The Public Health Nurse

Public Health Nurses

- Are found in various health settings and occupying various positions in the hierarchy.
- Are assigned in rural health units, city health centers, provincial health offices, regional health
offices, and evening the national office of the Department of Health.
- Are also assigned in public schools and in the offices of government agencies providing health
care services.
- Occupy a range of positions from Public Health Nurse I to Nurse Program

Supervisors to Chief Nurse in public health settings.

- Uses various tools and procedures necessary for her to properly practice her profession and
deliver basic health service.
- Uses nursing process in her practice and is adept in documenting and reporting
accomplishments through records and reports.
- Technically competent in various nursing procedures conducted in settings where she is
assigned
-

Qualifications and Functions

The standards of Public Health Nursing in the Philippines developed by the National League of
Philippine government Nurses in 2005 described the qualification and functions of a Public Health Nurse.

Public health nurse

- must be professionally qualified and licensed to practice in the area of public health nursing.
- Must possess personal qualities and “people skills” that would allow her practice to make a
difference in the lives of these people.
- Functions in accordance with the dominant values of public health nurses, within the ethico-
legal framework of the nursing profession, and in accordance with the needs of the clients and
available resources for health care.
- Functions of PHN are consistent with the Nursing Law 2002 and program policies formulated by
the DOH and local government health agencies. They are related to management, supervision,
provision of nursing care, collaboration and coordination, health promotion and education
training and research.

Management Function

- the management function of the public health nurse is inherent in her practice.
- The nurse, in whatever setting and role has been trained to lead and manage.
- Objectives set for work being done can only be achieved through the execution of the five
management functions of planning, organizing, staffing, directing and controlling.
- This function is performed when she organizes the “nursing service” of the local health agency.
 - Managing the nurses and their activities
- Program management. This is a function where the PHN actually excels in. A program manager
is responsible for the delivery of the package of services provided by the program to the target
clientele.
- Reports on program accomplishments is a documentation of her management skills.

Supervisory Function

- PHN is the supervisor of the midwives and other auxillary health workers in the catchment area.
- Formulates a supervisory plan and conducts supervisory visits to implement plan.
- Conducts supervisory visits using a supervisory checklist
- During the visit the PHN identifies together with the supervisee any issue or problem
encountered and addresses them accordingly.
- Coaching
- Enhancement of training for the supervisee
- Report of the encounter is given to the supervisee and kept in her personal file for
future reference.

Nursing Function

- Her practice as a nurse is based on the science and art of caring

- Public health nursing is caring for individuals, families and communities toward health
- promotion and disease prevention
- PHN are expected to provide nursing care
- PHN uses her knowledge and skill in the nursing process. She does assessment,
- plans, and implements care, and evaluates outcomes.
- Establishes rapport with her client: individual, family or community
- Home visits
- Referral of patients to appropriate levels of care

Collaborating and coordinating Function

- Brings activities or group activities systematically into proper relation or harmony with each
other.
- Care coordinators for communities and their members
- Actively involved both socially and politically to empower individuals, families and communities
as an entity to initiate and maintain health promoting environments.
- Establishes linkages and collaborative relationships with other health professionals, government
agencies, the private sector, NGOs, people’s organizations to address health problems.
- Identifies persons, groups, organizations, other agencies and communities whose resources are
available within and outside the community and which can be tapped in the implementation of
individuals, family and community health care.
Health Promotion and Education Function

- Activities goes beyond health teachings and health information campaigns.

- Understands that health is determined by various factors such as physical and political
environment, socio-economic status, personal coping skills and many other circumstances, and
it is inappropriate to blame or credit a person’s health to himself alone because he is unlikely to
control many of these factors.
- Understanding the multidimensional nature of health will enable her to plan and implement
health promoting interventions for individuals and communities.
- Uses her skills in advocacy for the creating of a supportive environment through policies and
reengineering of the physical environment for healthier actions.
- As an educator, the nurse provides clients with information that allows them to make healthier
choices and practices. Health education is a major component of any public health program.
- PHN are expected to teach on a daily basis as part of their practices.

