Community Health Nursing

Reviewer Midterm

Topic 1

I. Global and National Health Status

Global Health Status

 Studies describe the state of global health by measuring the burden of disease – the loss
of health from all causes of illness and deaths worldwide. (WHO 2018)

Collecting and comparing health data from across the globe is a way to describe health problems, identify
trends and help decision-makers set priorities

Studies describe the state of global health by measuring the burden of disease – the loss of health from all
causes of illness and deaths worldwide. They detail the leading causes of deaths worldwide and in every
region, and provide information on more than 130 diseases and injuries across the world.

II. Definition and Focus

Community

 Is a social unit with commonality such as norms, religion, values, customs, or identity. Communities
may share a sense of place situated in a given geographical area or in virtual space through
communication platforms. (wikipedia)
 The definition of community is all the people living in an area or a group or groups of people who share
common interests. (Webester Dictionary)
Health

 Is a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity. (WHO)
 The state of being free from illness or injury. (Dictionary)

Nursing

 Encompasses autonomous and collaborative care of individuals of all ages, families, groups and
communities, sick or well and in all settings.
 It includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people.
(WHO)
 The profession or practice of providing care for the sick and infirm. (Dictionary)

Public Health

 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 social machinery to ensure
everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to
Enable Every Citizen to Realize His Birth right to Health and Longevity (DR. C.E Winslow)

 Art of applying Science in the Context of Politics so as to Reduce Inequalities in Health while ensuring
the best health for the greatest number (WHO)

Public Health Nursing

 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 program for the promotion of health, the
 improvement of the conditions in the social and physical environment, rehabilitation of illness and
disability. (WHO)

Community Health Nursing

 Service rendered by a professional nurse with communities, groups, families, individuals at home, in
health centers, in clinics, in schools, in places of work for the promotion of health, prevention of illness,
care of the sick at home and rehabilitation. (Ruth B. Freeman
 Nursing Practice in a wide variety of community services and consumer advocate areas, and in a variety
of roles, at times including independent practice. Community nursing is certainly not confined to public
health nursing agencies (Jacobson)
 The utilization of the Nursing Process in the Different Levels of Clientele-Individuals, Families,
Population Groups and Community, concerned with the Promotion of Health, Prevention of Disease and
Disability and Rehabilitation (Dr. Araceli Maglaya)

III. The Standards of Public Health Nursing in the Philippines

A. Public Health Nurses

 are found in various health settings and occupying various positions in the hierarchy.
 are assigned in rural health units, city health centers, provincial health offices, regional health offices,
and evening the national office of the Department of Health.
 are also assigned in public schools and in the offices of government agencies providing health care
services.
 occupy a range of positions from Public Health Nurse I to Nurse Program Supervisors to Chief Nurse in
public health settings.
 uses various tools and procedures necessary for her to properly practice her profession and deliver
basic health service.
 uses nursing process in her practice and is adept in documenting and reporting accomplishments
through records and reports.
 technically competent in various nursing procedures conducted in settings where she is assigned

B. Qualifications and Functions of A Public Health Nurse

The standards of Public Health Nursing in the Philippines developed by the National League of
Philippine government Nurses in 2005 described the qualification and functions of a Public Health Nurse.

Qualifications :
 must be professionally qualified and licensed to practice in the area of public health nursing.
 Must possess personal qualities and “people skills” that would allow her practice to make a difference
in the lives of these people.

Functions

 Functions in accordance with the dominant values of public health nurses, within the ethico-legal
framework of the nursing profession, and in accordance with the needs of the clients and available
resources for health care.

 Functions of PHN are consistent with the Nursing Law 2002 and program policies formulated by the
DOH and local government health agencies. They are related to management, supervision, provision of
nursing care, collaboration and coordination, health promotion and education training and research.

