Basic Concepts and Principles of Community Organized, legislated, and tax-supported efforts

Health Nursing that serve all people through health departments or

related governmental agencies.
Health So, organizing these benefits as to ENABLE
A state of complete physical, mental, and social EVERY CITIZEN TO REALIZE HIS BIRTHRIGHT
well-being and not merely the absence of disease TO HEALTH AND LONGEVITY
or infirmity. ---DR. C. E. WINSLOW---
-WHO (1958)- The art of applying science in the context of politics
“The extent to which an individual or group is able, so as to reduce inequalities in health while ensuring
on the one hand, to realize aspirations and satisfy the best health for the greatest number.
needs; and, on the other hand, to change or cope ---World Health Organization---
with the environment. Health is, therefore, seen as
a resource for everyday life, not the objective of Community Health Nursing
living; it is a positive concept emphasizing social Service rendered by a professional nurse or
and personal resources, and physical capacities.” midwife to communities, groups, families, and
individuals at home, in health centers, in clinics, in
“A state of well-being in which the person is able to schools and in places of work for the promotion of
use purposeful, adaptive responses and process health, prevention of illness, care of the sick at
physically, mentally, emotionally, spiritually and home and rehabilitation
socially.” (Murray et al., 2009) ---RUTH B. FREEMAN--
“Actualization of inherent and acquired human -
potential through goal-directed behavior, competent Nursing and midwifery practice in a wide variety of
self care, and satisfying relationship with others.” community services and consumer advocate areas,
(Pender et al., 2006) and in a variety of roles, at times including
“A state of well-being in which the person is able to independent practice
use purposeful, adaptive responses and process Is certainly NOT confined to public health nursing
physically, mentally, emotionally, spiritually and agencies
socially.” (Murray et al., 2009) ---JACOBSON, 1975---
“Actualization of inherent and acquired human The utilization of the NURSING PROCESS in the
potential through goal-directed behavior, competent different levels of clientele – individuals, families,
self care, and satisfying relationship with others.” population groups, and communities, concerned
(Pender et al., 2006) with the promotion of health, prevention of disease
and disability and rehabilitation
Community ---DR. ARACELI MAGLAYA,
“A collection of people who interact with one et al.---
another and whose common interests or The goal of CHN is to raise level of health of the
characteristics form the basis for a sense of unity or citizenry by helping communities and families cope
belonging.” (Allender et. Al, 2009) with the discontinuities in and threats to health in
“A group of people who share something in such a way as to maximize their potential for high-
common and who interact with one another, who level wellness
may exhibit a commitment with one another, who the synthesis of nursing practice and public health
may share a geographic boundary.” practice applied to promoting and preserving the
(Lundy and Janes, 2009) health of populations. (ANA, 1980)
“A locality-based entity, composed of systems of subspecialties: public health nursing, school
formal organizations reflecting society’s institutions, nursing, occupational health nursing
informal groups and aggregates.” The practice of nursing and midwifery in national
(Shuster and Goeppinger, 2008) and local government health departments and
geographical boundaries public schools
social attributes of people

It is COMMUNITY HEALTH (NURSING)

