CHAPTER 1

I. Community Health Nursing Concepts

A. Definition
 “The utilization of the nursing process in the different levels of clientele-
individuals, families, population groups and communities, concerned with
the promotion of health, prevention of disease and disability and
rehabilitation.” ( Maglaya, et al)

 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 Expert Committee of Nursing)

 A learned practice discipline with the ultimate goal of contributing as

individuals and in collaboration with others to the promotion of the client’s
optimum level of functioning thru’ teaching and delivery of care (Jacobson)
 A service rendered by a professional nurse to IFCs, population groups in
Health centers, clinics, schools, workplace for the promotion of health,
prevention of illness, care of the sick at home and rehabilitation (DR. Ruth
B. Freeman

 Community/ public health nursing is the synthesis of nursing practice and

public health practice.
 Major goal of CHN- preserve the health of the community and surrounding
population by focusing on health promotion and health maintenance of
individual, family and group within community.
- Thus CHN/ PHN is associated with health and identification of population at
risks rather than with an episodic response to patient demand.
 Mission of public health- is social justice that entitles all people to basic
necessities, such as adequate income and health protection, and accepts
collective burdens to make possible.

 Definition of health according to:

a. WHO- “a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity.”
b. Murray- “a state of well-being in which the person is able to use
purposeful, adaptive responses and processes physically, mentally, emotionally,
spiritually, and socially.”

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B. Philosophy and Principles

“The philosophy of CHN is based on the worth and dignity of man.”(Dr. M.
Shetland)

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

C. Features of CHN
Characteristics of Community Health Nursing:
There are six important characteristics of community nursing; those are
mentioned in the following:

 It is a specialty field of nursing.

 Its practice combines public health with nursing.
 It is population based.
 It emphasizes on wellness and other than disease or Illness.
 It includes inter-disciplinary collaboration.
 It amplifies client’s responsibility and self-care.

D. Theoretical models/ approaches

1. Health belief model (HBM)

 This model is based on the premise that for a behavioral change to

succeed, individuals must have the incentive to change, feel threatened by
their current behavior, and feel that a change will be beneficial and be at
acceptable cost.
 They must also feel competent to implement that change.
 The purpose of the model is to explain and predict preventive health
behavior. 
 The Health Belief Model
o Initially proposed in 1958, the model provides the basis for much of
the practice of health education and promotion today.
o This model found that information alone is rarely enough to motivate
people to act for their health. Individuals must know what to do and
how to do it before they can take action.

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Concept Definition

Perceived susceptibility One’s belief regarding the chance

of getting a given condition

Perceived severity One’s belief in the seriousness of

a given condition

Perceived benefits One’s belief in the ability of an

advised action to reduce the
health risk or seriousness of a
given condition

Perceived barriers One’s belief regarding the tangible

and psychological costs of an
advised action

Cues to an action Strategies or conditions in one’s

environment that activate
readiness to take action

Self-efficacy One’s confidence in one’s ability

to take action to reduce health
risks

 The model’s concepts all relate to the client’s perceptions

 For example: the cue to action in the prevention of dengue fever may
be provided through an information campaign. This makes the people
in a baranggay aware of the disease and that everyone is susceptible
to the possibly fatal disease. The HBM would be used by the nurse to
help clients in making behavior modifications to avoid dengue.
2. Milio’s Framework for Prevention

Milio’s Framework for Prevention

 Nancy Milio developed a framework for prevention that includes concepts

of community – oriented, population- focused care.
 Milio stated that behavioral patterns of the populations-and individuals who
make up populations – are a result of habitual selection from limited
choices.
 She challenged the common notion that a main determinant for
unhealthful behavioral choice is lack of knowledge.
 Milio’s framework described a sometimes neglected role of community
health nursing to examine the determinants of a community’s health and
attempt to influence those determinants through public policy.

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Levels of Prevention Model

 This model, advocated by Leavell and Clark in 1975, has influenced both
public health practice and ambulatory care delivery worldwide.
 This model suggests that the natural history of any disease exists on a
continuum, with health at one end and advanced disease at the other.
 The model delineates three levels of the application of preventive
measures that can be used to promote health and arrest the disease
process at different points along the continuum.
 The goal is to maintain a healthy state and to prevent disease or injury.

It has been defined in terms of four levels:

 Primordial prevention
 Primary prevention
 Secondary prevention
 Tertiary  prevention

Primordial prevention

 Prevention of the emergence or development of risk factors in population

or countries in which they have not yet appeared.
 Efforts are directed towards discouraging children from adopting harmful
lifestyles.

Primary prevention

 An action taken prior to the onset of disease, which removes the possibility
that the disease will ever occur.
 It includes the concept of positive health that encourages the achievement
and maintenance of an “acceptable level of health that will enable every
individual to lead a socially and economically productive life.

Secondary prevention

 Action which halts the progress of a disease at its incipient stage and
prevents complications.
 The domain of clinical medicine.
 An imperfect tool in the transmission of disease.
 More expensive and less effective than primary prevention.

Tertiary prevention

 All measures available to reduce or limit impairment and disabilities,

minimize suffering caused by existing departures from good health and to
promote the patient's adjustment to irremediable conditions.

3. Nola Pender’s Health Promotion

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Nola Pender’s Health Promotion Model theory was originally published in

1982 and later improved in 1996 and 2002. It has been used for nursing
research, education, and practice. Applying this nursing theory and the
body of knowledge that has been collected through observation and
research, nurses are in the top profession to enable people to improve
their well-being with self-care and positive health behaviors.

The Health Promotion Model

 Designed to be a “complementary counterpart to models of health

protection.”
 It develops to incorporate behaviors for improving health and
applies across the life span. Its purpose is to assist nurses in
knowing and understanding the major determinants of health
behaviors as a foundation for behavioral counseling to promote well-
being and healthy lifestyles.
 Defines health as “a positive dynamic state not merely the absence
of disease.” Health promotion is directed at increasing a client’s
level of well-being. It describes the multi-dimensional nature of
persons as they interact within the environment to pursue health.
 The model focuses on the following three areas:
o individual characteristics and experiences,
o behavior-specific cognitions and affect,
o Behavioral outcomes.

