Overview of Community Health Nursing as a Field of Nursing Practice:

A. Global and National Health Situations.

The Top 10 Common Health Issues in the Philippines:
1. Physical Activity and Nutrition
2. Overweight and Obesity
3. Tobacco
4. Substance Abuse
5. HIV/AIDS
6. Mental Health
7. Injury and Violence
8. Environmental Quality
9. Immunization
10. Access to Health Care
Global health concerns arise from the spread of infectious diseases. Some of the most
dangerous infectious diseases that continually affect large populations include
HIV/AIDS, influenza, malaria, tuberculosis, and SARS and now COVID 19
The World Health Organization has released a list of 9 threats to global health in 2021.
1. COVID-19 vaccine and inequities
2. Humanitarian crisis in Afghanistan
3. Universal health coverage
4. Tobacco use in decline
5. Violence against women
6. Malaria vaccine
7. Diabetes in the spotlight
8. The state of dementia
9. Health and climate change
DISASTER HAPPENED IN 2019 TO 2020
🠶 Philippines: Dengue Outbreak - Jul 2019
🠶 Philippines: Earthquakes - Oct 2019
🠶 Philippines: Measles Outbreak - Feb 2019
🠶 Philippines: Taal Volcano - Jan 2020
🠶 Philippines/Malaysia: Polio Outbreak - Sep 2019
🠶 Southeast Asia: Drought - 2019-2020
🠶 Corona Virus Jan 2020 to present
🠶 Monkey pox 2022 to present
COMMUNITY HEALTH NURSING:
• A field of nursing that is blend or synthesis of nursing practice with the public
health using primary health care as the tool in the delivery of health services.
• A learned practice discipline with the ultimate goal of contributing as individual’s
and in collaboration with others to the promotion of the client’s optimum level of
functioning, thru teaching and delivery of care. (Jacobson, 1969)
• Service rendered by a professional nurse with communities, groups, families,
individual at home, in health centers, in clinics, in schools, in places of work for
health promotion, disease prevention, care of the sick at home and rehabilitation.
(Ruth B. Freeman)
Philosophy of Community Health Nursing
• “The philosophy of CHN is based on the worth and dignity of men. This
philosophy of care is based on the belief that care directed to the individual, the
family, and the group contributes to the health care of the population as a whole.
BASIC PRINCIPLES OF CHN:
🠶 The community is the patient in CHN, the family is the unit of care and there are
four levels of clientele: individual, family, population group, (those who share
common characteristics, developmental stages and common exposure to health
problems – e.g. children, elderly), and the community.
🠶 In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient
of care
 🠶 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.
🠶 Community health nurses are generalists in terms of their practice
GOAL OF CHN:
🠶 Is to assist the individual, family and community in attaining their highest level of
holistic health which is attained through multidisciplinary effort.
🠶 To promote reciprocally supportive relationship between people and their
physical and social environment.
RECIPIENTS OF CARE BY COMMUNITY HEALTH NURSES:
1. Individual – is a specific person or client in various stages of health or illness who
is given the appropriate nursing intervention by the community health nurse.
2. The family – is a group of people affiliated by consanguinity, affinity, or
co-residence. The family is the principal institution for the socialization of children
and is often called the “basic unit of society”
3. Population Groups - are vulnerable groups or those at risk of developing certain
health or health-related problems. These are groups of people who share
common characteristic, developmental stage or common exposure to particular
environmental factors, thus resulting in common health problems.
4. The Community – comes from the Old French word “communite” which is derived
from the Latin (cum “with together minus gift) a broad term for fellowship or
organized community
A group of people with common characteristic or interest living together within a
territory or geographical boundary
A social group interacting with each other determined by geographic boundaries,
living together to attain certain and common goals, and sharing the same interest.
(Untalan, 2005)
HEALTH
🠶 It is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. (WHO 1946/1948)
Components of Health:
 1. Availability – requires that operational public health and channels of service
delivery products and services as well as programs be adequate for all
2. Accessibility – entails that health facilities, service and goods must be made
possible and obtainable to everyone.
3. Acceptability – corresponds to respect for the medical ethics, being culturally
appropriate and gender sensitive. This clearly define the need for health care
centers, products, services, and programs. To be people centered.
4. Quality – implies that the health facilities, commodities, and service must be in
accordance with scientific and medical standards. Quality health services need to
be safe, effective, people-centered, timely, equitable, integrated, and efficient

