APPROACHES

IN COMMUNITY
HEALTH
NURSING

NURSING 4005 (Unit 1-3)

Public Health Nursing

– Term used before for Community Health Nursing

– involves working with communities and populations as equal partners, and focusing on primary
prevention and health promotion
– Public health nursing (PHN) practice is population-focused and requires unique knowledge,
competencies, and skills. Early public health nursing roles extended beyond sick care to encompass
advocacy, community organizing, health education, and political and social reform. Likewise,
contemporary public health nurses practice in collaboration with agencies and community members.
– A science and art of 3P’s:
1. Prevention of Diseases
2. Prolonging of Life
3. Promotion of Health and efficiency through organized community effort
Community Health Nursing

– It is 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.
– A specialized field of nursing practice
– Public Health + Public Health Nursing Skills + Social Assistance
=Increase level of health of the citizenry
=Increase optimum level of functioning
CHARACTERISTICS OF CHN
PRACTIVE
– It is a specialty field of nursing.
– Its practice combines public health with nursing.
– It is population based.
– It emphasizes on wellness and other than disease or Illness.
– It includes inter-disciplinary collaboration.
– It amplifies client’s responsibility and self-care.
PHILIPPINE HEALTH CARE
DELIVERY SYSTEM
– is a complex set of organizations interacting to provide an array of health
services

1. PRIVATE ENTERPRISE HEALTH CARE

2. SOCIAL SECURITY HEALTH MODEL
3. PUBLICLY FUNDED HEALTH CARE MODEL
4. SOCIAL HEALTH INSURANCE
1. PRIVATE ENTERPRISE HEALTH
CARE
– Purely private enterprise health care systems are comparatively rare.
– Where they exist, it is usually for a comparatively well-off subpopulation in a
poorer country with a poorer standard of health care. For instance, private
clinics for a small, wealthy expatriate population in an otherwise poor country.
– But there are countries with a majority-private health care system with residual
public service
2. SOCIAL SECURITY HEALTH
MODEL
– Where workers and their families are insured by the state
– refers to social welfare service concerned with social protection, or protection against socially
recognized conditions, including poverty, old age, disability, unemployment and others.
– Social Security may refer to:
 Social insurance, where people receive benefits or services in recognition of contributions to an
insurance scheme. These services typically include provision for retirement pensions, disability
insurance, survivor benefits and unemployment insurance.
 Income maintenance mainly the distribution of cash in the event of interruption of employment,
including retirement, disability and unemployment
 Services provided by administrations responsible for social security. In different countries this may
include medical care, aspects of social work and even industrial relations.
3. PUBLICLY FUNDED HEALTH
CARE MODEL
– Where the residents of the country are insured by the state
– Health care that is financed entirely or in majority part by citizens' tax payments
instead of through private payments made to insurance companies or directly
to health care providers
4. SOCIAL HEALTH INSURANCE

– where the whole population or most of the population is a member of a sickness

insurance company
– SHI is a method for financing health care costs through a social insurance program
based on the collection of funds contributed by individuals, employers, and sometimes
government subsidies
– characterized by the presence of sickness funds which usually receive a proportional
contribution of their members' wages.
– With this insurance contributions these funds pay medical costs of their members
– Affiliation to such funds is usually based on professional, geographic, religious/political
and/or non-partisan criteria
LEVELS OF HEALTH CARE
FACILITIES