Public Health PRACTICED IN THE PUBLIC SECTOR
The science and art of preventing disease,
prolonging life, and promoting health and efficiency --- Standards of Public Health Nursing in the
through organized community effort for: Philippines---
a. sanitation of the environment; Special field of nursing and midwifery that
b. control of communicable diseases; combines the skills of nursing & midwifery, public
c. education of individuals in personal health and some phases of social assistance and
hygiene; functions as part of the total public health program
d. organization of medical and nursing for:
services for the early diagnosis and preventive a. promotion of health
treatment of disease; b. improvement of conditions in the
e. development of the social machinery to social and physical environment
ensure everyone a standard of living adequate for c. rehabilitation
the maintenance of health. d. prevention of illness and disability
---WHO Expert Committee on Nursing---
Community-Based Nursing Determinants of Health and Disease
“Application of the nursing process in caring for Income and social status
individuals, families and groups where they live, Education
work or go to school or as they move through the Physical environment
health care system. Employment and working conditions
Social support networks
Related Terms Culture
Population Genetics
- typically used to denote a group of people Personal behavior and coping skills
having common personal or environmental Health services
characteristics Gender
Aggregates
- subgroups or subpopulations that have Focus of PHN
some common characteristics or concerns Health promotion
- activities enhance resources directed at
Community: Main Types improving well-being
Geopolitical communities Disease Prevention
a.k.a. Territorial communities - activities protect people from disease and
Formed by man-made and natural the effects of disease
boundaries
Phenomenological communities
→ a.k.a functional communities Levels of Prevention
→ people share a group perspective Primary Prevention
or identity based on culture, values, history, - directed at preventing a problem before it
interests and goals occurs by altering susceptibility or reducing
exposure for susceptible individuals.
Community: Defining Attributes -General health promotion
People -Specific protection
Place Activites/Examples:
Interaction • Immunization
Common characteristics, interests, or goals • Promotion of good nutrition
• Provision of adequate shelter
• Encouraging regular exercise
Primary Function of Public Health Secondary Prevention
- early detection and prompt intervention
ASSESSMENT: Regular collection, analysis, and during the period of early disease pathogenesis
information sharing about health conditions, risks, Activites/Examples:
and resources in a community. • Screening for sexually transmitted disease
• Mammography
POLICY DEVELOPMENT: Use of information
• Blood pressure screening
gathered during assessment to develop local and
• Newborn screening
state health policies and to direct resources toward
• Sputum examination
those policies.
Assurance: Focuses on the availability of Tertiary prevention
necessary health services throughout the - targets populations that have experienced
disease or injury and focuses on limitation of
community.
disability and rehabilitation.
Essential Public Health Functions - aims to reduce the effects of disease and
injury and to restore individuals to their optimal
• Health situation monitoring and analysis level of functioning.
• Epidemiological surveillance/disease Activites/Examples:
prevention and control • Teaching how to perform insulin injection
• Strategic management of health systems • Referring a patient with a spinal cord injury
and services for population health gain for occupational and physical therapy
• Regulation and enforcement to protect
public health
Population-Focused Approach and Community
• Health promotion, social participation, and Health Nursing Interventions
empowerment • Focuses on the entire population
• Human resources development and • Is based on assessment of the populations’
planning in public health health status
• Ensuring the quality of personal and • Considers the broad determinants of health
population based health service • Emphasizes all levels of prevention
• Research, development, and • Intervenes with communities, systems,
implementation of innovative public health individuals and families
solution
Philosophy of Community Health Nursing a. atomistic
Practice b. holistic