Major Concepts of the Health Promotion Model

Individual characteristics and experiences (prior related behavior and

personal factors).

Behavior-specific cognitions and affect (perceived benefits of action,

perceived barriers to action, perceived self-efficacy, activity-related affect,
interpersonal influences, and situational influences)

Behavioral outcomes (commitment to a plan of action, immediate

competing demands and preferences, and health-promoting behavior).

Sub concepts of the Health Promotion Model

A. Personal Factors

Personal factors categorized as biological, psychological and socio-cultural.

These factors are predictive of a given behavior and shaped by the nature
of the target behavior being considered.

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 Personal biological factors. Include variables such as age gender

body mass index pubertal status, aerobic capacity, strength, agility, or
balance.
 Personal psychological factors. Include variables such as self-
esteem, self-motivation, personal competence, perceived health status,
and definition of health.
 Personal socio-cultural factors. Include variables such as race,
ethnicity, acculturation, education, and socioeconomic status.

B. Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.

C. Perceived Barriers to Action

Anticipated, imagined or real blocks and personal costs of understanding a

given behavior.

D. Perceived Self-Efficacy

Judgment of personal capability to organize and execute a health-

promoting behavior. Perceived self-efficacy influences perceived barriers
to action so higher efficacy results in lowered perceptions of barriers to the
performance of the behavior.

E. Activity-Related Affect

Subjective positive or negative feeling that occurs before, during and

following behavior based on the stimulus properties of the behavior itself.

Activity-related affect influences perceived self-efficacy, which means the

more positive the subjective feeling, the greater the feeling of efficacy. In
turn, increased feelings of efficacy can generate a further positive affect.

F. Interpersonal Influences

Cognition concerning behaviors, beliefs, or attitudes of the others.

Interpersonal influences include norms (expectations of significant others),
social support (instrumental and emotional encouragement) and modeling
(vicarious learning through observing others engaged in a particular
behavior). Primary sources of interpersonal influences are families, peers,
and healthcare providers.

G. Situational Influences

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Personal perceptions and cognitions of any given situation or context that

can facilitate or impede behavior. Include perceptions of options available,
demand characteristics and aesthetic features of the environment in which
given health promoting is proposed to take place. Situational influences
may have direct or indirect influences on health behavior.

H. Commitment to Plan of Action

The concept of intention and identification of a planned strategy leads to

the implementation of health behavior

I. Immediate Competing Demands and Preferences

Competing demands are those alternative behaviors over which

individuals have low control because there are environmental
contingencies such as work or family care responsibilities. Competing
preferences are alternative behaviors over which individuals exert
relatively high control, such as choice of ice cream or apple for a snack

J. Health-Promoting Behavior

A health-promoting behavior is an endpoint or action outcome that is

directed toward attaining positive health outcomes such as optimal well-
being, personal fulfillment, and productive living

4. Lawrence Green’s PRECEDE-PROCEED – MODEL

PRECEDE/PROCEED model

 PRECEDE/PROCEED model is a widely used model in public health for bringing

change in behavior.

PRECEDE stands for: PROCEED Stands for:

P – Predisposing, P – Policy,
R-   Reinforcing, R – Regulatory,
E – Enabling, O – Organizational,
C – Construct in, C – Construct in,
E-   Educational, E – Educational and
D – Diagnosis and E – Environmental,
E – Evaluation. D – Development.

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 Epidemiological data includes vital statistics, disability, incidence,

prevalence etc.

PHASE 3: Behavioral and environmental assessment

 Behaviors, practices, lifestyle, environmental factors are

determined affecting health problem identified in phase 2.
 This assessment facilitate planner to prioritize behavior which will
be targeted in intervention program.
 Behavioral diagnosis analyzes behaviors that influence the
problem identified in phase 1 and 2.
 Environmental diagnosis analyzes physical and social
environment that would affect the behavior of the individual.
 Non behavioral factors include factors such as climate, workplace,
availability and adequacy of health institutions.

PHASE 4: Educational diagnosis

 In this phase, predisposing, reinforcing and enabling factor that

may support or form barrier to changing environment. 

Predisposing factor

It includes any characteristics of individual or population that affects

personal motivation to bring change in their behavior. It includes:

 Knowledge
 Beliefs
 Values
 Attitudes
 Norms etc.

E.g. believe that smoking harmful for health.

Reinforcing factors

Reinforcing factors are feedbacks from others which may be positive or

negative; continued reward, incentive can motivate repetition of certain
behavior. It includes:

 Reward/Punishment
 Peer influence
 Teacher
 Family etc.

E.g. peer pressure for smoking.

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Enabling factors

They are social and environmental factors that enable motivation attain
specific behavior.

 Availability
 Access
 Health related laws
 Resources
 Skills

E.g. cigarette is readily available in market.

PHASE 5: Administrative and policy diagnosis

 It identifies administrative and policy factors which should be

focused before program implementation.
 Policy diagnosis: it analyzes if goals/ objective of program is
compatible with that of organization.
 Administrative diagnosis: it analyses policies, resources in
organizational situation that facilitate or hinder development of
program.

PHASE 6: Implementation of program

 In this phase, planned program is put into action in targeted

population.

PHASE 7: Process evaluation

 In process evaluation, implementation process is evaluated; it

helps to determine if the program is being conducted as planned
and helps to bring modification if necessary to improve the
program.

PHASE 8: Impact evaluation

 This evaluation is carried out immediately after implementation of

program.
 It helps to determine effectiveness and efficiency of the program
as well as change in predisposing, reinforcing and enabling
factors.

