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I. Community Health Nursing special field

in nursing profession w/c deals w/ combination of o Components of OLOF (BSPH2E)
skills in public health & nursing w/c focuses on: a.Behavioral  culture, habit and mores
1.prevention of disease b.Socio-economic  employment,
2.improvement of health education, housing
3.rehabilitation & assistance c.Political  safety, oppression and people
d.Hereditary  genetic endowment
A. Philosophy of CHN (Margaret Shetland) à worth e.Health care delivery system promotive,
& dignity of man preventive, curative and rehab.
B. Principles of CHN f. Environment  air, food and water
1.prevention
2.family à smallest or basic unit of society  Nursing  tool of CHN
3.multi-disciplinary approach à integrated health  diagnosis and treatment of human
department responses to actual or potential health problems
4.focus on community involvement  Knowledge  base of CHN
5.comprehensive care à DOES NOT only focus on a.biological and social sciences
the sick b.ecology
à continuous care for pt. c.clinical nursing
C. ULTIMATE GOAL: Raise the level of health of the d.CH organizations
citizenry
III. IMPORTANT CONCEPTS IN COMMUNITY
II. 3 Broad Concepts of PHN/ CHN HEALTH NURSING/ FACTS of CHN
 Community  Focus of CHN A. Focus  promotion of health/ prevention of illness
B. Area of Content  nursing and public health
 Types of Community C. Clients 
1)Rural  simple way of life 1. individual  unit of entry
2)Urban  complex way of life and increase cost 2. family  unit of service
of living 3. population group  specific unit of care
3)Rurban  mixed urban and rural 4. communities  entire clients
4)Suburban  found in the periphery of urban D. Time  continuous
areas  Change in community is inherent and inevitable
5)Metropolitan  aggregate of urban areas o Fragmented/ episodic wrong, it should be
(pinagtabi-tabi na urban) continuous
E. Scope  comprehensive and general
 8 Subsystems in the Community (HCRP, EEFH)
1) housing
2) communication
 Types of Family
3) recreation 1.nuclear à mother, father, & children
4) politics o nuclear dyad à couple only (no children)
5) education 2.extended à mother, father & children & relatives
6) economics
7) fire and safety 3.single-parent
8) health 4.blended àwidow & widower
 Health  goal of CHN 5.matriarchal
 state of complete physical, mental and 6.patriarchal
social well-being and not merely the absence of 7.communal à no blood rel. (ex. CFC)
disease & infirmity (WHO, 1995)
 basic human right  FAMILY NURSING CARE PLAN (RAPIE)Set of
 seen as a spectrum or continuous actions the nurse decides to implement to be able to
(Travis) solve the problems and meet the needs of the family
 OLOF (modern concept of health)  Characteristics
a.Solves an existing problem
b.Systematic
ecosystem
c.Futuristic
d.Continuous
OLOF  Importance
wellness a.Individualized client care
b.Set priorities by providing info about the client
c.Systematic communication
d.Continuity of care
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e.Coordination of HC High 3 X 1
Moderate 2
Low 1
 Steps
a.Problem Identification  1st step in any plan
b.Setting/ Formulating Goals & Objectives 
how family feels towards problem
4. Salience à