1. Primary
2. Secondary
3. Tertiary
1. PRIMARY LEVEL OF HEALTH
CARE FACILITIES
– are the rural health units, their sub-centers, chest clinics, malaria eradication
units, and schistosomiasis control units operated by the DOH; puericulture
centers operated by League of Puericulture Centers; tuberculosis clinics and
hospitals of the Philippine Tuberculosis
– Society; private clinics, clinics operated by the Philippine Medical Association;
clinics operated by large industrial firms for their employees; community
hospitals and health centers operated by the Philippine Medicare Care
Commission and other health facilities operated by voluntary religious and civic
groups
2. SECONDARY LEVEL OF
HEALTH CARE FACILITIES
– are the smaller, non-departmentalized hospitals including emergency and
regional hospitals.
– Services offered to patients with symptomatic stages of disease, which require
moderately specialized knowledge and technical resources for adequate
treatment.
3. TERTIARY LEVEL OF HEALTH
CARE FACILITIES
– Are the highly technological and sophisticated services offered by medical
centers and large hospitals. These are the specialized national hospitals.
– Services rendered at this level are for clients afflicted with diseases which
seriously threaten their health and which require highly technical and
specialized knowledge, facilities and personnel to treat effectively
PRESSING PROBLEMS IN THE
COMMUNITY
– Adolescent pregnancy – Hunger
– Access to clean drinking water – Inadequate emergency services
– Child abuse and neglect – Inequality
– Crime – Jobs
– Domestic violence – Lack of affordable housing
– Illegal drug use – Poverty
– Environmental contamination – Transportation
– HIV/ AIDS – Violence
HEALTHY COMMUNITY/PEOPLE
INITIATIVE
There are 10 important components of a Healthy Cities/Healthy Communities process:
– Create a compelling vision based on shared values.
– Embrace a broad definition of health and well-being.
– Address quality of life for everyone.
– Engage diverse citizen participation and be citizen-driven.
– Multi-sectoral membership and widespread community ownership.
– Acknowledge the social determinants of health and the interrelationship of health
with other issues (housing, education, peace, equity, social justice).
– Address issues through collaborative problem-solving.
– Focus on systems change.
– Build capacity using local assets and resources.
– Measure and benchmark progress and outcomes.
Although there is no one step-by-step procedure for a Healthy Cities/Healthy
Communities initiative – both the content and the structure of the process
depend upon your community’s needs, and, particularly on community
decisions – there is, given the ten components above, a reasonable way to
approach it in most cases.

– Assemble a diverse and inclusive group.

– Generate a vision.
– Assess the assets and resources in the community that can help you realize your vision, and the issues that
act as barriers to it.
– Choose a first issue to focus on.
– Develop a community-wide strategy, incorporating as many organizations, levels, and sectors as possible.
– Implement the plan.
– Monitor and adjust your initiative or intervention.
– Establish new systems that will maintain and build on the gains you’ve made.
– Celebrate benchmarks and successes.
– Tackle the next issue.
Like the Ottawa Charter, the World Health Organization, in its publication The Solid
Facts, recognizes the need to break these factors down into more manageable pieces. It
lists ten factors that affect health and life expectancy, and advocates addressing each
within a coherent program that looks at all of them within a society. These ten factors
are:

– The social gradient (equity)

– Stress
– Early life
– Social exclusion (the opposite of social connectedness)
– Work
– Unemployment
– Social support
– Addiction
– Food
– Transport
In Orlando, Florida, the Healthy Community Initiative began with meetings of a few
influential people. As they learned about healthy communities, the convened a
group of about 160, representing all sectors of the city’s population – citizens of all
races and economic levels, organizations and institutions, city government, other
groups – to hash out a vision. That group, in turn, conducted citizen focus groups
and public meetings to hear and understand citizens’ concerns. Ultimately, they
drafted a vision, based on their own discussions and the input of hundreds of
others from all walks of life, that contained 14 statements about what Orlando
should be. That vision became the foundation of the initiative.
CORE PUBLIC HEALTH
FUNCTIONS
1. Assessment
-Regular collection, analysis, interpretation, and communication of information about health conditions, risks and
assets in a community.

2. Policy Development
-Development, implementation, and evaluation of plans and policies, for public health in general and priority health
needs in particular, in a manner that incorporates scientific information and community values and in accordance
with state public health policy.
 