PHASE 9: Outcome evaluation

 It evaluates if the program implemented produce effect favorable

to outcomes identified in phase 1.
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 It measures achievement of overall objective of program and

change in quality of life.
 It determines effect of program in health and quality of life of the
community.
E. Different Fields of Community Health Nursing
1. School Health Nursing
 School Nursing is a type of public health nursing that
focuses on the promotion of health and wellness of
pupils/students, teaching and non-teaching personnel
of the school.
 Assist young people in making choices for a healthy
lifestyle, reduce risk taking behavior and focus on
issues such as prevention of drugs and substance
abuse, teenage pregnancy, sexually transmitted
infection, malnutrition, communicable and non-
communicable disease.
Objectives:

General: To promote and maintain the health of

the school and populace by providing
comprehensive quality nursing care.

Specific:
1. Provide quality nursing service to the school
population
2. Create awareness among school children,
personnel and administration on the
importance of the promotive and preventive
aspects of health through health education.
3. Encourage the provision of standard functional
facilities.
4. Provide nursing personnel with opportunities
for continuing education and training
5. Conduct and participate in researches related
to nursing, and
6. Establish/ strengthen linkages with government
and non- government organization/agencies for
school community health work.

Duties and Responsibilities:

1. Health Advocacy
2. Health and nutrition assessment including other
screening procedures such as vision and hearing
3. Supervision of the health and safety of the school
plant.
4. Treatment of common ailments and attending to
emergency cases.
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5. Referrals and follow-up of pupils and personnel

6. Home visits
7. Community outreach like attending community
assemblies and organizing school community
health councils.
8. Recording and reporting accomplishments.
9. Monitoring and evaluation of programs and
projects.

Functions:
A. School Health and Nutrition Survey
 This shall done initially to provide data for
evaluation and for planning purposes.
 Survey shall include among others the
current health and nutritional status of
school children, situation on health facilities
as well as actual status of health education
activities undertaken by the teachers and
health personnel

B. Putting up a Functional School Clinic

 R.A 124 mandates that all the schools are
to provide school clinics for the treatment of
minor ailments and attendance of
emergency cases.
C. Health Assessment
 Aims to discover the signs of illness and
physical defects in order to correct them,
check on the health habits of pupils and
prevent the progress of those which cannot
be corrected.

D. Standard Vision Testing for School children

E. Ear examination
F. Height and Weight Measurement and Nutritional
Status Determination
G. Medical Referrals
H. Attendance to Emergency cases
I. Student Health Counselling
J. Health and Nutrition Education Activities
K. Organization of School Community Health and
Nutrition Councils.
L. Communicable Disease Control
M. Establishment of Data Bank on school health and
Nutrition Activities.
N. School Plant Inspection for Healthy Environment
O. Rapid classroom inspection.
P. Home Visitation
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 The school nurse visits four to six schools per month, with each
visit lasting for 3 days or more, depending on the type of school
and school location and population.
 Revisits may be done within the month in a particular school.
 Teachers who also serve as school guardians, provide primary
care as necessary. Such as detection of obvious health
problems and administration of first aid.
 The school nurse is responsible for planning and conducting
training programs for teachers on health and nutrition.
 Poverty is associated with decreased or inferior health care and
has been linked to serious health problems that result in
absenteeism and failure in school.
 The school nurse and in the absence of the school nurse, the
well-prepared school teacher, serving as school health guardian,
can effectively manage minor complaints of illnesses, helping
these children to return to or remain in class.
 There is a need for mental and physical health services for
student of all ages in an effort to improve both academic
performance and the sense of well-being.

 School health program were defined as:

1. School health services
2. School health education
3. A healthy school environment to include both physical
and psycho-social aspects of environment (WHO, 1997)

 RA 124 in 1947- an act to provide for Medical Inspection of

Children Enrolled in Private Schools, Colleges and
Universities in the Philippines. This law stated that it was
the duty of the school heads of private schools with a total
enrolment of 300 or more to provide for a part-or full time
physician for the annual medical examination of pupils and
students.
 The physicians were to render of their school health
activities at the end of every quarter of each school year to
the Director of Health.

 SCHOOL HEALTH SERVICES/ Programs:

EIGHT COMPONENTS OF SCHOOL HEALTH

RPOGRAMS
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Health Physical Health Nutrition

education Education Services Services

Family and
Healthy Health community
Counseling, school promotion for involvement
psychological environment staff
and social
services

 Health Education- these are culture sensitive and

based on the identified educational needs of the target
population.
Areas of concern for health education:
1. Oral Hygiene- the oral health care program involves the 7
o‘clock tooth brushing habit activity.
2. Injury prevention and developing safety conscious behavior
in the use of the school playground, while engaging in sports,
and the like. MAPEH period is a good time for the school
nurse or teacher to talk with and counsel students about risk
of developing health problems related too physical activity.
3. Tobacco Use- Smoking is a major problem in this country.
- Prevention should be emphasized in young people.
4. Substance Abuse- The use of alcohol and other drugs is
associated with problems in schools, injuries and violence,
and motor vehicle deaths.
- National Drug Education Program- designed to promote
collaboration of other sectors with the school system by
establishing linkages among government, private and socio-
civic organizations.
- Random drug testing is also carried as part of this program.
5. HIV, AIDS- School-base HIV and AIDS Education and
prevention program is an information dissemination
campaign to educate the general
Population on the risks of HIV and AIDS.
 Physical Education - Sedentary lifestyle is associated with
obesity, hypertension, heart disease and diabetes
- Regular Physical activity helps build and maintain
healthy bones and muscles.
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 Health services
1. Health Screening- one of the objective of the school
health nursing program in the Philippines is to detect
early signs and symptoms of illness, disabilities and
deviations from normal.
a. Annual Individual health assessment- examination of
the eyes, ears, nose, throat, neck, mouth, skin,
extremities, posture, nutritional status, heart and lungs.
b. Visual acuity test is done with the use of Snellen’s chart,
E-chart or symbol chart.
c. Ball pen click test (auditory screening) - test for hearing
acuity.

d. Height and weight measurement- done at the beginning

and at the end of the school year.
e. Rapid Classroom Inspection- inspection of the pupils in
the classroom or while they are in line formation outside
the classroom.
f. Done to detect illness, particularly when there is
outbreak in the community.

