COMMUNITY HEALTH NURSING 1

MODULE 1

Public Health Nursing in the Philippines

Course Learning Outcomes

At the end of the module, the students are expected to apply the principles,
concepts and approaches of community health nursing in the care of the individual,
family, population group in particular and the community in general to improve one’s
and the community’s health.

Specific Learning Outcomes

a. Analyze national and global health situation in terms of health promotion
and disease management
b. Contextualize the role of public health, community health nursing and the
roles of a community health nurse in the development of the individual,
family and the community
c. Articulate comprehensively the MDG’s and SDG’s
d. Formulate strategies on how to implement the MDG’s and SDG’s in their
respective barangays

Contents of the Module

This module contains the following lessons:
Lesson 1: Global and national health situations
Lesson 2: Definition and focus
Lesson 3. WHO Millennium Development Goals and Sustainable Development
Goals

Introduction

 Community health nursing involves a holistic approach to patient care

 As such nurses need to possess critical thinking skills to solve problems and
make decisions
 Interventions are aimed at individuals, families and groups within a geographic
area
 Nursing care focuses on managing and preventing diseases as well as educating
a community about maintaining well-being
 To educate and treat the community, the nurse need to consider several factors
such as Community health nursing is important because there are members of
society who do not have access to healthcare. Nurses work in communities to
 reach people who need assistance with treating medical conditions and
maintaining their health
 Part of the community health nursing activities include visiting families in their
homes as some may not seek medical care due to lack of funds to finance their
healthcare needs, lack of transportation and lack of knowledge where to seek
medical help
 Responsibilities of community health nurses include providing care to children
and adults, give health education, maternal and child care, etc.
(https://online.stu.edu/articles/nursing/whats-important-community-health-
nursing.aspx)

LESSON 1 - Global and National Health Situations

PHILIPPINE HEALTH SITUATION ((http://www.doh.gov.ph/sites/default/files/basic-

page/chapter-one.pdf)
 Health care has been defined by the WHO as solution and maintenance of the
health needs of the individual, family and community
 large gap between the quality and quantity of health services for the poor and
the rich has been noted (WHO)
 reasons for the gap includes low budget, low number of man power, or general
neglect for the poor
(https://en.wikipedia.org/wiki/Health_care_in_the_Philippines)
 advances in health care has been made in recent years but not all have
reached the vulnerable groups
 maternal and child health services have improved, with more children living
beyond infancy, a higher number of women delivering at health facilities and
more births being attended by professional service providers than ever before
 access to and provision of preventive, diagnostic and treatment services for
communicable diseases have also improved
 many Filipinos continue to die or suffer from illnesses that have well-proven,
cost-effective interventions, such tuberculosis, HIV and dengue, or diseases
affecting mothers and children
 many people also lack sufficient knowledge to make informed decisions about
their own health.
 rapid economic development, urbanization, escalating climate change, and
widening exposure to diseases and pathogens in an increasingly global world
also increases the risks associated with disasters, environmental threats, and
emerging and re-emerging infections
 health reforms were later initiated to address the health issues such as the
adoption of primary health care (PHC) approach in 1979 promoted
participatory management of the local health care system
 PHC emphasized the delivery of eight essential elements of health care,
including the prevention and control of prevalent health problems; the
promotion of adequate food supply and proper nutrition; basic sanitation and
 adequate supply of water; maternal and child care; immunization; prevention
and control of endemic diseases; appropriate treatment and control of
common diseases; and provision of essential drugs
 the Generics Act was adopted in 1988 to ensure adequate supply, distribution
and use of generics thereby improving access to affordable drugs and
medicines
 Local Government Code (LGC, R.A. 7160) transferred the responsibility of
health service provision to the local government units. The intention of LGC
was to establish a more responsive and accountable local government
structure
 During that time, more than half of the population had no coverage, especially
the poor, the self-employed and informal sector workers (World Health
Organization, 2011).
 National Health Insurance Act of 1995 or RA 9875 was enacted which aims to
provide all citizens a mechanism for financial protection with priority given to
the poor.
 Resulted in the creation of the National Health Insurance Program “which shall
provide health insurance coverage and ensure affordable, acceptable,
available and accessible health services for all citizens of the Philippines.”
(http://www.doh.gov.ph/sites/default/files/basic-page/chapter-one.pdf)

