Overview of the Public Health Nursing in Philippines

Learning Outcomes

Upon completion of this lesson, the student nurse will be able to:
1. Define health and community
2. Discuss the focus of public health
3. Explain the differences among community health nursing, public health
nursing, and community-based nursing
4. Cite the distinguishing features of community health nursing
5. Apply the competency standards of nursing practice in the Philippines in
community health nursing practice
6. Outline the historical development of public health and public health nursing
in the Philippines.
Learning Content

Global and National Health Situations

 Definition and Focus

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
Health
− a state of complete physical, mental, social, and emotional wellbeing and
not merely the absence of disease and infirmity (WHO,1958).
− Optimum Level of Functioning (OLOF) of Individuals, Families and
Communities

o Ecosystem influences the OLOF

▪ Factors belonging to the ecosystem
• Political - This factor pertains to the power and
authority to regulate the environment
o Example:
▪ Safety
▪ Oppression
▪ People empowerment
• Behavioral
o Components
▪ Culture
▪ Habits
▪ Ethnic customs
o Examples
▪ Smoking
▪ Intake of alcoholic drinks
▪ Substance abuse
▪ Lack of exercise
• Heredity
o Components
▪ Genetic endowment
▪ Defects
▪ Strengths
▪ Risks:
• Familial
• Ethnic
• Racial
• Healthcare Delivery System – One component of
this factor is the primary health care which is a
partnership approach
o Component
 ▪ Promotive
▪ Preventive
▪ Curative
▪ Rehabilitative
• Environment
o Components
▪ Air
▪ Food
▪ Water waste
▪ Urban/rural noise
▪ Radiation
▪ Pollution
• Socioeconomic Influence
o Components
▪ Employment
▪ Education
▪ Housing
o Determinants of Health and Illness
▪ Income and Social Status
▪ Education
▪ Physical environment
▪ Employment and working conditions
▪ Social support networks
▪ Culture
▪ Genetics
▪ Personal behavior and coping skills
▪ Health services
▪ Gender
Public Health
− science and art of (3 Ps): Prevention of Disease, Prolonging life,
Promotion of health and efficiency through organized community effort for:
(Dr. C.E. Winslow)
o Control of Communicable Diseases
o Organization of Medical and Nursing Services
o Development of Social Machineries
o Education of IFC on personal Hygiene→ Health Education is the
essential task of every health worker
o Sanitation of the environment
− 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 (WHO)
− Goal of Public Health: to contribute to the most effective total development
and life of the individual and his society.
− Three (3) Primary Core Functions of Public Health (Institute of Medicine of
United
 States, 1988)
o Assessment
o Assurance
o Policy
development
− Nine (9) Essential Public Health Functions (WHO-WPR)
o Health situation monitoring and analysis
o Epidemiological surveillance/ disease prevention and control
o Development of policies and planning in public health
o Strategic management of health systems and services for population
health gain
o Regulation and enforcement to protect public health o Human resources
development and planning in public health o Health promotion, social
participation, and empowerment
o Ensuring the quality of personal and population-based health service
o Research, development, and implementation of innovative public health
solutions
Community Health
− part of paramedical and medical intervention/ approach which is concerned
on the health of the whole population
− Aims:
o health promotion
o disease prevention
o management of factors affecting health
Nursing
− both a profession and vocation
− assisting sick individuals to become healthy and healthy individuals
achieve optimum wellness
− client-centered, need-based, and goal-oriented profession
Community-based Nursing
− application of the nursing process in caring for individuals, families and
groups where they live, work or go to school or as they move through the
health care system (McEwen and Pullis, 2008)

Community-based Nursing Community Health Nursing

• Managing acute or chronic • Preserving and protection of
conditions health
• Individual and Families • Primary client is the
Community
• Largely direct • Both direct and indirect
Population-focused Nursing
− Concentrates on specific groups of people focuses on health promotion and
disease prevention, regardless of geographical location (Baldwin et al,
1998)
Public Health Nursing
− synthesis of public and nursing practice
− a field of professional practice in nursing and in public health in which
technical nursing, interpersonal, analytical and organizational skills are
applied to problems of health as they affect the community. (Freeman,
1963)
− a special field of nursing that combine skills of nursing, public health and
some phases of social assistance, and functions as a part of the total
public health programs (WHO, Expert Committee of Nursing)
− A practice of promoting and protecting the health of populations using
knowledge from nursing, social, and public health sciences. (American
Public Health
Association Committee on Public Health Nursing)
Community Health Nursing