 Emergency Care- emergencies can include natural events

such as typhoons, floods, and earthquake and man-made
disasters, such as hazardous material spills, fires and civil
disobedience.
- Basic first aid equipment should be available in all schools.
- The school nurse and school health guardians must be
knowledgeable about standard first aid.
- EMS activation and Referral system should be in place.
 Nutrition- a variety of foods must be ingested to meet their
daily requirement.
- Diets should include a proper balance of carbohydrates,
proteins, and fats with sufficient intake of vitamins and
minerals. S
- Skipping meals, especially breakfast and eating unhealthy
snacks contribute to poor childhood nutrition.
- Food preparation is expected to be undertaken by the home
economics, feeding teachers, homeroom Parent-Teachers
Association on a rotation basis or both.
 Obesity – not considered as an eating disorder
- must be of concern to the school nurse
- 3 most common eating disorder:
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1. Anorexia- severely restricted intake of food

based on an extreme fear of weight gain.
2. Bulimia- chaotic eating pattern with recurrent
episodes of binge eating.
3. Binge eating-out of control eating of large
amounts of food whether hungry or not.

 Counseling, Psychological and social services- children

and teens struggle with depression, substance abuse,
conduct disorders, self-esteem, suicide ideation, eating
disorders and under or over achievement.
- One of the most important roles of the nurse with
various vague complaints, such as recurrent
stomachaches, headaches, or sexually promiscuous
behavior.
- Early detection and treatment may prevent untoward
consequences.
- It is important for the nurse to be cognizant of the
warning signs associated with suicide and to recognize
and refer at-risk adolescents to appropriate mental
health professionals.
-
 Healthy School Environment- the healthy school environment
should consist of (WHO, 1997)
1. A Physical, psychological and social environment
2. A healthy organizational culture within the school
3. Productive interaction between the school and community.
 Health Promotion for school staff- staff that participate in
health promotion increase their health knowledge and positively
change their attitudes and behaviors relative to smoking
practices, nutrition, physical activity, stress and emotional
health.

Truths about adolescent suicide

1. Most adolescent who attempt suicide are torn between wanting to die and
wanting to live
2. Any threat of suicide should be taken seriously
3. There are usually warning signs preceding an attempt(depression, isolation,
sleep changes)
4. Suicide is more common in adolescents than Homicide
5. Education concerning suicide
6. Does not lead to an increased number of attempts.
7. Females are more likely to attempt suicide. Males are more likely to suicide
8. One attempt can result in a subsequent attempt
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9. Firearms and strangulation are predominant modalities of completed suicides in

children and adolescents.
10. Most adolescents who attempted suicide have not been diagnoses as having
mental disorder.
11. All socioeconomic groups are affected by suicide.
Warning Signs of Stress

 Difficulty eating or sleeping

 Use of alcohol or other substances (sedatives, sleep enhancer)
 Difficulty in making decisions
 Persistent angry or hostile feelings
 Inability to concentrate
 Increased boredom
 Frequent headaches and ailments
 Inconsistent school attendance

Standards of school nursing practice

Standards Of Practice

Standard 1. Assessment Nurse collects comprehensive data

pertinent to the clients health or the
situation

Nurse analyzes the assessment data to

Standard 2. Diagnosis determine the diagnoses or issues

Standard 3. Outcomes Nurse identifies expected outcome for a

identification plan individualized to the client or the
situation

Standard 4. Planning School nurse develops a plan that

prescribes strategies and alternatives to
attain expected outcome.

Standard 5 A. Coordination Nurse provides health education and

of care employs strategies to promote health and
a safe environment.

Standard 5 B. health Nurse provides health education and

teaching and health employs strategies to promote health and
promotion a safe environment.

Standard 6. Evaluation School nurse evaluates the client’s

progress towards attainment of
outcomes.

Standards of professional performance

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Standard 7. Quality of School nurse systematically enhances

practice the quality and effectiveness of nursing
practice

Standard 8. Education School nurse attains knowledge and

competency that reflects current school
nursing practice.

Standard 9. Profession Nurse evaluates ones own nursing

practice evaluation practice

Standard 10. Collegiality Nurse interacts with to the professional

development of peers and school
personnel as colleagues.

Standard 11. Collaboration School collaborates with the client, family,

school, staff

Standard 12. Ethics School nurse integrates ethical provision

in all areas of practice.

Standard 13. Research School nurse integrates research findings

into practice.

Standard 14. Resource School nurse considers factors related to

utilization safety, effectiveness, cost and impact.

Standard 15. Leadership School nurse provides leadership in the

professional practice setting and the
profession

Standard 16. Program Manages school health services.

Management

School Nursing Practice- is a specialty unto itself. School

nurses need education in specific areas, such as growth and
development, public health, mental health nursing, case
management, family theory, leadership and cultural sensitivity to
effectively perform their roles.

2. Occupational Health Nursing

OCCUPATIONAL HEALTH

 Occupational Health Nursing is defined as a specialty practice

that focuses on the promotion, prevention, and restoration of
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health within the context of a safe and healthy environment. It

includes the prevention of adverse health effects from
occupational and environmental hazards.

 Department of Labor and Employment – the lead agency on

Occupational Safety and Health

 They are given RULE MAKING and RULE ENFORCEMENT

powers to implement stipulations of the Philippine Constitution
and the Philippine Labor Code.

 The National Profile on Occupational Safety and Health (of

the Department of Labor and Employment – Occupational
Safety and Health Center (OSHC) – defined OSH as a discipline
involved in “the promotion and maintenance of the highest
degree of physical, mental and social well-being of workers in all
occupations.”