GLOBAL HEALTH SITUATION

(https://www.who.int/whr/1998/media_centre/50facts/en/)
 the goal is to improve public health and strengthen national security through
global disease detection, response, prevention, and control strategies.
 infectious diseases will still dominate in developing countries.
 as the economies of these countries grow, non-communicable diseases will
become more prevalent. This will be due largely to the adoption of
"western" lifestyles and their accompanying risk factors - smoking, high-fat
diet, obesity and lack of exercise.
 In developed countries, non-communicable diseases will remain dominant.
Heart disease and stroke have declined as causes of death in recent
decades, while death rates from some cancers have risen.
 About 1.8 million adults died of AIDS in 1997 and the annual death toll is
likely to continue to rise for some years.
 Diabetes cases in adults will more than double globally from 143 million in
1997 to 300 million by 2025 largely because of dietary and other lifestyle
factors.
 Cancer will remain one of the leading causes of death worldwide.
 Cancer and heart disease are more related to the 70-75 age group than any
other; people over 75 become more prone to impairments of hearing,
vision, mobility and mental function.
 By 2025 the risk of cancer will continue to increase in developing countries,
with stable if not declining rates in industrialized countries.
  Cases and deaths of lung cancer and colorectal cancer will increase,
largely due to smoking and unhealthy diet respectively.
 Cervical cancer is expected to decrease further in industrialized countries
due to screening. The incidence is almost four times greater in the
developing world. The possible advent of a vaccine would greatly benefit
both the developed and developing countries.
 Liver cancer will decrease because of the results of current and future
immunization against the hepatitis B virus in many countries.
 Data from France and the United States show breast cancer on average
deprives women of at least 10 years of life expectancy, while prostate
cancer reduces male average life expectancy by only one year.
 In general, more than 15 million adults aged 20-64 are dying every year.
Most of these deaths are premature and preventable.
 Among the premature deaths are those of 585 000 young women who die
each year in pregnancy or childbirth. Most of these deaths are preventable.
Where women have many pregnancies the risk of related death over the
course of a lifetime is compounded. While the risk in Europe is just one in 1
400, in Asia it is one in 65, and in Africa, one in 16.

LESSON 2 - Definition and focus of Community Health Nursing

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 insure 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 (Nisce,
2000)

Community Health - The WHO defines community health as: environmental, social,
and economic resources to sustain emotional and physical well-being among
people in ways that advance their aspirations and satisfy their needs in their
unique environment.
Community Health Nursing - a service rendered by a professional nurse with the
community, groups, families and 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 (Freeman as cited in
Cuevas, 2007).

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 (Cuevas, 2007).
- refers to the practice of nursing in national and local government health
departments which includes health centers and rural health units and public
schools (Famorca et al., 2013)

Community – geographical boundaries combined with social attributes of people

(Famorca et al., 2013)
- a collection of people who interact with one another and whose
common interests or characteristics form a basis for a sense of
unity or belonging (Allender, 2009, p. 6 as cited in Famorca et
al., 2013)

Health – a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity (WHO)

Concepts (Nisce, 2000):

1. The primary focus of Community Health Nursing is health promotion. The
community health nurse, by the nature of his/her work, has the opportunity
and responsibility of evaluating the health status of people and groups and
relating them to practice.
2. Community health nursing practice is extended to benefit not only the
individual but the whole family and community.
3. Community health nurses are generalists in terms of their practice through
life’s continuum – its full range of health problems and needs.
4. Contact with the client and family may continue over a long period of time
which includes all ages and all types of health care.
5. The nature of community health nursing practice requires that current
knowledge derived from the biological and social sciences, ecology, clinical
nursing and community health organizations be utilized.
6. The dynamic process of assessing, planning, implementing and intervening
provide periodic measurements of progress, evaluation and a continuum of
the cycle until the termination of nursing is implicit in the practice of
community health nursing.

Principles (Nisce, 2000):

1. Community health nursing is based on recognized needs of communities,
families, groups and individuals.
2. The community health nurse must understand fully the objectives and policies
of the agency she represents.
3. In community health nursing, the family is the unit of service.
4. Community health nursing must be available to all regardless of race, creed
and socio-economic status.
5. Health teaching is a primary responsibility of the community health nurse.
6. The community health nurse works as a member of the health team.
 7. There must be provision for periodic evaluation of community health nursing
services.
8. Opportunities for continuing staff education programs for nurses must be
provided by the community health nursing agency. The community health
nurse also has a responsibility for his/her own professional growth.
9. The community health nurse makes use of available community health
resources.
10. The community health nurse utilizes the already existing active organized
groups in the community.
11. There must be provision for educative supervision in community health
nursing.
12. There should be accurate recording and reporting in community health
nursing.

