Behavioral

OVERVIEW OF COMMUNITY HEALTH NURSING - culture, habits, mores, ethnic

customs

Community
Socio-economic
- from a latin word “comunicas” which
- employment, education, housing
means a group of people.

Political
Community Health
- safety, oppression, people &
- Part of paramedical and medical
empowerment
intervention/approach which is
concerned on the health of the whole
Hereditary
population.
- genetic endowment, familial & racial.

GOAL Health Care Delivery System

- promotive, preventive, curative, &
rehabilitative
“To raise the level of citizenry by helping
communities and families to cope with the
Environment
discontinuities in and threats to health in such
- air, food, water, wastes, noise,
a way as to maximize their potential for
radiation, pollution, & congestion
high-level wellness”

AIMS

● Health Promotion
● Disease Prevention
● Management of Factors Affecting
Health

WHO Health Definition

A state of complete physical, mental, and

social well- being and not merely the absence
of disease and infirmity.
CONCEPT OF THE HEALTH-ILLNESS
CONTINUUM EXPLAINED
CONCEPTS OF HEALTH

- wellness or wellbeing is dynamic & not

Modern concept of health refers it to be:
Optimum Level Of Functioning (OLOF)
- the highest possible level of
functioning, especially in
relationships, work, education, &
subjective well-being.
Which is affected by several factors or myriad
of factors such as:
stagnant, it moves the patient to
greater health & welfare.
- the person’s outlook, attitude or
viewpoint contributes to his/her state
of wellness.
- Ex: Positive vision of a person
having any disability or disease
would face the right side of the
continuum in contrast to a fit
person who is unhappy in life &
is always complaining,
depressed, & anxious. This
outlook is negative, & hinders

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 the growth of mental & - The science and art of preventing
emotional wellbeing whereas disease, prolonging life and efficiency
the positive outlook influences through organized community effort
mental and emotional wellness for:
to growth, awareness, &
knowledge.
1. The sanitation of the environment
2. The control of communicable
EPIDEMIOLOGICAL TRIAD OF infections
CAUSAL FACTORS 3. The education of the individual in
personal hygiene
4. The organization of medical and
nursing services for the early
diagnosis and preventive treatment
of disease
5. The development of a social
machinery to ensure everyone has a
standard of living, adequate for
maintenance of health to enable
every citizen to realize his birth right
of health and longevity (Dr. C.E
Winslow)
- Disease & other health events do not
occur randomly in a population, but
are more likely to occur in some NURSING
members of the population than
others because of risk factors. The
- Both a profession & a vocation.
model is used to identify the factors
- Assisting sick individuals to become
that place some individuals at greater
healthy and healthy individuals
risk than others.
achieve optimum wellness.
- The diagnosis and treatment of
- It is one of the simplest models that
human responses to actual or
helps explain infectious diseases
potential health problems (ANA, 1980)
affecting the health of the people. The
triad consists of an external agent, a
susceptible host, and an environment PUBLIC HEALTH NURSING
that brings the host and agent
together.
Practice of nursing in national & local
government health departments (health
- In this model, disease results from the
center and rural health unit), & public schools.
interaction between the agent and the
susceptible host in an environment
Community Health Nursing practiced in the
that supports transmission of the
public sector.
agent from a source to that host.

- Interruption or blocking a component A. CHN as a Field of Nursing

disrupts transmission of the disease.
CHN is a field of nursing practice where
PUBLIC HEALTH services are delivered outside of purely
curative institutions (i.e. hospitals), but in
community settings such as the home, the
- directed towards assisting every citizen
school, places of work, health centers & clinics.
to realize his birth rights & longevity.

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 The scope of services provided covers the DOH is to provide national policy direction &
whole range of health promotive, preventive, develop national plans, technical standards &
curative & rehabilitative nursing services, guidelines on health.
with bias towards & priority given to health
FACTS of CHN
promotion and disease prevention especially
for the underserved and high-risk individuals,
Focus : promotion & preservation of health
families, population groups and areas of the
Area of Content: skills & knowledge relevant to
community.
both nursing & public health
Clients : general populations (individuals, families,
The ultimate objective of care is achieving
communities)
the highest possible level of community
Time : continual, not limited to episodic care
health by developing and enhancing the
Scope : comprehensive and general, not limited to
capabilities of individuals, families, various
a particular age or group
population groups & the community as a
whole to take care of their own health &
effectively cope with health problems. To
B. Basic concepts and principles
achieve this objective the nurse works in full
partnership with her client (be it an
individual, family, specific group or the whole The following principles were adapted from
community). those formulated by Mary S. Gardner and by
Leahy , Cobb and Jones.

