COMMUNITY HEALTH NURSING 1 & 2 (2023)

COMMUNITY HEALTH NURSING
By ROMMEL LUIS C. ISRAEL
III
1

TERMINOLOGY:
HEALTH is a state of complete physical,
mental, social and spiritual being and not merely
the absence of disease or infirmity
COMMUNITY is a place with spatial
boundaries, physical and environmental
characteristics and natural and man made
resources where a group of people, who shares
common needs, characteristics, interests, ethnic
or cultural ties live
By ROMMEL LUIS C. 2

PUBLIC HEALTH is a science and art of preventing
diseases, prolonging life, promoting health and efficiency
through organized community effort, control of CD’s,
education of individuals in personal hygiene, the
organization of medical and nursing services for the early
diagnosis and preventive treatment of disease and the
development of social machinery to insure everyone a
standard of living adequate for the maintenance of
health, so organizing this benefits as to enable every
citizen to realize his right of health and longetivity
By ROMMEL LUIS C. 3

COMMUNITY HEALTH NURSING is a
field of nursing practice where services are
delivered outside of purely curative institutions,
but in community such as in home, school, work
places, health centers and clinics
A learned practice discipline with the ultimate
goal of contributing, as individuals and in
collaboration with others, to the promotion of
client’s optimum level of functioning through
teaching and delivery of health
By ROMMEL LUIS C. 4

COMMUNITY HEALTH NURSE is
referred to as the Visiting Nurse,Health
Visitor or Community Health Nurse
By ROMMEL LUIS C. 5

W.H.O. DEFINITION OF CHN
Special field of nursing that combines the
skills of nursing and public health for the
promotion of health, the improvement of
the conditions in the social and physical
environment, rehabilitation of illness and
disability
By ROMMEL LUIS C. 6

FREEMAN DEFINITION
OF CHN
It is a service rendered by a professional
nurse…in places of work for the promotion of
health, prevention of illness, care of the sick
at home and rehabilitation
By ROMMEL LUIS C. 7

JACOBSON DEFINITION
OF CHN
It is a learned practice discipline with
the ultimate goal of contributing,
and in collaboration with others, to
the promoton of the client’s
optimum level of functioning
through teaching and delivery of
care
By ROMMEL LUIS C. 8

Community
- a group of people with common
characteristics or interest living
together within a territory or
geographical boundary.

PHILOSOPHY OF CHN
By ROMMEL LUIS C. 10

The nurse has a unique role and functions to
contribute to the achievement of goal of a
healthy and productive community
CHN is interdependent among the health
professions
CHN views an individual a unique whole human
being with physical, psychosocial and spiritual
needs and views family as the unit of care

CHN believes in the primacy of health as a goal
and an essential element that affects the
quality of life of individuals, families, group
and community
Nursing care is independent and self-reliant in
health care of patient
CHN recognizes the relationship of non-health
problems to health problems and the role of
non-health interventions in the solution of
health problems

The nurse work with the client and not for the client
CHN practice is not a body or set of the same repeating
tasks
The nurse has the responsibility to keep their knowledge
and skills current and up-to-date according to the
development of nursing and public health
The nurse always sets a realistic goal, targets and
standard of care in consideration of the available
resources in the place of her practice

PRINCIPLES OF
COMMUNITY
HEALTH
NURSINGNG

COMMUNITY HEALTH NURSING
It is an essential
component of
public health
It is guided by a
set of 12
principles
Reference: Community Health Nursing Diagnosis and Nursing Care Plan. (2022,
February 20). NurseStudy.net. https://nursestudy.net/community-health-nursing-
diagnosis/

12 PRINCIPLES OF CHN
1. Individuals, families and communities’identified needs are the
formulation for CHN work. Its main goal is to expand the use of
public health measures as part of the overall CHN approach.
2. Goal attainment is facilitated by having an excellent
comprehension of the agency’s goals and policies. Towards this
goal, the mission statement engages community health nurses to
positively realize their work.
diagnosis/

3. Family is the main unit of service for CHN. The degree to
which it can deal with its own challenges has an impact on
its level of functioning. As a result, the most effective and
accessible medium for CHN initiatives is the family.
4. The efficacy of client care is strengthened by sensitivity to
the client’s values, customs, and beliefs. Regardless of race,
faith and color, or socio-economic level, CHN services must
be sustainable and accessible to all.
diagnosis/

• Reference:
Community Health
Nursing Diagnosis and
Nursing Care Plan.
(2022, February 20).
NurseStudy.net.
https://nursestudy.net
/community-health-
nursing-diagnosis/
5. Health education and counselling
are integrated in CHN.
This foster and encourage
community efforts to enhance
people’s health by bringing
concerns up for discussion.
6. The achievement of goals is made
easier when co-workers and
members of the health team work
together.
Employees observe themselves on
how their contributions benefit the
entire organization.

7. Evaluation of the degree to which the CHN goals and
objectives are being met can be performed at a regular and
continuous basis. Through consultations, observations, and
precise recording, clients are involved in the evaluation of
their health programs.
8. To improve and maintain effective nursing practices in their
context, a continuing staff education program and high
quality client services are required. The agency’s staff
development program take into account the professional
interests and needs of community health nurses.
diagnosis/

9. Maximizing the success of the community health nurses
activities by utilizing existing community resources. The ability
to connect with existing community resources, both public and
private, raises an understanding of what they require and what
they are entitled to.
10. The success of CHN program is greatly determined by the
active participation of the individual, family and community in
planning and making health care decisions. Participation in
activities of organized community groups satisfies the needs
and interests of the community.
diagnosis/

11. The task completed is guided and directed by the supervision
of nursing services by qualified CHN employees. Employees’
ability to perform effectively and efficiently is enhanced.
12. The basis for evaluating the progress of planned programs and
activities, as well as guide for future actions, is accurate
recording and reporting. Community health records are used
in studies and research as well as legal documents, thus,
keeping accurate records is an essential responsibility of the
community health nurse and community leaders.
diagnosis/

PHILOSOPHY
It is based on the worth and dignity of man
GOAL
The ultimate goal of community health
services is to raise the level of health of the
citizenry

The goal of community health nursing is to
promote, protect and preserve the health of the
public. Community health nursing involves these
basic concepts:
 Promote healthy lifestyle
 Prevent disease and health problems
 Provide direct care
 Educate community about managing chronic conditions and
making healthy choices
 Evaluate a community’s delivery of patient care and wellness
projects
 Institute health and wellness programs
 Conduct research to improve healthcare

THEORETICAL
FOUNDATIONS OF
COMMUNITY HEALTH
NURSING

Introduction
Disease management in the community is
challenging as illnesses are interwoven with social,
economic, genetic and environmental risks in ways
that are difficult to understand and more difficult to
change.
In the face of these challenges, how can nurses
succeed in their goal to improve public health?

