Overview of Public Health Nursing

DEFINTION & FOCUS a. Relational / interactive grps., in which

setting is more abstract & people
Health share perspective / identity based on
culture, values, interests, goals,
 State of complete physical, mental & social history (schools, churches, org.)
well-being & not merely absence of disease
(WHO) COMMUNITY HEALTH NURSING & PUBLIC HEALTH
 Extent to which individual is able to realize NURSING
aspirations & satisfy needs; change / cope w.
environment Community Health Nursing (CHN)

Social Health  Synthesis of nursing practice & public health

practice applied to promoting & preserving
 Community vitality & result of (+) interaction health of pop.
among grps. Within community w/ emphasis on
health promotion & illness prevention Public Health Nursing (PHN)

Concept of wellness (Dunn)  Practice of promoting & protecting health of

pop. Using knowledge from nursing, social &
 Family, community, society, & environment are public health sciences
interrelated & have impact on health
 Illness, health & peak of wellness are on Community-based nursing
continuum
 Application of nursing process in caring for
Community individuals, families, & grps. Where they lie,
work / go to school / as they move through
 Grp. Of people sharing common geographic health care sys.
boundaries / values & interests
 Collection of people who interact w/ one GOALS
another & whose common interest /
characteristic form basis for sense of unity / Community Health Nursing
belonging
 Preservation & protection of heath
Community health  Primary client is community

 Part of paramedical & medical intervention / Community-based Nursing

approach which is concerned on health of
whole pop.  Managing acute / chronic conditions
 Aims  Primary clients are individual & family
o Health promotion
PUBLIC HEALTH
o Disease prevention
o Management of factors affecting Public Health (Winslow)
health
 Is science & art
Characteristics of a community o Preventing disease, prolonging life, &
promoting health efficiency through
 Defined by its geographical boundaries w/ organized community effort
certain identifiable characteristics o Ensure everyone standard of living
 Made up of instit. organized into social sys. w/ adequate for maintenance of health
instit.& org. linked in complex network having o Enable citizen to realize his birthright
formal & informal power structure & of health & longevity
communicable sys.
 Common / shared that binds members together Basic principles
exists
 Has area w/ fluid boundaries within which  PHN gives emphasis on primary level of
problem can be identified & solved prevention
 Has pop. Aggregate concept  Involvement & cooperation w/ other members
of health care team is needed
Types of Community (Maurer & Smith)
ADVANTAGES OF PUBLIC HEALTH NURSING
1) Geopolitical
a. Natural & man-made boundaries  Gives nurse vivid picture of over all health
(brgy., municipalities, cities, status of community
provinces, regions)  Learn, conceive, & implement DOH programs
2) Phenomenological  Nurse appreciate role in nation building
Grps. = groups Pop. = population Sys. = system
Instit. = institution Org. = organizations Imp. = importance
No. = number Act. = activities Gen. = general
Gov.’t = government
  Focuses on care from individual to family & LEVELS OF HEALTH CARE AND REFERRAL SYSTEM
community
 Tend to assume their health responsibility
 Utilize inside & outside org.
 Due to lack of facilities, nurse creates sense of
resourcefulness