PHILOSOPHY A. ATOMISTIC APPROACH

Defined as a system of beliefs that provides a basis Proposed by Byrne and Thompson
for and guides action ➢ Views man as an organism
It provides the direction and describes the whats, ➢ Sees the whole as equal to the sum of its
whys and hows of activities within the profession parts or subparts
➢ Levels of organization include: 8-12
Philosophy of CHN Practice a. chemical level
H – humanistic values of the nursing profession b. organelle level
upheld c. cellular level
U – unique & distinct component of health care d. tissue level
M – multiple factors of health considered e. organ level
A – active participation of clients encouraged f. system level
N – nurse considers availability of resources
I – interdependence among health team members
practiced B. HOLISTIC APPROACH
S – scientific and up-to-date ➢ Traces the pattern of man’s relationship with
T – tasks of CH nurse vary with time and place other beings in the suprasystem of society
I – independence or self-reliance is the end goal ➢ How man acts and reacts to situational stimuli
C – connectedness of health & development provide clues in understanding his responses
regarded and the reasons behind them
➢ Man as a whole is different from and is more
Basic Principles of CHN then the sum of his component parts
The COMMUNITY is the PATIENT in CHN ➢ Dimensions include: physical, social, spiritual,
FAMILY is the UNIT OF CARE cognitive and psychological
FOUR LEVELS OF CLIENTELE:
a. individuals Five Dimensions of Man
b. families
c. population groups 1. PHYSICAL BEING
d. Community Genetic endowment
Sex
Physical attributes
Client is considered an ACTIVE PARTNER 2. SOCIAL BEING
Affected by developments in health technology in Capable of relating to others
particular and changes in society in general Process of social learning by which a person
The goal is achieved through MULTISECTORAL acquires KSA and roles appropriate to sex, social
EFFORTS class, and ethnic or cultural group
CHN is part of HEALTH CARE SYSTEM and the
larger HUMAN SERVICES SYSTEM
Five Dimensions of Man
Levels of Clientele
CLIENT PATIENT 3. SPIRITUAL BEING
May or may not be sick • sick capable of virtues such as faith, hope and charity
•From the Greek word Believes in a power beyond himself and in
pathein which means transcending one’s limitations in order to become a
"to suffer" better person
Collaborates with the Dependent on health 4. THINKING OR INTELLECTUAL BEING
health professionals professionals for Capable of perception, cognition & communication
when it comes to decisions and health Capable of logical thinking and reasoning
his/her care care 5. PSYCHOLOGICAL BEING
Assumes an active role Passive receiver of capable of feeling, rationality, and all conscious and
in healthcare health services unconscious mental states
Health professionals Health professionals
perform health generally perform FAMILY
promotion and disease disease prevention Defined by Murray and Zentner, 1997, a small
prevention activities activities social system and primary reference group made
up of two or more persons living together who are
Individual as a Client related by blood, marriage, or adoption or who are
• Deals with sick or well living together by arrangement over a period of
time
• Consults the health center & receives health
services in different forms
• Can be seen both as clients and patients
• Can be used as an “entry point” in working
with the whole family
• Can be seen in two ways/approach:
POPULATION GROUP OR AGGREGATE 3. Maintains coordination/linkages with other health
Is a group of people sharing the same team members, NGO/government agencies in the
characteristics, developmental stage, or common provision of public health services
exposure to particular environmental factors 4. Initiates and conducts researches relevant to
Examples are: CHN services to improve provision of health care
a. children 5. Initiates and provides opportunities for
b. women professional growth and continuing education for
c. farmers staff development
d. cultural minorities 6. NOTE: The Public health nurse will take charge
e. elderly of the Municipal Health Officer’s (MHO)
responsibilities in the event that the MHO is unable
to perform his/her duties/functions or is not
A. CHILDREN available
Most vulnerable to different types of diseases,
especially those brought about by socio-economic IN THE CARE OF FAMILIES
difficulties ➢ Provision of primary health care services
Predominantly afflicted with infectious diseases and ➢ Development/utilization of family nursing care
nutrition problems plan in the provision of care
B. ELDERLY IN THE CARE OF THE COMMUNITIES
Individuals belonging to the age group of 60 years ➢ Community organizing, mobilization,
and above community development, and people
With the lengthening of the lifespan of the Filipinos, empowerment
it is best that health professionals understand the ➢ Case finding & epidemiological investigation
health needs of the elderly ➢ Program planning, implementation &
C. WOMEN evaluation
Roles of the Public Health Nurse ➢ Influencing executive and legislative
individuals or bodies concerning health &
development