Nursing Theories
Theories or parts of theoretical frameworks to guide
practice best achieves the goal of improving nursing
practice- including that of public health.
A theory is like a map of a territory as opposed to an aerial
photograph. The map does not give the full terrain (i.e.,
the full picture); instead it picks out those parts that are
important for its given purpose
-Barnum, 1998

Historical Perspectives on Nursing
Theory
Era of Florence Nightingale
First nurse to formulate a conceptual foundation for nursing
practice
Believed that clean water, clean linens, access to adequate
sanitation, and quiet would improve health outcomes, and
she put these beliefs into practice during the Crimean War
1980 onwards
Several nursing theorists, Dorothy Johnson, Sister Callista
Roy, Imogene King, Betty Neuman, and Jean Watson among
them, have included community perspectives in their
definition of health.

General Systems Theory
Viewed as an “open system,” the client is
considered as a set of interacting elements
that exchange energy, matter, or information
with the external environment to exist.
This concept is particularly useful when
analyzing interrelationships of the elements
within the client, as well as those of the client
and the environment.

Open Systems
The basic structures of a family that is found in all open
systems:
Boundaries
Environment
Inputs
Outputs
Processing (throughput)
Feedback
Subsystems

Health Belief Model
Provides the basis for much of the practice of health
education and health promotion.
Developed by a group of social psychologists to explain
why the public failed to participate in screening for
tuberculosis.
“Behavior is based on current dynamics confronting an
individual rather than prior experiences “ –Kurt Lewin

Constructs of the Health
Belief Model
Perceived severity/ seriousness
Perceived susceptibility
Perceived benefits
Perceived barriers
Cues to action
Self-efficacy

Health Belief Model
Limitations of the model:
It places the burden of action exclusively on the
client.
It assumes that only those clients who have
distorted or negative perceptions of the specified
disease or recommended health action will fail to
act.
It focuses the nurse's energies on interventions
designed to modify the client's distorted
perceptions, without acknowledging the health
professional's responsibility to reduce or alter
health care barriers other than patients’
perspectives

Milio’s Framework for
Prevention
Provides a complement to the Health Belief Model
Provides a mechanism for directing attention
“upstream.”
Provides for the inclusion of economic, political, and
environmental health determinants; therefore, the
nurse is given broader range in the diagnosis and
interpretation of health problems.
Encourages the nurse to understand health behaviors in
the context of their societal milieu.

Milio’s Propositions
Population health results from deprivation and/or
excess of critical health resources.
Behaviors of populations result from selection
from limited choices; these arise from actual and
perceived options available as well as beliefs and
expectations resulting from socialization,
education and experience.
Organizational decisions and policies (both
governmental and non-governmental) dictate
many of the options available to individuals and
populations and influence choices.

Milio’s Propositions
Individual choices related to health promotion or health
damaging behaviors is influenced by efforts to maximize
valued resources.
Alteration in patterns of behavior resulting from decision
making of a significant number of people in a population
can result in social change.
Without concurrent availability of alternative health-
promoting options for investment of personal resources,
health education will be largely ineffective in changing
behavior patterns.

Pender’s Health Promotion
Model
Explores the many biopsychosocial factors that
influence individuals to pursue health promotion
activities.
Contains seven variables related to health
behaviors, as well as individual characteristics
that may influence a behavioral outcome.
Does not include threat as a motivator, as threat
may not be a motivating factor for clients in all
age groups.

Seven Variables of
Pender’s Health Promotion Model
Prior related behaviors
Personal factors
Behavior specific cognition and affect
Perceived benefits of action
Perceived barriers to action
Perceived self-efficacy
Activity-related affect
Interpersonal influences
Situational influences
Commitment to a plan of action
Immediate competing demands and preferences
Health-promoting behavior

Transtheoretical Model
Combines several theories of intervention, thus
the name “transtheoretical”.
Based on the assumption that behavior change
takes place over time, progressing through a
sequence of stages.
Assumes that each of the stages is both stable and
open to change.

Constructs of the
Transtheoretical Model
Stages of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance
Decisional Balance
Pros
Cons

Precede-Proceed Model
Developed by Dr. Lawrence W. Green
and colleagues.
Provides a model for community
assessment, health education
planning and evaluation.

PRECEDE: stands for Predisposing, Reinforcing, and
Enabling Constructs in Educational Diagnosis and
Evaluation.
A model for community diagnosis
PROCEED: stands for Policy, Regulatory, and
Organizational Constructs in Educational and
Environmental Development
a model for implementing and evaluating health
programs based on PRECEDE

Predisposing factors refer to people’s characteristics
that motivate them towards health-related behavior.
Enabling factors refer to conditions in people and the
environment that facilitate or impede health-related
behavior.
Reinforcing factors refer to feedback given by support
persons or groups resulting from the performance of the
health-related behavior.

Classifications of Communities:
1.URBAN
- increased in population; industrial-type of work
2. RURAL
- decreased in population; agricultural-type of work
3. RURBAN
- combination of rural and urban
4. SUBURBAN
- periphery around the urban areas
5. METROPOLITAN
- expanding urban areas

4 Aspects of Community:
1.Social
- communication and interaction of the people.
2. Cultural
- norms, values and beliefs of the people.
3. Political
- governance and leadership of the people.
4. Geographical
- boundaries of the community.

Components of a Community:
A. PEOPLE
B. 8 SUBSYSTEMS
1. Housing
2. Education
3. Fire and Safety
4. Politics and Environment
5. Health
6. Communication
7. Economics
8. Recreation

DETERMINANTS OF
HEALTH

Determinants of health
- factors or things that make people healthy or not.
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support network
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services
10. Gender

New concept in determinants of health
- OLOF (Optimum Level Of Functioning)
Factors that affects OLOF:
- Ecosystem
Composition of Ecosystem:
1. Political – power, authority, empowerment, safety
2. Behavior – lifestyle related such as diet, exercise
3. Heredity – genes, familial history
4. Environment – air, water, garbage, food, noise
5. Socio-Economic – education, employment, housing
6. Health Care Delivery System – availability, accessibility
and affordability of services and facilities

Nursing
care to
- an art and science of rendering
individual, families and community.
- assisting an individual, sick or well, in the
performance of those activities contributing to
health or its recovery in such a way as to help gain
independence. (OLOF)

Community Health Nursing
- a direct goal oriented and adaptable to the needs
of the individual, the family and community during health
and illness.
- (ANA, 1973)
- an area of human services directed toward
developing and enhancing the health capabilities of
people – either singly, as an individual or collectively as
groups and communities.
- (John Henrich, 1981)

- the utilization of the nursing process in different
level of clientele concerned with the promotion of health,
prevention of disease and disability and rehabilitation.
- (Aracelli Maglaya)
*** a service rendered by a professional nurse
with the community, groups, families and individuals
at home, in health centers, in clinics, in schools, in
places of work for the promotion of health,
prevention of illness, care of the sick at home and
rehabilitation.