DISADVANTAGES OF PUBLIC HEALTH NURSING

 Most cases are hazardous & proper universal

precaution is not appropriately practice
 Technological awareness is not practiced &
delayed
 Work hrs. are long & not fixed
 Diff. places have diff. practices SPECIALIZED FIELD IN COMMUNITY HEALTH
 Not all health workers are enjoying & NURSING
appreciating wonderful world of PHN
1)School health nursing (SHN)
QUALITIES OF GOOD PUBLIC HEALTH NURSE
 Type of PHN that focuses on promotion of
 Knowledgeable health & wellness of pupils, teaching & non-
 Skillful teaching personnel of schools
 Good judgement  Determined by characteristics of clientele (age,
 Right attitude developmental age, common health problems)
 Other determinants
FUNCTIONS OF PHN o Health problems of school children
1) Manager are result of economic &
2) Supervisory environmental factors
3) Nursing care o School nursing practice which include
4) Collaboration & coordinating policies & standards of DEPED,
5) Health promotion & education culture & sports & DOH, & standards
6) Training of nursing profession
7) Research
Health is an important requisite in education
COMMUNITY HEALTH NURSING
 SHN aims @ promoting health of students &
Community health Nursing preventing health problems that hinder their
learning & performance of their developmental
 Specialized field of nursing practice anchored tasks
on nursing theories & imp. concepts from  SHN accepts that health is affected by factors
science of public health such as: outside school setting such as poverty, family
o Emphasis on importance of “greatest dynamics, lifestyle
good for greatest no.
o Priority of health-promotive & Objective of school nursing
disease-preventive strategies over
 Promote quality nursing service to school pop.
curative interventions
By providing comprehensive & quality nursing
Clients of community health nursing care

 Individual Health & Nutrition Center (HNC) of DEPED

 Family
 mandated to safeguard health & nutritional well-
 Population groups being of total school pop.
 community  2 divisions:
o Health
RESPONSIBILITIES OF COMMUNITY HEALTH
NURSING o Nutrition
 4 sections of health division:
 Providing care to disabled ones o Medical
 Maintaining healthy environment o Dental
 Teaching / advocating / collaborating o Nursing
 Identify needs & referring them for service o Health education
 Preventing & reporting neglect & abuse
 Participate in professional development act. Duties & responsibilities
 Ensuring quality nursing research &
 Health advocacy
engagement in nursing research
 Health & nutrition assessment

Grps. = groups Pop. = population Sys. = system

Instit. = institution Org. = organizations Imp. = importance
No. = number Act. = activities Gen. = general
Gov.’t = government
  Supervision of health & safety of school plant  PHN can be occupational nurse who is in
 Treatment of common ailments & attending to position to assess needs of working pop. &
emergency cases design working interventions
 Referrals & follow up of pupils & personnel
 Home visits Primary focus:
 Community outreach like attending community
 Assure so far as possible every working man &
assemblies & organizing school community
woman in country is safe & in healthful working
councils
conditions
 Recording & reporting of accomplishments
 Occupational health & safety should be
 Monitoring & evaluation of programs & projects
considered integral part of all health services
Skills needed by & provided to the school nurses to
Professional goals
enable them to deliver effective health care to school
populace 1) Occupational health nurses
a. Promote & maintain health & safety
 Assessment & screening skills of workers through systemic process
 Health counseling skills of assessment, planning, intervention
 Social mobilization skills & evaluation
 Good oral & written skills 2) Occupational physicians
 Basic management skills 3) Industrial hygienists
 Life skills 4) Safety engineers & other safety professionals
5) Epidemiologists
Functions of school nurse 6) Toxicologists
7) Industrial engineers
 School health & nutrition survey 8) Ergonomist
 Putting up functional school clinic 9) Health educators
 Health assessment interviewing 10) Environmental engineers
 Nutritional assessment (height & weight
measurement) Essential components of this specialty practice
 Vision acuity / hearing test
 4 methods of physical examination (inspection,  Health promotion & prevention principles
percussion, palpation, auscultation)  Worker / workplace health hazard assessment
 Taking viral signs & surveillance
 Appraisal of gen. physical & mental condition  Injury & illness investigation, analysis, &
 Recording of findings prevention
 Medical referrals  Primary care
 Attendance to emergency cases  Case management
 Student health counseling  Counseling
 Health & nutrition education act.  Management & administration
 Legal & ethical monitoring
2)Communicable Disease Control  Research
 Community orientation
3)Establishment of data bank on school health & nutrition
activities COMMUNITY MENTAL HEALTH NURSING

4)School plant inspection for healing environment Community mental health nursing

