Public Health the Promotion of Health, Prevention of

Disease and Disability and

According to WHO Rehabilitation.

Art of applying Science in the Context of Broader -includes CHNs in both public &
Politics so as to Reduce Inequalities in private sectors.
Health while ensuring the best health for
the greatest number. CHN Process: Assessment (diagnosis is
embedded)
Planning
According to Dr. Charles Edward Winslow, Implementation
Father of Public Health Evaluation
Goal: Maglaya
1. Promotion of Health
rt of Preventing Disease, Prolonging Life, Promoting Health and efficiency
2. Preservation of Health

Nisce, et. al
"To raise the level of health of the
citizenry by helping communities and
Through: Organized
families to cope with the discontinuities
Community Effort
in and threats to health in such a way
for
as to maximize their potential for high-
EnvironmentalMedical
Sanitation
Standard
& Nursingof living adequate
services for level wellness"
to maintain health
1. Early Diagnosis Setting: Community -place where people
2. Preventive Treatment under usual or normal conditions are found
mmunicable Disease Control (villages, schools, workplaces, etc.)
-must be outside the institutional
setting (hospitals, etc. are excluded)
Nature
ble Every Citizen to Realize His Birthright to Health and of
Longevity Practice: Comprehensive,
general, continual
Not limited to a particular
specialization, not episodic, and spans the
entire life cycle.
Knowledge: Integration of nursing with
public health as well as sociology,
Public Health Nursing psychology, anthropology, economics
and political science
According to WHO Expert Committee on
Nursing Important concepts to note in
answering questions:
Special Field of Nursing that Combines 1. “Greatest good for the greatest
the Skills of Nursing, Public Health, and number”
Some Phases of Social Assistance and 2. Health promotion & disease
Functions as part of the Total Public prevention are prioritized over curative
Health Program for the promotion of care
health, the improvement of the conditions in 3. The primary responsibility of the
the social and physical environment, nurse is to the population as a whole
rehabilitation of illness and disability. 4. Client is an active, equal partner
of the nurse, not a passive recipient of care
Includes nurses in the public sector or the 5. CHN is affected by its immediate
context, the healthcare delivery system,
government. as well as overall political, economic,
socio-cultural, and environmental factors
Community Health Nursing 6. CHN is dynamic and flexible due
to varying objective and subjective
According to Dr. Araceli Maglaya realities in different settings
7. Community PARTICIPATION is
The utilization of the Nursing Process in key!!!
the Different Levels of Clientele-
Individuals, Families, Population Remember!
“The philosophy CHN on the worth and dignity of m
of CHN is based
Groups and Communities, concerned with means
Community  the
client
Health  the goal

CHN is HUMANISTIC. It is guided by
these beliefs:
Humanistic values of nursing are upheld
Unique and distinct component of healthcare
Multiple factors of heath considered
Active participation of clients encouraged
Nurse considers availability of resources
Interdependence among health team members
practiced
Scientific and up-to-date
Tasks of CH nurse vary with time and place
Independence or self-reliance of the people is
the end-goal
Roles of a Community Health
Nurse
Clinician
Coordinator and Collaborator Educator
Supervisor
Manager
Leader and Change Agent
Researcher
■ Clinician or Health Care Provider
utilizes the nursing process in the
care of the client in the home
setting through home visits and in
public health care facilities;
conducts referral of patients to
appropriate levels of care when
necessary
■ Health Educator
utilizes teaching skills to improve the
health knowledge, skills and attitude of
the individual, family and the
community and conducts health
information campaigns to various
groups for the purpose of health
promotion and disease prevention
■ Coordinator and Collaborator
establishes linkages and
collaborative relationships with
other health professionals, government
agencies, the private sector, non-
government organizations and people's
organizations to address health
problems
■ Supervisor
monitors and supervises the
performance of midwives and other
auxiliary health workers; also initiates
the formulation of staff development and
training programs for midwives and
other auxiliary health workers as part of
their training function as supervisors
■ Leader and Change Agent
influences people to participate in the
overall process of community
development
■ Manager
organizes the nursing service
component of the local health agency or
local government unit (ex. Nursing
service plan component of the overall
municipal health plan); also, as program
manager, the PHN is responsible for the
delivery of the package of services
provided by the health program to the
target clientele (ex. The PHN is almost
always the program manager of the
National Tuberculosis Program)
■ Researcher
participates in the conduct of research
and utilizes research findings in
practice (ex. disease surveillance or the
continuous collection and analysis of
data on diseases and causes of death)
In the event that the Municipal Health
Officer (MHO) is unavailable or is
unable to perform his duties, the
Public Health Nurse will take charge.
Specialized Fields in CHN
■ Community Mental Health Nursing
A unique clinical process which includes
an integration of concepts from nursing,
mental health, social psychology,
psychology, community networks, and
the basic sciences
■ Occupational Health Nursing
 The application of nursing principles and
procedures in conserving the health of
workers in all occupations
■ School Health Nursing
The application of nursing theories and
principles in the care of the school
population
Three Levels of Healthcare Services
Primary Level of Care - the first contact between the community people and the different
levels of health facility; refers to health care provided by the health center staff
Secondary Level of Care - rendered by physicians with basic health training in district
hospitals, provincial hospitals and city hospitals; these facilities are capable of basic surgical
procedures and simple laboratory examinations; serves as the referral center of primary health
facilities
Tertiary Level of Care - rendered by specialists in medical centers, regional hospitals and
specialized hospitals like the Heart Center of the Philippines; serves as the referral center of
secondary health facilities