MODEL OF HEALTH BY EDELMAN AND KUDZAMA(2018)

1. Clinical Model – Health is the absence of sign and symptoms of disease and
illness refers to its presence. This model is the traditional lens of hoe medical
science deals with patient. It illustrates an adult individual who is not particular
with his lifestyle choices will only seek health care when chest pain is
encountered and begin to suspect a cardiovascular disease.
2. Role Performance model – The individuals’ ability to perform societal roles
defines what health is in this model. The society is preoccupied with expectations
on how should perform at work, within the family and society. Failure to fulfil
these roles means illness. Ex. An employee who reported for work, even if
she/he is febrile may still be considered healthy.
3. Adaptive Model – Health is a dynamic state. An individual is considered to be
healthy if she/he was able to adjust positively to social, mental, and physiological
changes.
4. Eudaimonistic Model – An elevated level of wellness suggests optimal health and
illness is reflected by a lack of vitality. This model highlights the interactions
between physical, social, psychological, and spiritual facts of life.
FACTORS AFFECTING OPTIMUM LEVEL OF FUNCTIONING (OLOF)

OPTIMUM LEVEL OF FUNCTIONING:

The modern concept of health refers it to be the “optimum level of functioning”
(OLOF)of individuals, families, communities, which if affected by several factor in the
ecosystem.
1. Political factors – politics have power and authority to regulate the environment
or social climate. Example: laws and legislative acts are often related to promoting
safety and people empowerment.
2. Behavioral factors – a person’s level of functioning is affected by certain habits while
their lifestyle, health care and child-rearing practices are determined by their culture
and ethnic heritage. Example: culture, habits, mores, and ethnic custom influence a
person’s health behavior.
3. Hereditary factors – understanding of genetically-influenced disease and genetic
risks. Example: familial, ethnic, racial defects, strengths, and/or risk maybe passed
through genes of both parents.
4. Health care delivery system – primary health care is a partnership approach to the
effective provision of essential health services that are community-based, accessible,
acceptable, sustainable, affordable.
5. Environmental factor – the menace of pollution, communicable disease due to poor
sanitation, poor garbage collection, smoking, utilization of pesticides. Example: air
pollution, contaminated food, water waste, health hazards and health risk.
6. Socio-economic influences – Families in lower income group are the ones mostly
served. Example: unemployment, or underemployment, lack of education and lack of
descent housing may also have some effect on the optimum level of functioning.
HEALTH CARE DELIVERY SYSTEM:
DOH MILESTONE:
• 1898 – Emilio Aguilnaldo created the Department of Public Works, Education and
Hygiene
▪ Board of City of Manila
• 1901 – Board of Health of Philippine Island
• Creation of provincial and municipal board
• 1905 – Bureau of Health
• 1915 – from BOH to Philippine Health Service
• Semi –military system of public health administration
• 1932 – Examination boards were created for Medicine, Dentistry, Pharmacy,
Nursing, Optometry
• 1941 – created the Department of Public Health and Welfare and Dr. Jose
Fabella became its first secretary
DOH MILESTONES:
• 1947 – Post – war split of Department of Public Welfare and the Department of
health
- Another split between curative (Bureau of Hospital) and preventive services
(Bureau of Health)