Training Function

- Initiates the formulation of staff development and training programs for midwives and other
auxillary workers
- Does training needs assessment for these health workers, designs the training program and
conducts them in collaboration with other resource persons.
- Also does evaluation of training.
- PHN participates in the training of nursing and midwifery affiliates in coordination with the
faculty of colleges of nursing and midwifery.
- Participates in teaching, guidance and supervision of student affiliates for their RLEs in the
community setting.
- Health promotion calls for the active participation of the community.
- Mobilize communities for health actions.
- Community organizing is a means of mobilizing people to solve their own problems.
- Through this, people learn that their problems have social causes and fighting back is a more
reasonable, dignified approach than passive acceptance and personal alienation.

Research Function

- Participates in the conduct of research and utilizes research findings.

- PHN function is disease surveillance. Purposes of disease surveillance:
 To measure the magnitude of the problem
 To measure the effect of the control program
- It is important in monitoring the progress of the disease reduction initiatives:

Poliomyelitis, Neonatal Tetanus Elimination, Measles Control, NCD risk factors, etc.

HISTORY OF PUBLIC HEALTH IN THE PHILIPPINES

History of Public health in the Philippines based on socio-political periods

1. Pre-American Occupation (up to 1898)

1. Pre-American Occupation

> 1577- Public health began at the old Franciscan Convent in Intramuros where Fr. Juan
Clemente put up dispensary for treating indigents in Manila.

-San Juan de Dios Hospital

1.2 During Spanish Time

1. Creation of Vaccinators to prevent smallpox
2. Creation of Board of Health
3. First medical school in the Philippines- UST
4. School of Midwifery
5. Public Health Laboratory
6. Forensic Medicine

1.3 Hospital before the Americans came to Philippines

1.3.1 General Hospitals

1. San Juan de Dios Hospital
2. Chinese General Hospital
3. Hospicio de San Jose in Cavite
4. Casa dela Caridad in Cebu
5. Enfermeria de Sta. Cruz in Lguna

1.3.2 Contagious Hospitals

1. San Lazaro Hospital
2. Hospital de Palestina in Camarines Sur
3. Hospital delos Lesporosos in Cebu
4. Hospital de Argencina in Manila for smallpox and cholera

2. American Military Government (1898-1907)

2. American Military Government
2.1 Control of epidemics such as cholera, small pox and plague
2.2 Fight against communicable diseases such as common cold, Hepa A-D, chickenpox, SARS, flu,
mumps, malaria, herpes, STD, measles
2.3 Projects and activities:

1. Garbage crematory
2. First sanitary ordinance and rat control
3. Cholera vaccine was first tried
 4. Confirmed that plague in man comes from infected rat
5. Opened the UP College of Medicine
6. Establishes Bureau of Science

3. Philippine assembly (1907-1916)

3. Philippine Assembly
1. Hygiene and Physiology were included in curriculum of public elementary school
2. Anti-TB campaign was started
3. Philippine Tuberculosis Society was organized
4. Opening of PGH (Phil. Gen. Hospital)
5. Use of anti-typhoid vaccine was initiated
6. Dry vaccine against small pox was first Use