PRIMARY GOAL OF CHN:
- Enhance people’s capability.
ULTIMATE GOAL OF CHN:
- “ To raise the level of health of the citizenry.”
PHILOSOPHY OF CHN:
- CHN is based on the worth and dignity of man.
- (Margaret Shetland)
EMPHASIS/FOCUS:
- Health promotion and Disease prevention.

Important Concepts of CHN:
1. The primary focus of CHN is on health promotion.
2.Recognized needs of individuals, families and
communities provide the basis for CHN.
3. The family is the unit of service.
4.Contact with the client may continue over a long period
of time which include all ages and all types of health care.
5.CH nurses are generalists in terms of their practice
throughout life’s continuum –its full range of health
problems and needs.
6.CHN practice is extended to benefit not only the
individual but the whole family and community

Roles and Functions of CH Nurse:
1. Advocate
- defends the rights of the client for self-determination
-intercedes, supports, pleads or acts as guardian of the
client’s rights to autonomy and free choice for self-care
2. Supervisor
- provides administrative support
- oversees, monitors and evaluates the function of
the subordinates
3. Counselor
- encourages client to verbalize and express feelings
and concerns
- key task is active listening

4. Educator
- teaches the client to provide skills, knowledge and
attitude
- primary task is to assess readiness to learn
4. Trainer
- provides technical support
-identifies training needs, formulates training program
designs
- arranges and conducts training to provide learning
experiences to subordinates and clients

Levels of Clientele:
1. Individual
- “point entry”
2. Family
- center of delivery of care.
3. Group
- point of specific care.
4. Community
- point of entire care

PLACES IN CHN:
A. Public Health Nursing
- is a special field of nursing that combines the skills of
nursing, public health and some phases of social assistance
and functions as part of the total health program.
Public Health
- the science and art of preventing disease, prolonging
life and promoting life and efficiency. (C. E. Winslow)
- is the art of applying science in the context of politics to
reduce inequalities while ensuring the best health for the
greatest number. (WHO)

B. School Health Nursing
> Home Visitation – effective implementation of total school
program
> RA 124 – it mandates the school to provide clinics for the
minor treatment and attendance to emergency cases
> Assessment:
5. Ears
6. Neck and Chest
7. Hair
8. Lower extremities
1. Arms
2. Eyes and Visual Acuity
3. Nose
4. Mouth and Teeth
> Feeding Program
- Should run for 120 days
- Deworming with consent

C. Occupational Health Nursing
> RA 1054
– Occupational Health Act
>Business Firm must employ an occupational health nurse
when it has at least ?
101 employees

The Family
Basic Concepts :
• A complex social system, the basic unit
of all societies.
• A primary group that gives an
individual
– the earliest and most complete experience
of social unity and self concept formation

Definition of a Family
1. It is the basic social institution and the primary
group in the society.
2. Murdok defines family as a social group
characterized by
a. common residence,
b. economic cooperation and
c. reproduction.
It includes both sexes, at least two of
who maintain a socially approved sexual
relationship, and one or two children.
Primary Health Care Manual 1 and 2

Burgess and Locke define family as a group
of persons united by
a. ties of marriage, blood or adoption,
b. constituting a single household, interacting
and communicating with each other in
their respective social roles of husband and
wife, mother and father, son and daughter,
brother and sister
c. and creating and maintaining a
common culture.

The family is generally regarded as a major
social institution and a locus of much of a
person's social activity.
It is a social unit created by blood, marriage,
or adoption, and can be described as
nuclear (parents and children) or extended
(encompassing other relatives).
- Charles B. Nam

• Allender and Spradley
–Two or more people who live in
the same household,
–Share a common emotional
bond
–Perform certain interrelated
social tasks

All family systems have
goals:
–reproduction
–meeting the physiological needs of
an individual
– love and affection
– economic survival
– socialization

Basic Needs that each Family
Member Assume
1. Physical need for food, shelter and
Clothing
2. Personal need for personal
enrichment through education,
attending religious services, joining
religious organizations
3. Social needs, the need to belong
4. Personal need for personal enrichment through
education, attending religious services, joining
religious organizations
5. Social needs, the need to belong

–Structural Definition
• Refers to kinship by blood
–Functional
• Relations not necessarily due to
blood relations
Today, the Family is the basic
biological, psychological and
sociological unit that creates a
community.

Family structures
• According to internal
organization
• According to place of
residence
• According to descent
• According to authority

Family Structures
A. Based on Internal
Organization and Membership

1. Nuclear
– also known as primary or
elementary family. It is
composed of mother, father
and the children.

2. Extended – composed of two or more
nuclear families related to
each other economically or
socially.
a. the parent-child relationships, when the
unmarriedchildren and the married
children with their families live with the
parents.
b. husband-wife relationship, as in a
polygamous marriage.

• Disadvantage/s of extended
family
–Financial shortage
• Advantage
–More support group

3. Dyad family
– Consist of 2 people living together, usually
man and woman, without children.
– Companionship and security.
– Temporary arrangement

4. Cohabitation family
– Heterosexual couple live together like a
nuclear family but remain unmarried.
Advantage/disadvantage:
• No commitment, security

5. Foster family
6. Single parent family
7.Blended family
(Misunderstanding and abuse)
8. Communal family (motivated by social
religious
values)
9. Gay and lesbian family

Family Structures
B. Based on Place of Residence

1. Patrilocal – requires the newly wed couple to
live with the family of the
bridegroom or near the residence
of the parents of the bridegroom.
2.Matrilocal – requires the newly wed couple to
live with or near the residence of
the bride’s parent, maternal uncle of
the groom

3. Bilocal – provides the newly wed couple the
choice of staying with either the
groom’s parents or the bride’s
parents, depending on the factors
like:
a. the relative wealth of the families or
b. their status,
c. the wishes of their parents,
d.certain personal preferences of the bride or
the groom.