Specialized Fields of CHN

COMMUNITY MENTAL HEALTH NURSING

A unique clinical process which includes an
integration of concepts from nursing, mental health,
social psychology, psychology, community
networks and the basic sciences
OCCUPATIONAL HEALTH NURSING
The application of nursing principles & procedures
in conserving the health of workers in all
occupations
Duties and Responsibilities of a Nurse SCHOOL HEALTH NURSING
1. Provides nursing care through the utilization of Application of nursing theories & principles in the
the nursing process care of the school population
2. Establishes linkages with community resources
and coordination with the health team Public Health Interventions
3.Provides health education to individuals, families
and communities Surveillance
4.Teaches, guides, and supervises students in ➢ Describes and monitors health events
nursing education programs including the through ongoing and systematic
administration of nursing services in varied settings collection, analysis, and interpretation
such as hospitals and clinics of health data for the purpose of
5. Undertake consultation services. planning, implementing, and evaluating
6. Engages in such activities that require the public health interventions.
utilization of knowledge and decision-making skills
of a registered nurse; and Disease and other health event intervention
7. Undertakes nursing and health human resource ➢ Systematically gathers and analyzes data
development training and research, which shall regarding threat to the health of populations,
include, but is not limited to, the development of ascertains the source of the threat, identifies
advance nursing practice. cases and others at risk, and determines
control measures.
Duties and Responsibilities of a Community
Health Nurse Disease and other health event intervention
1. Participates in the development of an overall ➢ Systematically gathers and analyzes data
health plan, its implementation, and evaluation for regarding threat to the health of populations,
communities ascertains the source of the threat, identifies
2. Provides quality nursing services to the four cases and others at risk, and determines
levels of clientele control measures.
Outreach Community organizing
➢ Locates populations of interest or populations ➢ Helps community groups to identify common
at risk and provides information about the problems or goals, mobilize resources, an
nature of the concern, what can be done develop and implement
about it, and how services can be obtained. ➢ strategies for realizing the goals they
collectively have set.
Screening
➢ Indentifies individuals with unrecognized Advocacy
health risk factors or asymptomatic disease ➢ Pleads someone’s cause or acts on
conditions. someone’s behalf, with a focus on developing
the community, system, and individual or
Case finding family’s capacity to plead their own cause or
➢ Locates individuals and families with act on their own behalf.
identified risk factors and connects
them with resources. Social marketing
➢ Utilizes commercial marketing
principles and technologies for
Referral and follow-up programs designed to influence the
➢ Assists individuals, families, groups, knowledge, attitudes, values, beliefs,
organizations, and/or behaviors, and practices of the
communities to identify and access necessary population of interest.
resources to prevent or resolve problems and
concerns. Policy development and enforcement
➢ Places health issues on decision makers’
Case management agenda, acquires a plan of resolution, and
➢ Optimizes self-care capabilities of determines needed resources, resulting in
individuals and families and the laws, rules, regulations, ordinances, and
capacity of systems and communities policies. Policy enforcement compels others