EVOLUTION OF OCCUPATIONAL HEALTH NURSING IN THE

PHILIPPINES

 MS. MAGDALENA VALENZUELA – she instituted the

INDUSTRIAL NURSING UNIT of the Philippine Nurses
Association on November 11, 1950.

 MS. PERLA GORRES – from the Philippine Manufacturing

Company (PMC) served as the first chairperson of the said unit.

 MS. ANITA SANTOS – was elected as first president on August

19, 1964. She paved way to the modification in the name of the
organization to Occupational Health Nurses Association of the
Philippines, Inc. on November 12, 1966.

 June 5 – 6, 1970 – first annual convention was held.

 September 25, 1979 – the organization was registered with the
Securities and Exchange Commission.

ASSESSMENT AND CONTROL OF HAZARDS IN THE

WORKPLACE

 HEALTH HAZARDS – are the elements in the work

environment that can cause work-related disease.
 SAFETY HAZARDS – are the unsafe conditions or unsafe acts
that significantly increase the risk of a worker to be injured.

TYPES OF HAZARDS:
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1. Biological-infectious hazards – infectious agents such as

bacteria, viruses, fungi.
2. Chemical hazards – various forms of chemical agents.
3. Enviromechanical hazards – factors that cause accident,
injuries, strains or discomfort (eg. Poor equipments)
4. Physical hazards – radiation, electricity, temperature, and noise
5. Psychosocial hazards – anything that causes emotional stress
and strain or interpersonal problem.

CONTROL MEASURES FOR OCCUPATIONAL HAZARDS:

1. Administrative Control – refers to the development and
implementation of policies, standards, trainings, job design and
the like.
2. Engineering – refers to the adoption of physical, chemical or
technological improvements to limit exposure to hazards.
3. Materials Provision – refers to providing the workers with
supplies or supplements that can decrease their exposure to
hazards.

DUTIES OF OCCUPATIONAL HEALTH NURSE as stated in Rule

1965.04 of the amended OSHS by DOLE:

“The duties and functions of the Occupational Health Nurse are:

(1) In the absence of a physician, to organize and administer a health

service program integrating occupational safety, otherwise, these
activities of the nurse shall be in accordance with the physician;

(2) Provide nursing care to injured or ill workers;

(3) Participate in health maintenance examination. If a physician is not

available, to perform work activities which are within the scope allowed
by the nursing profession, and if more extensive examinations are
needed, to refer the same to a physician;

(4) Participate in the maintenance of occupational health and safety by

giving suggestions in the improvement of working environment
affecting the health and well-being of the workers; and

(5) Maintain a reporting and records system, and, if a physician is not

available, prepare and submit an annual medical report, using form
DOLE/BWC/HSD/OH-47, to the employer, as required by this
Standards.

CODE OF ETHICS OF THE AMERICAN ASSOCIATION OF

OCCUPATIONAL HEALTH NURSES:

1. The American Association of Occupational Health Nurses (AAOHN)

articulates occupational and environmental health nursing values,
maintains the integrity of our specialty practice area and the nursing
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profession, and integrates principles of social justice into nursing and

health policy

2. The occupational and environmental health nurse (OHN) practices

with compassion and respect for the inherent dignity, worth, and unique
attributes of every person.

3. The occupational and environmental health nurse's (OHN) primary

commitment is to the client, whether an individual, group, community,
or population.

4. The occupational and environmental health nurse (OHN) promotes,

advocates for, and protects the rights, health, and safety of the client.

5. The occupational and environmental health nurse (OHN) has

authority, accountability, and responsibility for nursing practice; makes
decisions; and takes action consistent with the obligation to prevent
illness and injury, promote health, and provide optimal health care.

6. The occupational and environmental health nurse (OHN) owes the

same duties to self as to others, including the responsibility to promote
health and safety, preserve wholeness of character and integrity,
maintain competence, and continue personal and professional growth.

7. The occupational and environmental health nurse (OHN), through

individual and collective effort, establishes, maintains, and improves
the ethical environment of the work setting and conditions of
employment that are conducive to safe, quality health care.

8. Occupational and environmental health nurses (OHN) help advance

the nursing profession and our specialty practice through research and
scholarly inquiry, professional standards development, and the
generation of nursing and health policy.

9. The occupational and environmental health nurse (OHN)

collaborates with other health professionals and the public to protect
human rights, promote health, and reduce health disparities.

COMPETENCY CATEGORY IN OCCUPATIONAL AND

ENVIRONMENTAL HEALTH NURSING by AAOHN

1. Clinical and primary care

2. Case management
3. Workforce, workplace and environmental issues
4. Regulatory and legislative
5. Management
6. Health promotion and disease prevention
7. Occupational and environmental health and safety education and
training
8. Research
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9. Professionalism

IMPACT OF LEGISLATION ON OCCUPATIONAL HEALTH:

The DOLE possesses legislative and rule-making powers with regards

to the following laws and standards:
1. Presidential Decree 442 Philippine Labor Code on prevention
and compensation
2. The Administrative Code on Enforcement of Safety and Health
Standards
3. The Occupational Safety and Health Standards
4. Executive Order 307
5. Presidential Decree 626
6. RA 9165 or the Comprehensive Drug Act
7. RA 8504 of the National HIV/AIDS Law
8. DOH: Sanitation Code
9. DA: Fertilizer and Pesticide Act
10. DENR: RA 6969
11. RA 9185 or the Comprehensive Dangerous Drug Act
12. RA 6541 of the National Building Code of the Philippines
13. RA 9231 or the Special Protection of Children against Child
Abuse, Exploitation and Discrimination

THE PHILIPPINE LABOR CODE (PD 442)

- Aims to protect every citizen desiring to work locally or overseas
by securing the best possible terms and conditions of
employment.
- Under Article 6, all rights and benefits granted to workers under
this Code shall, except as may otherwise be provided herein,
apply alike to all workers, whether agricultural or non-
agricultural. 

