UNIT 1: INTRODUCTION TO COMMUNITY AND PUBLIC positive concept emphasizing social and personal

HEALTH NURSING resources, and physical capacities” (1986).

OVERVIEW OF PUBLIC HEALTH NURSING IN THE HEALTH AS A HUMAN RIGHT

PHILIPPINE Health as a human right is grounded in:

CHAPTER 1 1. Universal Declaration of Human Rights (UDHR)-

HEALTH: KEY CONCEPT IN NURSING SCIENCE proclaimed by the United Nations (UN) General
Assembly in Paris on Dec. 1948
NURSING
As a profession -it did set that fundamental human rights be
- aimed at helping the population achieve better health universally protected.
thru their own hands
• Article 25.1 declares: “Everyone has the right
As a science to a standard of living adequate for the health
- relies on an understanding the key towards genuine and well-being of himself and of his family,
development in investing on health and healthcare of including food, clothing, housing and medical
people regardless of age, gender, religion, and color care and necessary social services” (United
(Sumile, 2018) Nations, UDHR, 1948)

HEALTH (in nursing science) 2. International Covenant on Economic, Social and

• it is a shared, complex reality Cultural Rights (United Nations, CESCR)
• is multidimensional, the well-being of an individual is
determined by factors such as biological and behavioral Art.12: “ Health is a fundamental human right
characteristics, the physical and social environment. indispensable for the exercise of other human
• is a fundamental right of every individual regardless of rights. Every human being is entitled to the
race, religion, political belief, economic and social enjoyment of the highest attainable standard of
condition. health conducive to living a life in dignity. The
realization of the right to health may be
DEFINITION OF HEALTH (WORLD HEALTH pursued through numerous, complementary
ORGANIZATION) approaches, such as the formulation of health
“a state of complete, physical, mental, and social well- policies, or the implementation of health
being and not merely the absence of disease or programmes developed by the World Health
infirmity” (1958) Organization (WHO), or the adoption of specific
legal instruments” (United Nations, CESCR,
• Social means relating to living together in organized 2000)
groups or similar close aggregates (American Heritage
College Dictionary, 1997, p.1291) According to the Committee on Economic,
Social and Cultural Rights, (United Nations,
-Refers to units of people in communities who interact CESCR, 2000) the right to health consist of
with one another interconnected and indispensable components:

• Social health connotes community vitality and is a • 1. Availability-requires that operational public
result of positive interaction among groups within the health and channels of service delivery,
community, with an emphasis on health promotion and products and services as well as programs be
illness prevention. adequate for all.

“ Health is the extent to which an individual or group is • 2. Accessibility- entails that health facilities,
able, on the one hand, to realize aspirations and satisfy services and goods must be made possible and
needs; and, on the other hand, to change or cope with obtainable to everyone. Being
the environment. Health is therefore, seen as a source nondiscriminatory, physically accessible,
for everyday life, not the objective of living; it is a economically accessible (affordable) and
 information accessible are the four intersecting social, mental, and physiological. Illness exist when the
features of accessibility. person failed to cope or become maladaptive to these
changes.
• 3. Acceptability- corresponds to respect for
the medical ethics, being culturally appropriate 4. Eudaimonistic Model
and gender sensitive. This clearly define the • An elevated (exuberant) level of wellness or well-
need for health care centers, products services being. Illness is reflected by a lack of vitality.
and programs to be people-centered, able to • Derived from Greek terminology, this term indicates a
accommodate the specific needs of diverse model that embodies the interaction and inter-
population groups and adheres to the relationships among the physical, social, psychological
international standards of medical ethics for and spiritual aspects of life and the environment.
informed consent and confidentiality • Illness is indicated by a denervation or languishing, a
wasting away, or lack of involvement with life.
• 4. Quality-implies that the health facilities,
commodities and services must be in 5. Wellness-illness Continuum
accordance with specific and medical standards. A dichotomous depiction of the relationship between
Quality health services need to be safe, the concepts of health and illness.
effective, people-centered,timely, equitable,
integrated and efficient.

3. Article II Section 11 and 15 of the 1987 Philippine

Constitution

-at the National Level, affirms health as a Fig 1: Wellness – Illness continuum with high-level
fundamental human right and recognizes the wellness added. Movement from the center to the left
obligation of the state to protect and promote demonstrates movement toward health, movement
the right to health of all Filipinos ( Republic of from the center to the right demonstrates movement
the Philippines Official Gazette, 1987) toward illness. Moving above the line demonstrates
movement toward increasing wellness. Moving below
Department of Health (DOH) the line demonstrates movement toward decreasing
Leads the health sector towards assuring quality wellness.
health care in promoting and protecting the
health of all Filipinos.