to coordinate and provide services. to comply with laws, rules, regulations,
ordinances, and policies.
Delegated functions
➢ Direct care tasks that a registered III. Brief History of Community Health/Public
professional nurse carries out under the Health Nursing Practice in the Philippines
authority of a health care practitioner as
allowed by law. Pre-Spanish and Spanish Periods (before 1898)
➢Use traditional health care practices
Health teaching ➢Establishment of the first medical
➢ Communicates facts, ideas, and skills dispensary for indigent patients of Manila by
that change knowledge, attitudes, Franciscan Friar Juan Clemente
values, beliefs, behaviors, and 1690
practices of individuals, families, Installation of water system in San Juan del
systems, and/or communities. Monte and Manila by Dominican Father
Juan de Pergero
Counseling 1805
➢ Establishes an interpersonal Introduction of smallpox vaccination by Dr.
relationship with a community, a Francisco de Balmis
system, and a family or individual, with
the intention of increasing or enhancing 1876
the capacity for self-care and coping. Appointment of the first medicos titulares
1888
Consultation Graduation of the first cirujanos ministrantes from
➢ Seeks information and generates UST
optional solutions to perceived 1901
problems or issues through interactive Creation of the Board of Health of the
problem solving with a community Philippine Islands by the United States
system and family or individual. Philippine Commission through Act 157.
1905
Collaboration Foundation of La Gota de Leche by
➢ Commits two or more persons or an Asociacion Feminista Filipina
organization to achieve a common goal 1912
through enhancing the capacity of one Creation of sanitary divisions by the Fajardo
or more of the members to promote Act
and protect health. 1915
Organization of the Social and Home Care
Coalition building Service unit of PGH
➢ Promotes and develops alliances
among organizations or constituencies
for a common purpose.
Before WW II ➢ Exercise oversight functions and monitoring
Establishment of municipal and charity and evaluation of national health plans,
clinics programs, and policies.
1947 ➢ Ensure the highest achievable standards of
Reorganization of DOH into bureaus quality health care, health promotion and
1954 health protection.
Approval of R.A.1082 (Rural Health Act) by
the Congress Administrator of Specific Services
1957 ➢ Manages selected national health facilities
Enactment of R. A. 1891 amending certain and hospitals and referral centers.
provisions in the Rural Health Act ➢ Administer direct services for emergent health
1970s concerns that require new complicated
Restructure of the Philippine health care technologies.
delivery system classifying health services ➢ Administer health emergency response
1954 services.
Approval of R.A.1082 (Rural Health Act) by
the Congress Vision of DOH
The DOH is the leader, staunch advocate
1957 and model promoting Health for All in the
Enactment of R. A. 1891 amending certain Philippines.
provisions in the Rural Health Act
1970s Mission of DOH
Restructure of the Philippine health care Guarantee equitable, sustainable and
delivery system classifying health services quality health for all Filipinos, especially the poor
1991 and shall lead the quest for excellence in health.
enactment of R.A. 7160 ( Local
Government Code) Core Values of DOH
1999 1. Integrity
Launched the Health Sector Reform
Agenda 2. Excellence
3. Compassion and respect for human
Its implementation framework FOURmula One (F1)
dignity
in 2005 and Universal Health Care in 2010
4. Commitment
September 2000
Signed to the United Nations Millennium 5.Professionalism
Declaration
6.Teamwork
IV. The Philippine HealthCare Delivery System 7. Stewardship of the health of the people

