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Community Health Nursing:
Definitions:
1.) World Health Organization:
a. Special field of nursing that combines
skills of nursing public health…
b. Function as part of total public health
program for:
i. Promotion of health
ii. Improvement of condition
iii. Rehabilitation of illness and
disability
2.) Jacobsen
a. Learned practice discipline with
ultimate goal of contributing as
individuals to promote client’s
optimum level of functioning through
teaching and delivery of care
3.) Dr. Ruth B. Freeman
a. CHN is a unique blend of nursing and
public health practice aimed at
developing and enhancing health
capabilities of people. It is involved in
entire spectrum of health services for
the community
4.) Tinkham and Voorhies, 1972
a. CHN is a field of nursing in which
family and communities are patients
b. Unique blend of nursing and public
health practice woven into human
service
c. “The hallmark of CHN is that it is
population or aggregate-focused.”
Philosophy of CHN
Dr. Margaret Shetland:
“Philosophy is based on the worth and
dignity of man.”
Ultimate Goal
“To raise level of health of the citizenry.”
Objectives of CHN
1.) participate…
2.) conduct researches…
3.) coordinate…
Concepts of CHN
 emphasis on importance of “greatest good for
the greatest number”
 assessing health needs, planning,
implementing and evaluating impact of health
services on population group
 priority of health promotive and disease
preventive strategies over curative
interventions
 tools for measuring and analyzing community
health problems
 application of principles of management and
organization of the delivery of health services
to the community
Basic Principles of Community Health Nursing
 family is the unit of care, community is the
patient and the four levels of clientele of CHN
are:
o individual
o family
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o group
o community
 goal of improving community health involves
multidisciplinary effort
 CHN works not for individual patient, family,
group or community. The latter are active
partners, not passive-recipients of care
 Practice of CHN is affected by changes in
society in general and by developments in
health field in particular
 CHN is part of community health system,
which in turn is part of the larger human
services system
Barangay Health Centers
1 doctor, 1 nurse, midwives, 2 barangay health workers. 1
nurse= 5000 people
Wednesday: check-up and free immunizations
Roles and Functions
 Planner: e.g. IMCI = Integrated management of
childhood illnesses
 Provider of Nsg Services: direct nursing care
of sick; provides patient continuity of care
 Manager/Supervisor: formulates individual,
family, group and community centered care of
plan; organize work force
 Coordinator of Services: coordinates with
individuals, family, group for health related
services provided by GO’s and NGO’s
 Trainer/health educator/counselor: identifies
and interprets training needs of RHM’s, BHW’s
and hilots; resource speaker; IEC materials
 Health Monitor: detects deviation from health
of individual, family, group and community
through contact visits with them; use of
systematic and objective assessment
 Role model: provides good example/ model of
healthful living to public
 Change agent: motivates changes in health
behavior of individual, family, group and
community including lifestyle to promote and
maintain health. “most difficult role.”
 Recorder/reporter/statisticiain: prepares and
submits records and reports
 Researcher: participates/assists in conduct of
surveys
Community Health Nursing:
History:
 Early Christian era: virgins, noblewomen and
plebeians took care of sick
 Phoebe: 1st visiting nurse
 Mr. William Rathbone:
o Philanthropist who first thought of
public health nursing
o District nursing service in Liverpool
in 1859
o More emphasis on midwifery
o Forerunner of public health nursing
system
 In the USA:
o Public HN developed from visiting
nursing service under missionary
societies and visiting nursing
associations

