HISTORY HEALTH NURSING PRACTICE IN THE PHILIPPINES

“Money alone does not buy better health. Good policies that promote equity have a
better chance”

OBJECTIVES
At the end of 2 hours, the students will be able to:
• Describe global and national health situation
• Define salient terms related to Community health nursing
• Discuss what community nursing is all about including its features
• Identify the standards of PHN in the Philippines
• Discuss the evolution of Public health nursing in the Philippines
• Identify the roles and responsibilities of a CHN nurse

Population: 108, 255,227

Life Expectancy: 66.9 years for males and 72.2 for females
With a mean of 69.6 years

National Health Situations

Health Indices
• Every minute 1 child dies of measles
• Every hour 6 Filipinos die of heart disease while 4 Filipinos die of cancer
• 12 million are at risk for malaria
• Everyday 28 babies die of tetanus, 1,277 children die of pneumonia, and 217 children
die of diarrhea
Health Indices
• Everyday 55 die of tuberculosis, 15 die of renal disease, and 300 Filipinos develop
Malaria
• 2.5 million children are malnourished
• More than 50% of pregnant and lactating women suffer from anemia
• 23.4 million Filipinos don’t have access to toilets
• Some 194 babies are born every hour with less than 50% of couples using reliable
methods of family planning
• More than 2 million Filipinos are suffering from Diabetes which is the 10th leading
cause of death.

Leading Causes of Morbidity

• Diarrheal diseases
• Acute bronchitis
• Pneumonias
• Influenza
• Chickenpox, hypertension, dengue, typhoid and paratyphoid fever
• Tuberculosis (all forms)
• Malaria
• Malignant neoplasms
• Disease of the heart

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Leading Causes of Mortality
• Diseases of the heart
• Diseases of the cardiovascular system
• Pneumonias
• Other diseases of the respiratory system
• Chronic obstructive pulmonary disease
• Tuberculosis (all forms)
• Accidents and diarrheal diseases
• Diabetes mellitus
• Malignant neoplasms (cancer)
• Nephritis, nephrotic syndrome and nephrosis

INFANT AND CHILDREN

Leading causes of mortality:
bacterial sepsis of newborn, respiratory distress, pneumonia, disorders related to short
gestation and low birth weight not elsewhere classified, congenital pneumonias,
congenital malformation of the heart, neonatal aspiration syndrome, other congenital
misinformation, intrauterine hypoxia and birth asphyxia, diarrhea and gastroenteritis of
presumed origin

Maternal mortality
▪ Leading causes of maternal mortality (DOH,2010)
• Complications related to pregnancy occurring in the course of labor, delivery,
puerperium
• Hypertension complicating pregnancy, childbirth and puerperium
• Postpartum hemorrhage
• Pregnancy with abortive outcome

PUBLIC HEALTH NURSING

- Refers to the practice of nursing in national and local government health departments
(which includes Health Centers and RHU) and public schools
- It is community health nursing practiced in the public sector
“A 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)

DOH
- A unique blend of nursing and public health practice woven into a human service that,
properly developed and applied has a tremendous impact on human well being.
- Its responsibilities extend to the care and supervision of individuals and families in
their homes, in place of work, in schools and clinics.

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MAGLAYA
“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.”

Public Health Nursing

Refer to nurses in the local/national health departments or public schools whether their
position title is Public Health Nurse or Nurse or School Nurse.

Community Health Nursing

- A service rendered by a professional nurse with communities, groups, families,
individuals at home, in health centers, in clinics, in schools, in places of work for the
promotion of health, prevention of illness, care of the sick at home and rehabilitation
(Ruth Freeman)
- Some definitions indicates CHN is broader than PHN because it encompasses
“nursing practice in a wide variety of community services and consumer advocate
areas, and in variety of roles, at times inducing independent practice, CHN is certainly
not confined to PHN agencies.” (Jacobson)
- A field of nursing that is a blend or synthesis of nursing practice with public health
using primary health care as the tool in the delivery of health services.
- A service rendered by professional nurse to individuals, families, communities and
population groups in health centers, clinics, schools, and the workplace in order to
promote health, prevent illness, provide care for the sick at their respective homes,
provide effective rehabilitation

Philosophy of Community Health Nurse

- The philosophy of CHN is based on the worth and dignity of men.
- This philosophy of care is based on the belief that care directed to the individual, the
family, and the group contributes to the healthcare of the population as a whole.