4.Neolocal – permits the couple to
reside independently of
their parents. They can
decide on their own as far
as their residence is
concerned.
5. Avunculocal – prescribes the newly
wed couple to reside with or
near the maternal uncle of
the groom

Family Structures
C. Based on Descent

1. Patrilineal – affiliates a person with a
group of relatives through
his or her father.
2. Matrilineal – affiliates a person with a
group of relatives through
his or her mother.
3. Bilateral – affiliates a person
with a group of
relatives related
through both his or
her parents

Family Structures
D. Based on Authority

1. Patriarchal – authority is vested in the oldest
male in the family, often the father.
2. Matriarchal – authority is vested in the mother or
the mother’s kin.
3. Egalitarian– husband and wife exercise a more or less
equal amount of authority.
4. Matricentric – prolonged absence of the father gives the
mother a dominant position in the family,
although the father may also
share with the mother in
decision-making

Roles of a Family
• Wage earner, supplies the bulk of the
income of the family/
• Financial manager
• Problem solver
• Nurturer
• Decision maker
• Health manager
• Gate keeper

Functions of a Family
1. Regulates sexual behavior.
- It serves to provide legitimate
children with a status.
2. Biological maintenance function
• - Parenting role, protector, provider,
guardian for the infant as new
member, and other kids

3. Socialization function –
a. the family transmit culture of the group,
b. its patterned ways of living and values
through example, teaching and
indoctrination.

4. The family gives its membership
status.
- A child is born into a family,which gives
him or her a name and lineage.

5. Social control function – the family
continually exerts pressure on its
members to make them conform to what it
considers as desirable behavior.
6. Economic functions – the family
provides economic needs of the
members. It may likewise perform
educational, recreational, religious and
political functions.

Characteristics of a Family
1. The family as a social group is universal and a significant
element in man’s social life.
2. It is the first social group to which the individual is exposed.
3. Family contact and any relationships are repetitive and
continuous.
4. The family is very close and intimate group.
5. It is the setting of the most intense emotional experience
during the life time of the individual – birth, childhood,
puberty, adolescence, marriage and death.
6. The family affects the individual’s social values, disposition
and outlook in life.
7. The family has the unique position of serving as a link
between the individual and the larger society.
8. The family is also unique in providing continuity of social
life.

CHARACTERISTICS OFAHEALTHY FAMILY
1. Communicate / interact with each other.
2. Make decisions
3. Resolve important issues and concern
4. Supportive
5. Follow and respect family rules being imposed.
6. Provide basic needs of the family.
7. Leadership
8. Perform specific tasks/roles and flexible
9. Respond to other needs of the members

Duvall’s 8 Stages of Family Life
• Stage 1: Beginning families
• Stage 2: Early Childbearing families
• Stage 3: Families with preschool children
• Stage 4: Families with School Children
• Stage 5: Families with Teenagers
• Stage 6: Launching Center families
• Stage 7: Families of Middle age years
• Stage 8: Family in Retirement and Old age

Stages Description
Stage 1 Beginning families
Stage 2 Childbearing families
(without children)
(oldest child, birth-30
mo.)
Stage 3 Families w/ preschool (oldest child, 2.5- 5 yrs)
Stage 4 Families w/ school
children
(oldest child, 6-13 yrs)
(oldest child, 13- 20 yrs.)
Stage 5 Families w/
teenagers

Stages Description
Stage 6 Families launching (first child gone-last)
young adults
Stage 7 Middle-age parents (empty nest to
retirement)
(retirement-death
of spouse)
Stage 8 Aging family members

Family Stages and Tasks
STAGES OF A FAMILY
1. Beginning family
2. Child-bearing family
• Having and adjusting to
infant
• Supporting the needs of
all three members
• Renegotiating martial
relationships
TASKS
• Establishing a mutually
satisfying marriage
• Planning to have or not
to have children
• Formation of good
and harmonious
relationships with kin
network
Health Concerns
• Sexual and marital role
adjustment
• Family planning
education and
counseling
• Communication

3. Family with pre-school children
4. Family with school-age children
• Adjusting to costs of family life
• Adapting to needs of pre-
school
• Coping with parental loss of
energy and privacy
• Adjusting to the activity of the
growing children
• Promoting joint decisions
between children and parents
• Encouraging and supporting
children’s educational
achievements

5. Family with teenagers •
and young adults
Maintaining open communication
among members
• Supporting ethical and moral values
within the family
• Balancing freedom and responsibility
of teenagers
• Releasing young adults with
appropriate rituals and assistance

6. Post-parental family •
7. Aging family
Strengthening marital
relationships
• Maintaining supportive
home base
• Preparing for retirement
• Maintaining ties with
younger and older
generations
• Adjusting to retirement
• Adjusting to loss of spouse
• Closing family house

FAMILY HEALTH NURSING
PROCESS
By: ROMMEL LUIS C. ISRAEL III

The Family Health Nursing Process
Involves a set of actions by which the nurse
measures
the status of the family as a client,
its ability to maintain itself as a system and
functioning unit, and
its ability to prevent, control or resolve
problems in order to achieve health and well-
being among its members
By ROMMEL LUIS C. ISRAEL III
100

Nursing ASSESSMENT
DATA COLLECTION
Data analysis or interpretation
Problem definition or nursing diagnosis
FIRST LEVEL ASSESSMENT
Existing and potential problems categorized as
wellness states, health
threats, health deficits, stress point or foreseeable
crisis
SECOND LEVEL ASSESSMENT
Defining the nature or type of nursing problems

DATA COLLECTION: FIRST LEVEL DATA
DATA ON:
Family structure, characteristics and dynamics
Socioeconomic and cultural characteristics
Home and environment
Health status of each member
Values and practices on health
promotion/maintenance and disease
prevention

DATA COLLECTION: 2nd LEVEL DATA
Data on family’s assumption on health task on
each health condition or problem
Family’s perception of the condition or problem
Decisions made and appropriateness; if none,
reasons
Effects of decisions and actions on other family
members

DATA ANALYSIS
 Sort data
 Cluster/group related data
 Distinguish relevant from
irrelevant data
 Identify patterns with norms
 Make inferences

HEALTH PROBLEMS AND NURSING DIAGNOSIS
First level assessment
Define health problems
Second level assessment
Define the family nursing problem
diagnosis

Data gathering
methods/tools

OBSERVATION
Use of sensory capacities
Gather information about the family’s state of being
and behavioral responses
- Communication, interaction patterns,
interpersonal relationships
- Role perceptions/tasks assumptions; decision-
making patterns
- Home and environment condition