Health problems that are beyond the capability of the primary health care units are referred to
an intermediate health facility like the rural health unit (RHU). The RHU team usually consists of:
» Rural Health Physician or the Municipal Health Officer (MHO)
» Dentist
» Public Health Nurse (PHN)
» Rural Health Midwife (RHM) PRIMARY
» Sanitary Inspector
» Community Volunteer Health Workers (CVHW) or Barangay Health Workers (BHW)
Health problems that are beyond the capability of the RHU Team are referred to the District
Hospital. Clients manifesting more complicated conditions need referral to higher levels of care.
Higher levels of health services at the provincial, regional and national levels provide secondary
or tertiary care to complete the health care given at the district and peripheral levels. With this,
the functionality and strengths of the health care delivery system lie on the strength of the
referral system. The two-way referral system creates and maintains the SECONDARY
network of health
services.

Two levels of Primary Healthcare Workers

1. Village or Barangay Health Workers (V/BHWs) - refers to trained community health
workers or health auxiliary volunteers 6r traditional birth attendants or healers
2. Intermediate Level Health Workers - refers to general medicalTERTIARYpractitioners or their
assistants, public health nurses, rural sanitary inspectors, and midwives
Midwife 1:5,000 MHO 1:20,000 Dentist: 1:50,000
Nurse 1:20,000 Sanitary Inspector 1:20,000