WORKING CONDITIONS AND REST PERIODS:

Article 83. Normal hours of work. The normal hours of work of any

employee shall not exceed eight (8) hours a day.

Health personnel in cities and municipalities with a population of at

least one million (1,000,000) or in hospitals and clinics with a bed
capacity of at least one hundred (100) shall hold regular office hours for
eight (8) hours a day, for five (5) days a week, exclusive of time for
meals, except where the exigencies of the service require that such
personnel work for six (6) days or forty-eight (48) hours, in which case,
they shall be entitled to an additional compensation of at least thirty
percent (30%) of their regular wage for work on the sixth day. For
purposes of this Article, "health personnel" shall include resident
physicians, nurses, nutritionists, dietitians, pharmacists, social workers,
laboratory technicians, paramedical technicians, psychologists,
midwives, attendants and all other hospital or clinic personnel.
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Article 84. Hours worked. Hours worked shall include (a) all time

during which an employee is required to be on duty or to be at a
prescribed workplace; and (b) all time during which an employee is
suffered or permitted to work.

Rest periods of short duration during working hours shall be counted as

hours worked.

Article 85. Meal periods. Subject to such regulations as the Secretary

of Labor may prescribe, it shall be the duty of every employer to give
his employees not less than sixty (60) minutes time-off for their regular
meals.

MEDICAL, DENTAL AND OCCUPATIONAL SAFETY

Article 156. First-aid treatment. Every employer shall keep in his

establishment such first-aid medicines and equipment as the nature
and conditions of work may require, in accordance with such
regulations as the Department of Labor and Employment shall
prescribe.

The employer shall take steps for the training of a sufficient number of
employees in first-aid treatment.

Article 157. Emergency medical and dental services. It shall be the

duty of every employer to furnish his employees in any locality with free
medical and dental attendance and facilities consisting of:

The services of a full-time registered nurse when the number of

employees exceeds fifty (50) but not more than two hundred (200)
except when the employer does not maintain hazardous workplaces, in
which case, the services of a graduate first-aider shall be provided for
the protection of workers, where no registered nurse is available. The
Secretary of Labor and Employment shall provide by appropriate
regulations, the services that shall be required where the number of
employees does not exceed fifty (50) and shall determine by
appropriate order, hazardous workplaces for purposes of this Article;

The services of a full-time registered nurse, a part-time physician and

dentist, and an emergency clinic, when the number of employees
exceeds two hundred (200) but not more than three hundred (300); and

The services of a full-time physician, dentist and a full-time registered

nurse as well as a dental clinic and an infirmary or emergency hospital
with one bed capacity for every one hundred (100) employees when
the number of employees exceeds three hundred (300).

In cases of hazardous workplaces, no employer shall engage the

services of a physician or a dentist who cannot stay in the premises of
the establishment for at least two (2) hours, in the case of those
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engaged on part-time basis, and not less than eight (8) hours, in the
case of those employed on full-time basis. Where the undertaking is
non-hazardous in nature, the physician and dentist may be engaged on
retainer basis, subject to such regulations as the Secretary of Labor
and Employment may prescribe to insure immediate availability of
medical and dental treatment and attendance in case of emergency.
(As amended by Presidential Decree NO. 570-A, Section 26).

Article 159. Health program. The physician engaged by an employer

shall, in addition to his duties under this Chapter, develop and
implement a comprehensive occupational health program for the
benefit of the employees of his employer.

COMPENSATION

Article 86. Night shift differential. Every employee shall be paid a night

shift differential of not less than ten percent (10%) of his regular wage
for each hour of work performed between ten o’clock in the evening
and six o’clock in the morning.

Article 89. Emergency overtime work. Any employee may be required

by the employer to perform overtime work in any of the following cases:

When the country is at war or when any other national or local

emergency has been declared by the National Assembly or the Chief
Executive;

When it is necessary to prevent loss of life or property or in case of

imminent danger to public safety due to an actual or impending
emergency in the locality caused by serious accidents, fire, flood,
typhoon, earthquake, epidemic, or other disaster or calamity;

When there is urgent work to be performed on machines, installations,

or equipment, in order to avoid serious loss or damage to the employer
or some other cause of similar nature;

When the work is necessary to prevent loss or damage to perishable

goods; and

Where the completion or continuation of the work started before the

eighth hour is necessary to prevent serious obstruction or prejudice to
the business or operations of the employer.

Article 91. Right to weekly rest day.

It shall be the duty of every employer, whether operating for profit or

not, to provide each of his employees a rest period of not less than
twenty-four (24) consecutive hours after every six (6) consecutive
normal work days.
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The employer shall determine and schedule the weekly rest day of his
employee’s subject to collective bargaining agreement and to such
rules and regulations as the Secretary of Labor and Employment may
provide. However, the employer shall respect the preference of
employees as to their weekly rest day when such preference is based
on religious grounds.

Article 92. When employer may require work on a rest day. The

employer may require his employees to work on any day:

In case of actual or impending emergencies caused by serious

accident, fire, flood, typhoon, earthquake, epidemic or other disaster or
calamity to prevent loss of life and property, or imminent danger to
public safety;

In cases of urgent work to be performed on the machinery, equipment,

or installation, to avoid serious loss which the employer would
otherwise suffer;

In the event of abnormal pressure of work due to special

circumstances, where the employer cannot ordinarily be expected to
resort to other measures;

To prevent loss or damage to perishable goods;

Where the nature of the work requires continuous operations and the
stoppage of work may result in irreparable injury or loss to the
employer; and

Under other circumstances analogous or similar to the foregoing as

determined by the Secretary of Labor and Employment.

Article 93. Compensation for rest day, Sunday or holiday work.

Where an employee is made or permitted to work on his scheduled rest

day, he shall be paid an additional compensation of at least thirty
percent (30%) of his regular wage. An employee shall be entitled to
such additional compensation for work performed on Sunday only
when it is his established rest day.