PHYSICAL EXAMINATION &
INTERVIEW
Physical examination
Direct examination
Interview
Completing health history of family members
Personally asking significant family members
Collecting information from colleagues who
work with the family

RECORDS REVIEW &
LAB/DIAGNOSTIC TESTS
Records review
Reviewing existing records and reports
Laboratory/diagnostic test

FAMILY COPING INDEX
 Basis for estimating the nursing needs of the
family
 A family health care need is present when:
- The family has a health problem with
which they are unable to cope
- There is a reasonable likelihood that nursing
will make a difference in the family’s ability to
cope

FAMILY COPING INDEX
Direction for scaling
Two parts:
1. A point on the scale
2. A justification statement
A point on the scale
Placing the family in relation to their ability to
cope with the nine areas of family nursing at the
time you observed and as you would expect it to
be

FAMILY COPING INDEX
 A point on the scale (general
considerations)
It is the coping capacity and not the
underlying problem that is being rated
It is the family and the individual that is
being rated
Rating should be done after 2 – 3 home
visits when the nurse is more acquainted
with the family

FAMILY COPING INDEX
Scale is as follows
0 – 2 or no competence
3 – 5 coping in some fashion but poorly
6 – 8 moderately competent
9 fairly competent
Terminal rating is done at the end of the given
period of time (enables the nurse to see progress the
family has made in their competence)

FAMILY COPING INDEX
Scaling cues
0 – no competence
3 – moderate competence
5 - complete competence

FAMILY COPING INDEX
 Justification statement
Brief statement or phrase that
explain why you have rated the
family as you have

FAMILY COPING INDEX
 Justification statement
Expressed in terms of behavior of observable facts
Physical independence
Therapeutic competence
Knowledge of health condition
Application of principles of general hygiene
Health attitudes
Emotional competence
Family living
Physical environment
Use of community facilities

FAMILY COPING INDEX
Physical independence
Ability to move about, get out of
bed, take care of daily grooming,
walking and other things which I
nvolves daily activities

FAMILY COPING INDEX
Therapeutic competence
- Includes all the procedures or
treatment prescribed for the care
of ill
- Giving medications, dressings,
exercise and relaxation, special
diets

FAMILY COPING INDEX
Knowledge of health condition
- Concerned with the particular health
condition that is the occasion of care
Application of the principles of general hygiene
- Family action in relation to maintaining
family nutrition, securing adequate rest and
relaxation for family members, carrying out
accepted preventive measures

FAMILY COPING INDEX
Health attitudes
- The way the family feels about health care in
general, including preventive services, care of
illness and public health measures
Emotional competence
- Maturity and integrity with which the members of
the family are able to met the usual stresses and
problems of life, and to plan for happy and fruitful
living

FAMILY COPING INDEX
Family living
- Interpersonal or group aspects of family
life
– how well the members of the family
get along with each other, the ways in
which they take decisions affecting the
family as a whole
Physical environment
- Home, the community and the work
environment as it affects family health

FAMILY COPING INDEX
Use of community facilities
- Generally keeps appointments,
follow through referrals, tells
others about health department
services

INITIAL DATA BASE
Family structure, characteristics and
dynamics
Socio-economic and cultural
characteristics
Home and environment
Health status of each family member
Values and practices on health
promotion/maintenance and disease
prevention

First level assessment
Presence of wellness condition
- Potential for enhanced
capability
- Readiness for enhanced
capability
Health threats
Health deficit
Stress point or foreseeable crisis

SECOND LEVEL ASSESSMENT
Inability to recognize the presence of a problem
Inability to make decisions with respect to taking
appropriate health action
Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable/at risk member of
the family
Inability to conducive to health maintenance and
personal development
Failure to utilize community resources for health care

Nursing diagnosis
Wellness condition
- Capability for wellness
Health condition or problem
- Interferes with health maintenance
Nursing diagnosis
- Family’s failure to adequately perform
specific health task

PRIORITY SETTING: NATURE OF
THE PROBLEM
Wellness (3)
Health deficit (3)
Health threat (2)
Foreseeable crisis (1)

PRIORITY SETTING: MODIFIABILITY OF
THE PROBLEM
Modifiability
Current knowledge, technology,
interventions to manage the problem
Resources of the family
Resources of the nurse
Resources of the community

PRIORITY SETTING: PREVENTIVE
POTENTIAL
Gravity or severity of the problem
More severe – lower Preventive
Potential
Duration of the problem
Direct relationship to gravity
Current management
Exposure of any high risk group
Increases Preventive Potential

PRIORITY SETTING: Salience
Family’s perception and evaluation of
the problem

FAMILY – NURSE
CONTACT
1. Home Visit

I. HOME VISIT
- professional face to face contact done by a nurse to
the family.
Purposes:
1. Give nursing to the sick, post partum mother & newborn.
2.Assess living condition of client and their health
practices.
3. Give health teachings.
4. Establish relationship with health agency and public.
5.Make use of inter-referral system and promote utilization
of community services.

Principles:
1. Must have a purpose and objective.
2.Make use available information about the patient and his
family.
3.Consider and prioritize essential needs of the individual
and family.
4.Should involve the individual and family in planning and
delivery of care.
5. Plan should be flexible.

Important Steps of Home Visit:
1. Greet client and family then introduce yourself.
2. Explain the purpose of the visit.
3. Observe the patient and determine the health needs.
4.Put the bag in a convenient place then perform bag
technique
5. Perform nursing care and give health teachings.
6.Record all important data, observation and care
rendered.
7. Make appointment for a return visit.

Phases:
1. Preparatory Phase
a. review existing records of referral data of the
family
b. notifies the family of the intention to make a
home visit
2. Home Visit Phase
a. actual visits of the family
b. makes plans, interventions, evaluation with the
family and set schedule for the next visit
3. Post Visit Phase
a. records data and plans for the next visit and
referrals

Priorities During Home Visit:
1. Newborn
2. Post partum
3. Pregnant women
4. Morbid individuals
Factors affecting Frequency of Home Visit:
1. Physical, psychological and educational
2. Acceptance of family
3. Policies given by the agency

Bag Technique:
- a tool making use of a public health bag and which
the public health nurse can perform procedures during
home visits.
Rationale :
- Helps render effective nursing care to clients.
Principles:
1. Minimize if not totally prevent the spread of infection.
2. Save time and effort.
*** Open bag TWICE during home visit.

Special Consideration:
B
-bag and its contents must be free from any
contamination.
A
- always perform handwashing.
G
-gather necessary equipments to render effective
nursing care.