Other related Concepts and Principles of Community Health Nursing:

1. The family is the unit of care; the community is the patient and there are four
levels of clientele in CHN.
2. The goal of improving community health is realized through multidisciplinary
effort.
3. The community health nurse works with and not for the individual, patient,
family group or community. The latter are active partners, not passive
recipients of care.
4. The practice of community health nursing is affected by changes in society in
general and by developments in the health field in particular.
5. Community health nursing is part of the community health system, which in
turn is part of the larger human services system.

Community Health Nursing is a synthesis of nursing and public health practice

(Nisce, 2000):
1. Emphasis is on the importance of the “greatest good for the greatest number”.
2. Assessing health needs, planning, implementing and evaluating the impact of
health services on population groups.
3. Priority of health is promotive and disease-preventive strategies over curative
interventions.
4. Utilizes tools for measuring and analyzing community health problems.
5. Application of principles of management and organization in the delivery of
health services to the community.

Determinants of Health (WHO, 2017)

Determinants of health are the broad range of personal, social, economic and
environmental factors that determine individual and population health
(https://www.canada.ca/en/public-health/services/health-
promotion/population-health/what-determines-health.html)
Social determinants of health refer to a specific group of social and economic factors
within the broader determinants of health. These relate to an individual's
place in society, such as income, education or employment
(https://www.canada.ca/en/public-health/services/health-
promotion/population-health/what-determines-health.html)

 Income and social status - higher income and social status are linked to better
health. The greater the gap between the richest and poorest people, the greater
the differences in health.
 Education – low education levels are linked with poor health, more stress and
lower self-confidence.
 Physical environment – safe water and clean air, healthy workplaces, safe
houses, communities and roads all contribute to good health. Employment and
working conditions – people in employment are healthier, particularly those who
have more control over their working conditions
 Social support networks – greater support from families, friends and communities
is linked to better health. Culture - customs and traditions, and the beliefs of the
family and community all affect health.
 Genetics - inheritance plays a part in determining lifespan, healthiness and the
likelihood of developing certain illnesses. Personal behaviour and coping skills –
balanced eating, keeping active, smoking, drinking, and how we deal with life’s
stresses and challenges all affect health.
 Health services - access and use of services that prevent and treat disease
influences health
 Gender - Men and women suffer from different types of diseases at different
ages.

Standards of Community Health Nursing in the Philippines (Famorca et al., 2013)

Standards of Care
Standard 1. Assessment The public health nurse collects comprehensive data
pertinent to the health status of populations
Standard 2. Population The public health nurse analyzes the assessment
Diagnosis and data to determine the population diagnosis and
Priorities priorities
Standard 3. Outcomes The public health nurse identifies the expected
identification outcomes for a plan that is based on population
diagnostic 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. Implementation The public health nurse implements the identified plan
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 activities Identifies, interprets, and implements public health
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 evalua- practice in relation to professional practice standards
tion. and guidelines, relevant statutes, rules, and
regulations.
Standard 10. Collegiality and The public health nurse establishes collegial
professional re- partnerships while interacting with representatives of
lationships 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 the 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 utili- The public health nurse considers factors related to
zation popula- safety, effectiveness, cost, and impact on practice
tion 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 (David et al., 2007)
Spanish Regime (1591-1898)
 Public health services was started through a dispensary in Intramuros was
started by Bro. Juan Clemente
 Introduction of small pox vaccine and water sanitation was started
 Position of district, provincial and national health officers was created

American Regime (1898-1942)

 Board of Health for Physicians was created and the first Commissioner of
Health was appointed
 Public Health Nursing in the Philippines started wherein four graduate
nurses from PGH were employed. They engaged purely on Maternal and
Child Health services (1912)
 Public health nursing began in OB patients and environmental sanitation
services
 Demands for nurses to work outside the hospital, in the homes and the
need for direction, supervision and guidance of public health nurses have
increased
 Public health nursing inaugurated its pioneer work in Tondo, manila
wherein a visiting nurse was assigned to do a house to house visit, hold
clinic and dispensary work with emphasis on maternal and child health
 Creation of the Department of Health (1940)

Japanese Regime (1942-1945)