o 1877: women’s board of NY mission
established 1st visiting nurses
History of Public Health
 Babylonians
o Understood need for hygiene
o Developed medical skills
 Egyptians
o Developed variety of pharmaceutical
preparations
o Constructed earth privies and public
drainage system
 Hebrew Mosaic Law
o Maternal health, communicable
disease control, protection of food,
water, waste and sanitary disposal
 Greeks
o Linked health to environment
o Wealthy people value personal
cleanliness, exercise, diet and
sanitation
 Romans
o Viewed medicine from a community
health and social medicine
perspective
o Emphasized regulation of medical
practice
o Provision of pure water
o Sewage systems, public food
preparation
o Women visited and cared for the sick
 Christianity
o Brought idea of personal
responsibility
o Started the care for the sick
 Middle Ages
o Poor sanitary conditions
o Increase in communicable diseases
(cholera, bubonic plague, smallpox)
o Religious convents and monasteries
established hospitals
o Started movement of health
education and personal hygiene
 Renaissance
o Health practices were influenced by
recognition of human dignity and
worth
o Elizabeth Poor Law: established
1601, guaranteed medical services to
poor and lame individuals
 Industrial Revolution
o Advances in transportation
o Religious women started to provide
nursing care in institutions and
homes
Milestones in history of public health
 1601- Elizabeth Poor Law
 1617- Sisterhood of Dames de Charite
organized by St. Vincent de Paul
 1789- Baltimore Health Department
 1798- Marine Hospital Service, nuns visited
poor
 1813- Ladies Benevolent Society of
Charleston, South Carolina founded
 1836- Lutheran deaconesses provided home
visits in Germany
 1851- Nightingale visited Kaiserwerth, 3
months of nursing training
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 1855- Quarantine Board, established in New
Orleans; beginning of tuberculosis campaign
in US
 1859- district nursing established by William
Rathbone
 1860- Florence Nightingale Training School
for Nurses established in St. Thomas Hospital
in London
 1864- Beginning of Red Cross
Community Health Nursing Historical Background in
Philippines
 1901- Act 157, est. Board of Health of
Philippines
 1905- Act 1407, est. Bureau of Health, under
Department of Interior
 1912- Fajardo Act (Act 2156) – Sanitary
Division, forerunner of present Municipal
Health Offices; President of Sanitary division
took charge of 2 to 3 municipalities. Philippine
General Hospital sent 4 nurses to Cebu
 1914- School of Nursing rendered by Filipino
Nurse employed by Bureau of Health in
Tacloban, Leyte
 1915- Philippine Health Service;
Reorganization Act 2462 created. Office of
Inspector General and Office of District
Nursing headed by Dr. Rosario Pastor, a nurse
and physician
 1915-1918- Ms. Perlita Clark took charge of
Public Health Nursing Works
 1919- 1st Filipino Nurse Supervisor was
appointed, 84 PHN’s assigned in 5 health
stations
 1927- Office of District Nursing abolished and
changed to Section of Public Health Nursing
 1930- Section for Nursing
 1941- Outbreak of war, PHN’s were assisted
to take care of sick and wounded
 1942- 31 nurses as POW’s at Bilibid Prison,
released to Director of Bureau and Health, Dr.
Eusebio Aguilar
 1948- 1st training center of Bureau of Health
organized in cooperation with Pasay City
Health Department
 1950- Rural Health Demonstration and
Training Center by DOH
 1958-1965- RA 977 abolished Division of
Nursing
o Annie Sand= nursing consultant,
Office of Secretary of Health
 Founded DOH National
League of Nurses Inc.
o RA 977created 8 regional offices in
country increased to 11 then to 16
Primary Health Care (Basic Health Care)
Definition
1.) World Health Organization: “essential
health care made universally
accessible to individuals and families
by means acceptable to them, through
full participation and at cost that the
community and country can afford at
every stage of development.”
Conceptual Framework

