UNIVERSITY OF THE CORDILLERAS
College of Nursing
NCM 104: COMMUNITY HEALTH NURSING (Lecture)
OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES
I. Definition and Focus
✓ Health
• State of complete physical, mental, and social well-being, not merely
the absence of disease or infirmity (World Health Organization)
✓ Determinants of health according to WHO
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support networks
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services
10. Gender
✓ Public Health
• The “science and art of preventing disease, prolonging life,
promoting health and efficiency through organized community effort for
the sanitation of the environment, control of communicable diseases, the
education of individuals in personal hygiene, the organization of medical
and nursing services for the early diagnosis and preventive treatment of
disease, and the development of the social machinery to ensure
everyone a standard of living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen to realize his birthright
of health and longevity.”
(Dr. C.E. Winslow)
• The “art of applying science in the context of politics so as to reduce
inequalities in health while ensuring the best health for the greatest
number.” (World Health Organization)
• Today public health could be defined in terms of its 3 core functions:
▪ Assessment is the regular collection and analysis of health data.
These data are used for program planning and policy
development.
▪ Policy development involves advocacy and political action to develop
policies in various levels of decision making.
▪ Assurance is making sure that health services are effective, available
and accessible to the people (Institute of Medicine, 1988 in Clark
• Core business of public health:
1. Disease control
2. Injury prevention
3. Health protection
4. Health public policy including those in relation to environmental
hazards such as in the workplace, housing food, water, etc.
5. Promotion of health and equitable health gain
• Essential public health functions
1. Health situation monitoring and analysis
2. Epidemiological surveillance/disease prevention and control
3. Development of policies and planning in public health
4. Strategic management of health systems and services for
population health gain
5. Regulation and enforcement to protect public health
6. Human resources development and planning in public health
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7. Health promotion, social participation and empowerment
8. Ensuring the quality of personal and population based health
services
9. Research, development and implementation of innovative
public health solutions
• Eco-system Influences on OLOF (Optimum Level of Functioning):
1. Socio-economic: Employment / Education / Housing
2. Environment: Air / Food / Water Waste / Urban/Rural / Noise /
Radiation / Pollution
3. Political: Safety / Oppression / People Empowerment
4. Behavior: Culture / Habits / Mores / Ethnic Customs
5. Heredity: Genetic Endowment / Familial / Ethnic / racial
6. Health Care Delivery System: Promotive / Preventive / Curative /
Rehabilitative
✓ Community Health
• Part of paramedical and medical intervention/approach which is
concerned on the health of the whole population
✓ Public Health Nursing
• A 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 programme for the promotion of health, the
improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability.” (World Health Organization
Expert Committee of Nursing)
• PHN was coined by Lilian Wald
• PHN in the Philippines 2005, the following are defined:
▪ Public Health Nurses – refer to the nurses in the local/national health
departments or public schools whether their official position title is PHN,
Nurse or School Nurse.
▪ Public Health Nursing – practice of nursing in national and local
government health departments (which include health centers and rural
health units), public schools.
• Ten Essential Health Services:
▪ Monitoring health status to identify community health problems;
▪ Diagnosing and investigating health problems and hazards in the
community;
▪ Informing, educating and empowering people about health issues;
▪ Mobilizing community partnerships to identify and solve health problems;
▪ Developing policies and plans that support individual, family and
community efforts;
▪ Enforcing laws and regulations that protect health and ensure safety;
▪ Linking people to needed personal health services and ensuring the
provision of health care that is otherwise unavailable;
▪ Ensuring competent public health and personal health care workforce;
▪ Evaluating effectiveness, accessibility and quality of personal and
population-based health services; and,
▪ Researching for new insights and innovative solutions to health problems
✓ Community Health Nursing
• A service rendered by a professional nurse with communities,
groups, families, individuals at home, in health centers, in clinics, in schools,
in places of work for the promotion of health, prevention of illness, care of
the sick at home and rehabilitation.” (Ruth B. Freeman)
• Broader than PHN because it encompasses “nursing practice in a
wide variety of community service and consumer advocate areas , and in
a variety of roles, at times including independent practice...community
nursing is certainly not confined to public health nursing agencies.”
(Jacobson)
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• The phrase CHN emerged out of an interest reaffirming the
original thrust of PHN: nursing for the health of the entire public/community
versus nursing only for the public who are poor.
✓
Characteristics of Community Health Nursing:
▪ Promotion of health and prevention of disease are the goals of professional
practice;
▪ CHN practice is comprehensive, general, continual, and not episodic;
▪ There are different levels of clientele-individuals, families and population
groups and the practitioner recognizes the primacy of the population as a
whole;
▪ The nurse and the client have greater control in making decisions related to
health care and the collaborate as equals;
▪ The nurse recognizes the impact of different factors on health and has a
greater awareness of his/her clients’ lives and situations.
• Framework of CHN:
▪ The health care delivery system, with its CHN subsystem;
▪ The clients:
1. Individual
2. Family
3. Population group
4. Community
▪ Health which is the goal of the health care delivery system (HCDS)
▪ The economic, sociocultural, political and environmental factors that
affect the HCDS, the practice of CHN and people’s health
• Clients of Community Health Nurse:
▪ Individual – sick and well – on a daily basis. Since the health problems of
individuals are intertwined with those of the other members of the family and
community, they are also considered as an “entry point” in working with
these clients.
▪ Family - a collection of people who are integrated, interacting and
interdependent. Family members interact with each other and the action of
one affects the other members
▪ Population group - a group of people who share common
characteristics,
developmental stage or common exposure to particular environmental
factors and consequently common health problems, issues and concerns are
the usual targets or beneficiaries of social services and health programs.
▪ Community - a group of people sharing common geographic
boundaries
and/or common values and interest within specific social system. The social
system includes health system, family system, economic system, education
system, religious system, welfare system, political system, recreational system,
legal system and communication system.
• Basic Priniciples of CHN:
▪ The community is the patient in CHN, the family is the unit of care and there are
four levels of clientele: individual, family, population group (those who share
common characteristics, developmental stages and common exposure to health
problems – e.g. children, elderly), and the community.
▪ In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of
care
✓ Roles and Responsibilities of a Community Health Nurse
• Responsibilities:
▪ be a part in developing an overall health plan, its implementation and
evaluation for communities
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▪ provide quality nursing services to the four 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
▪ provide opportunities for professional growth and continuing education for staff
development
• Roles:
▪ Client-oriented roles
o Caregiver
o Educator
o Counselor
o Referral resource
o Role model
o Case manager
▪ Delivery-Oriented roles
o Coordinator
o Collaborator
o Liaison
▪ Population-oriented roles
o Case finder
o Leader
o Change agent
o Community mobilizer
o Coalition builder
o Policy advocate
o Social marketer
o Researcher
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