1. Management Function

 the management function of the public health nurse is inherent in her practice. - The nurse, in
whatever setting and role has been trained to lead and manage.
 Objectives set for work being done can only be achieved through the execution of the five
management functions of planning, organizing, staffing, directing and controlling.
  This function is performed when she organizes the “nursing service” of the local health agency. -
Managing the nurses and their activities - Program management. This is a function where the PHN
actually excels in.
 A program manager is responsible for the delivery of the package of services provided by the program
to the target clientele.
 Reports on program accomplishments is a documentation of her management skills.

2. Supervisory Function

 PHN is the supervisor of the midwives and other auxillary health workers in the catchment area. -
Formulates a supervisory plan and conducts supervisory visits to implement plan.
 Conducts supervisory visits using a supervisory checklist - During the visit the PHN identifies together
with the supervisee any issue or problem encountered and addresses them accordingly.
 Coaching - Enhancement of training for the supervisee
 Report of the encounter is given to the supervisee and kept in her personal file for future reference.

3. Nursing Function

 An inherent function of the nurse

 Her practice as a nurse is based on the science and art of caring
 hPublic health nursing is caring for individuals, families and communities toward health promotion and
disease prevention
 PHN are expected to provide nursing care
 PHN uses her knowledge and skill in the nursing process. She does assessment, plans, and implements
care, and evaluates outcomes.
 Establishes rapport with her client: individual, family or community - Home visits
 Referral of patients to appropriate levels of care

4. Collaborating and coordinating Function

 Brings activities or group activities systematically into proper relation or harmony with each other. -
Care coordinators for communities and their members
 Actively involved both socially and politically to empower individuals, families and communities as an
entity to initiate and maintain health promoting environments.
 Establishes linkages and collaborative relationships with other health professionals, government
agencies, the private sector, NGOs, people’s organizations to address health problems.
 Identifies persons, groups, organizations, other agencies and communities whose resources are
available within and outside the community and which can be tapped in the implementation of
individuals, family and community health care.

5. Health Promotion and Education Function

 Activities goes beyond health teachings and health information campaigns.
 Understands that health is determined by various factors such as physical and political environment,
socio-economic status, personal coping skills and many other circumstances, and it is inappropriate to
blame or credit a person’s health to himself alone because he is unlikely to control many of these
factors.
 Understanding the multidimensional nature of health will enable her to plan and implement health
promoting interventions for individuals and communities.
 Uses her skills in advocacy for the creating of a supportive environment through policies and
reengineering of the physical environment for healthier actions.
 As an educator, the nurse provides clients with information that allows them to make healthier choices
and practices.
 Health education is a major component of any public health program.
 PHN are expected to teach on a daily basis as part of their practices.

6. Training Function
  Initiates the formulation of staff development and training programs for midwives and other auxillary
workers - Does training needs assessment for these health workers, designs the training program and
conducts them in collaboration with other resource persons.
 Also does evaluation of training.
 PHN participates in the training of nursing and midwifery affiliates in coordination with the faculty of
colleges of nursing and midwifery.
 Participates in teaching, guidance and supervision of student affiliates for their RLEs in the community
setting.
 Health promotion calls for the active participation of the community.
 Mobilize communities for health actions.
 Community organizing is a means of mobilizing people to solve their own problems. Through this,
people learn that their problems have social causes and fighting back is a more reasonable, dignified
approach than passive acceptance and personal alienation.

IV. Basic Principles of CHN

A. Evolution of Nursing

1898 Department of Health was first established as Department of Public Works,

Education and Hygiene.