Levels of Health Care Delivery and the Rural

Health Unit
General Hospital
➢ Provides services for all kinds of all illnesses,
injuries, or deformities.
➢ Services offered are classified as level 1, level
2, or level 3.

Hospitals Other Health

Facilities
General A. Primary Care
Roles and Functions of DOH • Level 1 Facility
Leadership in Health • Level 2 B. Custodial Care
➢ Serve as the national policy and regulatory •Leyel 3 Facility
institution. (teaching/training) C. Diagnostic/
➢ Provides leadership in the formulation, Therapeutic Facility
monitoring and evaluation of national health Specialty D. Specialized
policies, plans, and programs. Outpatient Facility
➢ Serve as advocate in the adoption of health
policies, plans and programs to address
national and sectoral concerns.

Enabler and Capacity Builder

➢ Innovate new strategies in health.
➢ Initiate public discussions on health issues.
➢ Disseminate policy research outputs.
 Hospitals Level 1 Level 2 Level 3 ➢Public Health Nurse (PHN)-Registered
Consulting Level 1 plus: Level 2 plus: Nurse
specialists Departmentalized Teaching/ ➢Rural Health Midwife (RHM)- Registered
in: clinical services training with Midwife
Medicine accredited ➢Dentist
Pediatrics residency ➢Nutritionist
OB-Gyne training ➢Medical Technologist
Surgery program in ➢Pharmacist
four major ➢Rural Sanitary Inspector (RSI)- must be a
clinical sanitary engineer
Clinical
services
services The Rural Health Unit
Emergency Respiratory unit Physical
for
and medicine and ➢Primary level health facility in the
inpatients municipality.
outpatient rehabilitation
services unit ➢Focuses on preventive and promotive
health services.
Isolation General ICU
➢Supervises the BHSs
Facilities
➢1 RHU: 20,000 population
Surgical/ High-risk Ambulatory
maternity pregnancy unit surgical clinic
Barangay Health Station
facilities
➢ first-contact health care facility offering
Dental MICU Dialysis clinic
basic services at the barangay
clinic
➢ Manned by the RHM and BHWs
Secondary Tertiary clinical Tertiary
clinical laboratory clinical The RHU Personnel
facilities laboratory Municipal Health Officer (MHO)
with ➢ A.k.a. Rural Health Physician
Ancillary histopathology ➢ Administrator of the RHU
services Blood Bloodbank ➢Community physician
station ➢Medico-legal officer of the municipality
First-level Second-level X- Third-level X- ➢1 MHO: 20,000 population
X-ray ray ray
Pharmacy Public Health Nurse (PHN)
➢ Supervises and guides all RHMs in the
Other Health Facilities municipality.
➢ Prepares FHSIS quarterly and annual
Primary Care Facility (Category A) reports of the municipality for
➢ A first-contact health care facility offers submission to the Provincial Health
basic services including emergency Office
services and provision for normal ➢ Public Health Nurse (PHN)
deliveries ➢ Utilizes the nursing process in
responding to health care needs,
Custodial care facility (Category B) including needs for health education
➢ Provides long-term care, including basic and promotions, of individuals, families,
services, to patients with chronic conditions and catchment community.
requiring ongoing health and nursing care due ➢ Collaborates wit the other members of
to impairment and a reduced degree of the health team, government agencies,
independence in ADLs, and patients in private businesses, NGOs, and
rehabilitation. people’s organizations to address the
community’s health problems.
➢ 1:20,0000 population
Diagnostic/therapeutic facility (Category C)
➢ For the examination of the human Rural Health Midwife (RHM)
body, specimens from the human body ➢ Manages the BHS and supervises and
for the diagnosis, sometimes treatment trains the BHW.
of disease, or water for drinking water ➢ Provides midwifery services and
analysis. executes health care programs and
➢ Laboratory facility, radiologic facility, activities for women of reproductive
nuclear medicine facility age.
➢ Conducts patient assessment and
Specialized Outpatient Facility diagnosis for referral or further
➢ Performs highly specialized procedures on an management.
outpatient basis. ➢ Performs health information ,
education, and communication
Public Health Workers (PHW) activities.
➢ Members of the health team who are ➢ Organizes the community.
professionals namely: ➢ Facilitates barangay health planning
➢Medical Officer (MO)-Physician and other community health services.
 ➢ 1;5,000 population V. The World Health Organization
The World Health Organization
The Health Referral System Constitution was established on April 7, 1948
Referral Headquarters in Geneva, Switzerland
➢ A set of activities undertaken by a health care Has 147 country offices
provide or facility in response to its inability to Has 6 regional offices ( Africa, the Americas,
provide the necessary health intervention to Eastern Mediterranean, Europe, Southeast Asia,
satisfy a patient’s need. Western Pacific
Internal referrals
➢ Occur within the health facility. Core Functions:
External referrals • Providing leadership on matters
➢ Movement of a patient from one health facility critical to health and engaging in
to another partnerships where joint action is
needed.
• Setting norms and standards and
promoting and monitoring their
implementation.
• Articulating ethical and evidence-
based policy options.
• Providing technical support,
catalyzing change, and building
sustainable institutional capacity.
• Shaping the research agenda and
stimulating the generation,
translation, and disseminating
valuable knowledge.
Priorities
Organization
Standards
Translation
Capacity
The Inter-Local Health Zone
➢ Defined catchment population within a defined
geographical area. Sustainable Development Goals
➢ Covers all sectors involved in the delivery off
health services. The Sustainable Development Goals are a set of
➢ Components 17 goals defined by the United Nations launched in
People September 2015. It addresses a number of social
Boundaries and environmental development issues. The goals
Health facilities are also known as “Transforming our World: the
Health workers; 2030 Agenda for Sustainable Development.”
Health System
➢ Consists of all organizations, people, and
actions whose primary intent is to promote,
restore, or maintain health.
➢ Building blocks
Service delivery
➢ Building blocks
✓ Service delivery
✓ Health workforce
✓ Information
✓ Medical products, vaccines, and
technologies
✓ Financing
✓ Leadership and governance or
stewardship

Factors Influencing the Health Care Delivery

System
➢Health care “reforms
➢Demographics
➢Globalization
➢Poverty and growing disparities
➢Social disintegration