OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

Objectives:

Upon completion of this lesson, the learner should be able to:

1. Define health and community

2. Discuss the focus of Public Health
3. List the three levels of prevention, and give one example for each
4. Explain the differences among community health nursing, public health nursing, and community-based nursing
5. Discuss public health nursing practice in terms of public health’s core functions and essential public health functions
6. Cite the distinguishing features of community health nursing
7. Compare the different fields of community health nursing practice
8. Apply the competency standards of nursing practice in the Philippines in community health nursing practice
9. Discuss community health nursing interventions based on the Intervention Wheel
10. Outline the historical development of public health and public health nursing in the Philippines

Global and National Health Situations

Introduction

 Community/ Public health nursing is the synthesis of nursing practice applied public health practice
 Major goal of CHN
o preserve the health of the community and surrounding population by focusing on health
promotion, health maintenance, and disease prevention of individual, family and
group within the community.
 Thus CHN/ PHN is associated with health and identification of population at risk rather than
episodic response to patient demand
o Do not wait for the patient to get disease is first
 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
- Health is a BIRTH RIGHT

DEFINITION OF HEALTH
 “a state of complete, physical,
mental and social well-being
WHO
and not merely the absence of
disease or infirmity”
 “a state of well-being in which the
person is able to use purposeful
, adaptive responses and
Murray
processes physically, mentally,
emotionally, spiritually and
socially.”
 actualization of inherent and
acquired human potential through
goal directed behavior,
Pender competent self-care and
satisfying relationships with
others
 Health Promotion Model
 a state of person that is
characterized by soundness or
developed human structures and
of bodily and mental
functioning
Orem  Self care activities
 Self Care theory
 Self care agency- self care- self
care demands- nursing agency
(deficit)
 Selfcare agency
 ability to perform and
engage ion self-care
 Selfcare
 activities that an
individual completes or
assist in order to maintain
life and high level of well-
being
 Selfcare deficit
 occurs when the demand
for self-care is greater
than the individual’s
ability to satisfactorily
attain it
 Nurse agency
 the roles and
responsibility of the nurse
 of or relating to living together
Social in organized groups or similar
Definition close aggregates

 connotes community vitality

and is a result of positive
interaction among groups within
the community with an emphasis
Social Health on health promotion and illness
prevention
 Vitality: state of being strong and
active
 Group effort

 is seen as a group or collection of

locality-based individuals,
interacting in social units and
Community sharing common interests,
Definition characteristics, values and/or
goals
 No man is an island

DEFINITION OF COMMUNITY
 a collection of people who interact
with one another and whose
Allender
common interests or
(overall)
characteristics form the basis
for a sense of unity or belonging
 a group of people who share
Lundy and
something in common and interact
James
with one another, who may exhibit
(within the
a commitment with one another
same
and may share geographic
location)
boundary
 a group of people who share
common interests, who interact
Clark (social with each other, and who function
structure) collectively within a defined social
structure to address common
concerns
 a locality-based entity,
Shuster & composed of systems of formal
Geoppinger organizations reflecting society’s
institutions, informal groups and
aggregates

Two main types of communities according to

Maurer and Smith (2009):

A. Geopolitical Communities
 also called as “territorial communities”
 most traditionally recognized; “ex. Barangays”
 defined or formed by both natural and man-made boundaries and include barangays,
municipalities, cities, provinces, regions and nation
B. Phenomenological Communities
 also called as functional communities
 refer to relational, interactive groups, in which the place or setting is more abstract, and
people share a group perspective or identity based on culture, values, history, interest and
goals
 Ex. LGBT, tribes, WLC Community, organizations

Population
- denote a group of people having common personal or environmental characteristics
- Numbers and geography

Aggregates
- subgroups or subpopulations that have some common characteristics and concerns
- ex. Elderly, pregnant, children, PWD
- PART of a community

Determinants of Health:

1. Income and social status

 higher income and social status are linked to better health, the greater the gap between
the richest and the poor health, the greater difference in health
 richer = healthier
2. Education
 low education are linked with poor health, more stress and lower confidence
 low education = poor health
3. Physical Environment
 safe water and clean air, health workplace, safe houses communities and roads all contribute
to good health
 polluted = at risk
4. Employment and working conditions
 people who are employed are healthier, particularly those who have control over their
working conditions
 higher rank in employment = more control = better health
5. Social support networks
 greater support from family, friends and communities linked to better health
6. Culture
 customs and traditions, and the beliefs of the family and community all affect health
7. Genetics
 inheritance plays a part in determining lifespan, healthiness and the likelihood of developing
illnesses
8. Personal behavior and coping skills
 balanced diet, keeping active, smoking, drinking, and how we deal with stress and
challenges all affect health
 not normal = no stressor
 be able to adapt
9. Health Services
 access and use of services that prevent and treat disease influences health
 if far, people are less likely to go because it is no longer a priority
10. Gender
 men and women suffer from different types of diseases at different age

MODELS OF HEALTH
 HEALTH-ILLNESS CONTINUUM – degree of client wellness that exist at any point in time, ranging
from optimal wellness condition up to death which represents total energy depletion.

