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Community Health Nurs ing

Arianne C. Jamison, MAN, RN Click to edit Master subtitle style



What is Community?

A group of people with common characteristics or interests living together within a territory or geographical boundary Place where people under usual conditions are found WHO DOH



Concept of Community

Derived from the Greek word komunitas meaning people Sander defines community as: - a collection of people - a place - a social system


WHO Expert Committee o f Nursing

special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability.


DOH Definition:

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


According to Ruth B. Freeman:

service rendered by professional nurse with communities, groups, families, individuals at home, in health centers, in clinics, in school, in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation


American Nurses Associa tion

CHN practice promotes and preserves the health of populations by integrating the skills and knowledge relevant to both nursing and public health


(Margaret Shetland)

The philosophy of Community Health Nursing is based on the worth and dignity of man. To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness



Basic Principles in CHN

The community is the patient of the community health nurse, the family is the unit of care and there are four levels of clientele- individual, family, population group and the community. In community health nursing, the client is considered as an active partner not a passive recipient of care The goal of improving the communitys health status is achieved through multidisciplinary effort CHN practice is affected by developments in health technology in particular, and changes in society in general.


Community Health Nursi ng

Goal of professional practice Nature of practice Knowledge base Levels of clientele Focus of practice Promotion and preservation of the health of the population Comprehensive, general, continual and not episodic Nursing and public health Individual, family, population group, community Primacy of the population as a whole

Concept of Health
World Health Organization (WHO), 1986 A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Health as a A dynamic state in the life cycle of an relative concept individual, family or community; implies continuous adaptation to the physical, biologic and social environment

Characteristics of CHN Pr actice

A field of nursing practice; a nursing specialty within a larger discipline Combines the specialized knowledge of public health with nursing practice - emphasis on populations - promotion of health and prevention of illness - use of measurement and analysis of aggregates - effective management and organization of health services Involves interdisciplinary collaboration with other professionals Promotes client self-care for their own health


Attributes of Community Health N ursing

Population consciousness Health orientation Autonomy Creativity Continuity Collaboration Intimacy Variability 5/1/12 Awareness of factors that impinge on health of populations as well as individuals Emphasis on health promotion and disease prevention rather than cure and illness Greater control over health care decisions by both nurse and client Use of innovative approaches to health promotion and resolution of health problems Provision of care on continuing, comprehensive basis rather than short-term, periodic basis Nurse and client as equals; collaboration with other segments of society Greater awareness of the reality of client lives and situations Wide array of clients at different levels, ethnic backgrounds and settings

Scope of CHN Practice

Curative Medicine Individuals Aggregates Epidemiology

or Nursing

Basic Nursing

Community Health Public Health


Salient Features of CHN

Theoretical bases for practice Setting/Place of practice and activities Objectives Knowledge and skills from the sciences of public health and nursing Outside of purely curative institutions; based in the community - health centers, homes, schools, places of work Promote and maintain health Prevent disease Recovery and restoration of the sick to health and rehabilitation Enhance capabilities of individuals, families and population groups for self-care

Salient Features of CHN

Patient and levels Individual patients, families, population groups of clientele at risk and the community as a whole Perspective and orientation when establishing priorities of care Health of total population or community as a whole The greatest good for the greatest number Impact on community health, rather than solely the needs of an individual patient or family

Range of services Whole range of services from health provided promotion, preventive, curative and rehabilitative nursing services

Salient Features of CHN

Priority concern/ Health promotion and maintenance stress or emphasis Disease prevention in care Types of people/patients seen and served All types of patients representing total health spectrum All conditions of health and illness All age group

2 Major Fields of Nursing in the Philippines

Hospital Nursing Community Health Nursing

School Health Nursing Occupational Health Nursing


Basic Skills of a CHN

Observation Communication

for one to build the kind of relationship that result in improved patient care and outcomes

Interpersonal relations



Analytic assessment skills Policy development/program planning skills Communication skills Cultural competency skills Community dimensions of practice skills Basic public health sciences skills






Has the necessary knowledge, skills and attributes in dealing with the health needs and problems of his/her clients Is familiar with the structure and dynamics of the health care systems and its broader socio-cultural, economic and political context

Is knowledgeable of laws and policies affecting the health care system in 5/1/12

Role Model Planner/Program mer Researc her Manager/Superv isor Provider of Nursing Care Communit y Organizer Recorder/Repo rter/ Statistician

Health Monit or Coordinator of Services Change Agent Traine r Health Educator/ Health Counselor



Formulates nursing component of health plans. In doctor less area, she/he is responsible for the formulation of Provides the municipal technical health plan. assistance to rural health midwives in health matters like target setting, etc.