When the nature of the work of the employee is such that he has no
regular workdays and no regular rest days can be scheduled, he shall
be paid an additional compensation of at least thirty percent (30%) of
his regular wage for work performed on Sundays and holidays.

Work performed on any special holiday shall be paid an additional

compensation of at least thirty percent (30%) of the regular wage of the
employee. Where such holiday work falls on the employee’s scheduled
rest day, he shall be entitled to an additional compensation of at least
fifty per cent (50%) of his regular wage.
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Where the collective bargaining agreement or other applicable

employment contract stipulates the payment of a higher premium pay
than that prescribed under this Article, the employer shall pay such
higher rate.

ETHICAL INSIGHT: CONFIDENTIALITY OF EMPLOYEE HEALTH

INFORMATION

In dealing with health information, the employee has a right to privacy

and should “be protected from unauthorized and inappropriate
disclosure of personal information” (AAOHN, 2004). However,
exemptions must be made. These include:
(1) life-threatening emergencies
(2) authorization by the employee to release information to
others
(3) worker’s compensation information
(4) compliance with government laws and regulations

LEVELS OF CONFIDENTIALITY
 LEVEL 1: relates to the information required by law (eg. Data on
occupational illness and injuries)
 LEVEL 2: covers information that will assist in management of
human resources (eg. Info from job placement and workability
status of employee)
 LEVEL 3: focuses on personal health information
- Disclosure of levels 1 and 2 information to management
should be allowed only on a need-to-know basis.

- Disclosure of level 3 information to management and

regulatory agencies should only be allowed as required
by law.

- Disclosure of level 3 information to health insurance

providers should only be made with the written
authorization of the employee.

Community Mental Health Nursing

DEFINITION
 
 Is the application of specialized knowledge to populations and
communities to promote and maintain mental health, and to
rehabilitate populations at risk that continue to have residual
effects of mental illness.

Why develop Nursing Resources for Mental Health?

 Mental health is crucial to the well-being of individuals,
societies and countries:
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 Mental health is more than the absence of mental

disorders. It involves a state of well-being whereby the
individual recognizes their abilities, is able to cope with
the normal stresses of life, works productively and
contributes to the community.
 Mental health problems are common: 450 million
people suffer from a mental or behavioral problem and
nearly one million people commit suicide every year.
Depression, alcohol use disorders, schizophrenia and
bipolar disorder are among the ten leading causes of
disability worldwide.

 Treatment is not available to most people : Despite the

existence of effective treatments, these are not available
to the overwhelming majority of people with a mental
disorder. Many of the resources that are available are
wasted on ineffective interventions.

 Nurses are important providers of treatment and

care: In most countries, nurses are the largest group of
professionals providing mental health care in both
primary and specialist health services. However, in many
countries the education of nurses is inadequate and their
role is under developed. With education and support,
nurses can contribute to the promotion of mental health
and the prevention and treatment of mental disorders

What are the priorities?

1. Primary Health Care
 WHO recommends that mental health treatment should
be part of or integrated into primary health care, however,
many nurses lack the knowledge and skills to identify and
treat mental disorders. Education is effective in improving
the recognition of mental disorders in primary health care,
increasing the referral to more specialized health
providers and enhancing the initiation of supportive
therapies. In addition, ongoing supervision and support
from specialist mental health services are needed to
assist nurses to care for people with more complex
mental health needs and facilitate referral to specialist
services when required.

2. Nurse Education
 Mental health should be incorporated into basic nursing
and midwifery education with mental health concepts
introduced early, reinforced and expanded throughout the
curricula and developed through experiential learning
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opportunities. Ongoing education is also needed to assist

nurses to further develop their knowledge and skills,
foster changes in attitudes and beliefs and reorient them
from custodial models of mental health care to community
based treatment. Specialist or post basic education
programs for nurses should be established to ensure that
nurses are able to provide services for people with severe
mental disorders and provide support to primary care
providers.
 The areas to include in the education of nurses will
depend on the needs of the country, the role of the nurse,
current competencies and the resources that are
available. The following is not intended as a
comprehensive list of areas for education, but as general
guidance when developing education programs:
o Advocacy
o Assessment of mental disorders
o Communication skills
o Community mental health nursing
o Emotional self-care (i.e. Nurses caring for their
own mental health)
o Evaluation and research
o Legal and ethical issues, including understanding
the rights of people with mental disorders
o Management of emergencies (e.g. suicidal
behavior, violence)
o Management of psychotropic medication
o Mental health care in humanitarian emergencies
o Promotion of mental health
o Public health models of mental health
o Stigma and discrimination
o Substance abuse
o Treatment of mental disorders
o Working in teams
o Working with service users and their families
o Working with specific groups (e.g. children and
adolescents, elderly)

 It is important to ensure that educational programs include

practical opportunities to develop skills.

3. Involve nurses in the development of mental health

policies
 Mental health policies define a vision for improving
mental health and reducing the burden of mental
disorders in a population, and establish a model
for action based on agreed values, principles and
objectives. Nurses are important stakeholders who
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should be consulted and actively involved in the

development policies and plans.
 The development of nursing resources for mental
health should be coordinated through a mental
health policy. The WHO Fact Sheet 'Mental health
policies and service development' provides more
information on developing and implementing
policies and plans.

4. Information for decision-making

 While there is a growing body of research
documenting good practice, many countries have little
or no information on the size, composition, or quality
of their nursing workforce for mental health, and no
knowledge of their impact on health outcomes. It is
important that countries gather this information in
order to better inform mental health policy
development and the role of nursing within this
context.