Village/Grassroots Intermediate Level Health Personnel of

Health Workers First-Line Hospitals
E • Trained community • General medical • Physicians with
X
A health worker practitioners specialization
M • Auxiliary health • Public health nurses • Nurses
P
L
volunteer • Midwives • Dentists
E • Traditional birth
attendant
C • Initial link, 1st contact • 1st source of • Establish close contact
H
A of the community professional health care with the village and
R • Works in liaison with • Attends to health intermediate level health
A
C
the local health service problems beyond the workers to promote the
T workers competence of village continuity of care from
E • Provides elementary health workers hospital to community to
R
I curative and preventive • Provides support to the home
S
T health care measures frontline health workers • Provides back-up
I in terms if supervision, health services for cases
C training, referral services requiring hospital or
S
and supplies thru diagnostic facilities not
linkages with other available in health
sectors centers, etc.
Adapted from CENE Nursing
Board Exam Review Notes Volume 2
Four Levels exposure to orgs e.g. NGO’s
particular like Red Cross.
of Clientele environmental
in the factors thus THE PUBLIC
Community resulting in SECTOR
common health
Individual problems ■ Department of
-sick or well Health
individuals in Community
homes and health -group of people Vision:
centers sharing common Leader
-considered as geographic
boundaries
Advocate
entry point in
in promoting
working with the and/or common
health for all
family values and
interests Model
Family -no 2 communities
-2 or more persons are alike Mission:
bound together by -exerts a strong Equitable
blood, marriage, influence on health Sustainable
or adoption of individuals, Health
(traditional families, and for all Filipinos
meaning) communities
-2 or more persons -most service Quality
who are joined by provisions are in
the community especially the poor
bonds of sharing
and emotional level
closeness and
who identify Healthcare
themselves as Delivery
being part of the
family System
(contemporary
meaning) MAJOR PLAYERS
-2 major functions:
reproduction and Public Sector -
socialization tax-based
-basic unit of care -
in CHN generally free at
-may contribute to point of service
wellness or illness
-locus of decision- National level -
making on health Department of
matters Health as lead
-solid source of agency
support to the Local health
young, elderly, system - run by
disabled, local
chronically ill government
units
Population group
-a group of people Private Sector –
sharing the same usually profit-
characteristics, oriented but some
developmental are also non-profit
stage or common
 -Administer promotion and ■ Local
service for health Government
Roles and protection Units
Commercial Non-Commercial -Innovate new
• Profit- • Oriented to social strategies in
oriented development, relief, health to
rehabilitation, and community improve the
organizing effectiveness of
• Socio-civic groups health
Manufacturing Religious programs
companies organizations/foundations -Initiate public
• Advertising NGO’s which assume the discussion on
agencies following roles health issues
• Private -Policy and Legislative and
practitioners advocacies disseminate
• Private -Organizing, Human Rights policy research
institutions advocacies outputs to
-Research and Development ensure
-Health Resource informed public
Development participation in
Personnel policy decision-
The Private
-Relief and Disaster making
Sector
Management -Oversee
-Networking implementation
Functions (based emerging , monitoring Primary
on EO 102): health concerns and evaluation
of national Health Care
LACE the require
complicated health plans,
technologies programs and Essential health
Leadership in policies care made
health -Provide universally
emergency
-Leader in the Goal of the DOH: accessible to
health response individuals and
formulation, Implementation of
for families in the
monitoring, and the HSRA (Health
catastrophic community by
evaluation of Sector Reform
events, means
national health Agenda)
epidemics, acceptable to
policies, plans,
and them, through
and programs Framework for
widespread their full
-Advocate implemention of
public danger participation and
adoption of HSRA: FOURmula
upon at a cost that the
health policies, One for Health
authorization by community and
plans, programs the President
Elements of FOURmula One for Health country can
-National policy and afford at every
and regulatory GOod GOvernance – enhance performance;
consultation stagekey player of is PhilHe
institution with the local
Health FInancing – health investments development.
Administrator of government. --WHO
specific services Health REgulation – quality and affordable health goods and serv
-Manage Capacity builder
Health Service Delivery – accessibility and Conceptual
availability of health s
selected health and Enabler Framework:
facilities e.g. -Ensure highest a. Health is a
national centers achievable fundamental
like special or standards of human right
tertiary quality health b.Health is
hospitals both an
care, health
 individual September 6-12, and intersectoral
and 1978 through the linkages.
collective sponsorship of
responsibilit WHO and UNICEF.
y Intrasectoral
c. Health Process • Decision- linkages means
should be an LEGAL BASIS OF
equal PHC IN THE making from relationship within
opportunity PHILIPPINES: top to bottom and between
to all Letter of Technolo • Curativedifferent levels of
d.Health is an Instruction (LOI) gy case healthcare
essential 949 signed in
element of October 19, 1979 based onservices…
socio- by former modern
economic President medicine Primary