Special Considerations
in the Use of the Bag
a. The bag should contain all necessary
articles, supplies and equipment which
may be used to answer emergency needs.
a. The bag and it’s contents should be
cleaned as often as possible, supplies
replaced and ready for use at any time.

c. The bag and it’s contents should be
well protected from contact with any
article in the home of the patients.
d. The arrangement of the contents of
the bag should be the one most
convenient to the user to facilitate the
efficiency and avoid confusion.

e. Hand washing is done as frequently as
the situation calls for, helps in
minimizing or avoiding contamination of
the bag and its contents.
f. The bag when used for a
communicable case should be
thoroughly cleaned and disinfected
before keeping and re-using.

Contents of the Bag
Paper lining
Extra paper for making bag for waste materials
(paper bag)
Plastic linen/lining
Apron
Hand towel in plastic bag
Soap in soap dish
Thermometers in case [one oral and rectal]
2 pairs of scissors [1 surgical and 1 bandage]
2 pairs of forceps [ curved and straight]
Syringes [5 ml and 2 ml]
Hypodermic needles g. 19, 22, 23, 25

Sterile dressings [OS, C.B]
Sterile Cord Tie
Adhesive Plaster
Dressing [OS, cotton ball]
Alcohol lamp
Tape Measure
Baby’s scale
1 pair of rubber gloves
2 test tubes
Test tube holder

Medicines
betadine
70% alcohol
ophthalmic ointment (antibiotic)
zephiran solution
hydrogen peroxide
spirit of ammonia
acetic acid
benedict’s solution
Note: Blood Pressure Apparatus and
Stethoscope are carried separately

1.FRONT OF THE BAG LEFT
OR RIGHT
Oral thermometer in case
Rectal thermometer in case

2. ON THE RIGHT REAR END OF THE
BAG
Test tube
Medicine dropper
Tube holder

3. ON THE LEFT REAR OF THE BAG
Medicine glass
Baby scale (spring balance)
Bandage scissors

4. BACK OF THE BAG LEFT TO RIGHT
Alcohol 70%
Aromatic spirit of ammonia
Liquid soap
Water (for cleaning
thermometer)
Betadine
Oil

5. In center of bag-
instruments tray with
cover containing:
Hemostat or “kelly forceps” (2)
Tissue forceps (1)
Cord scissors (1)
Rubber catheters (2) F-10, F-14
Medicine droppers

6. Cloth bag containing:
Sterile dressing (2)
Cotton balls (2) packets
Roller Bandage
Sterile cord dressings (2) packets

7. In rectangular bag:
Small metal funnel (1)
Rectal colon tube – 30 cm. long
Graduated measuring cup
Kidney basin

8. Hand washing
equipment is rear end in
plastic bag
Paper napkins (if available)
Hand towel
Soap dish with soap
Toothpicks or orange stick
Paper bags

9. On middle top of
bag
folded apron

10. Folded newspaper
or plastic under
cover of bag.

11. Records maybe placed on
flap or carried separately
in an envelope
Note: BP apparatus and
stethoscope are carried
separately.

Actions Rationale
1. Upon arriving at the
client’s home, place the
bag on the table or any flat
surface lined with paper
lining, clean side out
(folded part touching the
table). Put the bag’s
handles or strap beneath
the bag.
To protect the bag from
contamination.
2. Ask for a basin of water
and a glass of water if
faucet is not available.
Place these outside the
To be used for
handwashing.
To protect the work field
from being wet.

3. Open the bag, take the linen/plastic
lining and spread over work field or
area. The paper lining, clean side out
(folded part out).
To make a non-contaminated work field
or area
4. Take out hand towel, soap dish and
apron and the place them at one corner
of the work area (within the confines of
the linen/plastic lining).
To prepare for handwashing.
5. Do handwashing. Wipe, dry with
towel. Leave the plastic wrappers of the
towel in a soap dish in the bag.
Handwashing prevents possible
infection from one care provider to the
client.
6. Put on apron right side out and wrong
side with crease touching the body,
sliding the head into the neck strap.
Neatly tie the straps at the back.
To protect the nurses’ uniform. Keeping
the crease creates aesthetic appearance.

7. Put out things most needed
for the specific case (e.g.)
thermometer, kidney basin,
cotton ball, waste paper bag)
and place at one corner of the
work area.
To make them readily
accessible.
8. Place waste paper bag outside
of work area.
To prevent contamination of
clean area.
9. Close the bag. To give comfort and security,
maintain personal hygiene and
hasten recovery.
10. Proceed to the specific
nursing care or treatment.
To prevent contamination of bag
and contents.
11. After completing nursing care
or treatment, clean and
alcoholize the things used.
To protect caregiver and prevent
spread of infection to others.
12. Do handwashing again.

13. Open the bag and put back all
articles in their proper places.
14. Remove apron folding away from
the body, with soiled sidefolded
inwards, and the clean side out. Place it
in the bag.
15. Fold the linen/plastic lining, clean;
place it in the bag and close the bag.
16. Make post-visit conference on
matters relevant to health care, taking
anecdotal notes preparatory to final
reporting.
To be used as reference for future visit.
17. Make appointment for the next visit
( either home or clinic), taking note of
the date, time and purpose.
For follow-up care.

After Care
1. Before keeping all articles in the bag,
clean and alcoholize them.
2. Get the bag from the table, fold the
paper lining ( and insert), and place
in between the flaps and cover the
bag

Evaluation and
Documentation
3. Record all relevant findings about the
client and members of the family.
4. Take note of environmental factors which
affect the clients/family health.
5. Include quality of nurse-patient
relationship.
6. Assess effectiveness of nursing care
provided.

FAMILY – NURSE
CONTACT
2. Clinic Visit

II. CLINIC VISIT
Advantage:
- it is inexpensive in time and usually in cost both for the
service and for the family.
Standard Procedure in Conducting Clinic Visit:
I. Registration/Admission
1. Greet the client and establish rapport
2. Prepare records
3. Elicit client’s chief complaint and clinical history
4. Perform PE
II. Waiting Time
* Implement the “first come”, “first served” except for
emergency and urgent cases

III. Triaging
* Manage program-based cases
* Refer all non-program based cases
IV.Clinical Evaluation
* Validate clinical history and PE
* Inform client of the nature of the illness,
treatment, prevention and control measures
V.Laboratory and other diagnostic examinations
* Identify a designated referral laboratory when needed

VI. Referral System
1. Refer if needs further management (BHS to RHU, RHU
to RHU, RHU to Hospital)
2. Accompany patient if it is an emergency referral
VI. Prescription/ Dispensing
* Give proper instructions on drug intake
VIII. Health Education
1. Conduct one-on-one counseling with the patient
2. Reinforce health education and counseling messages
3. Give appointments for the next visit

Phases:
1. Pre-consultation
a. establish relationship
b. assessment on chief complaint, VS, PE
2. Consultation
A. Medical Consultation
B. Nursing Intervention
3. Post-consultation
a. explaining intervention to be done at home
b. follow-up care
c. referral (if possible)

PRIMARY HEALTH CARE
- is an essential health care made universally
accessible to individuals and families in the community by
means acceptable to them.
*** in Sept. 6-12, 1978 : UNICEF and WHO held the First
International Conference on Primary Health Care in Alma
Ata, USSR
Legal Basis:
LOI 949 : was signed by Pres Marcos on Oct 19, 1979
making Primary Health Care the thrust of the
Department of Health.