Why Is Community Health Nursing

Important?
It is important because there are
members of society who do not have
access to healthcare. Nurses work in
communities to reach people who
need assistance with treating medical
conditions & maintaining their health.
What is a Community Health Nurse?
- a registered nurse (RN) who
specializes in promoting health for
diverse communities, infants, children,
adolescents & adults.
1. Community Health Nursing is based on
recognized needs of communities,
families, groups & individuals
2. The community health nurse must
understand fully the objectives & policies
of the agency she represents.
3. In Community Health Nursing, the family
is the unit of service.
4. Community Health Nursing must be
available to all regardless of race, creed &
socio- economic status.
5. Health teaching is a primary responsibility
of the community health nurse.

Which is the primary goal of Community 6. The community health nurse works as a
Health Nursing? member of the health team.

To enhance the capacity of individuals, 7. There must be provision for periodic

families and communities to cope with their evaluation of Community Health Nursing
health needs. services.

8. Opportunities for continuing staff

What government agency is responsible
for promoting health care and awareness
among Filipinos?
DOH is mandated to be the overall technical
authority on health. The major mandate of
education programs for nurses must be
provided by the Community Health
Nursing agency. The community health
nurse also has a responsibility for his/her
own professional growth.

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9. The community health nurse makes use of
available community health resources.
10. The community health nurse utilizes the
already existing active organized groups in
the community.
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.
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 the health care system and
the larger human services system.
Basic Concepts of CHN
1. The primary focus of community health
nursing practice is on health promotion.
2. Community health nursing practice is
extended to benefit not only the individual
but the whole family & community.
3. Community health nurses are generalist in
terms of their practice through life
continuum- its full range of health
problems & needs.
4. Contact with the client &/or the family may
continue over a long period of time which
include all ages and all types of health care.
5. The nature of community health nursing
practice requires that current knowledge
derived from the biological & social
sciences, ecology, clinical nursing &
community health organizations be
utilized.
6. The dynamic process of assessing,
planning, implementing & interviewing ,
provides periodic measurements of
progress, evaluation & a continuum of cycle
until the termination of nursing is implicit
in the practice of community health
nursing.
SETTINGS FOR CHN SERVICES
In the Philippines, a community health nurse
is employed by a public health agency & is
assigned in a community, usually a town, city or
municipality with spatial boundaries, &
with a population that could range from 10,000 to
50,000 people. The nurse-population ratio varies
among towns, cities and municipalities
depending on different factors.
The nurse's work base is usually a health center
where she has an office & where she provides
services to clients and patients coming to various
types of clinics, like prenatal, well-baby or general
clinic for sick cases. In addition to clinic/health
center services, the nurse delivers nursing services
in clients' patients' homes, in the schools, in places
of work such as factories and other industrial
establishments, and in any other community
setting where her services may be needed.
C. Levels of Clientele
There are Four Levels of clientele
in CHN practice:
(a) the individual
(b) the family
(c) a specific population group
(d) the community as a whole
The Individual as the Client/Patient
- At the individual level of care,
community health nurses provide
care to specific clients/patients in
various conditions of health & illness.
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 - Is a unit of interacting persons bound
- from the healthy/well to the dying-,
by ties of blood, marriage or adoption.
and all age groups from birth to
- Two or more people who live in the
senescence.
same household (usually), share a
common emotional bond, and
The Family as the Client/Patient.
perform certain interrelated social
tasks (Spradley & Allender, 1996)
- At this level, the focus of care is the
- "The family is composed of two or
family as a total functioning unit,
more persons who are joined together
which is more than the sum of its
by bonds of sharing and emotional
parts. Individual members with
closeness and who identify themselves
certain defined or medically-
as being part of the family"- Friedman
diagnosed health problems are seen
et al. (2003)
as features or part of the situation in
a given family.
THE FAMILY IS CONSIDERED AS A UNIT OF
SERVICE FOR THE FOLLOWING REASONS:
A Group as the Client/Patient.