 Nursing performed in the community with the goal of achieving health

 a specialized field of nursing practice
 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.)
− 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 (Freeman)
− nursing Practice in a wide variety of community services 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)
− a synthesis of nursing practice and public health practice applied to
promoting and preserving the health of populations. (American Nurses
Association)
− 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 wellbeing. (DOH – Philippines)
− a (1) Science of Public Health combined with (2) Public Health Nursing
Skills and (2) Social Assistance (3 elements considered in CHN) with
the goal of raising the level of health of the citizenry ( Ultimate Goal of
CHN), to raise optimum level of functioning of the citizenry
− Primary Goal: self-reliance in health
− New Goal: achieve health of the people or to improve the health status of
IFC or achieving high (maximum) level of wellness or contribute to the
promotion of client’s optimum level of functioning
− Primary Focus: Health Promotion and/ or Disease Prevention
− CH Nurses: Generalists
− Unit of Care/ Service: Family
− Health Education/ Teaching: Primary responsibility/ duty of the CH
Nurse

Basic Principles of CHN

 Nursing: the means to achieve the CHN Goal
 The community (general population/ total population) is the patient in
CHN, the family is the unit of care and there are four levels of clientele:
individual (entry point of CHN), family (unit of society), population
group (those who share common characteristics, developmental
stages and common exposure to health problems – e.g. children,
elderly), and the community (social group).
 In CHN, the client is considered as an ACTIVE partner NOT PASSIVE
recipient of care
 CHN practice is affected by developments in health technology, in
particular, changes in society, in general
 The goal of CHN is achieved through multi-sectoral efforts
 CHN is a part of health care system and the larger human services
system.

Philosophy of CHN
 A philosophy is defined as a system of beliefs that provides a basis for
a guided action. A philosophy provides the direction and describes the
what’s, the why’s, and the how’s of activities within a profession.
 The philosophy of CHN is based on the worth and dignity of man.
(Dr. Margaret Shetland)
 CHN Practice is guided by the following beliefs:
▪ Humanistic values of the nursing profession upheld
▪ Unique and distinct component of health care
▪ Multiple factors of health considered
▪ Active participation of clients encouraged
▪ Nurse considers availability of resources
▪ Interdependence among health team members
practiced
▪ Scientific and up-to-date
▪ Tasks of CHN vary with time and place
▪ Independence or self-reliance of the people is the end
goal
 ▪ Connectedness of health and development regarded
Mission of CHN
 Health Promotion – activities related to enhancement of health
 Health Protection – activities designed to protect the people
 Health Balance – activities designed to maintain well being
 Disease prevention – activities relate to avoid complication
o Primary Prevention
o Secondary Prevention
o Tertiary Prevention

Level 1
Primary
Prevention Activities
Prevention of problems before
they occur
Ex: Immunizaion
Level 2
Secondary Prevention Activities
Early detection and intervention
Ex: X -ray
Level 3
Tertiary Prevention Activities
Correction and prevention of deterioration of a disease state
Ex: Teaching Insulin administration at home

➢ Social Justice – activities related to practice equity among clients

Standards of Public Health Nursing in The Philippines

Competency Standards in CHN
o Safe and Quality Nursing Care
 knowledge of health/illness status of the client, sound decision
making; safety, comfort, privacy, administration of meds and health
therapeutics and nursing process.
o Management of resources and environment
 organization of workload; use of financial resources for client care;
mechanism to ensure proper functioning of equipment and
maintenance of a safe environment
o Health Education
 assessment of client’s learning needs; development of health
education plan and learning materials and implementation and
evaluation of health education plan
o Legal Responsibility
 adherence to the nursing laws as well as to national, local, and
organizational policies including documentation of care given to
clients.
o Ethico-moral Responsibility
  respect for the rights of the client; responsibility and accountability
for own decisions and actions; and adherence to the international
and national codes of ethics for nurses o Personal and Professional
Development
 identification of own learning needs, pursuit of continuing
education; involvement in professional image; positive attitude
towards change and criticism
o Quality Improvement
 data gathering for quality improvement; participation in nursing
rounds; identification and reporting of solutions to identifies
problems related to client care.
o Research
 research-based formulation of solutions to problems in client care
and dissemination and application of research findings
o Records Management
 accurate and updated documentation of client care while observing
legal imperatives and record keeping
o Communication
 uses therapeutic communication techniques, identifies verbal and
nonverbal cues, responds to client needs, while using formal and
informal channels of communication and appropriate information
technology o Collaboration and Teamwork
 establishment of collaborative relationship with colleagues and
other members of health team