3. Assurance
-Ensuring by encouragement, regulation, or direct action that programs and interventions that maintain and
improve health are carried out.
The Public Health System
– all public, private, and voluntary entities that contribute to the delivery of essential public health
services within a jurisdiction. This concept ensures that all entities’ contributions to the health and
well-being of the community or state are recognized in assessing the provision of public health
services.
The public health system includes:
– Public health agencies at state and local levels
– Healthcare providers
– Public safety agencies
– Human service and charity organizations
– Education and youth development organizations
– Recreation and arts-related organizations
– Economic and philanthropic organizations
– Environmental agencies and organizations
10 Essential Public Health Services

The 10 Essential Public Health Services describe the public health activities that all communities should undertake:
1. Monitor health status to identify and solve community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships and action to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable
8. Assure competent public and personal health care workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services
10. Research for new insights and innovative solutions to health problems
PHILIPPINE HEALTH
LAWS
REPUBLIC ACT – an act passed by the Congress
of the Philippines, while the form of government is
Republican government.
– Republic Act 349 – Legalizes the use of human organs for surgical, medical and scientific purposes.
– Republic Act 1054 – Requires the owner, lessee or operator of any commercial, industrial or agricultural
establishment to furnish free emergency, medical and dental assistance to his employees and laborers.
– Republic Act 1080 – Civil Service Eligibility
– Republic Act 1082 – Rural Health Unit Act
– Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
– Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be paid January 31 of each year
– Republic Act 1891 – Act strengthening Health and Dental services in the rural areas
– Republic Act 2382 – Philippine Medical Act which regulates the practice of medicines in the Philippines
– Republic Act 2644 – Philippine Midwifery Act
– Republic Act 3573 – Law on reporting of Communicable Diseases
– Republic Act 4073 – Liberalized treatment of Leprosy
– Republic Act 4226 – Hospital Licensure Act requires all hospital to be licensed before it can operative
– Republic Act 5181 – Act prescribing permanent residence and reciprocity as qualifications for any
examination or registration for the practice of any profession in the Philippines
– Republic Act 5821 – The Pharmacy Act
– Republic Act 5901 – 40 hours work for hospital workers
– Republic Act 6111 – Medicare Act
– Republic Act 6365 – Established a National Policy on Population and created the Commission on
population
– Republic Act 6425 – Dangerous Drug Act of 1992
– Republic Act 6511 – Act to standardize the examination and registration fees charged
by the National Boards, and for other purposes.
– Republic Act 6675 – Generics Act of 1988
– Republic Act 6713 – Code of Conduct and Ethical Standards for Public Officials and
Employees
– Republic Act 6725 – Act strengthening the prohibition on discrimination against
women with respect to terms and condition of employment
– Republic Act 6727 – Wage Rationalization Act
– Republic Act 6758 – Standardized the salaries
– Republic Act 6809 – Majority age is 18 years old
– Republic Act 6972 – Day care center in every Barangay
– Republic Act 7160 – Local Government Code
– Republic Act 7164 – Philippine Nursing Act of 1991
– Republic Act 7170 – Law that govern organ donation
– Republic Act 7192 – Women in development nation building
– Republic Act 7277 – Magna Carta of Disabled Persons
– Republic Act 7305 – The Magna Carta of public Health Workers
– Republic Act 7392 – Philippine Midwifery Act of 1992
– Republic Act 7432 – Senior Citizen Act
– Republic Act 7600 – Rooming In and Breastfeeding Act of 1992
– Republic Act 7610 – Special protection of children against abuse, exploitation and
discrimination act
– Republic Act 7624 – Drug Education Law
– Republic Act 7641 – New Retirement Law
– Republic Act 7658 – An act prohibiting the employment of children below 15 years of age
– Republic Act 7719 – National Blood Service Act of 1994
– Republic Act 7875 – National Health Insurance Act of 1995
– Republic Act 7876 – Senior Citizen Center of every Barangay
– Republic Act 7877 – Anti-sexual harassment Act of 1995
– Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of 1992
– Republic Act 8042 – Migrant Workers and Overseas Filipino Act of 1995
– Republic Act 8172 – Asin Law
– Republic Act 8187 – Paternity Leave Act of 1995
– Republic Act 8203 – Special Law on Counterfeit Drugs
– Republic Act 8282 – Social Security Law of 1997 (amended RA 1161)
– Republic Act 8291 – Government Service Insurance System Act of 1997 (amended PD 1146)
– Republic Act 8344 – Hospital Doctors to treat emergency cases referred for treatment
– Republic Act 8423 – Philippine Institute of Traditional and Alternative Medicine
– Republic Act 8424 – Personal tax Exemption
– Republic Act 8749 – The Philippine Clean Air Act of 1999
– Republic Act 8981 – PRC Modernization Act of 2000
– Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002
– Republic Act 9173 – Philippine Nursing Act of 2002
– Republic Act 9288 – Newborn Screening Act
PRESIDENTIAL DECREE – An order of the President. This
power of the President which allows him/her to act as legislators
was exercised during the Marshall Law period.