Goals of Community Health Nurse

- To assist the individual, family and community in attaining their highest level of holistic
health which is attained through multidisciplinary effort and to promote reciprocally
supportive relationship between people and their physical and social environment.

Concepts and Principles

A. Family
B. Partnership
C. Change
D. Health care delivery system

Salient Features of Community Health Nursing

1. Population
2. Greatest Good for the Greatest Number
3. Utilizes the Nursing Process
4. Promotive-preventive by nature

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5. Uses a Variety of Instruments
6. Requires management skills

Principles of CHN
• CHN is based on recognized needs of individuals, families, groups and communities.
• The CHNurse must understand fully the objectives and policies of the agency she
represents.
• In community health nursing, the family is the unit of care.
• Community health nursing must be available to all regardless of race, creed, and
socioeconomic status.
• The CHNurse makes use of available health resources
• There must be provision for educative supervision in CHN.
• The CHNurse utilizes the already existing active organized groups in the community.
• There should be accurate recording and reporting in CHN.

Recipients of Care by Community Health Nurses

1. The Individual
- Specific person / client in various stages of health or illness

2. The Family
- Group of people affiliated by consanguinity, affinity, or co-residence.
- Basic unit of society

3. Population Groups
- Nuclear
- Conjugal
- Extended
- Single-parent
- Blended
- Traditional

4. The Community
- Vulnerable groups or those at risk of developing certain health or health related
problems.
- A broad term for fellowship or organized society.
- A group of people sharing common geographic boundaries and or common
values and interests
- The group which functions within a particular socio-cultural context and varying
physical environment

General characteristics of a community

• Geographic boundaries within certain identifiable characteristics
• Made up of institution organized into a social system with the institutions and
organizations linked in a complex network

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 • Geographic boundaries within certain identifiable characteristics
• Has common and shared interests that bind the members together
• Has an area with fluid boundaries within w/c a problem can be identified and
resolved
• Has a population aggregate concept
• Regarded as an organism which has its own stages and development and
responses to problems may be adequate, inadequate, inappropriate or delayed.

Classifications of a Community
• Rural communities
• Urban communities
• Suburban or urban or the capitals

Characteristics of a Healthy Community

• Awareness that “we are community”
• Conservation of natural resources
• Recognition of and respect for the existence of subgroups
• Participation of subgroups in community affairs
• Preparation to meet crises
• Ability to solve problems
• Communication through open channels
• Resources available to all
• Settling of disputes through legitimate mechanisms
• Participation by citizens in decision-making
• Wellness of a high degree among its members

The Community Health Nurse

- The priority of community health nurse is to promote and maintain health and prevent
the occurrence of disease or illness.
- Conducts a continuing and comprehensive practice that is preventive, promotive,
curative and rehabilitative.
- Delivers nursing services in community settings.
- Participation of all consumers of health care is encouraged in the development of
community activities.
- Management Functions of the Community Health Nurse:
• Planning • Organizing
• Directing. • Coordinating
• Controlling • Evaluating

The Community Health Nurse - Planning

- Establish the VMGO
- Attainment and maintenance of optimum individual and community heath
The Community Health Nurse – Organizing
- Putting order and system
- 3 components of community health organizing

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 • Man/ people – health care workers
• Work – machine and equipment
• Interpersonal relationships

The Community Health Nurse - Directing

- Communicating and conveying to the health workers what have transpired during the
planning and organizing

The Community Health Nurse - Coordinating

- Getting their acts together
- Singing the same tune
- Harmony, achievement of objectives, and the development of teamwork
The Community Health Nurse – Controlling
- Measures and corrects the activities or functions of the people so that objectives are
met.

The Community Health Nurse - Evaluating

- Assessing or appraising performance by comparing it with the performance standards
and performing the needed modifications or revisions

CHNurse:
• Role model
- Provides good example/model of healthful living to the public/community.
• Health Monitor
• Coordinator of Services
• Provider of Nursing Care
- Develops the family’s capability to take care of the sick, disabled or dependent
member.
- Provides direct nursing care to the sick, disabled in the home, clinic, school or
place of work.
- Provides continuity of patient care.
• Trainer/ Counselor/ Health Educator
- Conducts premarital counseling
- Trains BHWs
- Seminars on basic health services
• Recorder/ reporter/ Statistician
• Community Organizer
- Initiates and participates in community development.
- Responsible for motivating and enhancing community participation in terms of
planning, organizing and implementing and evaluating health programs/services.
• Change Agent
- Motivates changes in health behavior of individuals, families, group and
community including lifestyle in order to promote and maintain health.
• Manager/ Supervisor
- Interprets and implements program Policies Memoranda and circulars.

