Southern Luzon State University

College of Allied Medicine

Bachelor of Science in Nursing

COMMUNITY HEALTH NURSING 1

Module 1

OVERVIEW OF Public health nursing in the

Philippines

Prepared by:

Dr. Sandra D. Elma

Melena V. Quintos, MAN
Maria Luisa E. Barretto, MAN

OVERVIEW
 In this module, will give an idea about public health nursing in the Philippines as to the
definition of public health, community health, public health nursing and community health
nursing. The module will also give the standard and evolution of public health nursing in the
Philippines and the roles and functions of community health nurse. The nurse’s aim is to
improve the health status of the community in general but the nurse has several roles and
function in order to achieve the healthy community and so here the learners will understand
the different roles and functions of a community health nursing.

OBJECTIVES
1. Define public health, community health, public health nursing, and community health
nursing
2. Enumerate the different standard of Public Health Nursing in the Philippines
3. Discuss the evolution of Public Health Nursing in the Philippines
4. Identify the different roles and functions of community health nurse

DISCUSSION
PUBLIC HEALTH

C.E. Winslow defined public health as the science and art of preventing disease, prolonging life
and promoting health and efficiency through organized community effort for:

1. Sanitation of the environment

2. Control of communicable infections
3. Education of the individual in personal hygiene
4. Organization of medical and nursing services for the early diagnosis and preventive
treatment of disease
5. Development of the 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 birthright of health and longevity.

Community Health

It is a branch of public health which focuses on people and their role as determinants of their
own and other people’s health in contrast to the environmental health, which focuses on the
physical environment and its impact on people’s health

Extend the realm of public health to include organized health efforts at the community level
through both government and private efforts
Public Health Nursing

WHO defined as 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 program for the
promotion of health, the improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability

Freeman defined as a field of professional practice in nursing and in public health in which
technical nursing, interpersonal, analytical and organizational skills are applied to problems of
health as they affect the community.

It is the practice of promoting and protecting the health of populations using knowledge from
nursing, social and public health sciences (American Public Health Association, 1996)

It is a population focused with the goals of promoting health and preventing disease and
disability for all people through the creation of conditions in which people can be healthy (ANA,
2007)

Community Health Nursing

Ruth B. Freeman defined as a service rendered by a professional nurse with communities,

groups families, individuals at home, in a health centers, in clinics, in schools, in place of work
for the promotion of health, prevention of illness, care of the sick at home and rehabilitation.

American Nurses Association (ANA) defined as the synthesis of nursing practice and public
health practice applied to promoting and preserving the health of population

Public Health Nurse (PHN)

Refer to the nurses in the local/ national health departments of public school whether their official
position title is Public Health Nurse or nurse or school nurse

PHILOSOPHY

According to Dr. Margaret Shetland, the philosophy of Community Health Nursing is based on the
worth and dignity of man.

CONCEPTS

Concepts basic to nursing are used in working with the clients: individuals, families, groups and
communities. Some concepts of community health nursing are:

1. The primary focus of community health nursing practice is on health promotion

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 /or the 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.

GOAL

 The ultimate goal of community health services is to raise the level of health of the citizenry.
 The goal of community health nursing is to help communities and families to cope with the
discontinuities in health and threats in such a way as to maximize their potential for high level
wellness, as well as to promote reciprocally supportive relationship between people and their
physical and social environment.

OBJECTIVES

1. To participate in the development of an over-all health plan for the community and its
implementation and evaluation.
2. To provide quality nursing services to individuals, families and communities utilizing as basis, the
standards set for community health nursing practice.
3. To coordinate nursing services with various members of the health team, community leaders
and significant others, government and non-government agencies/organization in achieving the
aims of public health services within the community.
4. To participate in and /or conduct researches relevant to community health and community
health nursing services and disseminate their results for improvements of health care.
5. To provide community health nursing personnel with opportunities for continuing education
and professional growth through staff development.

PRINCIPLES

The following principles of Community Health Nursing were adapted from those formulated by
Mary S. Gardner and by Leahy, Cobb and Jones.
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 basic 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 work s 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 program for nurses must be provided 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.
STANDARDS OF PUBLIC HEALTH NURSING PRACTICE