1912  The Fajardo Act (Act No. 2156) created Sanitary Divisions.
 The President of Sanitary Division took charge of two or three
municipalities. Where there are no physicians available, male nurses were
assigned to perform the duties of the President, Sanitary Division.
 Philippine General Hospital (PGH), then under the Bureau of Health sent
four nurses to Cebu to take of mothers and their babies.
 St. Paul’s Hospital School of Nursing in Intramuros, also assigned two
nurses to do home visiting in Manila and gave nursing care to mothers and
newborn babies from the outpatient obstetrical service of the PGH.
1914 - School nursing was rendered by a nurse employed by the Bureau of Health in
Tacloban, Leyte.
- Reorganization Act No. 2462 created the Office of General Inspection.
- Dr. Rosario Pastor a lady physician was headed the Office of District Nursing.
- Two graduate Filipino nurses, Mrs. Casilang Eustaquia and Mrs. Matilde
Azurin were employed for Maternal and Child Health and Sanitation in Manila
under an American nurse, Mrs. G.D. Schudder.

1919 - The first Filipino nurse Supervisor under the Bureau of Health, Miss Carmen
del Rosario was appointed. She succeeded Miss Mabel Dabbs.

1923 - Two government Schools of Nursing were established: Zamboanga General

Hospital School of Nursing in Mindanao and Baguio General Hospital in
Northern Luzon. These schools were primarily intended to train non-Christian
women and prepare them to render service among their people.
- Four more government School of Nursing were establish: one in Southern
Luzon (Quezon Province) and three in the Visayan Islands of Cebu, Bohol and
Leyte.

1927 - The Office of District Nursing under the Office of General Inspection,
Philippine Health Service was abolished and supplanted by the Section of
Public Health Nursing. Mrs. Genara de Guzman acted as consultant to the
Director of Health on nursing matters.

1928 - First convention of nurses was held followed by yearly conventions until the
advent of World War II. Pre-service training was initiated as a pre-requisite for
appointment.
 1930 - The Section of Public Health Nursing was converted into Section of Nursing.
The Section of Nursing was transferred from the Office of General Services to
the Division of Administration. This Office covered the supervision and
guidance of nurses in the provincial hospitals and the government schools of
nursing.

1933 - Reorganization Act No. 4007 transferred the Division of Maternal and Child
Health of the Office of Public Welfare Commission to the Bureau of Health.
- Mrs. Soledad A. Buenafe, former Assistant Superintendent of Nurses of the
Public Welfare Commission was appointed as Assistant Chief Nurse of the
Section of Nursing, Bureau of Health.

1941 - Bureau of Health were transferred to the new department.

- Dr. Mariano Icasiano became the first City Health Officer of Manila.
- An office of Nursing was organized with Mrs. Vicenta C. Pnce. As Chief Nurse
and Mrs. Rosario A. Ordiz as Assistant Chief Nurse.

Dec 8. 1941 - World War II broke out, public health nurses in Manila were assigned to
devastated areas to attend to the sick and the wounded.
1942 - A group of public health nurses, physicians and administrators from the
Manila Health Department went to the internet camp in Capas, Tarlac to
receive sick prisoners of war repleased by the Japanese Army.
- They were confined at San Lazaro Hospital and 68 Public Health Nurses were
assigned to help the hospital staff take care of them.
-
July 1942 - 31 nurses who were taken prisoners of war by the Japanese army and
confined at the Bilibid Prison in Manila were released to the Director of the
Bureau of Health, Dr. Eusebio Aguilar who acted as their guarantor.
- Many public health nurses joined the guerillas or went to hide in the
mountains during World War II.
February - Post war records of the Bureau of Health showed that there were 308 public
1946 health nurses and 38 supervisors compared to pre-war when there were 556
public health nurses and 38 supervisors.
- Mrs. Genera M. de Guzman, Technical Assistant in Nursing of the
Department of Health and concurrent President of the Filipino Nurses
Association recommended the creation of a Nursing Office in the Department
of Health.
Oct. 7, 1947
- Executive Order No. 94 organized government offices and created the
Division of Nursing under the Office of the Secretary of Health. This was
implemented on

