COMMUNITY

HEALTH NURSING
Mrs. Tuppal
 Determinants of Health
• 1. Demographic profile
• The total population of the Philippines as of 2010 is 92,097,978.
Life expectancy as of 2010 is 66.10 for male and 71.6 for female, and for
the year 2020 is 68.8 and female 74.3. The leading causes of death are
disease of the heart, diseases of the vascular system, pneumonias,
malignant neoplasms/cancer, all forms of tuberculosis, accidents COPD
and allied conditions, diabetes mellitus, nephritis/nephritic syndrome, and
other diseases of respiratory system.
 Determinants of Health
• 2. Cultural Influence on Health/Hereditary
• Culture is a way of life it is stable, which is the reason why it
endures time and is passed on to the next generation, it is obviously
important in the influence when we are talking of health. It includes,
belief, values and customs or practices, the food we eat, our lifestyle how
we take care of ourselves, how we cope up with problems and how we
seek help.
 Determinants of Health
• 3. Environmental Influence
• The environment plays a major role in the health of the community a dirty or
unsanitary environment could lead to different disease in the community an example
of this are the unsafe waste disposal which leads to diarrheal disease, and could also
be the harbor place for animals and insects that could bring different diseases. The
denudation of the forest that could be a major factor in the different calamities the
country is experiencing, the rivers that is already polluted depriving many in the
source of food from the rivers, exposure to harmful radiation, chemicals and
pollutants cause by the progress in the country could also play a major factor in the
diseases in the country.
 Determinants of Health
• 4. Political Influence
The political influence can be a major player when it comes to health
provision because they are considered the governing body in the policy
making regarding the delivery of health in the country.
The health budget is the most concrete expression of the political influence
of the governing bodies of the country, the different law regarding health is
also influence by the different politician in the country.
 B. Definition and Focus
• Public Health – According to Dr. C.E. Winslow, Public Health is a science & art
of 3 P’s:
1. Prevention of Disease
2. Prolonging life
3. Promotion of health and efficiency - through organized community effort
sanitation of environment, control of communicable diseases, education of individuals
in personal hygiene, organization of medical and nursing services for the early
diagnosis and preventive treatment of disease, and development of social machinery to
ensure everyone a standard of living adequate for the maintenance of health
• Community Health – A part of paramedical and medical intervention/
approach which is concerned on the health of the whole population
AIM:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health
• Public health Nursing – The Practice of nursing in national and local
government health departments (which include health centers and rural
health units, and public schools. It is Community Health Nursing
Practiced in the Public Sector.
• Community Health Nursing (CHN) - “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.”- Maglaya,
et al
• Community - a group of people with common characteristics or
interests living together within a territory or geographical boundary
 5 MAIN FUNCTIONS OF A COMMUNITY

1. PRODUCTION, DISTRIBUTION AND CONSUMPTION OF GOODS

AND SERVICES
- The community provides for the economic needs of its members.
- includes not only supplying of foods and clothing but also
provision of water, electricity and police and fire protection and the
disposal of refuse
 5 MAIN FUNCTIONS OF A
COMMUNITY
2. SOCIALIZATION
-refers to the process of transmitting values, knowledge, culture, and
skills to others.
- Established institution of socialization: families, churches, schools,
media, voluntary, and social organization
 5 MAIN FUNCTIONS OF A
COMMUNITY
3. SOCIAL CONTROL
- refers to the way in which order is maintained in a community
- Laws are enforced
 5 MAIN FUNCTIONS OF A
COMMUNITY
4. SOCIAL INTERPARTICIPATION
-refers to the community activities that are designed to meet people’s
needs for companionship.
-e.g. Families, churches, organizations
 5 MAIN FUNCTIONS OF A
COMMUNITY
5. MUTUAL SUPPORT
- refers to community’s ability to provide resources at a time of
illness or disaster.
- Assistance
 TEN CHARACTERISTICS OF A HEALTHY
COMMUNITY
1. Is one in which members have a high degree of awareness of being a community.
2. Uses its natural resources while taking steps to conserve them for future generations.
3. Openly recognizes the existence of subgroups and welcomes their participation in community
affairs.
4. Is prepared to meet crises.
5. Is a problem-solving community; it identifies, analyzes, and organizes to meet its own needs.
6. Possesses open channels of communication that allow information to flow among all subgroups
of citizens in all directions.
7. Seeks to make each of its systems’ resources available to all members.
8. Has legitimate and effective ways to settle disputes that arise within the community.
9. Encourages maximum citizen participation in decision making
10. Promotes high level of wellness among all its members.
• Early Beliefs and Practice
Two words—mysticism and superstitions. These were the early beliefs of health and
illness in the Philippines. The cause of a disease was primarily believed to be due to
either another person, whom which was an enemy, or a witch or evil spirits. In the early
times, Filipinos were very cautious not to disturb other people or the evil spirits for the
good of their health. These evil spirits could be driven away by persons with power to
banish demons. Belief in special gods of healing, with the priest -physician (called
“word doctors”) as intermediary. If they used leaves or roots, they were called herb
doctors (“herbolarios”) Filipinos who became sick were usually cared for by the female
family members or friends in the home.
• Early Care of the Sick
The early Filipinos subscribed to superstitious belief and practices in relation to health
and sickness. Herb men were called “herbicheros” meaning one who practiced
witchcraft. Persons suffering from diseases without any identified cause were believed
bewitched by “mangkukulam” or “manggagaway”. Difficult childbirth and some
diseases (called “pamao”) were attributed to “nunos”. Midwives assisted in childbirth.
During labor, the “mabuting hilot” (good midwife) was called in. If the birth became
difficult, witches were supposed to be the cause. To disperse their influence,
gunpowder were exploded from a bamboo cane close to the head of the sufferer.
• Health Care During the Spanish Regime
The context of nursing has manifested through simple nutrition, wound care,
and taking care of an ill member of the family. Certain practices when taking
care of a sick individuals entails interventions from babaylan (priest
physicians) or albularyo (herb doctor). In 1578, male nurses were
acknowledged as Spanish Friars’ assistants for caring sick individuals in the
hospital. These male nurses were referred as practicante or enfermero.
 The religious orders exerted their efforts to care for the sick by building hospitals in
different parts of the Philippines. The earliest hospitals were:

• Hospital Real de Manila (1577) – it was established mainly to care for the Spanish king’s soldiers,
but also admitted Spanish civilians; founded by Gov. Francisco de Sande.
• San Lazaro Hospital (1578) – founded by Brother Juan Clemente and was administered for many
years by the Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy.
• Hospital de Indios (1586) – established by the Franciscan Order; service was in general supported by
alms and contributions from charitable persons.
• Hospital de Aguas Santas (1590) – established in Laguna; near a medicinal spring, founded by
Brother J. Bautista of the Franciscan Order.
• San Juan de Dios Hospital (1596) – founded by the Brotherhood of Misericordia and administered
by the Hospitaliers of San Juan de Dios; support was delivered from alms and rents; rendered general
health service to the public.
• Nursing During the Philippine Revolution
In the late 1890’s, the war between Philippines and Spain emerges which
resulted to significant amount of casualties. With this, many women have
assumed the role of nurses in order to assist the wounded soldiers. The
emergence of Filipina nurses brought about the development of Philippines
Red Cross.
• Josephine Bracken — wife of Jose Rizal, installed a field hospital in an estate house in Tejeros. She provided nursing care
to the wounded night and day.
• Rosa Sevilla de Alvero — converted their house into quarters for the Filipino soldiers; during the Philippine-American
War that broke out in 1899
• Dona Hilaria de Aguinaldo — wife of Emilio Aguinaldo who organized that Filipino Red Cross under the inspiration of
Mabini.
• Dona Maria Agoncillo de Aguinaldo — second wife of Emilio Aguinaldo; provided nursing care to Filipino soldiers
during the revolution, President of the Filipino Red Cross branch in Batangas.
• Melchora Aquino a.k.a. “Tandang Sora” — nursed the wounded Filipino soldiers and gave them shelter and food.
• Capitan Salome — a revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in combat.
• Agueda Kahabagan — revolutionary leader in Laguna, also provided nursing services to her troops
• Trinidad Tecson (“Ina ng Biak-na-Bato”) — stayed in the hospital at Biak na Bato to care for wounded soldiers
 Hospitals and Nursing Schools
• Americans began training the first Filipino nursing students in 1907. Nursing
students in the Philippines studied many of the same subjects as nursing students in
the U.S. However, it was believed that the curriculum in the Philippines “was
never a mirror-image reproduction of the American nursing curriculum” and
involved more than a simple transfer of knowledge from American nurses to
Filipino nurses. The first Filipino nursing students also studied subjects that were
more relevant to their patients, such as “the nursing of tropical diseases” and
“industrial and living conditions in the islands,” as described by Lavinia L. Dock’s
1912 book A History of Nursing: From the Earliest Times to the Present Day with
Special Reference to the Work of the Past Thirty Years.
 Hospital School of Nursing’s Formal
Training (1901 – 1911)
• Formal training in hospital school of nursing transpire. This began when American
missionary doctors and nurses realized that they manpower is insufficient. Thus it resulted to
a decision of training Filipino nurses that would be catering to the hospitals that Americans
established in the 20th century.
• The first hospital in the Philippines which trained Filipino nurses in 1906 was Iloilo Mission
Hospital, established by the Baptist Missionaries. When this health institution was built, there
were no strict requirements for the applicants as long as they are all willing to work. This has
been the beginning of development of more nursing schools in the country. In this period,
Pensionado Act of 1903 (or Act 854) was mandated, allowing Filipino nursing student to
study in United States. Among of the first wave of nurses who went to United States
 Hospitals and Nursing Schools
Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)
- It was supervised and by the Baptist Foreign Mission Society of America.
Miss Rose Nicolet, a graduate of New England Hospital for Women and
Children in Boston, Massachusetts was the first superintendent for nurses. It
moved from its present location to Jaro Road, Iloilo City in 1929. Miss Flora
Ernst, an American nurse, took charge of the school in 1942. In April 1944