- At the third level of care, community C. Levels of Clientele

health nurses direct and focus their
activities to certain population
groups with common unique health 1. The family is considered as the "natural and
needs, are at risk of developing or fundamental unit of society.
have already developed certain
defined health problems, & to whom 2. The family as a group generates. prevents,
the nurse delivers health promotive, tolerates and corrects health problems
preventive, curative or rehabilitative within its membership.
nursing services.
3. The family acts as the basic care provider. It
The Community as the Client/Patient. Is the family that works to achieve certain
health goals.
- At this level of care, the community
as a whole is the client/patient to 4. The health problems of the family are
whom the nurse delivers nursing interlocking. Illness in one member affects
services addressed to community- the entire family and is functioning.
wide health problems, in
cooperation & coordination with 5. The family is the most frequent focus of
other members of the health team health decisions and actions in personal
as well as relevant intersectoral care.
teams.
6. The family Is an effective and available
channel for much of the community health
A. Family as a Basic Unit of the Society nursing efforts. Improved community
health Is realized only through improved
health of families.
WHAT IS A FAMILY?
- Basic unit in society, & is shaped by all
forces surrounding it.
- A family refers to two or more HEALTH AS A GOAL OF FAMILY HEALTH CARE
individuals joined or related by ties of
HEALTH DEFICIT
blood, marriage or adoption & who
- This refers to conditions of health
constitute a single household, interact
breakdowns/advent of illness in the family.
with each other in their familial roles &
who create and maintain a common
culture (cited by Bailon- Reyes, S. )

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HEALTH THREAT
- These are the conditions that make it
more likely for accidents, disease or failure
to thrive or develop to occur.
FORESEEABLE CRISIS
- These are anticipated periods of unusual
demand on the family in terms of time or
resources.
WELLNESS POTENTIAL
- This refers to states of wellness and the
likelihood for health maintenance or
improvement to occur depending on the
desire of the family.
B. Types
NURSING IMPLICATION
- The CHN must formulate a personal
definition of Family & be aware of the
changing definition held by other
disciplines, professionals and family
groups.
- There are many types of families. They
change overtime as a consequence of
BIRTH, DEATH, MIGRATION,
SEPARATION and GROWTH OF
FAMILY MEMBERS.
A. Structure
1. Nuclear family
- Family of marriage, parenthood or
procreation
- Composed of husband, wife and
immediate children- natural, adopted.
2. Dyad family
- Consisting only of husband and wife such
as the newly married couples and “ empty
nesters”
3. Extended family
- Consisting of 3 generations, which
includes married siblings and their
families and/or grandparents.
4. Blended family
- Results from union where one or both
spouses bring a child or children from a
previous marriage into new living
arrangements.
5. Compound
- A man has more than one spouse
- PD # 1083 Code of Muslim Personal Laws
of the Philippines
6. Cohabiting family
- “Live-in” arrangement between an
unmarried couples who are called
common-law spouses & children/child
from
7. Single Parent
- Results from death of spouse separation or
pregnancy out of wedlock
Other types of family:
1. GAY/LESBIAN
- homosexual couple living together with or
without children
2. NO-KIN
- a group of at least two people sharing a
relationship and exchange support who
have no legal or blood tie to each other
3. FOSTER
- substitute family for children whose
parents are unable to care for them
FUNCTIONAL TYPE:
FAMILY OF PROCREATION
- refers to the family you yourself created.
FAMILY OF ORIENTATION
- refers to the family where you came from.
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 D. Residence
B. Decisions in the family (Authority)
PATRILOCAL
1. PATRIARCHAL - family resides / stays with / near domicile
- full authority on the father or any male of the parents of the husband
member of the family e.g. eldest son,
grandfather MATRILOCAL
- live near the domicile of the parents of the
2. MATRIARCHAL wife
- full authority of the mother or any female
member of the family, e.g. eldest sister,
grandmother Ackerman States that Function of Family are:

3. EGALITARIAN Ensuring the physical survival of the species.

- husband and wife exercise a more or less
amount of authority, father and mother
decides
4. DEMOCRATIC
- Everybody is involved in decision making.
C. Decent
(cultural norms, which affiliate a
person with a particular group of kinsman
or certain social purposes)
1. PATRILINEAL
- Affiliates a person with a group of relatives
who are related to him though his father
2. BILATERAL
- both parents
3. MATRILINEAL
- related through the mother.
4. AUTOCRATIC
- Unquestioning obedience rather than
healthy development is fostered.
Transmitting the culture, thereby ensuring man’s
humanness.
1. Physical Functions
- are met through parents providing
food, clothing & shelter, protection
against danger provision for bodily
repairs after fatigue or illness, &
through reproduction.
2. Affectional function
- The family is the primary unit in
which the child tests his emotional
reactions.
3. Social functions
- include providing social
togetherness, fostering self esteem
& a personal identity tied to family
identity, providing opportunity for
observing & learning social &
sexual roles, accepting
responsibility for behavior &
supporting individual creativity &
initiative.

5. LAISSEZ-FAIRE
- “full autonomy” Universal Function of the Family by Doode

REPRODUCTION
6. MATRICENTRIC
- for replacement of members of society: to
- the mother decides/takes charge in
perpetuate the human species
absence of the father (e.g. father is
STATUS PLACEMENT of individual in society
working overseas)
BIOLOGICAL and MAINTENANCE OF THE
YOUNG and dependent members
7. PATRICENTIC
SOCIALIZATION AND CARE OF THE CHILDREN
- the father decides/ takes charge in
SOCIAL CONTROL
absence of the mother