 HIGH-LEVEL WEELNESS MODEL –it is oriented towards maximizing the wellness potential of an
individual.

 AGENT-HOST ENVIRONMENT MODEL -

the level of health of an individual or group depends on the dynamic relationship of the agent ,
host and environment.

HEALTH-BELIEF MODEL - – addressees the relationship between a person’s belief and behaviors. It
provides a way of understanding and predicting how clients will behave in relation to their health and
how they will comply with health care therapies.
Four Components:

 The individual’s perception of susceptibility to an illness.

 The individual’s perception of the seriousness of the illness.
 The perceived threat of a disease.
 The perceived benefits of taking the necessary preventive measures.

Indicators of Health:

A. National Epidemiology Center of DOH, PSA (Philippine Statistics Authority : NSO before)
and local health centers/ offices/ departments
- provide morbidity, mortality, and other health status related data
- morbidity: number of people who got the disease
- mortality: number of people who died from the disease
B. Local health centers/ offices/ departments
- are responsible for collecting morbidity and mortality data and forwarding the information to the
higher level of health, such as the Provincial Health Office
- Morbidity: condition of being unhealthy or ill
- Mortality: death rate
- Chief (PHO)- Dr. Rene Catan at the Cebu Capitol

 Nurses should participate in investigative efforts to determine what is precipitating the

increased disease rate and work to remedy the identified threats or risk

Definition and Focus of Public Health

and Community Health

Definition of Public Health according to:

1. C.E. Winslow
 “Science and art of (1) preventing disease; (2) prolonging life; and (3) promoting health and
efficiency through organized community effort for:
a. Sanitation of the environment
b. Control communicable infections
c. Education of the individual on personal hygiene
d. Organization of medical and nursing services for the early diagnosis and preventive
treatment of disease
e. Development of the social machinery to ensure everyone a standard of living adequate for
the maintenance of health, so organizing these benefits as to enable every citizens to realize
his birthright of health and longevity
- Social machinery = social structure
i. Approach things by hierarchy and by what is most needed
ii. Funding
2. Public Health
 Key phrase definition “through organized community effort” connotes organized, legislated
and tax-supported efforts that serve all people through health departments or related governmental
agencies
- Not all nurses or doctors but include the community itself

9 Essential Public Health Functions according to WHO Regional Office for the Western
Pacific:

1. Health situation monitoring and analysis (Prenatal Checkup)

2. Epidemiological surveillance/ disease prevention and control (Dengue and HIV+)
3. Development of policies and planning in public health (Universal Health Care Law)
- Health is a birth right, so it is available for all regardless of member of Phil health or not
4. Strategic management of health systems and services for population health gain (TB DOTS)
- TB DOTS: tuberculosis directly observed treatment short course
5. Regulation and enforcement to protect public health (Tobacco Ban)
6. Human resources development and planning in public health (Doctors to the barangay and Nurse
Deployment Program)
7. Health promotion, social participation, and empowerment (TV ads)
8. Ensuring the quality of personal and population based health service (accreditations)
9. Research, development, and implementation of innovative public health solutions (government funded
research: tawa-tawa for dengue and mansanitas for diabetes)

Health Promotion and Levels of Prevention:

 Health Promotion
o activities enhance resources directed at improving well-being
 Disease Prevention
o protect people from disease and the effects of the disease

Leavell and Clark (1958) Three Levels of Prevention:

1. Primary Prevention
 activities directed at preventing a problem before it occurs by altering susceptibility or reducing
exposure for susceptible individuals
 Ex. Good nutrition, provision of adequate shelter, encouraging regular exercise, immunization and
water purification

2. Secondary Prevention
 early detection and prompt intervention during the period of early disease pathogenesis. Occurs
after the problem has begun and before the signs and symptoms appear and target those
population at risk
 Ex. Mammography: breast tumors, blood pressure screening: hyper tension or hypotension,
newborn screening: congenital , mass sputum examination for pulmonary tuberculosis

3. Tertiary Prevention
 target populations that have experienced disease or injury and focuses on limitations of
disability and rehabilitation.
 Aim: to reduce the effects of the disease and injury and to restore individuals to their optimal
level of functioning (Keller, et al 2004)
 Ex. Perform insulin administration; referring an individual with spinal cord injury to an OT or PT;
leading a support group for patients with cancer who have undergone chemotherapy, surgery or
radiation.