graduate nurses took the first Nurses Board Examination at the Iloilo
Mission Hospital.
 Hospitals and Nursing Schools
Saint Paul’s Hospital School of Nursing (Manila, 1907 )
- The hospital was established by the Archbishop of Manila, Jeremiah Harty
under the supervision of the Sisters of St. Paul de Chartres located in
Intramuros. It provided general hospital services. It opened its training
school for nurses in 1908, with Mother Melanie as superintendent and Miss
Chambers as Principal.
 Hospitals and Nursing Schools
• Philippine General Hospital School of Nursing (Manila, 1907)
- PGH began in 1901 as a small dispensary for Civil officers and Employees in the City of Manila and later
grew as a Civil Hospital. In 1906, Mary Coleman Masters, an educator advocated for the idea of training
Filipino girls for the profession of nursing with the approval of Government officials, she first opened a
dormitory for Girls enrolled at the Philippine Normal Hall and the University of the Philippines.
In 1907, with the support of Governor General Forbes and the Director of Health and among others, she opened
classes in nursing under the Auspices of the Bureau of Education. Admission was based on an entrance
examination. The applicant must have completed elementary education to the seventh grade. Julia Nichols and
Charlotte Clayton taught the students nursing subjects. American physician also served as lecturers.
In 1910, the Act No. 1976 modified the organization of the school placing it under the supervision of the
Department of Health. The Civil Hospital was abolished and the Philippine General Hospital was established.
 Hospitals and Nursing Schools
St. Luke’s Hospital School of Nursing (Quezon City, 1907)
- The hospital is an Episcopalian Institution. It began as a small dispensary
in 1903. In 1907, the school opened with three girls admitted. These three
girls had their first year in combined classes with the PGH School of
Nursing and St. Paul’s Hospital School of Nursing. Miss Helen Hicks was
the first principal. Mrs. Vitaliana Beltran was the first Filipino
superintendent of nurses and Dr. Jose Fores was the first medical director of
the hospital.
 Hospitals and Nursing Schools
Mary Johnston Hospital and School of Nursing (Manila, 1907)
- It started as a small dispensary on Calle Cervantes (now Avenida). It was
called the Bethany Dispensary and funded by the Methodist Mission for the
relief of suffering among women and children. In 1907, Sister Rebecca Parrish
together with registered nurses Rose Dudley and Gertude Dreisbach, organized
the Mary Johnston School of Nursing. The nurses’ training course began with
three Filipino young girls fresh from elementary as their first students.
Philippine Christian Mission Institute School Nursing
- The United Christian Missionary Society of Indianapolis, Indiana- a
Protestant organization of the disciples of Christ operated three schools of
nursing.
Sallie Long Read Memorial Hospital School of Nursing
(Laoag Ilocos Norte, 1903)
 Hospitals and Nursing Schools
The Start of Nursing Practice (1911- 1921)
- Promulgation of Act No. 2493 which amends Medical Law (Act No. 310)
allowing the regulation of nursing practice transpired during this period.
However, in 1919, the First True Nursing Law was enacted through Act
2808. During this period the Board Examiners for Nursing was also created.
The first nursing board examination was given on 1920. The first executive
officer of the Board Examiners for Nurses is a physicians.
 Hospitals and Nursing Schools
Mary Chiles Hospital School of Nursing (Manila, 1911 )
- The hospital was established by Dr. WN Lemon in a small house on
Azcarraga, Sampaloc, Manila. In 1913, Miss Mary Chiles of Montana
donated a large sum of money with which the preset building at Gastambide
was bought. The Tuason Annex was donated by Miss Esperanza Tuason, a
Filipino Philanthropist.
 Hospitals and Nursing Schools
Frank Dunn Memorial Hospital (Vigan Ilocos Sur, 1912 )
 Hospitals and Nursing Schools
San Juan de Dios Hospital School of Nursing (Manila, 1913 )
- In 1913, through the initiative of Dr. Benito Valdez, the board of inspectors
and the executive board of the hospital passed a resolution to open school of
nursing. The school has been run by the Daughters of Charity since then.
Sister Taciana Tinanes was the first Directress of the School
 Hospitals and Nursing Schools