Standards of care
The public health collects comprehensive data
Standard 1. Assessment
pertinent to the health status of populations.
Standard 2. Population The public health nurse analyzes the assessment
diagnosis and Priorities data to determine the population diagnoses and
priorities.
Standard 3. Outcomes The public health nurse identifies expected outcomes
identification for a plan based on population diagnoses and
priorities.
Standard 4. Planning The public health nurse develops a plan that reflects
best practices by identifying strategies, action plans,
and alternatives to attain expected outcomes.
Standard 5. The public health nurse implements the identified plan
Implementation by partnering with others.
a. Coordination Coordinates programs, services, and other activities
to implement the identified plan.
b. Health education and Employs multiple strategies to promote health,
health promotion prevent disease, and ensure a safe environment for
populations.
c. Consultation Provides consultation to various community groups
 and officials to facilitate the implementation of
programs and services.
d. Regulatory Identifies, interprets, and implements public health
activities laws, regulations, and policies.
Standard 6. Evaluation The public health nurse evaluates the health status of
the population.
Standards of professional performance
Standard 7. Quality of The public health nurse systematically enhances the
practice quality and effectiveness of nursing practice.
Standard 8. Education The public health nurse attains knowledge and
competency that reflects current nursing and public
health practice.
Standard 9. Professional The public health nurse evaluates one’s own nursing
practice evaluation practice in relation to professional practice standards
and guidelines, relevant statutes, rules, and
regulations.
Standard 10. Collegiality The public health nurse establishes collegial
and professional partnerships while interacting with representatives of
relationships the population, organizations, and health and human
services professionals, and contributes to the
professional development of peers, students,
colleagues, and others.
Standard 11. Collaboration The public health nurse collaborates with the
representatives of the population, organizations, and
health and human services professionals in providing
for and promoting health of the population.
Standard 12. Ethics The public health nurse integrates ethical provisions in
all areas of practice.
Standard 13. Research The public health nurse integrates research findings in
practice.
Standard 14. Resource The public health nurse considers factors related to
utilization population safety, effectiveness, cost, and impact on practice
and in the planning and delivery of nursing and public
health programs, policies, and services.
Standard 15. Leadership The public health nurse provides leadership in nursing
and public health.

Evolution of Public Health Nursing in The Philippines

Brief History of Public/ Community Health Nursing:

• Early Christian era: virgins, noble women and plebeians took care of sick
• Phoebe: 1st visiting nurse
• Mr. William Rathbone:
 o Philanthropist who first thought of public health nursing
o District nursing service in Liverpool in 1859
o More emphasis on midwifery
o Forerunner of public health nursing system
• In the USA:
o Public HN developed from visiting nursing service under missionary
societies and visiting nursing associations
o 1877: women’s board of NY mission established 1 st visiting nurses

History of Public Health

• Babylonians
o Understood need for hygiene
o Developed medical skills
• Egyptians (ca. 3000 BC)
o Developed variety of pharmaceutical preparations
o Constructed earth privies and public drainage system
• Hebrew Mosaic Law o Moses – “Father of Sanitation”
o Mosaic Health Code
o Maternal health, communicable disease control, protection of food,
water, waste, and sanitary disposal
• Greeks
o Linked health to environment
o Wealthy people value personal cleanliness, exercise, diet, and
sanitation
• Romans
o Viewed medicine from a community health and social medicine
perspective
o Emphasized regulation of medical practice
o Provision of pure water
o Sewage systems, public food preparation
o Women visited and cared for the sick
• Christianity
o Brought idea of personal responsibility
o Started the care for the sick
• Middle Ages
o Poor sanitary conditions
o Increase in communicable diseases (cholera, bubonic plague,
smallpox)
o Religious convents and monasteries established hospitals
o Started movement of health education and personal hygiene
• Renaissance
o Health practices were influenced by recognition of human dignity and
worth
o Elizabeth Poor Law: established 1601, guaranteed medical services to
poor and lame individuals
 • Industrial Revolution
o Advances in transportation
o Religious women started to provide nursing care in institutions and