Interprets and implements the nursing care plan, program politics, memoranda and circulars for the concerned staff/personnel. Identifies needs, priorities and problems of individuals, families and

Develops the familys capability to take care of the sick, disabled or dependent member. Provides direct nursing care to the sick, disabled in the home, clinic, school or place of work.

Provides continuity of patient care.


REQUIREMENTS: Philippine RN At least 2 yrs. Experience in general nursing service administration With at least 9 units in Management and Administrative courses in MA Be a member of good standing of the accredited professional organization of nurses

Interprets and implements program policies memoranda and circulars.


Initiates and participates in community development.


Responsible for motivating and enhancing community participation in terms of planning, organizing and implementing and

Coordinates with individuals, families, and groups for health and relaxed health services provided by various members of health team and other GOs an NGOs.

Coordinates with nursing program with other health programs such as environmental sanitation, health education, dental health and mental health.

Conducts pre-marital counseling Trains new parents Seminars on basic health services Teaches health prevention


Detects deviation from health of individuals, families, groups of the community through contact/visits with them.

Uses symptomatic and objective observation and other forms of data gathering Morbidity Registry Questionnaire Checklist Annual report record to monitor growth and development Health status of individuals, families and communities.


Provides good example/ model of healthful living to the public/community.


Motivates changes in health behavior of individuals, families, group and community including lifestyle in order to promote and maintain health.


Epidemiological Skills Records and reports appropriately to the authorities



Participates/assists in the

conduct of surveys, studies and researches on nursing and health-related subjects.

Coordinates with GOs and NGOs in the implementation of studies/research.


History of Public Health Nur sing

PHN started in 1912 when the Bureau of Health employed 4 graduate nurses from the Philippine General Hospital School of Nursing. They were assigned in Cebu and engaged purely on maternal and child nursing


PHN inaugurated its pioneer work in Tondo, Manila in 1919 when a visiting nurse Ms. Balbina Basa made a house to house visit, hold a clinic and dispensary work with special emphasis on maternal care. At that time, problem on these areas posed a serious problem. As a remedy, Red Cross introduced the operation on puericulture centers in the crowded districts of Manila which was later on extended to the provinces


There were 2 groups of nurses, one group was engaged in puericulture centers and were known as health center nurses while the other group assigned in 3 towns were called district nurses. Later, they were merged and became known as

Public Health Nurses


In 1933, 175 nurses performed maternal and child health work in Manila and provinces. The Commonwealth Government appropriated fund for 215 positions for public health nurse in 1935 which include 26 positions for nurse supervisors. This was done to intensify campaign against the high infant mortality rates


Puericulture centers were under the supervision of the Office of the Public Welfare Commission until the Reorganization Act of 1933 took effect placing them under the Bureau of Health. Mrs. Soledad Buenafe became the assistant chief nurse of the Section of Nursing


The Section of Nursing was transferred to the Division of Maternal and Child Hygiene and later became the Section of Public Health Nursing in 1935 in when Mrs. Buenafe became the chief

The Department of Health and Welfare was created in 1940 where 6 of the public health nurses of the Bureau of Health were transferred in 1941. This formed the nucleus of the present Division of Nursing of Manila 5/1/12Health Department

Public Health Nurses wore a beige uniform which later are replaced by the blue and white stripes due to scarcity of materials. October 1, 1941, PHN donned a nurses cap but was discontinued upon recommendation of Mrs. Buenafe. She also created the Division of Nursing to replace the Section of Nursing of the Bureau of Health


During the WWII on December 8, 1941, twelve emergency units were organized, one of them was sent to Bataan

31 nurses who were taken

prisoners of war by the Japanese army and confined at the Bilibid Prison in Manila were released on July 22, 1942


During early liberation period of 1945, many of the public health nurses found jobs in the US Army Hospitals and Manila Health Department which was managed by the US Army The PHN service in the DOH received a big boost in 1953 with the creation of 81 Rural Health Units which was made possible through bilateral agreement between US and Philippine Government which paved the way for progressive PHN especially in the rural areas


On May 18, 1954, the Philippine Congress passed and approved Republic Act No. 1082, known as the Rural Health Unit Act which was implemented in July of the same year.


In June 1957, Republic Act No. 1891 An Act to Amend Sections 2, 3, 4, 7 and 8 of RA No. 1082 entitled An Act Strengthening Health and Dental Services in Rural Areas and Providing funds therefore was approved RA No. 1891 created 8 categories of rural health units corresponding to 8 population groups to be served


In 1975, 2,000 midwives were recruited and trained to serve in the rural areas. The aim was for the ratio of one Rural Health Midwife per 5,000 population Executive Order No. 119 reorganized the DOH and created several offices and services within the DOH


Between 1990-1992 the Local

Government Code of 1991 RA 7160 was passed and implemented.

In May 24, 1999, EO 102

Redirecting the Functions and Operations of the DOH

was signed by President Joseph E. Estrada