MENTAL HEALTH PROGRAM

Description
Mental health and well-being is a concern of all. Addressing concerns
related to MNS contributes to the attainment of the SDGs. Through a
comprehensive mental health program that includes a wide range of
promotive, preventive, treatment and rehabilitative services; that is for
all individuals across the life course especially those at risk of and
suffering from MNS disorders; integrated in various treatment settings
from community to facility that is implemented from the national to the
barangay level; and backed with institutional support mechanisms
from different government agencies and CSOs, we hope to attain the
highest possible level of health for the nation because there is no
Universal Health Care without mental health

Vision
A society that promotes the well-being of all Filipinos, supported by
transformative multi-sectoral partnerships, comprehensive mental
health policies and programs, and a responsive service delivery
network

Mission

To promote over-all wellness of all Filipinos, prevent mental,

psychosocial, and neurologic disorders, substance abuse and other
forms of addiction, and reduce burden of disease by improving
access to quality care and recovery in order to attain the highest
possible level of health to participate fully in society.
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Objectives

 To promote participatory governance and leadership in

mental health
 To strengthen coverage of mental health services through
multi-sectoral partnership to provide high quality service
aiming at best patient experience in a responsive service
delivery network
 To harness capacities of LGUs and organized groups to
implement promotive and preventive interventions on
mental health
 To leverage quality data and research evidence for mental
health
 To set standards for compliance in different aspects of
services

Program Components

1. Wellness of Daily Living

 All health/social/poverty reduction/safety and security

programs and the like are protective factors in general for the
entire population
 Promotion of Healthy Lifestyle, Prevention and Control of
Diseases, Family wellness programs, etc
 School and workplace health and wellness programs

2. Extreme Life Experience

 Provision of mental health and psychosocial support

(MHPSS) during personal and community wide disasters
3. Mental Disorder
4. Neurologic Disorders
5. Substance Abuse and other Forms of Addiction
 Provision of services for mental, neurologic and substance
use disorders at the primary level from assessment,
treatment and management to referral; and provision of
psychotropic drugs which are provided for free.
 Enhancement of mental health facilities under HFEP

Partner Institutions
NGAs ( DOLE, DSWD, DepEd, Tesda, CHED, DILG)
NGOs (WHO, PPA, PAP, PNA, PLAE, AWIT Foundation, WAPR,
NGF)

Policies and Laws

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DOH Administrative Order No. 8 series of 2001 The National Mental

Health Policy
DOH Administrative Order No. 2016-0039 Revised Operational
Framework for a Comprehensive National Mental Health Program
Republic Act No. 11036 Mental Health Act

Strategies, Action Points and Timeline

 Governance
 Service coverage
 Advocacy
 Evidence
 Regulation

Program Accomplishments/Status
1. Passage of the Republic Act No. 11036 dataed June 20,
2018 "An Act Establishing a National Mental Health Policy
for the Purpose of Enhancing the Delivery of Integrated
Mental Health Services, Promoting and Protecting the
Rights of Persons Utilizing Psychiatric, Neurologic and
Psychosocial Health Services, Appropriating Funds
Therefore and for Other Purposes"
2. DOH Administrative Oreder No. 2016-0039 dated October
28, 2016 " Revised Operational Framework for a
Comprehensive National Mental Health Program"
3. National Mental Health Program Strategic Plan 2018-2022
4. Harmonized MHPPS Training Manual
5. Development of the Implementing Rules and Regulation
of the RA No. 11036 also known as The Mental Health
Act
6. Conduct of the Advocacy Activities such as 2nd Public
Health Convention on Mental Health, Observance of the
World Health Day, World Suicide Prevention Day,
National Mental Health Week and Mental Health Fairs
7. Training on Mental Health Gap Action Programme
8. Conduct of The National Prevalence Survey on Mental
Health
9. Establishment of the Medicine Access Program for Mental
Health

Calendar of Activities
September 10 - World Suicide Prevention Day
October 10 -World Mental Health Day
2nd Week of Ocotber - National Mental Week

Statistics
The World Health Organization (WHO) estimates that:

a. 154 million people suffer from depression

b. million from schizophrenia
c. 877,000 people die by suicide every year
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d. 50 million people suffer from epilepsy

e. 24 million from Alzheimer’s disease and other dementias
f. 15.3 million persons with drug use disorders 

In the Philippines
 2004 WHO study, up to 60% of people attending primary care
clinics daily in the country are estimated to have one or more
MNS disorders.
 2000 Census of Population and Housing showed that mental
illness and mental retardation rank 3rd and 4th respectively
among the types of disabilities in the country (88/100,000    
 Data from the Philippine General Hospital in 2014 show that
epilepsy accounts for 33.44% of adult and 66.20% of pediatric
neurologic out-patient visits per year.  
 Drug use prevalence among Filipinos aged 10 to 69 years old
is at 2.3%, or an estimated 1.8 million users according to the
DDB 2015 Nationwide Survey on the Nature and Extent of
Drug Abuse in the Philippines
 2011 WHO Global School-Based Health Survey has shown
that in the Philippines, 16% of students between 13-15 years
old have ever seriously considered attempting suicide while
13% have actually attempted suicide one or more times
during the past year.
 The incidence of suicide in males increased from 0.23 to 3.59
per 100,000 between 1984 and 2005 while rates rose from
0.12 to 1.09 per 100,000 in females (Redaniel, Dalida and
Gunnell, 2011).
 Intentional self-harm is the 9th leading cause of death among
the 20-24 years old (DOH, 2003.
 A study conducted among government employees in Metro
Manila revealed that 32% out of 327 respondents have
experienced a mental health problem in their lifetime (DOH
2006).
 Based on Global Epidemiology on Kaplan and Sadock’s
Synopsis of Psychiatry, 2015 and Kaufman’s Clinical
Neurology for Psychiatrists, 7th edition, 2013
A. Schizophrenia ---1% …..1 Million
B. Bipolar ---1% …. 1 Million
C. Major Depressive Disorder     ---17% …. 17 M
D. Dementia  ---    5% (of older than 65) …..
E. Epilepsy   ---0.06% …. 600,000