December 16, - Mrs. Genara de Guzman was appointed as Chief of the Division, with three
1947 Assistant: Miss Annie Sand for Nursing Education; Mrs. Magdalena C.
Valenzuela for Public Health Nursing and Mrs. Patrocinio J. Montellano for
Staff Education.
- At the Bureau of Health, the Section of Nursing Supervision took over the
functions of the former Section of Nursing. - Mrs. Soledad Buenafe was
appointed Chief and Miss Marcela Gabatin, Assistant Chief.
- Mrs. Genara de Guzman was appointed as Chief of the Division, with three
Assistant: Miss Annie Sand for Nursing Education; Mrs. Magdalena C.
Valenzuela for Public Health Nursing and Mrs. Patrocinio J. Montellano for
Staff Education.
- At the Bureau of Health, the Section of Nursing Supervision took over the
functions of the former Section of Nursing. - Mrs. Soledad Buenafe was
appointed Chief and Miss Marcela Gabatin, Assistant Chief.
 1948 - The first training Center of the Bureau of Health was organized in
cooperation with the Pasay City Health Department. This was housed at the
Tabon Health Center located in a marginalized part of the city. It was later
renamed as Doña Marta Health Center.
- Physicians and nurses undergoing pre-service and in-service training in public
health/public health nursing as well as nursing student on affiliation were
assigned to the above training center.

1950 - The Rural Health Demonstration and Training Center (RHDTC) was
established by the Department of Health through the initiative of Dr. Hilario
Lara, Dean, institute of Hygiene, now College of Public Health, University of
the Philippines.
- The WHO/UNICEF assisted project used health centers of the Quezon City
Health Department, which were located in the rural areas of the city.
- Dr. Amansia S. Mangay (Mrs. Andres Angara), a Doctor of Public Health
Graduate form Harvard was chosen tobe the Chief of the RHDTC.
- Dr. Antonio V. Acosta, former Physician of the Manila Health Department
was Medical Training Officer.

1953 - The Office of Health Education and Personnel Training was established with
Dr. Trinidad Gomez as Chief
- Philippine Congress approved Republic Act No. 1082 or the Rural Health Law.
It created the first 81 Rural Health Units.

1957 - Republic Act 1891 was approved amending Sections Two, Three, Four, Seven
and Eight of R.A. 1082 :Strengthening Health and Dental Services in the Rural
Areas and Providing Funds thereto.”

1958-1965 - Republic Act 977 passed by Congress in 1954 was implemented. This
abolished the Division of Nursing. However, it created nursing positions at
different levels in the health organization. Miss Annie Sand was appointed
Nursing Consultant under the Office of the Secretary of Health.
- The Department of Health National League of Nurses, Inc. was founded by
Miss Annie Sand in 1961. She became its first President and Adviser.
- The Reorganization Act with implementing details embodied in Executive
Order 288, series of 1959 de-centralized and integrated health services.
- The reorganization of 1959 also merged two Bereaus in the Department of
Health. The Bureau of Health was merged with the Bureau of Hospitals to form
the Bureau of Health and Medical Services.

1967 - In the Burea of Disease Control, Mrs. Zenaida Panlilio – Nisce was appointed
as Nursing Program Supervisor and served as consultant on the nursing
aspects of the 5 special diseases: TB, Leprosy, Venereal Disease, Cancer,
Filariasis, and Mental Health.

1974 - The Project Management Staff was organized as part of Population II of the
Philippine Government with Dr. Francisco Aguilar as Project Manager.

1975 - The roles of the public health nurse and the midwife were expanded. 2000
midwives were recruited and trained to serve in the rural areas.
1987-1989 - Executive Order No. 119 reorganized the Department of Health and created
several offices and services within the Depratment of Health.
1990-1992 - Department Order No. 29 designated Mrs. Neila F. Hizon, Nurse VI, then
President of the National League of Philippine Government Nurses, as Nursing
Adviser. She was detailed at the Office Public Health Services. As Nursing
Adviser, matters affecting nurses and nursing are referred to her.
May 24, 1999 - Executive Order No. 102 was signed by President Joseph Ejercito Estrada,
 redirecting the functions and operations of the Department of Health.
2005-2006 - The development of the Rationalization Plan to streamline the bureaucracy
further was started and is in the last stages of finalization.