SectorsHCmost
developmen Ferdinand E. and closely related
ELEMENTs:
t Marcos to health:
sophistic Health education
ated LEAPPS
NEW GOAL for Communicable disease
TRANSLATED the Philippine technolog Local Governments
control
y
into ACTION, implementation Education
the PHC of PHC: Health in • Physician
APPROACH the Hands of the dominate
E Agriculture
xpanded program on
focuses on: immunization
People by 2020 d Public Works
Locally endemic
Partnership with the community Population Control
disease treatment
PHC as a service
Equitable distribution of
delivery
health policy of Outcome • Reliance on
Social Welfare
Environmental
resources the DOH health sanitation
Organized and appropriate health
permeates all professionals Maternal and child
system infrastructure strategies and health and family
thrusts of
Prevention of disease and promotion Four Pillars of planning
of health is the focus government health PHC Essential drugs
programs from the
Linked multisectorally national to the provision
Use of appropriate Nutrition and adequate
Emphasis on appropriate technology
community levels. technology
5A’s of PHC food provision
Support mechanism made
Dimensio Commercialized available
Treatment of
n Healthcare Active community DOH-
vailable Goal • Absence of
the disease for
Approved
ccessible the individual technology means…Super
Appropriate Medicinal
Capal FACES (SC FACE
Plants
Scope of technology – serves a variety of purposes
ffordable
Focus of •CSick
omplexity – should be simple and easy to apply under local conditions
cceptable Care Sambong Lagu
Feasibility – compatible with local conditions Ampalaya Ulas
Setting • Hospital-
ttainable for based
Services •AUrban- Niyog-niyogan
cceptability – measured in terms of the degree of utilization of the peo
centered
Cost – should be affordable Tsaang gubat
PHC GOAL (in • Accessible
1978): Health for Akapulko
Effectiveness – should produce the desired effect Yerb
only to a few
All by the year
2000 people
Safety – effect of utilization should produce1. SAMBONG
no harm
People • Passive Indications: edema
PHC was declared recipients of and urolithiasis
in Alma-Ata (now healthcare (diuretic effect)
Almati), Structure • Health is PHC is a Preparation:
Kazakhstan, USSR isolated from Multisectoral
during the First Decoction
other sectors ofApproach – 2. AMPALAYA
International
Conference on society recognizes intra Indications:
PHC held on Diabetes Mellitus
Preparation: 8. BAYABAS achieve higher
Decoction or Indications: wound level or state of
steamed cleansing, as health
3. NIYUG- mouthwash in Health deficit
NIYOGAN cases of oral cavity – presence of
Indications: Ascaris infections & illness; gap
lumbricoides gingivitis between actual
intestinal (antiseptic and ideal health
infestation properties) *both are equally
Preparation: Preparation: considered as
Prepare dried, Decoction priority #1
mature niyug- 9. BAWANG 2. Health threat
niyugan seeds Indications: lowers – condition that
Dosage: Consume serum cholesterol promote disease or
by chewing the Preparation: May injury
right amount of be roasted, soaked 3. Stress
seeds two hours in vinegar or used point/foreseeabl
after meals. for sauteing e crisis –
Repeat same dose 10. Community anticipated periods
after 1 week. of unusual
Side-effects: YERBABUENA
Health demands
stomachache, Indications: for Nursing
diarrhea muscle pain Process Initial Data Base
4. TSAANG Preparation: 1. Family structure
GUBAT Decoction ■ Assessment and characteristics
Indications: -initiate contact 2. Socio-economic
Stomachache In "23 in '93", the -collect data and cultural factors
Preparation: utilization of the -identify health 3. Environmental
Decoction 10 Herbal Plants problems factors
5. AKAPULKO was aggressively -assess coping 4. Health
Indications: prescribed through ability assessment of
Ringworm, Tinea community wide -analyze and each member
Flava, Athlete's implementation of interpret data 5. Value placed on
foot and other projects such as prevention of
types of fungal herbal garden in 2 Levels of disease
infection communities Family
Preparation: Assessment Family Diagnosis
Poultice or RA 8423: 1. First level – Point Component
ointment utilization of determine actual give
medicinal plants as and potential n
alternative for high health problems. x1 Nature  (1)Defic
6. LAGUNDI cost medications. Answers ‘what’ (2)Threat, (3)Stress
Indications: Cough, Policies: questions. x2 Modifiability  po
Asthma, Fever, The 2. Second level – (highly, partially, or
Muscle Pain indications/uses of determine barriers x1 Preventive poten
Preparation: plants to family’s of future problems
Decoction or syrup The part of the performance of minimized by solvin
7. plant to be used tasks. Answers x1 Salience  family
Preparation of ‘why’ questions. problem
ULASIMANG herbal medicines Total=5
Categories of
BATO
Health Problems Community
Indications: lowers
Guidelines: (according to Diagnosis
serum uric acid in
priority) Point Component
P
gouty arthritis
roperly labelled herbal medicine containers
1. Wellness state
Preparation: Salad give
A ppropriate herbal plant to specific symptom only
or decoction
– readiness to n
Palayok or clay pots and a wooden spoon are used when cooking herbal medicines
Use only the recommended plant part
Administer only at recommended dose
R
x1emove the potcover
Nature healthwhen
statusthe(illness,
herbal preparation starts
2. Socio-economic to boil
-document Action
If the symptoms
stats), health resource
persists and (material,
despite cultural responses
using the herbal medicine 2-3 times, consult the nearest physician
Research)
Watch manpower), health-related
variables(social,
out for allergic reactions ~ if observed, stop using the herbal preparation