MODELS OF HEALTH
Guides the nurses in understanding health as a concept:

1. Clinical Model
• Health is the absence of signs and symptoms of
disease and illness. Ex: An adult individual who is not • The concept demonstrates that a person can have a
particular with his lifestyle choices will only seek terminal disease and be emotionally prepared for
healthcare when chest pain is encountered and begins death, while acting as a support for other people and
to suspect a cardiovascular disease. achieving high-level wellness. Highlevel wellness
involves progression towards a higher level of
2. Role Performance Model functioning, an open-ended and ever-expanding future
• The ability to perform societal roles defines what with its challenge of fuller potential, and the integration
health is, failure to perform these roles means illness. of the whole being.
• Ex: An employee who reported for work, even if
he/she is febrile. AGENT HOST ENVIRONMENT AND HEALTH BELIEF

3. Adaptive Model
• Health is a dynamic state. An individual is considered
to be healthy if he/she was able to adjust positively to
 that promote health at the individual, family, aggregate,
and population levels.

SOCIAL DETERMINANTS OF HEALTH

Social Determinants of Health (SDH) are:

“ conditions in which people are born, grow, live, work
and age; might also be circumstantial elements as such
DETERMINANTS OF HEALTH AND DISEASE housing, work conditions and access to recreational
It is essential to the community health nurse to activities; circumstances that influence how an
understand the determinants of health and recognize individual will develop sickness, what risk factor they
the interaction of the factors that leads to disease, are exposed to, how they access services; and is shaped
death, and disability : by the distribution of money, power and resources at
global, national and local levels” (CSDH, 2008)
1. Biology
• The individual’s genetic make up, family history, and SHD may also include:
any physical and mental health problems developed in • occupation, • circumstances affecting the way in
the course of life. which people work, • Income, • Culture, • Religion, •
Ex: Heredity, Aging, Diet, Physical Activity, Smoking, Education, • Racial, and • Gender discrimination
Stress, Alcohol or Drug Abuse, Injury, Violence, or a
Toxic on Infectious Agent CASE SCENARIO
➢A family of seven (7), a couple with five (5) kids; living
2. Behaviors in a depressed area in Metro Manila; both parents are
• The individual’s responses to internal stimuli and high school drop outs, father working as a construction
external conditions. worker (not a regular basis), earning below the
minimum wage; mother is a full time housewife, cares
3. Social Environment for her infant, toddler, preschooler, and two school
• Includes interactions and relationships with family, aged children; not even one of the children goes to
friends, coworkers, and others in the community. school. To satisfy their hunger, the usual foods served
• Has a great impact on the health of individuals, every meal are salt bread “pandesal” and instant
groups, and communities. noodles.
• Complex in nature because of differing cultures and
practices. What are the health related problems may be identified
Ex: Social institutions- law enforcement, religious in the given scenario?
communities, schools, and government agencies are
also part of the social environment. -housing, public ❑At present, public health sector is particularly
transportation and availability of resources working on the social determinants of health
(Schrammer & Ramon, 2018)
4. Physical Environment ❑In order to improve health equity, WHO advocated
• Pertains to an environment that is experienced by the for intersectoral actions; thus, leading to a multisectoral
senses-what is smelled, seen, touched, heard, and approach to health
tasted. Ex: Presence of infectious substances in the ❑Aside from the health sector, other essential sectors
environment, has negative influence on health. in the society such as the government, civil society, local
communities, business, global assemblies and
5. Policies and Interventions international agencies were made involved ( CSDH,
• Can have a profound effect on the health of 2008)
individuals, groups, and communities. ❑Consequently, a better health outcome will be
Ex: Policies Against Smoking in public places, Seatbelt positively instrumental to the attainment of the goals of
and Child restraint laws Litter Ordinances the other sectors (UN Platform on Social Determinants
of Health)
➢Public Health Nurses must work with policy makers
and community leaders to identify patterns of disease
and death and to advocate for activities and policies
CHAPTER 2  A service rendered by a professional nurse to
IFCs, population groups in health centers,
COMMUNITY clinics, schools , workplace for the promotion of
·a group of people with common characteristics or health, prevention of illness, care of the sick at
interests living together within a territory or home and rehabilitation (DR. Ruth B. Freeman)
geographical boundary
· Place where people under usual conditions are found PUBLIC HEALTH
· Derived from a latin word “comunicas” which means a “Public Health is directed towards assisting every citizen
group of people. to realize his birth rights and longevity.”“The science
and art of preventing disease, prolonging life and
COMMUNITY HEALTH efficiency through organized community effort for:
· Part of paramedical and medical
intervention/approach which is concerned on the 1. The sanitation of the environment
health of the whole population 2. The control of communicable infections
3. The education of the individual in personal hygiene
AIMS: 4. The organization of medical and nursing services for
1. Health promotion the early diagnosis and preventive treatment of disease
2. Disease prevention 5. The development of a social machinery to ensure
3. Management of factors affecting health everyone a standard of living, adequate for
maintenance of health to enable every citizen to realize
NURSING his birth right of health and longevity (Dr. C.E Winslow)
Both profession & a vocation. Assisting sick individuals
to become healthy and healthy individuals achieve MISSION OF CHN
optimum wellness 1· Health Promotion
2· Health Protection
COMMUNITY HEALTH NURSING 3· Health Balance
“The utilization of the nursing process in the different 4· Disease prevention
levels of clientele-individuals, families, population 5· Social Justice
groups and communities, concerned with the
promotion of health, prevention of disease and PHILOSOPHY OF CHN
disability and rehabilitation.” ( Maglaya, et al) “The philosophy of CHN is based on the worth and
dignity of man.”(Dr. M. Shetland)
Goal : “To raise the level of citizenry by helping
communities and families to cope with the BASIC PRINCIPLES OF CHN
discontinuities in and threats to health in such a way as 1. The community is the patient in CHN, the family is
to maximize their potential for high-level wellness” ( the unit of care and there are four levels of clientele:
Nisce, et al) individual, family, population group (those who share
common characteristics, developmental stages and
 Special field of nursing that combines the skills common exposure to health problems – e.g. children,
of nursing, public health and some phases of elderly), and the community.
social assistance and functions as part of the
total public health program for the promotion 2. In CHN, the client is considered as an ACTIVE partner
of health, the improvement of the conditions in NOT PASSIVE recipient of care
the social and physical environment,
rehabilitation of illness and disability ( WHO 3. CHN practice is affected by developments in health
Expert Committee of Nursing) technology, in particular, changes in society, in general