B. Philosophy of CHN

A philosophy is defined as a system of beliefs that provides a basis for a guide action. A philosophy provides the
direction and describes the whats, the whys, and the hows of activities within a profession.

CHN Practice is guided by the following beliefs:

Humanistic values of the nursing profession upheld

Unique and distinct component of health care
Multiple factors of health considered
Active participation of clients encouraged
Nurse considers availability of resources
Interdependence among health team members practiced
Scientific and up-to-date
Tasks of CHN vary with time and place
Independence or self-reliance of the people is the end goal
Connectedness of health and development regarded

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 a 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 the Health Care System and the larger Human Services System
V. Roles of the Public Health Nurse

A. Roles of the CHN

Clinician or Health Care Provider: utilizes the nursing process in the care of the client in the
home setting through home visits and in public health care facilities; conducts referral of
patients to appropriate levels of care when necessary
 Health Educator: utilizes teaching skills to improve the health knowledge, skills and attitude of
the individual, family and the community and conducts health information campaigns to
various groups for the purpose of health promotion and disease prevention
 Coordinator and collaborator: establishes linkages and collaborative relationships with other
health professionals, government agencies, the private sector, non-government organizations
and people’s organizations to address health problems
 Supervisor: monitors and supervises the performance of midwives and other auxiliary health
workers; also initiates the formulation of staff development and training programs for midwives
and other auxiliary health workers as part of their training function as supervisors
 Leader and Change Agent: influences people to participate in the overall process of community
development
 Manager: organizes the nursing service component of the local health agency or local
government unit; also, as program manager, the PHN is responsible for the delivery of the
package of services provided by the health program to target clientele
 Researcher: participates in the conduct of research and utilizes research findings in practice

B. Responsibilities of the CHN

 Be a part in developing an overall health plan, its implementation and evaluation for
communities.
 Provide quality nursing services to the four levels of clientele
  Maintain coordination/linkages with other health team members, NGO/ government agencies
in the provision of public health services
 Conduct researches relevant to CHN services to improve provision of health care
 Provide opportunities for professional growth and continuing education for staff development

C. 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 and procedures conserving
the health of workers in all occupation
 School Health Nursing: the application of nursing theories and principles in the care of the
school population

FAMILY – topic 3
Family as a Basic Unit of the Society
The family is a group of persons usually living together and composed of the head and other persons related
to the head by blood, marriage or adoption.
 “Social unit interacting with a larger society.” Johnson,2000
 “A family is characterized by people together because of marriage, adoption, or choice”. Allen et
al.,2000
 ”A family is two or more persons who joined together by bonds of sharing and sharing emotional
closeness and who identify themselves as being part of the family. Friedman et al.2003
TYPES OF FAMILY
A. IN TERMS OF MEMBERSHIP
B. BASED ON DESCENT
C. BASED ON RESIDENCE
D. BASED ON AUTHORITY
A. In terms of Membership
1. Nuclear - composed of a husband, wife, and their immediate children – natural, adopted or both.
Classification of Nuclear Family:
a) Family of Orientation - is the family that person creates through having and or adopting children.
b) Family of Procreation - is the family that a person is born into and/or raised within
2. Extended - include married sibling and their families and/or grandparents.
3. Dyad - consisting of only husband and wife, such as newly married couple and empty nester.
4. Blended - one or both spouses bring a child or children from a previous marriage.
5. Compound - where a man has more than one spouse.
6. Cohabiting - a “live in” arrangement between an unmarried couple and children.
7. Single-parent - death of spouse, separation or pregnancy outside of wedlock.
8. Gay or Lesbian - same sex cohabiting couple in a sexual relationship.
B. Based on Descent:
1. Patrilineal descent - related through his father
2. Matrilineal descent - related through his mother
3. Bilateral descent - related through both parents
C. Based on Residence:
1. Patrilocal residence - live with or near the groom’s parents.
2. Matrilocal residence - live with or near the bride’s parents.
3. Bilocal - staying with either the groom’s parent or the bride’s parent.
4. Neolocal - reside independently from the parents.
5. Avunlocal - resides with or near the maternal relatives.
E. Based on Authority