 • 1951 – Development of Rural Health unit which deliver several medical services.
• 1970 – Reconstructured Healthcare Delivery system – Primary, Secondary, and
Tertiary levels of care
• 1972 – renamed to Ministry of Health during the Martial Law and Sec. Gatmaitan
was the first Minister of Health.
• 1982 – EO 851 – reorganized Ministry of Health as an integrated health care
delivery system through the creation of Integrated Provincial Health office,
combining public health and hospital operation under the PHOs
• 1987 – MOH was renamed back to Department of Health by President Cory
Aquino
• 1991 – RA 7160 – Local Government Code – devolved health sector
- Doctor to the Barrios
- National Micronutrient Campaign
• 1999 – 2004 – development of the Health Sector Reform Agenda
• 2005 – 2015 – Fourmula One for Health
• Financing, regulation, Service Delivery, Governance
• 2012 – Sin Tax Law
• 2015 – Universal Health Care
• 2016 – Philippine Health Agenda 2016 – 2022
• 2019 – submission into law of the Universal Health Care Law
- An effort towards Primary Health Care
- Every Filipino citizen should be automatically included into the National
Insurance Program
- Every Filipino shall be granted immediate eligibility and access tp preventive,
curative, rehabilitative, and palliative care for medical, dental, mental and emergency
health services
ROLE /FUNCTION OF THE DEPARTMENT OF HEALTH:
1. Leadership in Health
- National policy& regulatory institution
2. Enabler and Capacity builder
 - Innovate new strategies
- Monitoring and evaluation, of national health policies and plans and program
- Ensure highest achievable standards of quality health care, health promotion
and health protection.
3. Administrator of specific services
- Innovate new strategies in health
- Manage selected national and subnational health facilities and hospitals and
modern facilities that shall serve as referrals center
- Administer direct services for emerging health concern
- Emergency response services in disaster and epidemics
DOH SECRETARY
OIC Under Secretary Dr. Rosette Vergiere
Department of Health:
Vision:
“Filipinos are among the healthiest people in Southeast Asia by 2022 and Asia
by 2040”
Mission:
To lead the country in the development of a productive, resilient, equitable and
people- centered health system
PHILIPPINE HEALTH CARE DELIVERY SYSTEM:
Classification of Hospitals
1. According to ownership
- Government
- Private
2. According to scope of services
- General
- Specialty
3. According to functional capacity
- General
 - Specialty
- Trauma capability
✔ OWNERSHIP:
• Public sector
- National
- Local – LGU
• Private sector
• Hospital
• Clinics
• Health insurance
• Medicine manufacturer
• Vaccine maker
• Medical equipment supplier
• Research
✔ GOVERNMENT/PUBLIC SECTOR
- Financed through a tax-based budgeting system
- Managed by government facilities under national and local governments
• DOH – governments corporate hospitals, specialty and regional hospitals
• Department of National Defense (DND) – military hospital
• Provincial hospital – District and Provincial hospitals
• Municipal governments – primary care, health centers, and barangay
health station
✔ PRIVATE SECTOR
• For profit and non-profit health-care providers
• Market oriented
• Financed through users fees
According to scope of service
General:
 • Provides service for all kinds of illnesses, diseases, injuries or deformities
• Ex. Philippine General Hospital, Pasig City General Hospital
Specialty:
Specializes in a particular disease or condition in one type of patient
• According to illness – POC, NCMH, SLH
• According to organ – LCP, PHC, NKTI
• According to group – PCMC, NCH, Dr, Jose Fabella Memorial Hospital