– Presidential Decree 46 – An act making it punishable for any public officials or employee, whether
of the national or local government, to receive directly or indirectly any gifts or valuable things
– Presidential Decree 48 – Limits benefits of paid maternity leave privileges to four children
– Presidential Decree 69 – Limits the number of children to four (4) tax exemption purposes
– Presidential Decree 79 – Population Commission
– Presidential Decree 147 – Declares April and May as National Immunization Day
– Presidential Decree 148 – Regulation on Woman and Child Labor Law
– Presidential Decree 166 – Strengthened Family Planning program by promoting participation of
private sector in the formulation and implementation of program planning policies.
– Presidential Decree 169 – Requiring Attending Physician and/or persons treating injuries resulting
from any form of violence.
– Presidential Decree 223 – Professional Regulation Commission
– Presidential Decree 442 – Labor Code Promotes and protects employees self-organization and
collective bargaining rights. Provision for a 10% right differential pay for hospital workers.
– Presidential Decree 491 – Nutrition Program
– Presidential Decree 539 – Declaring last week of October every as Nurse’s Week. October 17,
1958
– Presidential Decree 541 – Allowing former Filipino professionals to practice their respective
professions in the Philippines so they can provide the latent and expertise urgently needed by
the homeland
– Presidential Decree 568 – Role of Public Health midwives has been expanded after the
implementation of the Restructed Health Care Delivery System (RHCDS)
– Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child Adoption
– Presidential Decree 626 – Employee Compensation and State Insurance Fund. Provide benefits to
person covered by SSS and GSIS for immediate injury, illness and disability.
– Presidential Decree 651 – All births and deaths must be registered 30 days after delivery.
– Presidential Decree 825 – Providing penalty for improper disposal garbage and other forms of
uncleanliness and for other purposes.
– Presidential Decree 851 – 13th Month pay
– Presidential Decree 856 – Code of Sanitation
– Presidential Decree 965 – Requiring applicants for Marriage License to receive instruction on
family planning and responsible parenthood.
– Presidential Decree 996 – Provides for compulsory basic immunization for children and infants
below 8 years of age.
– Presidential Decree 1083 – Muslim Holidays
– Presidential Decree 1359 – A law allowing applicants for Philippine citizenship
to take Board Examination pending their naturalization.
– Presidential Decree 1519 – Gives medicare benefits to all government
employees regardless of status of appointment.
– Presidential Decree 1636 – requires compulsory membership in the SSS and
self-employed
– Presidential Decree 4226 – Hospital Licensure Act
EXECUTIVE ORDER – an order issued by the executive
branch of the government in order to implement a constructional
mandate or a statutory provision.