 A learned practice discipline with the ultimate 4. The goal of CHN is achieved through multi-sectoral
goal of contributing as individuals and in efforts
collaboration with others to the promotion of
the client’s optimum level of functioning thru’ 5. CHN is a part of health care system and the larger
teaching and delivery of care (Jacobson) human services system.
ROLES OF A PUBLIC HEALTH NURSE In the care of the families:
· Clinician, who is a health care provider, taking care of · Provision of primary health care services
the sick people at home or in the RHU
· Developmental/Utilization of family nursing care plan
· Health Educator, who aims towards health promotion in the provision of care
and illness prevention through dissemination of correct
information; educating people In the care of the communities:
· Community organizing mobilization, community
· Facilitator, who establishes multi-sectoral linkages by development and people empowerment
referral system
· Case finding and epidemiological investigation
· Supervisor, who monitors and supervises the
performance of midwives · Program planning, implementation and evaluation

· Health Advocator, who speaks on behalf of the client · Influencing executive and legislative individuals or
bodies concerning health and development
· Advocator, who act on behalf of the client
RESPONSIBILITIES OF CHN
· Collaborator, who working with other health team be a part in developing an overall health plan, its
member implementation and evaluation for communities

· provide quality nursing services to the three levels of

clientele

· maintain coordination/linkages with other health team

members, NGO/government agencies in the provision
of public health services

· conduct researches relevant to CHN services to

improve provision of health care

· provide opportunities for professional growth and

continuing education for staff development
In the event that the Municipal Health Officer (MHO) is
STANDARDS OF CHN (9)
unable to perform his duties/functions or is not
1. Theory
available, the Public Health Nurse will take charge of the
· Applies theoretical concepts as basis for decisions in
MHO’s responsibilities.
practice
OTHER SPECIFIC RESPONSIBILITIES OF A NURSE,
2. Data Collection
SPELLED BY THE IMPLEMENTING RULES AND
· Gathers comprehensive, accurate data systematically
REGULATIONS OF RA 7164 (PHILIPPINE NURSING ACT
OF 1991) INCLUDES:
3. Diagnosis
· Supervision and care of women during pregnancy,
· Analyzes collected data to determine the needs/
labor and puerperium
health problems of IFC
· Performance of internal examination and delivery of
4. Planning
babies
· At each level of prevention, develops plans that specify
nursing actions unique to needs of clients
· Suturing lacerations in the absence of a physician

· Provision of first aid measures and emergency care

· Recommending herbal and symptomatic meds…etc.