THREE HEALTH CARE IN DELIVERING HEALTH SERVICES (ELEMENTS)

• Creation of Restructured Health Care Delivery System (RHCDS) regulated by
PD 568 (1976)
• Management Information Systems regulated by R.A. 3753: Vital Health Statistics
Law
• Primary Health Care (PHC) regulated by LOI 949 (1984) Legalization of
Implementation of PHC in the Philippines
Referral System in Levels of the Health Care
 • Barangay Health Station (BHS) is under the management of Rural Health
Midwife (RHM)
• Rural Health Unit (RHU) is under the management or supervision of PHN
• Public Health Nurse (PHN) caters to 1:10,000 population, acts as managers in
the implementation of the policies and activities of RHU, directly under the
supervision of MHO (who acts as administrator)
REFERRAL SYSTEM:
• BHS→ RHU→ MHO→ PHO→ RHO→ National Agencies→ Specialized
Agencies
• Home visit
• Is a professional face-to-face contact made by the nurse to the patient or the
family in order to provide necessary health care activities and further attain an
objective of the agency.
• Purposes of the Home visit:
• 1. Gather all available information regarding the family health status
• 2. Confirm all the data gathered during home visit.
• 3. Prioritize the needs which have been identified by the family
• 4. Involve the individual and family from the assessment of the implementation
process.
Three Phases of Home Visit:
1. Preparatory phase – review existing records or referral data before dong the home
visit.
• Notify the family of your intention to do the home visit. Introduce yourself and
explain your purpose.
2. Home visit phase – actual visit to the patient. Conduct assessment planning, and
health teaching. Perform nursing intervention for condition which will require your
nursing skills.
3. Post – visit phase – Record data in the chart. Plan for your next visit with the family.
Referral to other health professional must be done if warranted by the situation.
BAG TECHNIQUE
 • A TOOL making use of the public health bag through which the nurse during the
visit can perform nursing procedures with ease and deftness, saving time & effort
at the end in view of rendering effective nursing care.
PUBLIC HEALTH BAG – essential & indispensable equipment
• The use bag technique should minimize, if not totally prevent, the spread of
infection
• It should save time and effort in the performance of nursing procedure
• It should not overshadow concern for the patient
• It shows the effectiveness of total care given to individual or family
• It should contain all necessary articles and equipment
• The bag contents should be clean as often as possible
• It should be protected from contact with any article in the home of the
patient
• The arrangement of the bag contents should be convenient
• Handwashing should be done frequently
• When used in a communicable case, the PHN bag should be thoroughly
cleaned and disinfected before keeping and re-using.
• CONTENTS OF PHN BAG:
• Thermometer (one oral and one rectal)
• Syringes
• Alcohol lamp
• Sputum cap
• Medicine dropper
• Zephiran solution and Benedicts solution\
• Tape measure
• Hypodermic needles
• Paper lining
• Apron and hand towel
• Weighing scale
 • Stethoscope
• Adhesive plaster
• Soap in a soap dish
• Sphygmomanometer (should not be placed inside the PHN bag)
• Umbrella
PRIMARY HEALTH CARE:
According to WHO is whole-of-society approach to health that aims at ensuring the
highest possible level of health and well being and their equitable distribution by
focusing on people’s need
• From health promotion to disease prevention
• To treatment, rehabilitative and palliative care,
• And as close as feasible to people’s everyday environment

ALMA ATADECLARATION 1978:

• International Conference on Primary Health Care, Alma Ata USSR, September
6-12, 1978
• Considered as major milestones in the field of public health
• Expressed the need for urgent action by all governments, all health and
development workers and the world community to protect and promote the
health of all the people in the world – health for all
• Affirms health as a fundamental human right
• Was adapted in Letter of Instruction 949 (LOI 949), October 19, 1979, signed by
President Ferdinand E. Marcos with the goal “Health in the Hands of the People
ALMA ATA DECLARATION OF 1978
The declaration consists of 10partseach reinforcing widely accepted values and
policies on health care:
1. Definition of Health
2. Concern over inequality bet ween countries
3. Health as a pre-requisite for economic progress of countries
4. People’s right to participate in planning and implementation of health services
 5. State responsibility in provision of health care to all citizens
6. Reaffirmation of primary health care as an important strategy to organize health
services
7. Components of primary health care
8. Align national policies and build political will to achieve primary health care
9. Cooperation between countries to achieve these goals
10. Health for all
DECLERATION OF ASTANA
• Global conference on Primary Health Care
• October 25-26, 2018, at Astana Kazakhstan
• Renewed the declaration of Alma Ata
• Commitments:
• Make bold political choices for health across all sectors
• Build sustainable primary health care
• Empower individuals and communities
• Align stakeholder support to national policies, strategies and plan