 Goal: Health for all Filipinos and Health in the
hands of th epoeple by the year 2020
 Mission: to strengthen the health care system
by increasing opportunities and supporting
conditions wherein people will manage their
own health care.
 Concept: Primary Health Care (PHC)
characterized by partnership and
empowerment of people shall permeate as
core strategy in effective provision of
essential health services
Legal Basis
 Letter of Instruction (LOI) 949: signed on Oct.
19, 1979 by then Pres. Ferdinand E. Marcos
 Historical Background
o 1974- WHO and UNICEF conducted a
joint study
o 1975- World Health Assembly passed
a resolution giving priority to the
development of PHC
o 1977- World Health Assembly
decided that main target of
government and WHO is the
attainment of the level of health that
would allow or permit them to lead a
socially and economically productive
life by year 2000
o September 6-12, 1978- 1st
International Conference on Primary
Health Care in Alma Ata, USSR
o 1979- WHA launched global strategy
to attain health for all
o 1980- PHC endorsed for
implementation by respective
regional community
Why Philippines Adopted PHC
1.) magnitude of health problems
2.) inadequate and unequal distribution of health
resources
3.) increased cost of medical care
4.) isolation of health care activities from other
developmental activities
Principles of PHC
1.) Accessibility, acceptability, availability, and
affordability of health services
a. Health services are delivered where
people live and work
b. Development of indigenous or
resident volunteer health workers to
provide health care with an ideal
ration of 1:10-20 households
c. Use of low cost, appropriate
technology sustainable by community
d. Combined utilization of traditional
medicines and essential drugs
2.) Partnership between community and health
agencies in provision of quality, basic and
essential health services
a. Community needs and priorities are
basic for planning health services and
activities
b. Training curriculum of community
health workers I based on community
health problems and task analysis of
community health workers
c. Regular supervision and periodic
evaluation of community health
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workers’ performance by health staff
to community
d. Development of promotive,
preventive, curative and
rehabilitative care
e. Recognition of role and traditional
healers in delivery of health services
3.) Community Participation
a. Awareness building and
consciousness raising on health and
developmental issues
b. Community building and organizing
c. Planning, implementation,
monitoring and evaluation done by
community
d. Community discussions done through
small group discussions
e. Selection of community health
workers by community
f. Foundation of health committees
g. Establishment of community health
organizations
h. Mass health campaigns and
community mobilization
4.) Self-reliance
a. Community generates support for
health care
b. Mobilization of health resources
c. Training of community leaders on
leadership and managerial skills
d. Income-generating projects
5.) Recognition of interrelation of health and
development
a. Convergence of health, food,
nutrition, water, sanitation and
population services
b. Integration of PHC into national,
provincial, municipal and barangay
development plan
6.) Social Mobilization
a. Establishment of effective health
referral system
b. Multi-sectoral and inter-disciplinary
linkages
c. Integration, Education,
Communication (IEC) support using
multimedia channels
d. Collaboration among government
agencies, non-government
organizations and community groups
7.) Decentralization
a. Reallocation of budgetary resources
b. Advocacy for political will and
support
c. Re-orientation of health profession
Strategies of PHC
1.) reorientation and reorganization by local
government code of 1991 or RA 7160
2.) effective preparation and enabling process for
health action at all levels
3.) mobilization of people to know their
communities and identify basic health needs
4.) development of utilization of technology
5.) organization of communities arising from
needs
6.) increase opportunities
Essential Components of Primary Health Care
1.) Multi-Sectoral Approach
a. Intrasectoral linkages
b. Intersectoral linkages