Emmanuel Hospital School of Nursing (Capiz, 1913)

- In 1913, the American Baptist Foreign Mission Society sent Dr. PH Lerrigo
to Capiz for the purpose of opening a hospital. Miss Rose Nicolet assisted
him. The school offered a 3-year training course for an annual fee of Php
100.00. Miss Clara Pedroso was the first principal
 Hospitals and Nursing Schools
Southern Islands Hospital School of Nursing (Cebu, 1918)
- The hospital was established in 1911 under the Bureau of Health. The
school opened in 1918 with Anastacia Giron-Tupas as the organizer. Miss
Visitacion Perez was the first principal
 Hospitals and Nursing Schools
A Much-Established Professional Organization: 1921 – 1931
- During this period, the precursor to the accredited professional organization in the Philippines was
created. The Filipino Nurses Association was established on October 15, and the organization
initiated the publication of Filipino Nurse Journal. Later, this journal was changed to The Philippine
Journal of Nursing. Amendment of certain sections of the Act 2008 was conducted in 1922 under Act
3025 passed by the 5th Legislature. This policy is entitled An Act Regulating the Practice of Nursing
Profession in the Philippine Islands, which necessitates all nurses who are practicing the profession to
register yearly. In 1929, the organization also became a member of the International Council of
Nurses.
-Through the 1930s, Philippine schools of nursing continued to adopt those aspects of American
professional nursing they deemed relevant and appropriate, such as higher admission standards and
the specialization of public health nursing.
 Hospitals and Nursing Schools
• Public Health Nursing Development: 1931 – 1941
- In 1933, the nursing institution have increased their requirement. During
this period, they have implemented that to enter nursing education an
applicant must be able to complete secondary education. The first collegiate
nursing graduates of the Philippines graduated from University of the
Philippines School of Public Health Nursing in 1938.
 Hospitals and Nursing Schools

• Other Schools of Nursing

1. Zamboanga General Hospital School of Nursing (1921)
2. Chinese General Hospital School of Nursing (1921)
3. Baguio General Hospital School of Nursing (1923)
4. Manila Sanitarium Hospital and School of Nursing (1930)
5. St. Paul School of Nursing in Iloilo City (1946)
 ROLES AND RESPONSIBILITIES OF
COMMUNITY HEALTH NURSE
• 1. CLINICIAN OR HEALTH CARE PROVIDER- utilizes the nursing process in the care of the client in the
home setting through home visits and in public health care facilities; conducts referral of patients to appropriate level of care
when necessary.
• 2. HEALTH EDUCATOR- aims towards health promotion and illness prevention through dissemination of correct
information, educating people
• 3. COORDINATOR AND COLLABORATOR – establishes linkages and collaborative relationships with the
other health professionals, government agencies, the private sector, non-government organizations and people’s organizations
to address health problems.
• 4. SUPERVISOR- who monitors and supervises the performance of midwives and other auxiliary health workers.;
also initiates the formulation of staff development and training programs for midwives and other auxiliary health workers .
• 5. LEADER AND CHANGE AGENT- influences people to participate in the overall process of community
development.
• 6. MANAGER- organizes the nursing service component of the local health agency
• 7. RESEARCHER- participates in the conduct of research and utilizes research findings In the conduct
 RESPONSIBILITIES OF THE
COMMUNITY HEALTH NURSE
1. Participates in the development of an overall health plan, its implementation and
evaluation for communities
2. Provides quality nursing services to the four levels of clientele
3. Maintains coordination/linkages with other health team members,
NGO/government agencies in the provision of public health services
4. Initiates and conducts researches relevant to CHN services to improve provision
of health care
5. Initiates and provides opportunities for professional growth and continuing
education for staff development
In care of FAMILY:
• Provision of primary health care services
• Development/utilization of family nursing care plan in the provision of care

In care of COMMUNITY
• Community organizing, mobilization, community development, and people empowerment
• Case finding and epidemiological investigation
• Program planning., implementation and evaluation
• Influencing executive and legislative individuals or bodies concerning health and development
 Specialized Field of Community Health
Nursing
• COMMUNITY MENTAL HEALTH NURSING
• OCCUPATIONAL HEALTH NURSING
• SCHOOL HEALTH NURSING