 Public health nursing services were interrupted
 Public health nurses in manila were assigned to attend to the sick and
wounded civilians in devastated areas caused by bombing
 Some nurses were taken as prisoners of war and many public health
nurses joined the guerillas or went to hide in the mountain during the war
 During the liberation period, many of them found jobs in Army Hospitals
and the Manila Health Department
 In the middle of 1945, public health nurses were recalled to the Bureau of
Health Services

Era of the Republic of the Philippines (1946 to present)

 The department was renamed Department of health
 Rural health Unit Act (RA 1082) was passed in July 1954; employment of health
personnel including nurses who would man the RHU’s
  Approval of RA 1891 (An Act Strengthening Health and Dental Services in the
Rural Areas and Providing Funds Thereof) in June 1957
 Formulation of the National Health Plan and the Restructured Health Care
Delivery System (1975)
 The Local Government Code of 1991 (RA 7160) was implemented which
resulted in the devolution of power and authority from the national to the local
government
 Primary Health Care as a strategy to attain “Health for All by the year 2000” was
in focus (1996)
 Fourmula One was launched by the Department of Health to ensure speed,
precision, and effective coordination towards improving the efficiency,
effectiveness and equity of health care delivery (2005)

Clients of Community Health Nurses (Maglaya, 2009)

1. Individual- CHN deals with individuals sick or well on a daily basis. Since the
health problems of the 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.
2. Family – is defined as a collection of people who are integrated, interacting and
interdependent. Just like other systems, the parts (family members) interact with
each other and the action of one affects the other members. The family has its
boundaries, which means that other people can recognize its members and
those who are not. In fact, a person may be identified primarily as a member of a
particular family.
3. Population group – it is 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
- Allender and Spradley identified population “aggregates” those
with/are:
a. Developmental needs (such as: maternal, prenatal and
newborn populations; infant, toddler and preschool
populations; school aged and adolescent populations;
adults and working populations; and older adult
populations)
b. Vulnerable (rural clients, the poor, migrant workers,
minority populations experiencing health disparities,
those with mental health issues, those living with
addiction, those in correctional facilities and those in
long-term care settings)
 - Population groups are the usual targets or beneficiaries of
social health programs.
4. Community – a group of people sharing common geographic boundaries and or
common values and interest within a specific social system.
-“webs” of people shaped by relationships, interdependence, mutual
interests and patterns of interaction (Behringer and Richards)
- Although all communities are the same, each one is unique
because it functions with a specific socio-cultural, political, economic and
environmental context.
- They also vary in terms of community dynamics – citizen
participation, power and decision-making structures and community collaboration
efforts.

Roles and Functions of the PHN (Nisce, 2000):

1. Planner/Programmer – Identifies needs, priorities and problems of individuals,
families and community
- Formulates nursing component of health plans. In doctorless
area, he/she is responsible for the formulation of the municipal
health plan.
- Interprets and implements the nursing plan, program policies,
memoranda and circulars for the concerned staff/personnel
- Provides technical assistance to rural health midwives in health
matters like target setting, etc.
2. Provider of nursing care – provides direct nursing care to the sick, disabled in the
home, clinic, school or place of work.
- Develops the family’s capability to take care of the sick,
disabled or dependent member
- Provides continuity of care.
3. Manager/Supervisor – formulates individual, family, group and community
centered care plan
- Interprets and implements program policies, memoranda and
circulars
- Organizes workforce, resources, equipment and supplies and
delivery of health care at local levels
- Requisitions, allocates, distributes materials (medicine and
medicinal supplies, records and reports equipment)
- Provides technical and administrative support to Rural Health
Midwife
- Conducts regular supervisory visits and meetings to different
RHMs and gives feedback on accomplishments/performances
4. Community Organizer – responsible for motivating and enhancing community
participation in terms of planning, organizing and implementing and evaluating
health programs/services
- Initiates and participates in community development activities
5. Coordinator of Services – coordinates with individuals, families, and groups for
health and related health services provided by various members of the health
team and other government organizations (GO’s) and non-government
organizations (NGOs)
- Coordinates nursing program with other health programs as
environmental sanitation, health education, dental health and
mental health.
6. Trainer/Health Educator – identifies and interprets training needs of the RHMs,
Barangay Health workers and hilots
- Formulates appropriate training program designs for RHMs,
Barangay Health hilots
- Provides and arranges learning experience for RHMs, affiliates
and other health workers
- Conducts trainings for RHMs and hilots on health promotion
and disease prevention
- Conducts pre and post consultation conferences for clinics
- Facilitates training for barangay health workers
- Organizers orientation/training of concerned groups including
non-government organizations
- Acts as a resource speaker/person on health and health related
services
- Participates in the development and distribution of Information,
Education and Communication (IEC) materials.
- Conducts IEC orientation for selected group on specific
programs and projects
- Initiates the use of tri-media: radio/TV and cinema plugs, print
ads, and other indigenous resources for health education
purposes
- Conducts pre-marital counselling
7. Health monitoring – detects deviation from health of individuals, families, groups
of the community through contact/visits with them
- Uses symptomatic and objective observations and other forms
of data gathering like morbidity, registry, questionnaire,
checklist and anecdotal report/record to monitor growth and
development and health status of individuals, families and
communities
 8. Role Model – provides good example/model of healthful living to the
public/community
9. Change Agent – motivates changes in health behavior of individuals, families,
group and community including lifestyle in order to promote and maintain health
10. Recorder/Reporter/Statistician – prepares and submits required records and
reports
- Maintains adequate, accurate and complete recording and
reporting
- Reviews, validates, consolidates, analyzes and interprets all
records and reports
- Prepares statistical data/charts and other data presentations for
display and presentation in staff meetings, conferences and
seminar/workshops
11. Researcher – participates/assists in the conduct of surveys, studies and
researches on nursing health related subjects
- Coordinates with government and non-government
organizations in the implementation of studies/research