DECLARATION OF ASTANA
Strategies in building sustainable PHC:
1. Enhanced capacity and infrastructure for primary care
2. Prioritize disease prevention and health promotion
3. Provide comprehensive ranges of service and care
4. Increase access to integrate safe and sufficient services that are people centered
and gender sensitive
5. Ensure a functional referral system between primary and other level of care
 6. Enhance systems that prevent, detect, and response to infectious diseases and
outbreaks
PHC level of service delivery:
• Accessibility
• Generalist
• Orientation
• Continuity of care
• Recognition of family and social context of health and illness.
FOUR DIMENSIONS:
• Focus – from illness and cure to health, prevention, and care.
• Content – from treatment to episodic care of specific problems to health
promotion and continuous and comprehensive care.
• Organization – from specialists, physicians, and single-handed practice to
generalist practitioner other health care professional and teams.
• Responsibility – from health sector alone, professional-dominated with passive
reception to inter sectoral collaboration with active
Characteristic of PHC in the delivery of health care services:
1. Essential health care services accessible and acceptable to the community.
2. Partnership between and among health workers
3. Provision of health services at the district level
4. Top-down decision-making which is more conventional program which is
associated with disease prevention efforts.
FUNDAMENTAL SERVICES OF PRIMARY HEALTH CARE:
1. Adequate and safe supply of water problems and prevention of illness.
2. Control of communicable disease
3. Immunization
4. Education on prevailing health problems and prevention of illness
5. Maternal and child health and family planning
6. Adequate foo and proper nutrition
 7. Provision of medical care and emergency treatment
8. Treatment of locally endemic disease
9. Provision of essential drugs and herbal medicines
THREE MAJOR ASPECTS OF PHC ELEMENTS:
1. Promotive aspect – includes education concerning health problems and the
methods of preventing them: like promotion of food supply and proper nutrition
and adequate supply of safe water and basic sanitation.
2. Preventive aspects – includes maternal and child health care, including family
planning; immunization against major infectious disease; and prevention and
control of locally endemic disease.
3. Curative aspect – includes appropriate treatment of common diseases and
injuries and the provision of essential drugs.
FOUR CONERSTONES/PILLARS OF PHC.
1. Support Mechanism made available – equity
2. Active Community Participation
3. Intra-and inter – sectoral Linkages
4. Use Appropriate Technology
CHARACTERISTIC OF PHC ESSENTIAL SERVICES:
1. Community based – health services should be delivered where the people are.
2. Accessible – can be reached by majority of the population and those in far-flung
areas should not be deprived of these health services by regular periodic visits by
the health personnel and training of indigenous resident volunteers of the area.
3. Sustainable – for these health services to be successfully utilized, maintained
and continued needs the active participation and involvement of the community
members.
4. Affordable – traditional herbal medicines and other alternative forms of healing
must be used together with the essentials drugs which are generic and are more
affordable.
OBSTACLE TO PRIMARY HEALTH CARE NURSING:
 1. Role Complexity – the CHN is mandated to perform lot of functions with its
inherent responsibilities which requires the provision of a high level of nursing
care. The nurse needs to be skillful in both technical and communication skills.
2. Special responsibilities – despite recognition of the value of illness prevention
and health promotions, community nurses focus nursing care on individuals and
families to solve specific health problems.
3. Role confusion – nurses regardless of whether they work in the community or
in hospitals, face challenges when collaborating with other professional
discipline. Difficulties can emerge over role boundaries and over the care
provided by the team. In this situation, nurses need to be flexible, and flexibility
causes challenges and frustrations all the same time.
4. Lack of skills training – there is a need to change nurses’ attitudes to enable
them to work better with groups in the community, with other professional on the
health care team and with members of the society at large.
CORE HEALTH PROMOTION STRATEGIES:
1. Health awareness – raising awareness or consciousness of health issues.
a. Methods – health education talks, group work, mass media etc.
b. Actions – encourage people to seek early detection and treatment.
2. Changing attitudes and behaviors – changing or modifying lifestyle of
individuals through adoption of healthier options.
a. Methods – group work, skills training
b. Action – BSE teaching
3. Improving knowledge – providing information through health education using
different instruction media and materials.
a. Methods – demonstrating BSE. One to one teaching
b, Actions – clients identify what they know and what to know about breast cancer
4. Self – empowering – improving self- awareness,, self- esteem and decision
–making.
a. Methods – return demonstration of BSE
b. Action – CHN and other member of the health team should adopt supportive
and caring to motivate clients undergo regular BSE.
5. Societal and environment change – changing the physical or social environment.
ROLE OF PRACTITIONER IN INTEGRATED HEALTH PROMOTION PROGRAMS:
1. Enabler
2. Advocate
3. Mediator
MILLENIUM DEVELOPMENT GOALS (MDGs)
Are based on the fundamental values of freedom, equality, solidarity, tolerance, health,
respect for nature, and shared responsibility.
Target:
Reduce poverty and hunger
Based of fundamental values of:
• Freedom
• Equality
• Solidarity
• Tolerance
• Health
• Respect of nature
• Shared responsibility
The First 8 Millennium Development Goals (MDGs)
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower woman eliminate gender disparities in the
primary/secondary education
4. Reduce child mortality
5. Improve maternal health reduce ¾ of woman dying during childbirth.
6. Combat HIV/AIDS, malaria, and other diseases.
7. Ensure environmental sustainability reduce ½ of people without access to safe
water.
8. Develop global partnership for development