Vision :
Health for All Filipinos
Goal :
Health for All Filipinos and Health in the Hands of the
people by the Year 2020
Mission :
In partnership with the people, provide equity, access
and quality health care especially to the marginalized

Principles:
1. 4 A’s; Accessibility, Availability, Affordability and
Acceptability of health services
2. Community Participation
- is the heart and soul of PHC
3. People are the center, object and subject of development
4. Self – reliance
5.Partnership between the community and the health
agencies in provision of quality life
6.Recognition of interrelationship between the health and
development
7. Social mobilization
8. Decentralization

RA 7160 :
The Local government Code of 1991 which
resulted in devolution, which transferred the
power and authority from the national to the
local government units, aimed to build their
capabilities for self-government and develop
them fully as self-reliant communities.
- Devolution Code (Mandate of Devolution)
Local Government Code

Primary Health Care Team:
1. Local Chief Executive
2. Physician
3. Nurse
4. Medical technologist
5. Midwife
6. Sanitary Inspector
7. Auxiliaries
- BHW
- PHW

4 Pillars/Cornerstones:
1. Active community participation
2. Intra and inter- sectoral linkages
3. Use of appropriate technology
4. Support mechanisms made available
Levels of PHC Workers:
1. Village or Brgy. Health Workers
- health auxiliary or volunteers
2. Intermediate Level Health Workers
- Physician
- Nurse
- Sanitary Inspector
- Midwife

Ratios to catchment population:
Public Health Worker = 1:50,000
Public Health Physician = 1:20,000
Public Health Nurse = 1:20,000
Public Health Midwife = 1: 5,000
Dentist = 1:20,000

LEVELS OF PREVENTION
1.Primary Prevention
- health promotion
- specific protection
Behaviors:
1. Quit smoking
2. Avoid/limit alcohol intake
3. Exercise regularly
4. Eat well-balance diet
5. Reduce fat and increase fiber in the diet
6. Complete immunization program
7. Wear hazard devices in work site

2. Secondary Prevention
- early diagnosis/detection/screening
- prompt treatment
Behaviors:
1. Have annual physical examination
2. Regular Pap smear for women
3.Monthly BSE for women who are 20 yrs old and
above
4. Sputum examination for Tuberculosis
5. Annual stool Guaiac test and rectal exam for clients
over age 50 yrs old

3. Tertiary Prevention
- prevention of complication
-optimal health status after a disease or
disability
Behaviors:
1. Self-monitoring of blood glucose among diabetics
2. Physical therapy after CVA
3. Attending self-management education for diabetes
4. Undergoing speech therapy after laryngectomy

Levels of Health Care and Referral System
1. Primary Level of Care
1. Rural Health Units
2. Community Hospitals and Health Center
3. Private Practitioners (Puericulture Centers)
4. Brgy. Health Stations
- is usually the first contact between the community
members and the others levels of health facility.
- provided by center physicians, public health nurses,
rural health midwives, barangay health workers,
traditional healers

2. Secondary Level of Facilities
1. Provincial/City Health Services and Hospitals
2. Emergency and District Hospitals
- serves as a referral center for the primary health
facilities
- are capable of performing minor surgeries and perform
some simple laboratory examinations
3. Tertiary Level of Facilities
1. National and Regional Health Services
2. Teaching and Training Hospitals
- serves complicated cases and intensive care

HEALTH STATISTICS AND
EPIDEMIOLOGY
By: ROMMEL LUIS C. ISRAEL III

EPIDEMIOLOGY
Greek Words:
EPOS - which means “upon”
DEMOS - which means
“people”
- It is the systematic, scientific study of the
distribution patterns and determinants of health,
diseases and conditions in a population for the
purpose of promoting wellness and preventing
diseases or conditions
Reference:
Jimenez, C. E. (2008). Community Organizing Participatory Action Research for Community Health Development. C & E Pub.

USES OF EPIDEMIOLOGY
1. Study the history of the health population and the rise and
fall of diseases and changes in their character
2. Diagnose the health of the community and the condition of
the people to measure the distribution and dimension of
illness in terms of incidence. Prevalence, disability and
mortality, to set problems in perspective and to define
their relative importance and to identify groups needing
special attention
3. Study the work of health services with a view of improving
them. Operational research shows how community
expectations can result in the actual provisions of service.
Reference:
National League of Philippine Government Nurses. (2007). Public Health Nursing in the Philippines (10th ed.). National League of Philippine Government Nurses.

USES OF EPIDEMIOLOGY
4. estimate the risk of disease, accident, defects, and the
chances of avoiding them
5. Identify syndromes of describing the distribution and
association of clinical phenomena in the population
6. Complete the clinical picture of chronic disease and describe
their natural history
7. Search for causes of health and disease by comparing the
experience of groups that are clearly defined by their
composition, inheritance, experience, behavior, and
environments
Reference:

THE EPIDEMIOLOGIC PROCESS
1.Determine the nature, extent and scope of
the problem
2.Formulate a Tentative Hypothesis
3.Collect and Analyze data to test the
hypothesis
4.Plan for control
5.Implement control plan
6.Make an appropriate report
7.Conduct research
Reference:

EPIDEMIOLOGIC PROCESS AND THE
NURSING PROCESS
The epidemiologic Process is related to the Nursing Process because it
involves:
1. Assessing – data collection to determine the nature of client’s
problems
2. Analyzing – Formulation of nursing diagnosis
3. Planning
4. Implementing
5. Evaluating
6. Revising or terminating, and
7. Research – to Improve the plan if needed
Reference:

DETERMINE THE NATURE, EXTENT
AND SCOPE OF THE PROBLEM
1.Natural History of the
condition
2.Determinants influencing
the condition
3.Distribution Patterns
4.Condition Frequencies
Reference:
Jimenez, C. E. (2008). Community Organizing Participatory Action Research for Community Health Development. C
& E Pub.