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 1. Family as Client
- Significance of working w/ Families
1. The family is a critical resource.
- The members have the capability
to promote health and wellness.
2. Any dysfunctions (illness, injury,
separation) that affects one or more
members will affect other/s as a whole.
3. The family plays a role in case finding.
Health problems vis-à-vis health risk to all
members.
4. The family takes part in improving nursing
care.
Characteristics of a Family as a Client
The family is a product of time and
place
The family develops its own lifestyle
The family operate as a group
The family accommodates the needs
of the individual members.
The family relates to the community
The Family as a Unit of Care
● The family is considered the natural
and fundamental unit of society
● The family as a group generates,
prevents, tolerates and corrects health
problems within its membership
● The health problems of the family
members are interlocking
● The family is the most frequent focus
of health decisions and action in
personal care
● The family is an effective and available
channel for much of the effort of the
health worker
2. Family as a System
Families are interdependent
- Interdependence of family member
Families maintain boundaries
- Result from shared experiences and
expectations. These boundaries link the
family together in a bond that excludes
others. This is not to say that family
boundaries cannot be permeable.An
example is a family that has a special
family cookout on Sundays. (shared
experiences and expectations)
Families exchange energy w/ their
environments
- Linkages to outside community (input and
output relationship)
Families are adaptive
- One of major roles of community health
nurse is to help restore the equilibrium,
keep family stable within the environment
Families are goal-oriented
- Families exist for a purpose. This is to
establish a place where family members
can develop.
C. Family Theories
- Theoretical Approaches to Family
Health Care (family apgar) Family
Models
- the use of family model provides a
perspective of focus for understanding
the family
- have been categorized according to
their basic focus as developmental,
interactional structural-functional, and
systems model
The Family Systems Theory
- Psychiatrist, Dr Murray Bowen introduced
family systems theory in the 1950s.
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- He further developed it with Michael
Kerr (Kerr & Bowen, 1988).
- assumes that a family is understood
best by examining the family as one
whole system. This one system is a
complex, deeply-connected changing
collection of parts, subsystems and
family members, where each member
has a known purpose or function.
Family systems theory has been used
in psychotherapy, community
problems, health care, and business
structures.
Bowen’s three key assumptions
1. The Family Is A Complex Emotional Unit
2. The Family Is Emotionally Interconnected
3. Familial, Community, And Social Relationships
Are Reciprocal
Friedman’s Structural
Functional Family Model
- Was developed from sociological
frameworks and systems theory by
Marilyn Friedman (1986)
- The family is seen as a social system
passively adapting to external
influence, instead of acting a change
agent in itself.
- Structural component examines the
family unit, how it is organized and
how members relate to one another in
terms of values, communication
network, role system and power while
functional components refers to the
interaction outcomes resulting from
family organizational structure.
Friedman’s Family Model Components
Role Theory
- Family life is structured according to
the roles that are assumed by the
person in interaction with others.
- Roles are learned through socialization
& there is high mutual dependence on
division of labor within the family.
- Each family member has specialized
roles.
- The person is seen in terms of roles,
which are specialized/ shared,
depending on age, sex, social norms,
status & complementarity.
D. Family Developmental Stages
- According to Duvall’s Family
Development Theory (1988), families
move through stages in a particular
order across time after members
successfully master tasks for each
stage. Duvall’s theory is based on the
traditional, nuclear, intact family.
Duvall’s Family Development Theory
Stage 1: MARRIAGE & THE FAMILY
- Involves merging of values brought into the
relationship from the families of orientation.
- Includes adjustments to each other’s
routines(sleeping, eating, chores, etc.),
sexual and economic aspects.
Members work to achieve 3 separate identifiable
tasks:
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of orientation
3. If applicable, engage in reproductive life planning
Stage 2: EARLY CHILDBEARING FAMILY
- Birth or adoption of a first child which
requires economic and social role changes
- Establishing a satisfying home for parents &
infants. Oldest child: 2-1/2 years
Stage 3: FAMILY WITH PRESCHOOL CHILDREN
- This is a busy family because children at this
stage demand a great deal of time related
to growth and development needs and
safety considerations.
- Coping with energy depletion and lack of
privacy as parents
- Oldest child: 2-1/2 to 6 years old
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Stage 4: FAMILY WITH SCHOOL AGE CHILDREN
because it examines psychosocial patterns to
- Parents at this stage have the important
responsibility of preparing their children to
also does not include family structure, nor it
be able to function in a complex world while
addresses health promotion & health-related
at the same time maintaining their own
satisfying marriage relationship.
- Oldest child: 6-12 years old
Stage 5: FAMILY WITH ADOLESCENT CHILDREN
- A family allows the adolescents more
freedom and prepares them for their own
life as technology advances-gap between
generations increases.
- Oldest child: 12-20 years old
Stage 6: THE LAUNCHING CENTER FAMILY
- Stage when children leave to set their own
household, launching youth into adulthood
- Appears to represent the breaking of the
family
- Empty nests
Stage 7: FAMILY OF MIDDLE YEARS
- Family returns to two partners nuclear unit,
refocusing on the marriage relationship
- Period from empty nest to retirement
Stage 8: PERIOD FROM RETIREMENT TO DEATH
OF BOTH SPOUSES