– Executive Order 51 – The Milk Code

– Executive Order 174 – National Drug Policy on Availability, Affordability, Safe, Effective and
Good Quality drugs to all
– Executive Order 180 – Government Workers Collective Bargaining Rights Guidelines on the right
to Organize of government employee.
– Executive Order 203 – List of regular holidays and special holidays
– Executive Order 209 – The Family Code (amended by RA 6809)
– Executive Order 226 – Command responsibility
– Executive Order 503 – Provides for the rules and regulations implementing the transfer of
personnel, assets, liabilities and records of national agencies whose functions are to be devoted
to the local government units.
– Executive Order 857 – Compulsory Dollar Remittance Law
PUBLIC AND PRIVATE HEATLH
PROVIDERS
– HOSPITALS (REGIONAL, DISTRICT, PROVINCIAL)
– BARANGAY HEALTH CENTERS
– RURAL HEALTH UNITS
– CLINICS
 ENVIRONMENTAL
HEALTH DISASTERS
The environmental health response to a disaster aims to manage public health effects caused by the event
and improve disaster preparedness to respond to future events. The main elements considered in the
response include, but are not limited to:
– drinking water
– hazardous waste (e.g. asbestos)
– general waste
– sanitation
– food safety
– communicable diseases
– vector issues, and
– mass gatherings (e.g. evacuation centres).
– Environmental health hazards—threats to human health from exposure to disease causing agents—
are closely associated with disasters and emergencies in a variety of ways. A broad range of activities
can be designed to enable the health sector to prevent, mitigate and respond to such hazards.
– A hazard is any phenomenon that has the potential to cause disruption or damage to humans and
their environment. Hazards are the potential for an event, not the event itself.
– Disasters are events that occur when significant numbers of people are exposed to extreme events to
which they are vulnerable, with resulting injury and loss of life, often combined with damage to
property and livelihoods.
– An emergency is a situation or state characterized by a clear and marked reduction in the abilities of
people to sustain their normal living conditions, with resulting damage or risks to health, life and
livelihoods. Disasters commonly cause emergency situations, both directly and indirectly.
The disaster-management cycle

1. Disaster management—a developmental approach

– a core concept in environmental health management in disasters and
emergencies, and several variations of the cycle have been used effectively.
– Appropriate actions at all points in the cycle lead to greater preparedness, better
warnings, reduced vulnerability or the prevention of disasters during the next
iteration of the cycle. The objectives of such a development-oriented approach
are to reduce hazards, prevent disasters and prepare for emergencies.
Inappropriate humanitarian action and development processes can lead to
increased vulnerability to disasters and loss of preparedness for emergency
situations
2. Sustainable livelihoods and disaster management
– One of the major goals of disaster management, and one of its strongest links
with development, is the promotion of sustainable livelihoods and their
protection and recovery during disasters and emergencies. Where this goal is
achieved, people have a greater capacity to deal with disasters and their
recovery is more rapid and more durable.
Developmental considerations contributing to all
elements of the disaster-management cycle
Development temporarily interrupted
by sudden disaster
Steps in disaster management

1. Vulnerability Assessment - Using the disaster-management approach involves carrying out a number of
pro-active steps—as well as reacting to disasters and emergencies when they occur—the first of which is
vulnerability assessment. This provides the basis for reducing vulnerability through work in two areas:
disaster prevention/mitigation (to reduce susceptibility) and emergency preparedness (to increase
resilience).
2. Prevention and Mitigation - Complete prevention of disasters is feasible only if it is possible to eliminate
people’s susceptibility to hazards by moving populations away from hazard zones, providing complete
protection from hazards, or preventing the physical hazard altogether. This has occasionally been
achieved, e.g. the virus responsible for smallpox was eradicated, and cities have been protected from
flooding by diverting rivers to alternative courses. However, to survive or improve well-being, humans
are prepared to take risks and will even resettle in areas previously affected by natural disasters.
3. Emergency Preparedness - Emergency preparedness is “a programme of long-term development
activities whose goals are to strengthen the overall capacity and capability of a country to manage
efficiently all types of emergency and bring about a transition from relief through recovery, and back to
sustained development” (World Health Organization, 1995a).
4. Planning, Policy and Capacity Building - Planning is required at all levels, from the community level to
national and international levels, to ensure that programmes for disaster prevention and mitigation
are carried out according to clear objectives, with adequate resources and management
arrangements, and to ensure that strategies, resources, management structures, roles and resources
for emergency response and recovery are determined and understood by key actors. Effective
emergency planning can only take place once roles and responsibilities have been agreed.
5. Emergency Response - The appropriate response will depend on the nature of the emergency or
disaster and the effectiveness of mitigation measures, but is also very much conditioned by the degree
of preparedness achieved.
6. Rehabilitation, Reconstruction and Recovery - As the emergency is brought under control, the
affected population is capable of undertaking a growing number of activities aimed at restoring their
lives and the infrastructure that supports them. This may be a slow process and one in which the
capacity for such efforts must be carefully nurtured and built up over a period of time, but the process
should start early in the emergency phase.