this will set direction of the plan identified

Problem needing immediate 2 x 1
attention
♣ Reasons for Having a Mutual Goal Setting w/ Family
Members Problem not needing immediate 1
1) positive effect on interactions w/ families attention
2) tend to resist being told to do but are likely to work Not a felt problem 0
toward goals that they, themselves choose & support
3) People who make decisions tend to feel accountable for
them.
♣ Characteristics of Goals/ Objectives
1) S  specific IV. OVERVIEW OF PUBLIC HEALTH
2) M  measurable NURSING IN THE PHILIPPINES
3) A  attainable A. Health  state of complete physical,
4) R  realistic mental and social well-being and not merely the
5) T  time bound
absence of disease & infirmity (WHO, 1995)
c. Implementation/ Implementing the FHCP
B. Public Health  Preventing disease,
 actual doing of interventions to solve health
prolonging life, promoting Health (C.E. Winslow)
problems
 3 Ps
highly dependent on 2 Major Variables:
1) nature of the problem 1.promote health
2) the resources available to solve the problem 2.prevent disease
3.prolong life
d. Evaluation/ Evaluating the FHCP
determination of whether the objectives set  Philosophy of Public Health  health and
were attained or to what degree they were longevity of birthrights
attained 1.Longevity  ave. lifespan or life expectancy
 based on how effective the interventions ere 2.50 yrs  Swaroop’s index
that the family, HCP & others instituted 3.Untimely death  person who died without
 answering the question: “Did it make the reaching the average life span
difference?” 4.Combined Male and female  69.6 y/o
Typology of the nursing Process (FNCP) à tool a.Male  66.74 y/o
to prioritize a problem in the family b.Female  72,61 y/o
 4 Criteria
1. Nature of the problem  Core business of public health
a. Health deficit à failure in health maintenance • Health protection
Ex. Asthma, D.M.
b. Health Threatà conditions conducive to disease, • Injury prevention
accidents or failure in health potentials • Disease control
Ex. Hx of DM, presence of broken glasses, presence of • Equitable health gain
unsanitary living conditions • Promotion of health
c. Foreseeable Crisis/ Stress points à increase in
demands in terms if resources or adjustments • Health public policy
Ex. Death, pregnancy, loss of job, additional members C. Public Health Nursing  special field in
of the family, pregnancy nursing profession w/c deals w/ combination of
d. Wellness state à potential readiness
skills in public health & nursing w/c focuses on:
à ability of a family to 1.prevention of disease
maintain health or even in the future 2.improvement of health
HD 3 x 1 3.rehabilitation & assistance
HT 2
FC 1

2. Modifiability of the Problem à ability of the nurse to  STANDARDS OF PHN IN THE PHILIPPINES
alleviate, eliminate, eradicate a problem through 2005
nursing intervention 1.Difference of PHN and CHN in only one area:
Easily modifiable 2 x 2 setting pf work as dedicated by funding
Partially modifiable 1
Not modifiable 0 2.PH Nurses: employed in local/ national
gov’t health departments or public schools
3. Preventive potential à nursing interventions under
nursing considerations
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(whether position is PHN, Nurse, or School 5. change agent  changing clients behavior to
Nurse) promote and maintain health as a result of
3.PH Nursing practice of nursing in local/ teaching and counseling
national gov’t health departments and public 6. collaborator/ coordinator  brings together
schools; CHN practiced in public sector resources of people involved
a.Bring activities systematically to achieve the
 Qualifications of PHN goals
NURSE BSN RN MA EXPERIENCE b.Establishes linkages, networks, and
collaborative relations
1.Nurse yes yes MAN 3 years
Instructor experience 7. manager/supervisor  includes being as
2.Nurse yes yes MAN or 5 years planner, organizer, director, trainer
Supervisor PH experience as a.Executes the 5 management functions
PHN b.Organizes the “nursing service” of the local
3.Regional yes yes MAN or 6 years
PH experience, 3
health agency
Training c.Program managementa
years in training/
Nurse nursing education
4.Regional yes yes MAN or 5 years
PH experience, 2
Nurse 8. researcher  conducting studies that contribute
years in
Supervisor supervisory to the improvement of nursing and health
position services
5.Nursing yes yes MAN or 7 years a.utilizes data to predict future phenomenon and
PH experience modify interventions
Program
Supervisor b.Disease surveillance (continuous collection
6.Chief Nurse yes yes MAN or 5 years and analysis of data of cases and deaths) to
PH experience, 3 measure magnitude of problem and to
years as
supervisor measure the effect of the control program
7.Assistant yes yes MAN or 5 years
Chief Nurse PH experience, 2 9. role model  doing what you preach
years as 10. hospice care  providing carative skills in a
supervisor
home or other setting and balancing the
8.Occupational yes yes Training
units in terminally ill client needs
Health Nurse 11. Trainer
OHN
a.Formulate staff development and training
V. THE PUBLIC HEALTH NURSE programs for midwives and other auxiliary HW
A. Qualifications and evaluates them
1.BSN graduate b.Trains nursing and midwifery students
2.RN affiliates in coordination with CI
3.Professional competence c.Community organizer
4.Personal qualities and “people skills”
B. Functions VI. Community Health Nursing Process
1. clinician  focuses on health of individuals in A. Identifying the community Health Nursing
the larger context of the community; provides Problems
nursing care to the sick and disabled 1.Categories of Community Health Nursing
a.Provider of nursing care Problem
b.Utilizes the nursing process a.Health status problem à increased or
c.Conducts home visits and referrals decreased morbidity, mortality, fertility or
reduced capability for wellness
2. advocate  interceding, supporting, pleading or b.Health resource problem à lack of or absence
acting as a guardian of the client’s rights to of manpower, money, materials or institutions
autonomy and free choice; to defend the rights necessary to solve health problems
of the clients for self-determination c.Health-related problem à existence of social,
3. educator  provides skills, knowledge and economic, env’tal & political factors that
attitude to develop self-reliance aggravate the illness-inducing situations
4. counselor  tasks include listening and 2. Priority Setting
providing feed back and information • Criteria of Priority setting:
a.nature of the problem à health status, health
resources or health-related problems