1. Patriarchal Family - the authority is vested in the oldest male in the family.
2. Matriarchal Family - the authority is vested in the mother; or the mother’s kin.
3. Equalitarian Family- equal authority both husband and the wife.
4. Matricentric Family - the father commutes and therefore is absent for the greater part of descent.
 The Family as a Client
The family meets individual needs through provision of basic needs (food, shelter, clothing,
affection and education) and supports spouses or partners by meeting affective, sexual, and socioeconomic
needs.
 The Family as a System
Each member of the system is to a certain extent, independent of other member, yet the
members are in so many ways dependent on each other. Thus, the family is certainly more than just the sum
of its members.

FUNCTIONS OF THE FAMILY

The family fulfills two (2) important purposes:
1. The first is to meet the SOCIETY NEEDS of the family members through:
 Procreation - for reproductive function and child rearing.
 Socialization of family members - is the process of learning how to become productive
members of society.
 Status placement - Society is characterized by a hierarchy of its members into social
classes.
 Economic function - rural family works as a team, in farming, fishing, or cottage
industries while urban family productive member work separately to earn wages or
salaries.
2. The second, is to meet the INDIVIDUAL NEEDS of the family members.
 Physical maintenance - provides survival needs (foods, shelter and clothing) of its
dependent members.
 Welfare and production - supports spouses or partners by providing for companionship
and meeting affective, sexual and socioeconomic needs.
DEVELOPMENTAL STAGES OF THE FAMILY
Stages and Task of the Family Life Cycle
1. Marriage: joining of family
a. Formation of identity as a couple
b. Inclusion of spouse in realignment of relationships with extended families
c. Parenthood: making decisions
2. Families with young children
a. Integration of children into family unit
b. Adjustment of task: child rearing, financial and household
c. Accommodation of new parenting and grand parenting roles
3. Families with adolescents
a. Development of increasing autonomy for adolescent
b. Midlife reexamination of marital and career issues
c. Initial shift toward concern for the older generation
4. Families as a launching center
a. Establishment of independent identity for parents and grown children
b. Renegotiation of marital relationship
c. Readjustment of relationship to include in-laws and grandchildren
d. Dealing with disabilities and death of older generation
5. Aging families
a. Maintaining couple and individual functioning while adapting to the aging process
b. Support role of middle generation
c. Support and autonomy of older generation
d. Preparation for own death and dealing with the loss of spouse and/or siblings and other peers
FAMILY HEALTH TASKS
 Recognizing interruption of health or development.
 Seeking health care.
 Managing health and non health crises.
 Providing nursing care to sick, disabled, or dependent member of the family.
 Maintaining a home environment conducive to good health and personal development.
 Maintaining a reciprocal relationship with the community and its health institutions.
CHARACTERISTICS OF A HEALTHY FAMILY
 Member interacts with each other.
 Healthy families can establish priorities.
 Healthy families affirm, support, and respect each other.
 The members engage in flexible role relationships, share power, respond to change, support growth and
autonomy of others, and engage in decision making that affects them.
 The family teaches family and societal values and beliefs and shares a spiritual core.
 Healthy families foster responsibility and value service to others.
  Healthy families have a sense of play and humor and share leisure time.
 Healthy families have the ability to cope with stress and crisis and grow from problems.
“Families are the compass that guides us. They are the inspiration to reach great heights, and our comfort when
we occasionally falter. Things may change us, but we start and end with the FAMILY”.