Community Health Nursing

• Community


  A group of people that shares common geographic location, institution where they are organized into population aggregate concept (age group), common values or interest
• Health


  A complete state of physical, mental and social well-being and not merely the absence of disease or infirmity (WHO)
• Levels of Clientele


  • Individual
  • Family – focus of care (CHN)
  • Community – group of families; CHN directs its services to the community because the client is the community
  • Population Groups – common health needs
• Health is a basic right of every individual (Art. 25 Sec 1 of Universal Declaration of human Rights)
• The state shall protect and promote the right to health of the people and instill health consciousness among them (Art. 2, Sec. 15)
• The state shall adopt an integrated and comprehensive approach to health development (Art. 13, Sec. 11)
• Nursing


  Assisting an individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform if he head the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible (Virginia Henderson, 1964)
• Community Health Nursing


  Direct, goal-oriented, and adaptable to the needs of the individual, the family, and community during health and illness (ANA, 1973)
• Community Health Nursing


  An area of human services directed toward developing and enhancing the health capabilities of people – either singly, as individuals, or collectively as groups and communities (Ruth Freeman & Janet Heinrich, 1981)
• Community Health


  Part of paramedical and medical intervention/approach which is concerned on the health of the whole population
• Aims of Community Health

  • Health promotion
  • Disease prevention
  • Management of factors affecting health
• Public Health Nursing


  Philosophy—health and longevity as birthright<br>Objectives: Prevent disease, Prolong life, Promote health and efficiency<br>Through: organized community effort
• Public Health


  The application for science in the context of politics to remove inequalities in health and deliver the best health for the greatest number (WHO)
• WHO Expert Committee on Nursing

  • Promotion of health
  • Improvement of the physical & social environment
  • Rehabilitation
  • Prevention of illness and disability
• Milestones in history of public health

  • 1601- Elizabeth Poor Law
  • 1617- Sisterhood of Dames de Charite organized by St. Vincent de Paul
  • 1789- Baltimore Health Department
  • 1798- Marine Hospital Service, nuns visited poor
  • 1813- Ladies Benevolent Society of Charleston, South Carolina founded
  • 1836- Lutheran deaconesses provided home visits in Germany
  • 1851- Nightingale visited Kaiserwerth, 3 months of nursing training
  • 1855- Quarantine Board, established in New Orleans; beginning of tuberculosis campaign in US
  • 1859- district nursing established by William Rathbone
  • 1860- Florence Nightingale Training School for Nurses established in St. Thomas Hospital in London
  • 1864- Beginning of Red Cross
• Milestones in history of public health and public health nursing in the Philippines

  • 1577 - Franciscan FriarJuan Clemente opened medical dispensary in Intramuros for the indigent
  • 1690 – Dominican Father Juan de Pergero worked toward installinga water system in San Juan del Monte and Manila
  • 1805 – smallpox vaccination was introduced by Franciwsco de Balmis , the personal physician of King Charles IV of Spain
  • 1876 – first medicos titulares were appointed by the Spanish government
  • 1888 - 2-year courses consisting of fundamental medical and dental subjects was first offered in the University of Santo Tomas. Graduated were known as "cirujanosministrantes" and serve as male nurses and sanitation inspectors
  • 1901 – United States Philippines Commission, through Act 157, created the Board of Health of the Philippine Islands with a Commisioner of the Public Health ,as its chief executive officer (now the Departmnt of Health
  • Fajardo Act of 1912 – created sanitary divisions made up of one to four municipalities. Each sanitary division had a president who had to be a physician
  • 1915 - the Philippine General hospital began to extend public health nursing services in the homes of patients by organizing a unit called Social and Home Care services
  • Asociacion Feminista Filipina (1905) – Lagota de Leche was the first center dedicated to the service of the mothers and babies
  • 1947 – the Department of Health was reorganized into bureaus: quarantine, hospitals that took charge of the municipal and charity clinics and health with the sanitary divions under it
  • 1954 – Congress passed RA 1082 or the Rural Health Act that provided the creation of RHU in every municipality
  • RA 1891 – enacted in 1957 amendd certain provisions in the Rural Health Act -Created 8 categories of rural health units corresponding to the population size of the municipalities
  • RA 7160 (Local Government Code) – enacted in 1991, amended that devolution of bsic health services incuding health services, to ocal government units and the establishment of a local health board in every province and city of municipality
• Roles of a PUBLIC HEALTH NURSE

  • Clinician
  • Health Educator
  • Facilitator
  • Supervisor
  • Health Advocator
  • Advocator
  • Collaborator
  • Epidemiologist
• Health Care Delivery System