5)Rapid classroom inspection  Started in US (1960) w/ belief that person gets

better faster if he is placed in environment
6)Home visitation familiar to him
 Patient does not need to be hospitalized away
OCCUPATIONAL HEALTH NURSING from home & community
Occupational nursing  Emphasize work on mental health promotion
 Help people to recover from illness / come to
 CHN focused on people in their places of work, terms w/ its in order to maximize life potential
part of bigger community
Mental health nurses work w/:
 Focuses on promotion, protection, & restoration
of worker’s health within context of safe &
 Children, adults, & older people suffering from
healthy work environment
various types of mental health problems
 Autonomous, & make independent nursing
 Liaise w/ psychiatrists, occupational therapists,
judgements in providing occupational health
GPs, social workers & other health professional
services
to plan & deliver care using multidisciplinary
Determinants: client-centered approach

MHN work in:

 Gov.’t policies & standards (DOLE, DOH, SSS)
Grps. = groups Pop. = population Sys. = system
Instit. = institution Org. = organizations Imp. = importance
No. = number Act. = activities Gen. = general
Gov.’t = government
  Home, residential units, National Health Service Role in community mental health nursing involve:
(NHS), private specialist hospital services &
secure units  Coordinating care of patients
 Liaising w/ patients, relatives, & fellow
Advantages: professionals in community treatment team &
attending regular meetings to review & monitor
 Less expensive & intervention in familiar patients’ care plans
surroundings  Visiting patients in home to monitor progress
 Assessing patients’ behavior & psychological
Disadvantage: needs
 Identifying if & when patient is @ risk of
 Homelessness is linked to
harming themselves / others
deinstitutionalizations

STANDARDS OF PUBLIC HEALTH NURSING

Standards of care

STANDARD 1
Assessment PH nurse collects comprehensive data pertinent to health status of pop.
STANDARD 2
Population, Diagnosis, Priorities PH nurse analyzes assessment data to determine pop. Diagnosis & priorities
STANDARD 3
Outcomes identification PH nurse identifies expected outcomes for plan that is based on pop. Diagnoses
& priorities
STANDARD 4
Planning PH nurse develops plan that reflects best practices by identifying strategies,
action plans & alternatives to attain expected outcomes
STANDARD 5
Implementation PH nurse implements identified plan by partnering w/ others
Coordination Coordinate programs, services & other act. To implement identified plan
Health education & health promotion Employs multiple strategies to promote health, prevent disease & ensure safe
environment for pop.
Consultation Provide consultation to various community grps. Officials to facilitate
implementation of programs & services
Regulatory activities Identifies, interprets, & implements public health laws, regulations, & policies
STANDARD 6
Evaluation PH nurse evaluates health status of pop.
Standards of professional performance

STANDARD 7
Quality of practice PH nurse systematically enhances quality & effectiveness of nursing practice
STANDARD 8
Education PH nurse attains knowledge & competency that reflects current nursing & public
health practice
STANDARD 9
Professional practice evaluation PH nurse evaluates one’s nursing practice in relation to professional practice
standards & guidelines, relevant, statutes, rules, & regulations
STANDARD 10
Collegiality & professional relationship PH nurse establishes collegial partnerships while interacting w/ representatives
of pop., org., & health & human services professionals & contributes to
professional development of peers, students, colleagues, others
STANDARD 11
Collaboration PH nurse collaborates w/ representatives of pop., org., & health & human
services professionals in providing for & promoting health of pop.
STANDARD 12
Ethics PH nurse integrates ethical provisions in all areas of practice
STANDARD 13
Research PH nurse integrates research findings in practice
STANDARD 14
Resources utilization population PH nurse consider factors related to safety, effectiveness, cost & impact on
practice & in planning & delivery of nursing & public health programs, policies, &
services
STANDARD 15
Leadership PH nurse provides leadership in nursing & public health