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b.magnitude of the problem àrefers to the c.Provide first aid treatment to emergency cases
severity of the problem w/c can be measured in and refer when necessary
terms of the proportion of the population affected 4. Clinical Evaluation
by the problem a.Validate PE and clinical history
c.modifiability of the problem à probability of b.Provide treatment based on DOH programs
reducing, controlling or eradicating the problem c.Inform client of illness, treatment and prevention,
d.preventive potential à probability of controlling and control measures
or reducing the effects posed by the problem
e.social concern à perception of the population B. Home Visit professional face to face contact
as they are affected by the problem & their made by a nurse with the patient or the family to
readiness to act in the problem provide necessary health care activities and to
further attain the objective of the agency.
 Principles in a Home Visit (PURPIF)
 Scaling of Ranking Community 1.Purpose or objective
Health Problems 2.Use all available information
Criteria Weight 3.Revolve on essential needs
1. Nature of the Problem 1 4.Priority on needs recognized by family
 Health Status 3 5.Involve individual and family
 Health Resources 2 6.Flexible and practical
 Health-related 1
2. Magnitude of the problem 3
 75%-100% affected 4  Frequency of Home Visit (AAPOPE)
 50%-74% affected 3 1.Acceptance of the family
 25-49% affected 2 2.Ability to recognize own needs
 25% affected 1
3. Modifiability of the Problem
3.Physical, psychological and educational needs
 High 3 4 4.Other health agencies and health personnel
 Moderate 2 involved
 Low 1 5.Policy of a given health agency
 Not Modifiable 0
6.Evaluation of past services given to a family
4. Preventive Potential
 High 3 1
 Moderate 2  Steps
 Low 1 1.Greet patient and introduce self.
5. Social Concern
 Urgent Com’ty concern 2 1 2.State purpose of visit
 Recognized as a 1 a.Give nursing care to the sick
problem, but not needing b. Assess living condition of the patient
urgent concern c. Give health teaching
 Not a com’ty concern 0
d. Unify health agencies and public for the
promotion of health
e. Use the inter-referral system
VII. Common Nursing Procedures
3.Observe patient and determine health needs.
A. Clinic Visit process of checking the clients’
4.Put bag in a convenient place and perform bag
health condition in a medical clinic where the
technique.
nurse assists the client as well as the physician in
5.Perform nursing care.
the whole course of examination.
6.Document necessary data.
7.Make appointment for a return visit.
 STANDARD PROCEDURES IN A CLINIC VISIT
1.Registration/Admission
C. Bag Technique a tool making use of a public
a.Greet client
health bag through which the nurse, during his/her
b.Review family records of new pt/ retrieve old
home visit, can perform nursing procedures
client’s record
c.Obtain the chief complaint and clinical history
 Public health bag  essential and indispensable
d.Perform PE and record it accordingly
equipment of a PHN carried along during home
2.Waiting time
visits
a.Give priority numbers
b.First come serve policy, except for emergency
 Principles of Bag Technique
cases
1.prevent transfer of infection
3. Triaging ∞ How many times can you open the bag on caring for
a.Manage program based cases the client? 3 times
b.Refer all non-program based cases to physician o 1st  get articles needed for hand washing
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o 2nd  getting articles for the patient  Association of Nursing Service