- Adjusting to retirement
- Coping with death and living alone
Stevenson’s Family Developmental Model
She views family tasks as maintaining a
common household rearing children and
finding satisfying work and leisure. It also
includes sustaining appropriate health
patterns and providing mutual support and
acculturation of family members.
This model is useful for nuclear families
specific stages of development, however, it
concerns that the family may face.
E. Characteristics of a Healthy Family
● Family members maintain an open
communication.
● Healthy families can establish priorities.
● Family members engage in flexible roles &
shared decision making.
● Healthy families affirm , support & respect
each other.
● Healthy families cope w/ stress & crisis ,
grow w/ problems.
● The family teaches family & society the
values , beliefs & spiritual core.
● Healthy families shared leisure time w/
humor.
● Healthy families foster responsibility &
value service to others.
5 Universal Characteristics of Families
1. Every family is a small social system
2. Every family has its own cultural values
and rules.
3. Every family has a structure
4. Every family has a certain basic function.
5. Every family moves through stages in its
cycle
Overview of Public Health Nursing
in the Philippines
- Public Health Nursing in the
Philippines was created to promote
wellness in the community and to
protect the health of every individual,
with the help of the nurse's skills and
knowledge, to serve the community
through educating people about the
health issues that might affect the
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 individual's physical, emotional, and
spiritual aspect.
- PHN in the Philippines evolved
alongside the institutional
development of the DOH, the gov’t
agency mandated to protect &
promote people’s health.
A. Global and National Health Situations
- What is a global health situation?
- Global health as such implies a global
perspective on public health problems,
suggesting issues that are common
across the world and working
collaboratively to try and address and
manage these issues.
- Why is global health so important?
- Global health is about ensuring a
healthy future for everyone, no matter
where they live; it's defined as the area
of study, research and practice that
places a priority on improving health
and achieving equality in health for all
people worldwide.
Global Health Situation & Trends 1955-2030
❑ Global population was 2.8 billion in 1955.
❑ 2023 World Population 8,045,311,447
❑ India: Highest Population 1,428,627,663
- China: 1,425,671,352
- United States: 339,996,563
❑ United Nations prediction: The world
population is projected to reach 8.5 billion in
2030
❑ Philippines Population: 117,582,684 as of
Aug. 1, 2023
Life Expectancy
is a measure that is often used to gauge the
overall health of a community
Global life expectancy at birth:
- 2023: 73.4 years (life expectancy at
birth, both sexes combined)
- Female 76.0 years
- Male 70.8 years
- Rank #124 Philippines 72.30 (both)
74.32 (female) 70.30(male)
- Healthy life expectancy • 2019: 63.7
years
Age structure of deaths
❑ In 1955, 40% of all deaths were among
children under 5 years, 10% were in 5-19 year
olds, 28% were among adults aged 20-64, and
21% were among the over-65s.
❑ By 2025, 8% of all deaths will be in the under
5s, 3% among 5-19 year-olds, 27% among 20-64
year-olds and 63% among the over-65s.
❑ 65 and above is projected to rise from 10% in
2022 to 16%
❑ Fertility rate is 2.1 births per woman
Leading Cause of Death
❑ 153 M confirmed COVID-19 cases (as of 1 May
2021)
• ✓ 3.2 M related deaths
❑ Most affected are the Americas and
European • Region
❑ South East Asia (SEA) has 23.1 M cases, WHO
(2021). World Health Statistics 2021.
B. Definitions and Focus
1. Public health
- the science of protecting & improving
the health of people and their
communities. This work is achieved by
promoting healthy lifestyles,
researching disease and injury
prevention, and detecting, preventing
and responding to infectious diseases.
2. Community Health
- is a major field of study within the
medical and clinical sciences which
focuses on the maintenance,
protection, & improvement of the
health status of population groups and
communities. Community health
focuses on an overall geographic area
rather than on shared characteristics
such as age or diagnosis. The defined
area could be as small as a
neighborhood, or it could encompass a
city or an entire region.
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3. Public Health Nursing
- is defined as the practice of promoting
and protecting the health of
populations using knowledge from
nursing, social, and public health
sciences (American Public Health
Association, Public Health Nursing
Section, 1996). Public health nursing
practice focuses on population health,
with the goal of promoting health, and
preventing disease and disability.
4. Community Health Nursing (CHN)
- is the synthesis of nursing & public
health practice applied to promote
and protect the health of the
population. It combines all the basic
elements of professional, clinical
nursing with public health and
community practice.
5. Standards of Public Health Nursing
in the Philippines
1. The Public Health Nurse must be
professionally qualified and licensed to
practice in the arena of public health
nursing.
2. Public Health Nurses must possess
personal qualities and people skills.
3. The Public Nurse 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
4. The functions of the PHN are
consistent with the Nursing Law 2002
and program policies formulated by
the department of health and local
government health agencies.
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.
❑ 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 auxiliary health workers in the
catchment area.
❑ Formulates a supervisory plan and
conducts supervisory visits to implement the
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
Nursing Function
❑ An inherent function of the nurse
❑ 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
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❑ 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 go beyond health teachings and
health information campaigns.
❑ Understand 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.