5. Intervention
· Guided by the plan, intervenes to promote, maintain
or restore health, prevent illness and institute
rehabilitation

6. Evaluation
· Evaluates responses of clients to interventions to note
progress toward goal achievement, revise data base,
diagnoses and plan
ONE HEALTH CONCEPT: A FRAMEWORK FOR
7. Quality Assurance and Professional Development COMMUNITY AND PUBLIC HEALTH NURSING
· Participates in peer review and other means of ❑The world in the present times, is faced with
evaluation to assure quality of nursing practice immense challenges for health.
· Assumes professional development
· Contributes to development of others ❑Jones, et al., 2008 reported the appearance of 335
infectious disease among human population between
8. Interdisciplinary Collaboration 1940 and 2004
· Collaborates with other members of the health team,
professionals and community representatives in
❑COVID 19 immergence in the past 2 years and still
assessing, planning, implementing and evaluating
occurring at the present.
programs for community health

9. Research ❑Emerging infectious diseases (EIDs) are a matter of

· Indulges in research to contribute to theory and importance to a great extent if there is a rapid increase
practice in community health nursing in cases and high incidences of deaths cased by these
diseases (Petrosillo, 2019)
LEVELS OF CLIENTELE IN COMMUNITY AND PUBLIC
HEALTH NURSING (CPHN) ❑The most effective way to act in response to the
➢ The Philippine Nursing Law of 2002 ( RA 9173) threats of EIDs is the One Health Approach-recognizing
states that… the connection between human, animal, and
environmental health (Johnson et al., 2019)
“ A person shall be deemed to be practicing nursing ❑ consolidated interaction between human
within the meaning of this Act when he/she singly or in health, veterinary medicine, and public and
collaboration with another, initiates and performs environmental health professionals, clinicians,
nursing services to individuals, families and researchers, and agencies functioning hand in
communities in any health care setting. It includes, but hand for a worthwhile and sustainable health
not limited to, nursing care during conception, labor, interventions in addressing worldwide and
delivery, infancy, childhood, toddler, pre-school, school environmental health challenges. The reciprocal
age, adolescence, adulthood and old age.” actions may occur at several levels which is
from management of zoonotic infectious
➢Furthermore … disease outbreaks to consolidated policy-
”As independent practitioners, nurses are primarily making and funding resolution (Day, 2011)
responsible for the promotion of health and prevention
of illness. As members of the health team, nurses shall One Health Approach Activities example includes:
collaborate with other health care providers for the  National Rabies Prevention and Control
curative, preventive, and rehabilitative aspects of care, Program (NRPCP)
restoration of health, alleviation of suffering, and when  Avian Influenza Protection Program (AIPP)
recovery is not possible , towards a peaceful death”  Philippines Inter-agency Committee on
 ❑Integrated approach-One Health Concept, is vital for
an effective action to decrease the incidence of
emerging infectious disease.

SUMMARY
❑Health is multidimensional. The well-being of an
individual is determined by factors such as the
biological and behavioral characteristics, the physical,
and social environment, and of the policies and
interventions related to health.
❑Health is a fundamental right of every individual.
❑The social determinants of health are interconnected
and have an influence on the health of the individual,
family and community.
❑Community/Public Health Nursing is a specialized
field of practice that focuses on health promotion and
disease prevention
❑Health as a shared reality requires comprehensive
and collaborative interventions built on partnership.
❑Nurses in the community deal with individuals,
families, groups, and communities but the family
remains to be his/her unit of services.
❑Protecting and promoting the worth and dignity of
man is the philosophy of community/public health
nursing and ensuring the common good is his/her
framework in practice.
❑ Nursing practice should be guided by principles of
bioethics that spells out obligation of professionals
when dealing with population groups.