o 3rd  returning article Administration in the Phil. (ANSAP) IV
2.save time & effort nurse
3.should not over shadow the concern for the  Indications of I.V. Therapy
patient 1.for maintenance of dehydration & or correction
4.can be done on varieties of ways  depending of dehydration inpatients unable to tolerate
on agency you’re working; as long as you’re not sufficient volumes of oral fluid medications
violating principle number 1. 2.parenteral nutrition
3.administration of drugs (eg. Chemotherapy)
 Steps 4.transfusion of blood or blood components
1. Place bag on table lined with clean paper.  Contraindication of Peripheral I.V. Therapy 
2. Ask for a basin of water or glass of drinking administration of irritant fluids or drugs through
water. peripheral access (ie., highly concentrated, high
3. Open bag and take out towel and soap. osmolarity sol’ns like Na Cl, hypertonic K Cl)
4. Wash hands with soap and water, towel dry.
5. Take apron from bag and put it on.
6. Put out all necessary articles needed for VIII. Community Organizing & Health promotion
specific care.  Community organizing  process by which
7. Close bag and put it in one corner of working people, services & agencies of the community
area. work together to:
8. Perform necessary care and treatment. a.learn about problems
9. Perform after care and hand washing. b.conceive these problems as their own
10. Open bag and return all things used after c.work out plans & sol’n for such community
cleaning them. problems
11. Remove apron and place inside the bag. 1. Community Organizing  Continuous
12. Fold lining and place inside bag sustained process:
13. Document necessary data. Give health a.Educating  understand critical
teachings. consciousness of their conditions
14. Make appointment for next visit. b.Organizing  people to work collectively &
efficiently to respond & take action on their
 Contents of PHN Bag immediate & long term problems
1.thermometers in case (one oral and rectal) c.Mobilizing  develop[ their capability and
2.syringes readiness to respond & take action on their
3.alcohol lamp immediate needs towards solving their long
4.zephiran solution term problem
5.benedict solution
6.tape measure  BASIC METHODS AND STEPS IN
7.hypodermic needles COMMUNITY ORGANIZATION PROCESS
8.paper lining 1)Fact finding
9.apron 2)Determination of needs
10. hand towel 3)Program Formation
11. adhesive plaster 4)Education and Interpretation
12. soap in a soap dish
Community dev’t

Self-reliance
D. Thermometer Technique
1.Put out thermometer leaving case inside the bag
2.After getting temp.  wipe with dry cotton balls
then read
3.Clean in downward spiral motion
a.1st  3 cotton balls moistened w/ soap
b.2nd  3 cotton balls moistened with water CG
c.3rd  3 cotton balls moistened w/ alcohol

E. Intravenous Therapy  insertion of needle or

catheter into a vein w/c is based on physician’s
prescription

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CO/Par 4)Setting up community organization