❑ 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 auxiliary 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
❑ Participates in teaching, guidance and
supervision of student affiliates for their RLEs
in the community setting.
- nursing and midwifery.
❑ Health promotion calls for the active
participation of the community.
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
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❑ 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
6. Evolution of Public Health Nursing
in the Philippines
1. Pre-Spanish Era - no records
2. Spanish Regime (1591-1898)
- Bro. Juan Clemente (1577) - started
public health services through a
dispensary in Intramuros
3. American Regime (1898-1942)
- 1898 - creation of the board of health
for physicians
- 1899 - appointment of first
commissioner of health
4. Japanese Regime (1942-1945)
- PHN services were interrupted.
- PHN in Manila were assigned to
devastated areas to attend to the sick
and the wounded civilians caused by
bombing.
5. Era of the Republic of the Philippines
(1946-present)
- 1947 - reorganization of government
offices under Executive Order No. 94,
series of 1947 with the transfer of the
Bureau of Public Welfare.
- The office of the President and the
Department was renamed DOH.
- 1996 - Primary Health Care as a
strategy to attain Health for all by the
year 2000 was in focus
- May 24, 1999
- EO # 102, which redirects the functions
and operations of DOH, was signed by
former President Joseph Estrada
EO 102
• The DOH is hereby mandated to provide
assistance to local government units (LGUs),
people's organization (PO) and other
members of civic society in effectively
implementing programs, projects and services
that will:
a) promote the health and well-being
of every Filipino;
b) prevent and control diseases among
populations at risks;
c) protect individuals, families and
communities exposed to hazards • and
risks that could affect their health; and
d) treat, manage and rehabilitate
individuals affected by disease and
disability.
● National objectives for health 1999-2004
were launched. This states the Philippines
objectives for the eradication and control of
infectious diseases commonly affecting our
people, major chronic illnesses and injuries
that compromise lives of the productive
sector.
● It encourages promotion of healthy lifestyle
and health-seeking behaviors to prevent or
control certain debilitating illness and life-
threatening diseases.
● 2005 - the DOH launched Fourmula One for
Health to ensure speed, precision, and
effective coordination towards improving the
efficiency, effectiveness and equity of health
care delivery.
● 2010: Universal Health Care was launched to
provide the necessary revisions to the F1
framework.
● From 1999-2004, the Health Sector Reform
Agenda of the Philippines was launched.the
reforms are to provide fiscal autonomy to
government hospitals; secure funding for
priority health programs;
● February 20, 2009 - Nurses
Assigned in Rural Service
(NARS) program conceived to
provide employment and the
essential work experience to
unemployed nurses
● 2011 - Registered Nurses for
Health Enhancement and
Local Services (RN HEALS)
program
– to provide quality healthcare to rural
communities with little or no health
care services,
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Registered Nurses for Health Enhancement
and Local Service (RN HEALS) – Deployed
nurses are assigned for 6 months in the
community (Rural HealthUnits) and then
another 6 months for hospital service.
2014 up to present – Nurse Deployment
Program (NDP)
- Send nurses to poor communities and
•Geographically Isolated and
Disadvantaged •Areas (GIDA) in the
Philippines.
- It aims to augment the workforce in
the rural health units, birthing homes,
and barangay health stations.
7. Roles and Responsibilities of a Community
Health Nurse
Roles of the COMMUNITY HEALTH NURSE
- Clinician, who is a health care provider,
taking care of the sick people at home
or in the RHU
- Health Educator, who aims towards
health promotion and illness
prevention through dissemination of
correct information; educating people
- Facilitator, who establishes
multi-sectoral linkages by referral
system
- Supervisor, who monitors and
supervises the performance of
midwives
- Health Advocator, who speaks on
behalf of the client
- Advocator, who act on behalf of the
client
- Collaborator, who working with other
health team members
- Leader and Change Agent
- Researcher
Responsibilities of CHN
● Be a part in developing an overall
health plan, its implementation and
evaluation for communities
● Provide quality nursing services to the
three levels of clientele
● Maintain coordination/linkages with
other health team members,
● NGO/government agencies in the
provision of public health services
● Conduct researches relevant to CHN
services to improve provision of health
care
What are the duties of a community health
nurse in the Philippines?
● Provides immunizations and health
screenings in the community.
● Provides patient and community
education.
● Monitors and delivers high quality
patient care. Records and analyzes
medical data in various communities.
LEVELS OF PREVENTION IN FAMILY HEALTH
1. PRIMARY PREVENTION
- Encompasses health promotion &
health prevention
- It identifies actions taken to prevent
the occurrence of health problems in
families.
Ex. of activities:
- providing information about
normative changes that can be
expected in a child’s growth so that
parents are prepared for the changes &
are ready to deal w/ them when they
occur
- Helping family prepare a home after a
period of time spent in a mental
institution or prison.
2. SECONDARY PREVENTION
- Early recognition & treatment of
existing health problems
- Emphasizes screening examinations
that can detect problems early &
prevent long- term & costly care that
drains families resources.
Ex. Mammography , pap smears , fecal occult
blood testing
3. TERTIARY PREVENTION
- Rehabilitative level of health care in
families; the focus is on preventing the
return of the problem
Ex. Helping a homeless family , through
facilitating the family’s connection to
appropriate community services
Find permanent housing as well as
employment that will enable the family to
maintain housing.
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