in 2020 was 71.28 years, a 0.18% increase from
2019. The life expectancy for Philippines in 2019
was 71.16 years, a 0.18% increase from 2018. Basic Concepts:

1. Epidemiologic Triad: Agent- Host- Environment

PHILIPPINE HEALTH SITUATION The Epidemiologic Triangle, sometimes referred to as
the Epidemiologic Triad, is a tool that scientists use for
1. Demographic Profile addressing the three components that contribute to the
spread of disease: an external agent, a susceptible host and
Age, sex, ethnic group, country of birth, religion, an environment that brings the agent and host together.
marital status, population mobility.
2. Transmission of CD: Common vehicle, source- serial-
2. Health Profile transfer- propagated from host to host
3. Incubation period: Entry of pathogens with enough
The health profile is intended to be a set of infections load , up to the appearance of the 1st signs and
indicators of basic demographic and socioeconomic symptoms
characteristics, health status, health risk 4. Herd Immunity: percentage of immune population, some
factors, and health resource use, which are relevant to most individuals are immune
communities. Health profile data can help motivate
communities to address health issues.
Basic Health Indicators- to assess a national health Types of Immunity:
situation
1. Passive: Quick to come, quick to go
1. Nutrition
2. Disease Patterns Natural- in water, breast feeding
EPIDEMIOLOGY AND THE NURSE Artificial- serum globulin, antiserum, antitoxin
Epidemiology-
-Study of frequency of disease 2. Active: Slow to come, slow to go
 Natural active- getting the disease itself
Artificial- tetanus toxoid
Preg 1 --- 4th month --------------------------TT1
--- 8th month (before delivery) ---- TT2
Preg 2 --------------------------------------------- TT3 ( 1st booster
dose)
Preg 3 -------------------------------------------- TT4 (2nd booster
dose)
Preg 4 -----------------------------------------------TT5 (3rd booster
dose)
Factors Affecting Distribution of Disease:
1. Person- exposure, susceptibility or response to agents.
- Influenced by intrinsic characteristic
- Genetic/ family, prior immunologic experience
- Age, sex, ethnic grp, physiologic status
- Human behavior---most significant---can be
modified
Some identified increase risk groups.
- Mothers, infants, and young children
- School children, old people, contacts
- People far from medical assistance
- People in areas with endemic disease
- People at certain times
2. Place - Extrinsic factors, existence of etiologic factors &
exposure & susceptibility of human host, influenced by
extrinsic factors.
3. Time - Temporal patterns- fluctuations of incidence
1.
A. Short term- fluctuations
- Time of day
- Days of the week
B. Cyclic pattern- regular pattern
Seasonal cyclicity – annual cyclicity
Secular cyclicity – every other year typhoid,
measles
Patterns of Disease Occurrence:
a. Epidemic
- A situation when there is a high incidence of new cases of a
specific disease in excess of the expected.
- When the proportion of the susceptible are high compared to
the proportion of the immunes.
Ex. 20-30 diseases that you don’t know
Current number of cases exceeds the usual expectancy.
B. Endemic
- Habitual presence of a disease in a given geographic location
accounting for the low number of both immunes & susceptible.
- Causative factor is constantly available or present to the area
Ex. Malaria, constant
c. Sporadic
- Disease occurs every now & then affecting only a small
number of people relative to the total pop
- Intermittent
- On & off
D. Pandemic
- Global occurrence of a disease, bigger population
- Patient epidemic- easily the person can identify the cause

Common Epidemiologic Studies:

Retrospective Cross- Sectional Prospective Cohort

(Past) (Present) (Future)
Case Control study Prevalence study old & new cases Incidence or new cases
-Show an association bet. - Get prevalence of disease (Lung CA)

the risk factor & disease - Get prevalence of risk factor (smoking)

*Independent variable (Cause) - The one to be manipulated

*Dependent (Effect) - Will always be the interest of the
researcher