2.) Community participation
a. Identify problem
b. Identify solution
c. Mobilizing resources
d. Barriers
i. Lack of motivation
ii. Indifference on part of
community
iii. Resistant to change
iv. Bureaucracy of government
v. Lack of managerial skills
vi. Dependence on part of
community
3.) Appropriate Technology
a. 6 criteria:
i. effectiveness and safety
ii. less complex
iii. less costly
iv. broader scope of technology
v. acceptability to local culture
vi. feasibility
4.) Community involvement
a. Involvement level:
i. Individual
ii. Family-monitor growth and
development of child and
able to address to problems
in government
iii. Community- organizations
formed to promote health
development
Concepts of Primary Health Care
1.) PHC represents supplementary health system
2.) Equip community with capability to solve its
own problems by conducting trainings
3.) Come into being only when community
recognizes and accepts problems
4.) Government officials don’t work in place of
community and vice versa
5.) Community involvement is the heart and soul
of PHC
6.) Good health is related to living conditions and
lifestyle
7.) Provide opportunity to underprivileged
majority to develop to an acceptable level
a. Basic minimalistic needs:
i. Food
ii. Clothing
iii. Shelter and clean
environment
iv. Health
v. Education and information
vi. Security of life
vii. Means of livelihood
8.) Community must take its role and
responsibility to develop basic needs
9.) PHC activities must be in harmony with
existing institution
10.) PHC activities must be flexible in its
application
11.) Must be related to public health services and
technical support levels of public…
Elements of Primary Health Care
1.) Education
2.) Locally Endemic Diseases
a. Filariasis
b. Schistosomiasis
3.) Essential basic drugs
a. Cotrimoxazole
b. Amoxicillin
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c. Rifampicin
d. Isoniazid
e. Ethambutol
f. Paracetamol
g. Pyrazinamide
h. Oresol
i. Nifedipine
4.) Maternal and Child Health Care
5.) Expanded program of immunization
a. BCG- bacillus calmette guerin
b. OPV- oral polio vaccine
c. AMV- anti-measles vaccine
d. DPT- dyptheria pertussis tetanus
e. Anti-Hep B
6.) Nutrition
a. IDD- iodine deficiency disorder
b. IDA- iron deficiency anemia
c. PEM- protein energy malnutrition
7.) Treatment of common diseases
8.) Safe water supply and sanitation
9.) Prevention and control of leading
communicable diseases
10.) Promotion of dental health
11.) Elderly and disabled’s physical and mental
health
The Philippine Healthcare Delivery System
 Health Care System- organized plan of health
services
 Health Care Delivery- rendering services to
people
 Health Care Delivery System- network of
health facilities and personnel which carries
out task of rendering health care to people
 Philippine Health Care System- complex set of
organizations interacting to provide an array
of health services
 RA 7160
o Local Gov’t Code of 1991
o Provides for decentralization
o Places in local gov’ts to manage
health care system
Levels of Health Care Facilities
1.) Primary level
a. Composed of barangay, municipal
and medicare health facilities
b. 1st contact emergency care
c. rural health units, chest clinics,
malaria eradication units,
schistosomiasis control units,
puericulture units, private clinics,
company clincis
d. early symptomatic stage
2.) Secondary level
a. Consists of district health care
institutions with capabilities and
facilities for cases with
hospitalization
b. Smaller non-departmentalized
hospitals including emergency and
regional hospitals
3.) Tertiary level
a. Highly technological and
sophisticated services
b. Specialized centers, regional health
care institutions and provincial health
care centers
Multi-Sectoral Approach to Health
 Intersectoral
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o Sectors most closely related to health Referral- intervention to direct client to another healthcare
o Agriculture, education, public works, facility to continue his/her treatment
local governments, social welfare,
population control, private sectors Population
 Intrasectoral
BHS Midwife BHS
Restructured Healthcare Delivery System BHW

Rationale Sanitary Inspectors RHU

Midwife PHN
 healthcare system serves only small portion of
rural population Physician
 diseases do not require sohphistication
 some problems can be handled by other Secondary Health Care Facility
postiions besides MHO (Municipal Health
Officer) Tertiary Health Care Facility

Solutions

 3 levels of health care provided by RHU (rural
health unit) staff, with referral and
supervisory system support
 redefinition of roles and relationships among
RHU staff
 establishment of satellite health centers in
selected barangays
Features of DOH reorganization
 1958- RA 1082
o 1st Rural Health Act
o employment of more physicians,
dentists, nurses, midwives and
sanitary inspectors assigned to RHU’s
o 1st 81 rural health units
 1972- RA 5435
o defined authorities of regional
directors for more meaningful
decentralization
o 13 regional health offices
 1974
o IBRD- RHCDS implemented RHM
were sent to BHS to man BHS
o Midwives were trained and roles
expanded
 1982- EO 851
o integrated public health and hospital
systems with emphasis on
importance of putting together
promotive, preventive, curative and
rehabilitative components of health
care
o utilization of BHW
o implementation of DOH impact
programs
Role of Society in RHCDS
 participation in information drive of HCDS
 identifying problems
 identify sources
Local Health Board
 propose annual budget
 identify problems
 identify what programs
 Chairman, vice-chairman, chairman of
committee on health, DOH representative,
NGO representative
Two-way referral system
Types of Health Care Systems
1.) Traditional
a. E.g. client provider
2.) Non-Traditional
a. Holistic Health Centers
i. Believes that time, space and
encouragement can help people
find strength to deal with
problems confronting them
ii. Spiritual, physical and
psychological care
iii. Acts:
1. Pastoral counseling
2. Stress reduction
3. Parenting
4. Dietary conditioning
b. Faith Healing
i. Believes that disease is a state of
mind so one can alter his state of
mind so he will be healed
c. Chiropractic
i. System of manipulation
treatment which teaches that all
diseases are caused by
impringement on spinal column
and corrected by spinal
adjustment
ii. Daniel Palmer- founder
d. Acupuncture
i. Insertion of needles into selected
body parts to control pain
e. Acupressure
i. Finger pressure to control pain in
body parts
f. Kinesiology
i. Study of movement which applies
principles of anatomy to
movement
g. Reflexology
i. Systematic massage of soles of
feet
ii. Applies same principles as
applied in acupressure
h. Massage
i. Relieves tension, enhances
flexibility and creates
coordination between mind and
body
i. Homeopathy
i. Use of variety of herbs, drugs and
chemicals that when used in
small quantities can cure or
prevent disease caused by same
substance in larger doses
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 Health promotion is not just a responsibility