Grps. = groups Pop. = population Sys. = system

Instit. = institution Org. = organizations Imp. = importance
No. = number Act. = activities Gen. = general
Gov.’t = government
 EVOLUTION OF PUBLIC HEALTH NURSING IN THE 1954 – Congress passed RA 1082
PHILIPPINES
 Rural Health Act – provided for creation of rural
1577 – Spanish regimen health unit in every municipality
 Provided for employment of physicians to serve
 Franciscan Friar Juan Clemente as municipal health officers, health nurse,
o Opened medical dispensary in midwives & sanitation inspectors in rural health
Intramuros for indigent units
 Provided for provincial health officer for each
1690 - Dominican Father Juan de Pergero province & public health dentist for each
congressional district
 Worked toward installing water sys. In San
Juan del Monte (San Juan City, Metro Manila) RA 1891 enacted in 1957
& Manila
 Smallpox vaccination was introduced by Fr.  Amended certain provisions in the Rural Health
Francisco de Balmis (personal physician of Act
King Charles IV of Spain)  created 8 categories of rural health units
corresponding to the population size of the
1876 - Medicos Titulares municipalities
 Regional health offices were created as a result
 Appointed by Spanish Gov.’t
of decentralization efforts in 1958
 Worked as provincial health officers
 2-yr. course consisting of fundamental medical RA 1891 enacted in 1957
& dental subjects was offered in UST in 1888
 Cirujanos Ministrantes – graduate of this course  1970 – Philippine Health Care Delivery System
 Serve as male nurses & sanitation inspectors was restructured, paving the way for the health
care system that exist to this day were health
1901 – US Regimen care services are classified into
o Primary
 US Phil. Commission through Act 157 created o Secondary
Board of Health of the Philippine Islands, w/ o Tertiary levls
Commission of Public Health, as its chief
 redefinition and expansion of the roles of the
executive officer
public health nurse and midwife in health
 Board of Health evolved into Department of centers and rural health units
Health
 Provincial & municipal boards of health were RA 7160 – LOCAL GOVERNMENT CODE (1991)
formed
 mandated devolution of basic services,
Fajardo Act of 1912 including health services, to local government
units and the establishment of a local health
 Created sanitary divisions made up of 1-4 board in every province and city or municipality
municipalities  2000 –The Philippines is a signatory to the
o Each division had “president” United Nations Millennium Declaration adopted
(physician) during the World Summit in September
 Sanitation inspector (nurse) o 8 MDGs
o DOH has committed to attainment of
1915
the health MDGs to reduce child
 Phil. Gen. Hospital extend PHN services in mortality, to improve maternal health
home of patients by organizing unit (Social & & combat HIV/AIDS, malaria, etc.
Home care service), w/ 2 nurses as staff
The DOH has directed efforts toward comprehensive
Association Feminista Filipina in 1905 reforms in health care with the health Sector Reform
Agenda launched in 1999
 La Gota de Leche
o 1st center dedicated to service of  It’s implementation framework FOURmula one
(F1) for health in 2005
mothers & babies
 In addition to puericulture centers, municipal & Universal Health Care in 2010
charity clinics we set up, manned either by
physician nurse / midwife
 aims to achieve the health system goals of
1947 better health outcomes, sustained health
financing and responsive health system that will
 DOH was reorganized into bureaus provide equitable access to health reform
 Quarantine hospitals that took charge of implementation deliberately focused on
municipal & charity clinics economically disadvantaged Filipinos to ensure
 Health w/ sanitary divisions under it that they are given risk protection through

Grps. = groups Pop. = population Sys. = system

Instit. = institution Org. = organizations Imp. = importance
No. = number Act. = activities Gen. = general
Gov.’t = government
 enrolment in Philhealth & able to access
affordable and quality health services

Grps. = groups Pop. = population Sys. = system

Instit. = institution Org. = organizations Imp. = importance
No. = number Act. = activities Gen. = general
Gov.’t = government