 Characteristics of Good Leaders

2. Traditional VS Participatory Research a) charisma
Issue Traditional Participatory b) can read and write
Research Research
a. Problem Done by the outside Involves the c.Formation Phase/ EDUCATION AND
Identification researcher community or group TRAINING PHASE
experiencing prob. 1)form core group
b. Method of Quantitative methods Determined by local
culture &
2)define the roles/ functions of core group
Data Gathering 3)conduct team-building, self-awareness &
innovativeness – no
standard design leadership training among leaders
c. Use of Publications, books, Results are w/in full 4)informal education of core group members
journals, reports, control of people
Results 5)train community researchers
seminars &
conferences 6)consult community to organize: community
health organization
3.CoPAR Process or
Phases in Community Organizing 1)Community diagnosis
1) Preparatory Phase  COMMUNITY DIAGNOSIS  profile of local
2) Organizational Phase health situation that will serve as basis of
3) Education and Training Phase health programs and services to be
4) Collaboration Phase
5) Phase-out Phase delivered to the community= community is
directly involved
a.Pre-entry Phase/Preparatory Phase 2)Training health workers
1)Area selection 3)Health services mobilization
2)Community Profile 4)Leadership formation activities
3)Entry and integration
Or d.Organization Building/ Collaboration Phase
o community organizer looks for community to 1)elect CH officers
serve 2)organize/terrain community health members
o It takes one-two months to complete and 2nd liners
3)Conduct participation
4)Consolidate CDx and PAR Results
o Activities includes: 5)Formulate Community Health Plan
6)Organize working committee
 plan for community development
7)Link w/ LGUs/NGOs for financial & technical
 selection of site
assistance
 Actual selection of community
8)Implement/ Monitor/ Evaluate Health projects
 Choose host family/ staff house based on
Or
criteria
1)Intersectoral collaboration
2)Sourcing out of external resources
b.Entry/ Integration/ Organizational Phase
3)Coordination with external institutions,
1)arrival in community
agencies, and people
2)integrate w/ community
3)conduct deepening social investigation
4)disseminate information/ sensitize community
e.Sustenance and strengthening/ Phase out
residents on COPAR
phase
5)conduct community assembly
1)Develop financial & Mg’t systems
6)spot potential leaders and core group
2)Assess/ re-plan community Health Programs
members
3)Institutionalize linkages/ referral points
or
4)Hold continuing needs-based education/
training of community health workers by LGUs
1)Social preparation
5)Formulate/ Ratify Constitution & by laws
2)Spotting and developing potential leaders
6)Apply S.E.C. registration/ LGU accreditation
3)Core group formation
7)Negotiate for absorption of community health
 CORE GROUP – consists of the identified
workers by LGU
potential leaders that will be tasked with
or
laying down the foundation of a strong
1)Gradual preparation for turn over of work
people’s organization
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2)Planning for monitoring states that the sale, administration,

3)Follow-up delivery, distribution and
transportation of prohibited drugs is
punishable by law
IX. Public Health Nursing in Schools and Work 10.RA 8749 The Clean Air Act
Setting 11.RA 7160 The Local Government Code where
A. School Health Nursing school the responsibility for the delivery of
B. Occupational Health Nursing  work place basic services and facilities of the
 RA 1054  Occupational Health Act national government has been
No. of Required Occupational Health Service transferred to local government
Workers Provider 12.RA 6675 The Generics Act of 1988, which
<30 OHN services provided by PHN ensures production of adequate
30 – 100 OHN services provided by PHN supply of drugs and medicines
w/in 1km identified by their generic name
30 – 100 OHN supplies and equipment 13.RA 6713 Code of Conduct and Ethical
beyond Standards for Public Officials and
1km Employees
> 101 OHN supplies and equipment
>201 OHN supplies and equipment + resident B. Presidential Decrees
physician and dentist 1. PD 651 Requires that all health workers
>301 OHN supplies and equipment + resident shall identify and encourage the
physician and dentist + permanent clinic registration of all births within 30
(1:100) or accessible hospital w/in 2km days following delivery
2. PD 856 Sanitation Code; which controls all
C. Public Health Nursing  home, clinic, or any factors in man’s environment that
setting affect health
3. PD 825 Provides penalty for improper
X. LAWS AFFECTING PUBLIC HEALTH NURSING disposal of garbage
A. Republic Acts 4. PD 996 Requires compulsory immunization
Laws Description of all children below 8 years of age
1. RA 1082 The first Rural Health Act, against the 6 childhood
implemented in 1953, which called immunizable diseases
for employment of more doctors, 5. PD 965 Requires applicants for marriage
nurses, midwives and sanitary license to receive instruction on
inspectors in rural areas family planning and responsible
2. RA 1891 Improved the health and dental parenthood
services in the rural areas
3. RA 8423 Created the Philippine Institute of C. Circulars
Traditional and Alternative Care Ministry Includes Acquired Immune
4. RA 7305 Magna Carta for Public Health Circular Deficiency Syndrome (AIDS) as a
Workers; which aims to promote No. 2 in notifiable disease
and improve the social and 1986
economic well-being of health
workers D. Administrative Orders
5. RA 6758 Standardized salaries of Administr Revised/updated the roles and
government employees which ative functions of the Municipal Health
included the nursing personnel Order Officers, Public Health Nurses and
6. RA 3573 Declared that all communicable No.114 s. Rural Health Midwives
diseases should be reported to the 1991
nearest health station
7. RA 6365 Established a National Policy on
Population and created the E. Letters of Instruction
Commission of Population
Letter of The legal basis of primary health
8. RA 4073 Liberalized the treatment of leprosy; Instruction care
advocated home treatment of No. 949
leprosy cases
9. RA 6425 The Dangerous Drug Act, which