homes

Milestones in history of public health

• 1601- Elizabeth Poor Law

• 1617- Sisterhood of Dames de Charites organized by St. Vincent de Paul
• 1789- Baltimore Health Department
• 1798- Marine Hospital Service, nuns visited poor
• 1813- Ladies Benevolent Society of Charleston, South Carolina founded
• 1836- Lutheran deaconesses provided home visits in Germany
• 1851- Nightingale visited Kaiser Werth, 3 months of nursing training
• 1855- Quarantine Board, established in New Orleans; beginning of
tuberculosis campaign in US
• 1859- district nursing established by William Rathbone
• 1860- Florence Nightingale Training School for Nurses established in St.
Thomas Hospital in London
• 1864- Beginning of Red Cross
Community Health Nursing Historical Background in Philippines
• 1901- Act 157, est. Board of Health of Philippines
• 1905- Act 1407, est. Bureau of Health, under Department of Interior
• 1912- Fajardo Act (Act 2156) – Sanitary Division, forerunner of present
Municipal Health Offices; President of Sanitary division took charge of 2 to 3
municipalities. Philippine General Hospital sent 4 nurses to Cebu
• 1914- School of Nursing rendered by Filipino Nurse employed by Bureau of
Health in Tacloban, Leyte
• 1915- Philippine Health Service; Reorganization Act 2462 created. Office of
Inspector General and Office of District Nursing headed by Dr. Rosario
Pastor, a nurse and physician
• 1915-1918- Ms. Perlita Clark took charge of Public Health Nursing Works
• 1919- 1st Filipino Nurse Supervisor was appointed, 84 PHN’s assigned in 5
health stations
• 1927- Office of District Nursing abolished and changed to Section of Public
Health Nursing
• 1930- Section for Nursing
• 1941- Outbreak of war, PHN’s were assisted to take care of sick and
wounded
• 1942- 31 nurses as POW’s at Bilibid Prison, released to Director of Bureau
and Health, Dr. Eusebio Aguilar
• 1948- 1st training center of Bureau of Health organized in cooperation with
Pasay City Health Department
• 1950- Rural Health Demonstration and Training Center by DOH
• 1958-1965- RA 977 abolished Division of Nursing
 o Annie Sand = nursing consultant, Office of Secretary of Health
▪ Founded DOH National League of Nurses Inc.
o RA 977created 8 regional offices in country increased to 11 then to 16

Assessment

Enumeration

1 – 4. Philosophy of CHN according to American Nurses Association.

5 – 14. Determinants of Health.
15 – 17. Core business of Public Health
18 – 20. Conditions affecting health of the community.

Assignment:
Answer the following questions to test your understanding. Use your critical
thinking skills in deciding in each situation. Apply what you learn in this module.
Identify the problems in each scenario. Give the proper response as a nurse and
explain your basis in every action taken. You will be graded based on the rubrics shown
below.

Case scenario:

CASE # 1 About: History of Public Health and Public and Community Health
Nursing

Ahmad works as a home health nurse in his suburban community. He visits 7-10
clients each day. On today’s visitations, Ahmad will provide care for four clients who are
recovering from hip replacement surgery and three clients who are recovering from
heart surgery, and he will provide intravenous (IV) antibiotics for a man with an infected
wound.
Among this list of clients, Ahmad visits Mrs. T., an 87-year-old woman who lives
alone and is recovering from triple bypass surgery that she underwent a month ago.
Ahmad’s goals are to check on her recovery progress, reload her medications in her
weekly medication container, and administer an influenza vaccine.
Upon entering Mrs. T.’s small house, Ahmad finds the house in disarray: clothes
are scattered about, dirty dishes with crusted food line the kitchen counters, and no
lights are on. Ahmad finds Mrs. T. lying in bed watching television. Mrs. T. complains to
Ahmad of feeling too tired to do anything; she eats only what is already prepared (e.g.,
frozen dinners or snack foods like potato chips) because cooking requires too much
effort. She spends most of her days lying in bed and has not bathed in a week.
Ahmad helps Mrs. T. out of bed and assists her with a bath. After the bath,
Ahmad fixes Mrs. T. a quick lunch and refills her medication box while she eats. Ahmad
encourages Mrs. T. to start getting some exercise by doing the household chores so
that her heart can get stronger. “The stronger your heart is, the more energy you will
have,” Ahmad tells Mrs. T. Michael also enlists several services for Mrs. T.: A home
health aide will come to the house three times a week to help Mrs. T. bathe, and Meals-
on-Wheels will bring her breakfast and lunch. Finally, Nurse Ahmad administers the
influenza vaccine.
During Nurse Ahmad’s visit the following week, Mrs. T. is showing improvement.
She tells Ahmad, “I just love that little girl who comes to help me; she is just so sweet.
And the Meals-on-Wheels program is a blessing, I now have more energy to keep this
place clean the way I like it.”

Question:
1. What challenges did Nurse Ahmad face in his first visit with Mrs. T. that public
health nurses (PHNs) in the late 1800s also faced?

RUBRIC

POOR AVARAGE OUTSTANDING Score

1-3 points each 4-7 points each 8-10 points each

criterion criterion criterion

Identification of Identifies and Identifies and Identifies and

the main understands few of understands most understands all of the
issue/problem the main issues in of the main issues main issues in the
the scenario given in the scenario scenario given
given
Analysis of the Inappropriate Thorough analysis Insightful and thorough
issues solution to some of of most of the analysis of the issues in
the issues in the issues in the the scenario
scenario scenario
Discussion Inappropriate Appropriate, well Well documented,
making/ solutions to some of thorough reasoned and
solutions to the the issues in the case response and pedagogically
situation scenarios solution to the appropriate response
situation to all and solution to the
issues in the case situation to all issues in
scenarios the case scenarios

Links to the Limited Good Excellent documentation

course readings documentation and documentation and clear links to course
and additional links to course and clear links to reading and additional
research reading and course reading research
additional research and additional
research