of the health sector, but goes beyond healthy
lifestyles to well-being.
 Prerequesite for Health
Health Promotion, Health Maintenance, and Disease o Peace
Prevention o Shelter
o Education
Health Promotion
o Food
 Defintion o Income
o WHO- “Health promotion includes o A stable eco-system
encouraging healthy lifestyles, o Sustainable resources
creating supportive environments for o Social Justice
health, strengthening community o Equity
action, reorienting health services to  In order to operationalize the concept of
place primary focus on promoting Health Promotion, the Charter recommended
health and preventing disease, and the following areas.
building healthy public policy.” o Build Health Public Policy
o Pender, 1996- “Health promotion is a
behavior motivated by the desire to
increase well being and actualize
human health potential.”
 Health promotion includes any activity that
helps people to change or maintain lifestyles
that support a state of optimal health or
balance of physical, emotional, social, spiritual
and intellectual health.
 Prominence of health promotion came about
as a result of changing patterns of health and
corresponding emphasis on “lifestyle” as a
factor.
 PHE (Public Health Education) can only have
impact on PH only if joined other sectors and
brought multiples social forces to bear.
 Green- “Behavioral changes that health
education is able to effect can only be
maintained if supportive environment were
provided via: political, economic, social,
biological and other sectors.”
 1st use of term, health promotion- 1945, Henry
E. Sigerist
o Defined 4 major tasks of medicine
 Promotion of health
 Prevention of illness
 Restoration of the sick
 Rehabilitation
o Sigerist: “Health is promoted by
providing a good labor condition,
education, physical culture and
means of rest and recreation.”
 Concepts used and found in
Ottawa Charter for Health
Promotion which occurred
40 years later
 1986, WHO, Health and Welfare Canada and
Canadian Public Health Association organized
an International Conference on Health
Promotion
o later known as Ottawa Charter
o Guiding principle in health promotion
efforts currently

Ottawa Charter for Health Promotion

 “Process of enabling people to increase

control over and to improve their health”
 To reach a state of complete physical, mental
and social well-being , an individual or group
must be able to identify and to realized
aspiration; to satisfy needs and to change and
cope with environment
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 Coordinated action that leads

to health, income and social
policies that foster greater
equity
o Create Supportive Environment
 Societies are complex and
interrelated
 Overall guiding principle is
the need to encourage
reciprocal maintenance to
take care of each other, our
communities and our natural
environment
 Conservation of natural
resources throughout world
should be emphasized as a
global responsibility
 Changing patterns of life;
work and leisure leave a
significant impact on health
 Systematic assessment of
health impact of rapidly
changing environment,
especially in areas of
technology, works, energy
production and urbanization
o Strengthen Community Action
 Setting priorities, making
decisions, planning strategies
and implementing
 Heart of this process is
Empowerment of
communities
 Community development
helps to enhance self-help
and social support, to
develop flexible system for
strengthening public
participation in and direction
of health matters
o Develop Personal Skills
 Through providing
information, education for
health and enhancing life
skills
 Enabling people to learn
throughout life, to prepare
themselves for all of its
stages and to cope with
chronic illnesses and injuries
o Reorient Health Services
 Health services are shared
among individuals;
community groups, health
service institutions and
government