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3.Health service delivery

4.Good governance

XI. Department of Health  ROADMAP FOR ALL STAKEHOLDERS IN

 VISION: The DOH is the leader, staunch HEALTH:
advocate, and model in promoting Health for All in NATIONAL OBJECTIVES FOR HEALTH 2005 TO
the Philippines 2010
1. Improve the general health status of the
 MISSION: guarantee  equitable, sustainable and population
quality health for all Filipinos, especially the poor, 2. Reduce morbidity, mortality, disability and
and to lead the quest for excellence in health.  complications
3. Eliminate the certain diseases as public health
 Lead agency in health problems
 Roles and functions: 4. Promote healthy lifestyle and environmental
1.Leadership in Health health
a.National policy and regulatory institution 5. Protect vulnerable groups with special health
b.Leader and advocate in the formulation, and nutrition needs
monitoring, evaluation of health policies, plans, 6. Strengthen national and local health systems
and programs 7. Pursue public health and hospital reforms
2.Enabler and Capacity Builder 8. Reduce cost and ensure quality of essential
a.Innovates new strategies to improve health drugs
b.Ensures highest achievable standards of quality 9. Institute health regulatory reforms
HC 10. Strengthen health governance
3.Administrator of Specific Services
a.Manages national and local referral centers 11. Institute safety nets for vulnerable and
b.Administer direct services that requires new marginalized groups
complicated technologies 12. Expand coverage of health insurance
c.Administer health emergency response services 13. Mobilize more resources for health
14. Improve efficiency of resources for health
 GOAL: HEALTH SECTOR REFORM AGENDA
• Rationale:
1.Although there is a significant improvement in Government Calendar Programs:
the health of the Filipinos, the ff are still noted: January ∞ Cancer Awareness & Prevention Month
2.Slowing down in the reduction of IMR and MMR February ∞ Kutis Kilatis Month
∞ Healthy Heart Month
3.Persistence of large variations in health status March ∞ International Women’s Health Month (Free
4.High burden from infectious diseases pap smear & breast exam)
5.Rising burden from chronic and degenerative April ∞ Garantisadong Pambata Program Part 1
diseases May ∞ World No Tobacco Month
6.Emerging health risks from environment and ∞ No Smoking Month
June ∞ Kidney Month (Batong Buhay, Bantay
work-related factors Buhay)
7.Burden of disease is heaviest on the poor ∞ Nutrition Month
July ∞ National Voluntary Blood Donation Month
 Framework for the Implementation of HSRA; ∞ Sagip Mata
FOURmula One for Health Implementation of August ∞ TB Month
critical interventions as a single package through ∞ Family Planning Part 1 (rainy season)
effective management and financing to achieve the September ∞ Generic Month
October ∞ Garantisadong Pambata Program Part 2
health goals ∞ Family Planning Part 2
November ∞ Pneumonia Month
• Goals of FOURmula ONE for Health: (BME)
December ∞ AIDS Awareness Month
1.Better health outcomes
2.More responsive health systems
3.Equitable healthcare financing

 Four Elements of the Strategy (3H G)

1.Health financing
2.Health regulation

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