Standards of Care
Standard 1. Assessment The public health nurse collects comprehensive data pertinent to the health
status populations
Standard 2. Population The public health nurse identifies expected outcomes for a plan that is based on
diagnosis and priorities population diagnoses and priorities
Standard 3. Outcomes The public health nurse identifies expected outcomes for a plan that is based on
identification population diagnoses and priorities
Standard 4. Planning The public health nurse develop 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 Employs multiple strategies to promote health , prevent disease, ensure a safe
and Health environment for populations
Promotion
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
Standard of professional performance
Standard 7. Quality of The public health nurse systematically enhances the quality and effectiveness of
practice 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 in relation to
practice evaluation professional practice standards and guidelines, relevant statutes, rules and
regulations
Standard 10. Collegiality and The public health nurse collaborates with the representatives of the population,
professional relationships 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 The public health nurse considers factors related to safety, effectiveness, cost
Utilization population and impact on practice and in the planning and delivery of nursing and public
health programs, policies and services
Standard 15. Leadership The public health nurse provides leadership on nursing and public health

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

The history of public health nursing in the Philippines is embedded in the history of
Department of Health which was first established as Department of Public Works Education and
Hygiene in 1989

1912

Fajardo Act. (Act No. 2156) created Sanitary Divisions. The president of the sanitary Division
(forerunners of the present Municipal Health Officers) took charge of two or three
municipalities. Where there were no physicians available, male nurses were assigned to
perform the duties of the president, Sanitary Division.
1914

School Nursing was rendered by a nurse employed by the Bureau of Health in Tacloban Leyte

In the same year, Recognization Act No. 2462 created the Office of General Inspection

Two graduate Filipino nurses, Mrs. Casilang Eustaquio and Mrs. Matilde Azurin were employed
for Maternal and Child Health Sanitation in Manila under an American nurse, Mrs G. D.
Schudder.

1916 – 1918

Miss Perlita Clark took charge of the public health nursing work staff was composed:

 1 american nurse supervisor

 1 American dietitian
 36 Filipino nurse working in the provinces
 1 nurse and 1 dietitian assigned in two sanitary department

1917

Four graduate nurses paid by the City of Manila were employed to work in the City Schools

1018

The office of Miss Clark was abolished due to lack of funds

1919

The first Filipino nurse supervisor under the Bureau of Health, Miss Carmen del Rosario was
appointed. She succeeded Miss Madel Dabbs. There was gradual increase of public health
nurses and expansion of services.

1923

Two government schools of Nursing were established:

1. Zamboanga General Hospital School of Nursing in Mindanao

2. Baguio General Hospital in Northern Luzon

July 1, 1926

Miss Carmen Leogardo resigned and Miss Genara S. Manongdo, a ranking supervisor of the
American Red Cross, Philippine Chapter was appointed in her place.

1928

The first convention of nurses was held followed by yearly convention until the advent of World
War II. Pre service training was initiated as a pre-requisite for appointment.
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

October 7, 1947

The newly created Section of Puericulture center of the bureau of hospitals had Mrs
Teresa Malgapo as Chief.

1948

The first training Center of the Bureau of Health was organized in cooperation with Pasay City
Health Department. Physicians and nurses undergoing pre-service training in public health
nursing as well as nursing students on affiliation were assigned to the above training center.

1953

Phil. Congress approved Republic act No. 1082 or the Rural Health Law. It created the 81 Rural
health units. Each unit had a physician, a public health nurse, midwife, a sanitary inspector and
a clerk driver.

1957

Republic Act 1891 was approves amending Sections 2, 3, 4, & and 8 of R.A. 1082
“Strengthening Health and Dental Services in the rural areas and Providing Funds”

1967

In the merged bureau of Disease Control, Mrs. Zenaida Panlilio-Nince was appointed as Nursing
Program Supervisor and served as consultant on the nursing aspects of the 5 special diseases:
TB, Leprosy, Venereal Disease, Cancer, Filiariasis; and Mental Health. She was involved in
program planning, monitoring, evaluation and research

1987

Executive Order No. 119 reorganized the Department of Health and created several offices and
services within the Department of Health.

1990 – 1992

Aside from the usual services for mother and children, these nurses were involved in the
following programs: expanded program on immunization, Control of Diarrheal and control of
acute respiratory infections.

1990 - 1992

Aside from the usual services for mother and children, these nurses were involved in the following
programs: expanded program on immunization, Control of Diarrheal and control of acute respiratory
infections.

ROLES AND FUNCTIONS OF PUBLIC HEALTH NURSE

1. Planner /Programmer
 Identifies needs, priorities and problems of individual, families and community
 Formulates nursing component of health plan. In doctorless area, she/he is
responsible for the formulation of the municipal health plan
 Interprets and implements the nursing plan, program policies, memoranda and
circular for the concerned staff/ personnel
 Provides technical assistance to rural health midwives in health matter like target
setting etc.