LESSON 3 - Millennium Development Goals and Sustainable Development Goals

Millennium Development Goals (WHO, n.d.)

Goal 1. Eradicate extreme poverty and hunger
Goal 2. Achieve universal primary education
Goal 3. Promote gender equality and empower women
Goal 4. Reduce child mortality
Goal 5. Improve maternal health
Goal 6. Combat HIV/AIDS, malaria and other diseases
Goal 7. Ensure environmental sustainability
Goal 8. Develop a global partnership for development
(https://www.who.int/topics/millennium_development_goals/about/en/)

Sustainable Development Goals (UN, n.d.)

1. No poverty
2. Zero hunger
3. Good health and well-being
4. Quality education
5. Gender equality
6. Clean water and sanitation
7. Affordable and clean energy
8. Decent work and economic growth
9. Industry, innovation and infrastructure
 10. Reduced inequalities
11. Sustainable cities and communities
12. Responsible consumption and production
13. Climate action
14. Life below water
15. Life on land
16. Peace and justice strong institutions
17. Partnerships for the goals
(https://www.un.org/development/desa/disabilities/envision2030.html)

Activities:
 Interactive online lecture-discussion
 Brainstorming and sharing of experiences
 Concept Paper on “Analysis of the Health situation in our Respective
Barangays/Municipalities”
 Quiz through Google Classroom

Evaluation:
 Rubrics in grading Concept Papers
 75% passing rate in quizzes

References:
Castro, C.E. (2012). Community health nursing and community health development. 1st
ed., Educational Publishing House: Philippines
Cuevas, F.P. (2007). Public health nursing in the Philippines, 10th ed., Nationa League
of Government Nurses: Philippines
Country Cooperation Strategy at a Glance (WHO)
https://apps.who.int/iris/bitstream/handle/10665/136828/ccsbrief_phl_en.pdf;jsessionid=
162AFB0539FD4B5EEA2E0322EFCAEBDB?sequence=1
David, E.S., Rodolfo, M.J.L. S., Claudio, V.S., Ruiz, A.J. (2007). Community health
nursing. An approach to families and population groups. Merriam & Webster
Bookstore, Inc: Manila, Philippines
Famorca, Z.U., Nies, M.A., McEwan, M. (2013). Nursing care of the community. A
comprehensive text on community and public health nursing in the
Philippines, Elsevier: Singapore
Maglaya, A.S. (2009). Nursing practice in the community, 9th ed., Argonauta Corp.:
Philippines
Reyala, J.P., Nisce, Z.P., Martinez, F.R., Hizon, N.F., Ruzol, C.A., Dequiña, R.B.,
Alcantara, A.P., Bermudez, M.T.C., Estipona (2000). Community health
Nursing services in the Philippines, 9th ed., Community Health Nursing Section,
National League of Government Nurses, Inc.: Philippines
WHO (2017). Determinants of Health. Retrieved from https://www.who.int/news-room/q-
a-detail/determinants-of-health