  • Primary - Barangay Health Station, Rural Health Units
  • Secondary - Provincial Hospitals, District Hospitals
  • Tertiary - Regional Hospital, National Hospitals, DOH national office, Medical Centers, University Hospital, RITM
• Vision: Health for all by year 2000 ands Health in the Hands of the People by 2020
• Mission: In partnership with the people, provide equity, quality and access to health care esp. the marginalized
• Major Functions of Department of Health

  • Ensure equal access to basic health services
  • Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency jurisdictions
  • Ensure a minimum level of implementation nationwide of services regarded as public health goods
  • Plan and establish arrangements for the public health systems to achieve economies of scale
  • Maintain a medium of regulations and standards to protect consumers and guide providers
• Health Sectors


  • Government Sectors
  • Non Government Sectors
  • Private Sectors
• Aim of Devolution Code (RA 7160 - Local Government Code)

  • Self-reliant communities
  • Active partnership with the people
  • Responsive government representatives
  • Accountable government representatives
  • Decentralization system of health decision making
• Primary Strategies to Achieve Health Goals

  • Support for health goal
  • Assurance of health care
  • Increasing investment for PHC
  • Development of National Standard
• Milestone in Health Care Delivery System

  • RA 1082 – RHU Act
  • RA 1891 – Strengthen Health Services
  • PD 568 – Restructuring HCDS
  • RA 7160 – LGU Code
• Major Strategies of Primary Health Care

  • Education for Health
  • Locally Endemic Disease Control
  • Expanded Program on Immunization
  • Maternal and Child Health and Family Planning
  • Environmental Sanitation and Promotion of Safe Water Supply
  • Nutrition and Promotion of Adequate Food Supply
  • Treatment of Communicable Diseases and Common Illness
  • Supply of Essential Drugs
• Elements of Primary Health Care

  • Elevating Health to a Comprehensive and Sustained National Effort
  • Promoting and Supporting Community Managed Health Care
  • Increasing Efficiencies in the Health Sector
  • Advancing Essential National Health Research
• Four Cornerstones/Pillars in Primary Health Care

  • Active Community Participation
  • Intra and Inter-sectoral Linkages
  • Use of Appropriate Technology
  • Support mechanism made available
• Legal Basis—LOI 949 October 1979 by Ferdinand Marcos, one (1) year after the First International Conference on Primary Health Care in Alma Ata (Russia) sponsored by WHO & UNICEF
• Goal - Health for all Filipinos & Health in the Hands of the People by the year 2020
• Mission - To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care
• Essential health care made universally

  • Acceptable – does not conflict their values and beliefs in the locality
  • Accessible – to the people in the catchment of the barangay
  • Available
  • Appropriate – to the needs of the people
• Two Levels of Primary Health Care Workers

  • Barangay Health Workers – trained community health workers or health auxiliary volunteers or traditional birth attendants or healers
  • Intermediate Level—Professional group including Public Health Nurse, Rural Sanitary Inspector and midwives
• 8 Essential Health Services

  • Education for health
  • Locally endemic disease control
  • Expanded program for immunization
  • Maternal and child health including responsible parenthood
  • Essential drugs
  • Nutrition
  • Treatment of communicable and noncommunicable diseases
  • Safe water and sanitation
• Types of Health Care Systems

  • Traditional - client provider
  • Non-Traditional - Holistic Health Centers, Faith Healing, Chiropractic, Acupuncture, Acupressure, Kinesiology, Reflexology, Massage
• R.A. 8423 Traditional and Alternative Medicine Act of 1997 (Juan Flavier)
• Medicinal Plant Preparation


  • DECOCTION - boiling the plant material in water for 20 min
  • INFUSION - plant material is soaked in hot water for 10 - 15 minutes
  • POULTRICE - directly apply plant material on the affected part, usually in bruises, wounds and rashes
  • TINCTURE - mix the plant material in alcohol
• Primary Care


  Includes health promotion, disease prevention, health maintenance, counseling, patient education and diagnosis and treatment of acute and chronic illness in different health settings (American Association of Family Medicine)
• Philippine Health Care Laws

  • Republic Act 349 – Legalizes the use of human organs for surgical, medical and scientific purposes
  • Republic Act 1054 – Requires the owner, lessee or operator of any commercial, industrial or agricultural establishment to furnish free emergency, medical and dental assistance to his employees and laborers
  • Republic Act 1080 – Civil Service Eligibility
  • Republic Act 1082 – Rural Health Unit Act
  • Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
  • Republic Act 1612 –
• Integrate the principles of sustainable development into country politics and programs

  Reverse loss of environmental resources