economic, political,3.environmental)
Health and 2 Levels of
A CO: A Manual of
x4lways Modifiability
keep out of reach
 of children
illness patterns Nursing
Experience; PCPD
Prepare(highly, partially,
the herbal or4.non-modifiable)
medicine Health resources
as suggested Intervention in
x1 Preventive potential
5. Political and CHN
A continuous and
of future problems leadership
that can bepatterns 1. Anticipatory –
sustained
minimized by solving this primary level of
process of
x1 Salience  family’sComponents
perception ofofthe prevention
educating the
problem Community Dx 2. Participatory –
people to
x3 Magnitude of the1. problem
Primary Data - secondary &
understand and
severity: proportion
source
of population
would be tertiary levels
develop their
affected by problemthe community ■ Evaluation critical
Total=10 people through -nursing audit awareness of
survey, interview, -evaluate care their existing
Why Undertake focused group outcomes conditions,
Community Dx? discussions, -performance working with the
1. To have a clear observation and appraisal for people
picture of the through the actual workers collectively &
problems of the minutes of -estimate cost- efficiently on their
community and to community benefit ratio immediate and
identify the meetings (determine long-term
resources available 2. Secondary efficiency) problems, and
to the community Data - source -identify necessary mobilizing the
people. would be alterations people to develop
2. Community organizational -revise plans their capability and
diagnosis enables records of the
readiness to
the nurse/program program, health Framework for respond & take
coordinator to set center records and Evaluation action on their
priorities for other public 1. Structural immediate needs
planning and records through elements – towards solving
developing review of physical: their long-term
programs of health records manpower, problems
care for the equipment,
community. The ■ Planning infrastructure Principles of
data gathered -goal setting 2. Process COPAR
through the -constructing plan elements – People, especially
process serves as of action and actions, the most
the material for operational plan procedures, oppressed,
analysis. protocols exploited and
■ 3. Outcome deprived sectors
Types of Implementati elements – are open to
Community Dx changes in clients’
1. Comprehensive on health status vis-à-
change, have the
-put nursing plan capacity to
Community Dx — vis objectives and
to action change, and are
general view goals of care
-coordinate able to bring about
2. Problem- outcomes
care/services change.
oriented
Community Dx – -utilize community ■ COPAR should
resources COPAR be based on the
specific problem
-delegate and (Community interests of the
Components of supervise Organizing poorest sectors
-provide health of society
Community Dx Participatory
1. Demographic education ■ COPAR should
variables lead to self-
 reliant than appointed following
community and or selected by guidelines: 4. Sustenance
society some external » recognize the and
force or entity. role of the Strengthening
Processes/Metho local
authorities Phase
ds Used Phases of the by paying • Occurs when
■A Progressive COPAR Process them visits the community
Cycle of Action to inform organization
- Reflection - 1. Pre-entry them of their has already
Action -begins Phase presence and been
with the already activities established
• The initial » his/her and the
existing phase of the appearance, community
practice, organizing speech,
experience, and members are
process where behavior & already
concrete the lifestyle actively
conditions of the community should be in participating in
people, sums organizer keeping with community-
practice up into looks for those of the wide
a body of communities community undertakings
theory, puts to serve/help residents • The different
theory to • Designing without committees
practice…and criteria for the disregard of set-up in the
selection of their being organization-
the cycle site role model building phase
repeats, • Actually » avoid raising
constantly are already
selecting the the expected to be
modifying for site for consciousnes functioning by
the better. community s of the way of
■ Consciousness care community planning,
residents; implementing
-raising adopt a low-
2. Entry Phase and evaluating
through learning key profile their own
by experience. • Sometimes programs, with
Related to A-R-A called the 3. Organization- the overall
cycle. social guidance from
preparation Building Phase
■ COPAR is the
phase as the • Entails the community-
Participatory activities done formation of wide
and Mass- here include more formal organization
based because the structures and • Strategies:
it is primarily sensitization of the inclusion of
the people on more formal » Education
directed towards and training
and biased in the critical procedures of
events in their planning, » Networking
favor of the and linkages
poor, the life, motivating implementing,
them to share and evaluating » Conduct of
powerless and mobilization on
the oppressed their dreams community-
and ideas on wide activities health
and seeks to • Conduct of and
how to
empower the manage their trainings for development
masses to concerns and the organized concerns
participate in eventually leaders or » Developing
the changing of mobilizing groups to secondary
their conditions. them to take develop their leaders
collective skills in
■ COPAR is managing their
Group- action on
these. own
centered and • Signals the concerns/progr
not Leader- actual entry of ams
oriented. the community
Leaders are worker/organiz
identified, er into the
emerge and are community
tested through with the
action rather