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 REQUIREMENTS
a) Philippine RN
b) At least 2 yrs. experience in general nursing service administration
c) w/ at least 9 Units in Mgt. & Adm. Courses in MA
d) be a member of good standing of the accredited
e) professional organization of nurses

• Researcher
- Participates/assists in the conduct of surveys, studies and researches on nursing
and health-related subjects.
- Coordinates w/ GOs & NGOs in the implementation of studies/research
- Detects deviation from health of individuals, families, groups of the community
through contact/visits with them.
- Uses symptomatic and objective observation and other forms of data gathering
• Morbidity
• Registry
• Questionnaire
• Checklist
• Anecdote report
• record to monitor growth and development
- Health status of individuals, families and communities.

• Planner/ Programmer
- Formulates nursing component of health plans.
- In doctor-less area, she/he is responsible for the formulation of the municipal
health plan.
- Implements the nursing plan, program politics, memoranda and circulars for the
concerned staff/personnel.
- Provides technical assistance to rural health midwives in health matters like
target setting, etc.
- Identifies needs, priorities and problems of individuals, families and communities.
The Community Health Nurse – Activities
1. Home Visit
- A professional face to face contact made by a nurse to the patient or the family in
order to provide necessary health care activities and further attain an objective of
the agency.

Purpose of Home Visit

• Gather all available information
• Confirm all the data gathered during the home visit,
• Prioritize the needs which have been identified by the family ;
• Involve the individual and family from assessment to the implementation phases.

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 Phases in Home Visitation
Preparatory Phase
Review existing records or referral data before
Notify the family of your intent to visit
Introduce self and explain the purpose

Home Visit Phase

Actual visit to the patient.
Conduct assessment, planning, and health teaching
Perform nursing interventions as needed

Post Visit Phase

Record the data in the chart
Plan for your next visit.
Referral to other health professionals..

Public Health
Public health
- The science and art of preventing disease, prolonging life, promoting health and
efficiency through the following:
• Organized community effort for environmental sanitation
• Control of communicable diseases,
• The education of individuals in personal hygiene,
• The organization of medical and nursing services for the early diagnosis and
treatment of disease; and
• The development of the social machinery to insure everyone a standard of living
adequate for the maintenance of health for everyone
Health
- A state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity (WHO,1995)
- Modern concept of health refers it to the “Optimum level of functioning of individuals,
families and communities.
- As a continuum, is considered as the goal of public health in general.
- An integrated method of functioning which is oriented toward maximizing the potential
which the individual is capable (Dunn)
- A quality of life, involving social, emotional, mental, spiritual and biological fitness on
the part of the individual, which results from adaptations to the environment (Rene)
- Florence Nightingale looked into health and illness in relation to the environment –
ventilation, nose, cleanliness, diet and restful bed.
- Dorothea Orem – state characterized by soundness and wholeness of human
structures and bodily and mental functions.

Factors in the ecosystem that affects health

1. Political factors
2. Behavioral factors

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 3. Hereditary factors
4. Health care delivery system
5. Environmental influences
6. Socio-economic influences

History Health Nursing Practice in the Philippines

1901
• Act No. 157 – Board of Health of the Philippines
• Act No. 309 – Provincial and Municipal Boards of Health

1905
• Act No. 1407 – board of health was abolished; functions were transferred to Bureau
of Health

1919
• Act No. 2808 – Carmen Del Rosario, 1st Filipino Nurse supervisor under BOH

Oct 22, 1922

• Filipino Nurses Organization was organized.

1928
• First Nursing Convention was held

1940
• Manila Health Department was created

1990-1992
• Local Government Code of 1991 (RA 7160) as passed and implemented

Jan 1999
• Nelia Hizon was positioned as the nursing adviser at the Office of Public Health
Services – Dept Order No. 29

May 24, 1999

• EO 102 w/c redirects the functions and operations of DOH, as signed by Pres.
Estrada

1999-2004
• The Health Sector Reform Agenda was developed to describe major strategies,
organizational and policy changes.

2005
• A plan to rationalize or streamline the bureaucracy which includes the DOH was
developed.

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