4. JONES LAW YEARS

4.1 Retrogression rather than progression in so far as the health was concern

1. Increase CDR

2. Increase IMR

3. Increase Morbidity

4.2 Increase deaths from smallpox, cholera, typhoid, malaria and TB

4.3 Re-organized happened (reorganized the health service and encouraged effective supervision)

1. Study the cause and prevalence of typhoid fever

2. Schick test was used to determine the causes of diphtheria

3. Campaign against Hookworm was launched

4. Anti-dysentery vaccine was first tried

5. First training course for sanitary inspector was given

6. Women and child labor law was passed

7. Mechanisms of transmission of dengue fever through Aedes aegyti was studied

8. Establishment of School of Hygiene and Public Health

9. National Research Council of the Philippines was organized

10. BS in Education Major in Health Education was opened in UP

11. (PPHA) Philippine Public Health Association was organized

 5. The Commonwealth (1936-1941)

COMMONWEALTH PERIOD

5.1 The epidemiology of life threatening disease was studied- diphtheria, yaws, dengue

5.2 Research in the field of health was promoted

5.3 UP School of Public Health was established

5.4 Development of Maternal and Child Health (MCH)

5.5 1939 - Creation of Dept. of Public Health and Welfare

- Dr. Jose Fabella as the First secretary

5.6 1940- Bureau of Census and Statistics was created to gather vital statistics

5.7 In spite of development

1. Inequitable distribution of health services remained a problem

2. 80% of those who died were never given medical attention

6. Japanese occupation (1941-1945)

6. JAPANESE OCCUPATION/WORLD WAR II

1. During this time, all public health activities were practically paralyzed.

2. Increase incidence of TB, veneral dses, malaria, leprosy and malnutrition.

7. Post World war II (1945-1972)

POST WORLD WAR II

1. Philippine Independence

2. Completion of a research on Dichlorodiphenyltricholorothanel (DDT-as larvicidal/insecticide to

control malaria

3. Introduction of one-infection method for gonorrhea with penicillin

4. Manila was selected as Headquarters for World Health Organization (WHO) Western Pacific Office

5. Strengthening Health and Dental services in rural areas (per municipalities with 5,000-10,000
population)

1 Municipal Health Officer

1 Public Health Nurse

 1 Midwife

1 Sanitary Inspector

8. MARTIAL LAW YEARS

8.1 Creation of National Economic Development Authority

8.2 Department of Health was renamed as Ministry of Health (MOH)

8.3 Accomplishments during this period:

8.3.1 Formulation of National Health Plan

> Construction of Tertiary Hospital

* Philippine Heart Center

* Lung Center

*K idney Center

* Lungsod ng Kabataan / Phil. Childrens Medical Center

> Adaptation of the Primary Health Care

* Phil was the first country to implement PHC

> Launching of Operation Timbang and Mothercraft

* Nationwide program providing supplementary food for infants, pre-school and school children.

NUTRIBUN- bread with vitamins

8.3.2 Progress in Public Health research RITM- Research Institute for Topical Medicine • PCHRD-
Philippine Council for Health Research and Development

9. EDSA REVOLUTION

> From Ministry of Health, it was renamed again as Dept. of Health

> Increase in life expectancy slowed down

> Increased incidence of malnutrition

> Declined practice of family planning

10. AQUINO ADMINISTRATION

> 1987 Constitution- more provisions on health making comprehensive health care available

> Major activities:

• Milk code-required the marketing of breast feed milk substitute

• Universal child and mother immunization

•RA. 6725- Act prohibiting discrimination against women

• NESS- National Epidemic Surveillance System

RA. 6675- National Drug Policy and Generics Act

RA. 7170- Organ Donation Act

11. RAMOS ADMINISTRATION

> "Health in the Hands of People" and "Let's DOH it"

-by Sen Juan Flavier

*Memorable initiative during leadership of Flavier

> National Immunization Day

- BCG (Bacille Calmette-Guérin (BCG) is a live strain of Mycobacterium bovis developed by Calmette and
Guérin for use as an attenuated vaccine to prevent tuberculosis and other mycobacterial infections.)

- DPT (diphtheria, pertussis (whooping cough) and tetanus)

- OPV -Oral Polio Vaccine

- MMR- Immunization shot against measles, mumps, and rubella (also called German measles)

(Memorable initiative during leadership of Flavier)

> Promotion of Traditional Medicine- Herbal Medicine

> Yosi Kadiri

> Araw ng Sangkap Pinoy- aimed to prevent Vitamin A, Iron and lodine deficiency

> Voluntary Blood Donation Program

> Kung Sila'y Mahal Mo Magplano- Family Planning Program

> Doctors to the Barrio

Laws:
> EO 39- which created the Philippines National AIDS Council as a national policy and advisory body in
the prevention and control of HIV-AIDS

> RA 7719- the National Blood Services Act of 1994, this to promote voluntary blood donation

> RA 8172- Salt lodization Nationwide (ASIN), providing salt iodization nationwide approved in 1996 and
renamed FIDEL (Fortified for lodine Elimination)

Post EDSA revolution (1986 to present