2. Provider of Nursing Care

 An inherent function of the nurse; cares for individuals, families and
communities toward health promotion and disease prevention
 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 patient care

3. Manager /Supervisor
 Formulates individual, family, group and community centered care plan
 Interprets and implements program policies, memoranda and circulars
 Organizes work force, resources, equipment and supplies and delivery of health
care at local levels
 Requisitions, allocates, distributes materials (medicine and medical supplies,
records and reports equipment)
 Provides technical and administrative support to rural health midwife (RHM)
  Conducts regular supervisory visits and meetings to different RHMs and gives
feedback on accomplishment /performance
 Organizing nursing service of the local helth agency, the PHN responsible for the
delivery of the services provided by the program to the target clientele
 PHN is a supervisor of the midwives and other auxillary health workers, whom
formulates a supervisory plan and conducts supervisory visit to impliment the
plan

4. Community Organizer
 Responsible for motivating and enhancing community participation in terms of
planning, organizing, and implimenting 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 health team and Government
Organization and non Government Organization
 Brings activities or group activities systematically into proper relation or
harmony with each other
 Coordinates nursing programs as environmental sanitation, health education,
dental health and mental health

6. Trainer/ Health Educator / Councelor

 Identifies and interprets training needs of the RHMs, barangay health workers
(BHWs) and hilots
 Formulates appropriate training program designs for RHMs, BHWs and hilots
 Provides and arranges learning experience for RHMs, affiliates (nursing and
midwife) and other health workers
 Conducts training for RHMs and hilot on health promotion and disease
prevention
 Conducts pre and post consultation conferences for clinic patients
 Facilitates training for Barangay Health Workers
 Organizes orientation/ training of concerned groups including nongovernment
organization
 Provides information that allows clients to make healthier choices and practices
 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/projects.
 Initiates the use of tri media: radio/TV and cinema plugs, print ads and other
indigenous resources for health education purposes
 Conducts premarital counseling

7. Health Monitor
 Detects deviation from health of individuals, families, groups of the community
through contacts/ visits with them
  Uses symptomatic and objectives observation 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 reports and record
 Maintain adequate, accurate and complete recording and reporting
 Reviews, validates, consolidates, analyzes and interprets all records and reports
 Prepare statistical data/charts and other data presentations for display and for
presentations in staff meeting conferences and seminars/workshops

11. Researchers
 Participates/ assists in the conduct of survey studies and researches on nursing
and health related subjects
 Coordinates with government and non-government organization in the
implementation of studies/research

4 MANAGEMENT FUNCTIONS OF PUBLIC HEALTH NURSE

 Planning

 Organizing

 Directing

 Controlling

MANAGEMENT FUNCTION

 The community health nurse organizes the nursing service of the local health agency

 Prepares and implements the nursing service plan

  Manages the other nurses and midwives and their activities

 As a program manager, she is responsible for the delivery of the package of services
provided by the program to the target clientele

 Makes reports on program accomplishments

SUPERVISORY FUNCTION

 Supervises the work of midwives and other auxiliary health workers

 Formulates a supervisory plan and conducts supervisory visits

 Identifies issues, concerns and problems with the supervisee and addresses them
accordingly

NURSING CARE FUNCTION

 Provides nursing care to the individuals, families and communities toward health
promotion and disease prevention

 Does assessment, plans and implements care, and evaluates outcomes

 Conducts home visits to sick clients and to those needing follow up care

 Refers patients to appropriate levels of care when indicated

COLLABORATING AND COORDINATING FUNCTION

 Establishes linkages and collaborative relationships with other health professionals,

government agencies, the private sector, non-government organizations, 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 health care

 Refers patients to other health personnel, health facility or government agency

HEALTH PROMOTION AND EDUCATION FUNCTION

 Performs health teachings and health information campaigns promoting health to

individuals, families and communities
  Provides clients with information that allows them to make healthier choices and
practices

 Giving health information is a very important function of the PHN. It is a basic health
service. Health education activities is a major component of any public health program.

TRAINING FUNCTION

 Formulates staff development and training programs for the midwives and other
auxiliary workers

 Does training needs assessment for these health workers, designs the training program
and conducts them in collaboration with other resource persons

 Evaluates training outcomes

 Participates in 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 RLE in
the community setting

 Mobilizes the communities to solve their own problems

RESEARCH FUNCTION

 Participates in the conduct of research and utilizes research findings in her practice

 Performs disease surveillance

REFERENCE

Famorca et al., Nursing Care of the Community A Comprehensive text on Community and Public
Health Nursing in the Philippines, 2013
 The history of public
health nursing in the
Philippines is embedded in
the history of the
Department of health which
was first established as
Department of Public
Works, Education and
Hygiene in 1898.