DETERMINANTS INFLUENCING THE
CONDITION
1.Primary Data (essential agent)
a. Parasite
b. Nutritional
c. Psychosocial
2.Contributing Data
a. Agent
b. Host
c. Environment
Reference:
Jimenez, C. E. (2008). Community Organizing Participatory Action Research for Community Health
Development. C & E Pub.

THE EPIDEMIOLOGIC TRIANGLE
HOST
AGENT
ENVIRO
N MENT
HOST
• Any organism that harbors and provides nourishment
for another organism
• Any species (Human or other animals) capable of being
infected or affected
AGENT
• It is the intrinsic
property of
microorganism to
survive and multiply
in the environment
to produce disease
• An animate or
inanimate
factor that must
be present or
Lacking for a
disease or
condition to
occur
ENVIRONMENT
It affects both the
agent and the host.
It is the sum-total of
all external
condition and
influences that
affects the
development of an
organism
which can be:
a. Biological
b. Social
c. Physical

AGENTS OF DISEASE
AGENTS EXAMPLE OF ETIOLOGICAL FACTORS
NUTRITIVE ELEMENTS
Excess
Deficiencies
Cholesterol
Vitamins, Proteins
CHEMICAL AGENTS
Poisons
Allergens
Carbon Monoxide, Drugs
Ragweeds, Poison Ivy
PHYSICAL AGENTS Heat, Lights, Ionizing Radiation
INFECTIOUS AGENTS
Metazoa
Protozoa
Bacteria
Fungi
Rickettsia
Viruses
Hookworms, Schistosomiasis
Amoeba, Malaria
Pneumonia, Typhoid, Rheumatic Fever, Lobar
Histoplasmosis, Athlete’s Foot
Rocky Mountain, Spotted Fever
Measles, Mumps, Chicken pox, Poliomyelitis, Rabies
Reference:

HOST FACTORS (Intrinsic Factors)
Influences exposure, susceptibility, or response to agent
Reference:
GENETIC Sickle Cell Disease
AGE
SEX
ETHNIC GROUP
PHYSIOLOGIC Fatigue, pregnancy, puberty, stress
IMMUNOLOGIC EXPERIENCE
Active
Passive
Hypersensitivity
Prior to infection, immunization
Maternal Antibodies, gammaglobulin
INTER-CURRENT OR PRE-
EXISTING DISEASE
HUMAN BEHAVIOR Personal Hygiene, Food Handling

ENVIRONMENTAL FACTORS (Extrinsic
Factors)
Influences existence of the agent, exposure, or susceptibility
to agent
PHYSICAL ENVIRONMENT Geology, Climate
BIOLOGIC ENVIRONMENT
Human Population
Flora
Density
Sources of food, influence on vertebrates and
anthropods as source of agent
SOCIO-ECONOMIC
ENVIRONMENT
Occupation
Urbanization
Disruption
Exposure to chemical agents
Urban crowding, tension and pressures
Wars, Disasters
Reference:

DISTRIBUTION PATTERNS IN ANALYZING
EPIDEMIOLOGY DATA
1.Person –refers to the characteristics of the individual who were exposed and
who contacted the infection or the disease in question
2.Place – refers to the features, factors, or conditions which existed in or
described the environment in which the disease occurred
3.Time – refers both to the period during which the cases of the disease being studied
were exposed to the source of infection and the period during which the illness occurred
Reference:

TIME
1. EPIDEMIC PERIOD
The Period during which the reported number of cases of a disease
exceed the expected, or usual number for that period
2. YEAR
For many diseases, the incidence (frequency r occurrence) is not
uniform during each of 12 consecutive months. This seasonal variation
is associated with variations in the risk of exposure of susceptible to
the source of infection
3. PERIOD OF CONSECUTIVE YEARS
Recording the reported cases of a disease over a period of years-by
weeks, months, or year of occurrence.
It is useful in predicting the probable future incidence of the disease
and in planning appropriate prevention and control program.
Reference:

PERSON CAN BE DESCRIBED IN TERMS OF:
TEIR INHERENT OR THEIR ACQUIRED
CHARACTERISTICS
Age, Race, Sex, immune status, and marital status
THEIR ACTIVITIES Form of work, play, religious practices, customs
CIRCUMSTANCES UNDER WHICH THEY
LIVE
Social, economic, and environmental conditions
AGE
- There is more variation in disease frequency by age than any other variable
- The single most useful variable associated in describing the occurrence
and distribution of disease because of
the association between the person’s age and their:
a. potential for exposure to a source of infection
b. level of immunity or resistance
c. physiologic activity at the tissue level (which sets the manifestation of a
disease subsequent to infection
SEX AND OCCUPATION
- Males experience higher mortality rate than females for a wide range of
diseases
- Females have higher morbidity rates
- Rationale: Because of differing pattern of behavior between sexes or
activities as recreation, travel, occupation which results in different
opportunities for exposure to source of infection

PLACE
It is the geographic
area described in
terms of:
• Street
• Address
• City
• Municipality
• Province
• Region or
• Country
URBAN/RURAL
DIFFERENCES:
• Disease spreads more
rapidly in urban areas
because of greater
population density
where it provides more
opportunities for
susceptible individual
to come in contact with
a source of infection
SOCIO-ECONOMIC AREAS
• The incidence rate of many
diseases, both communicable
and chronic, varies inversely
with differences in large
geographic areas within a
country
• Geographic variations in the
incidence of infectious
diseases commonly results
from variations in the
geographic distribution of the
reservoirs or vectors of the
disease or in the ecological
requirement of the disease
agent
Reference:

PATTERN OF
OCCURRENCE AND
DISTRIBUTION
SPORADIC
ENDEMIC
EPIDEMIC
EPIDEMIC

SPORADIC OCCURRENCE
Intermittent occurrence of a few isolated
and unrelated cases in a given locality
The cases are few and scattered, so that
there is no apparent relationship between
them
They occur on and off intermittently
through a period of time
Reference:
EPIDEMI
C

SPORADIC
OCCURRENCE
Example:
RABIES
In the Philippines, there are few
cases during certain weeks of the year
Cases are scattered throughout the
country so that the cases are not related
at all to the cases in other area
Reference:
EPIDEMI
C

ENDEMIC OCCURRENCE
Continuous occurrence throughout a period of time,
of the usual number of cases in a given locality
The disease is always occurring in the locality and the
level of occurrence is more or les constant through a
period of time.
It is in a way identified in the locality itself, it may be
high endemic or low endemic when the given level is
continuously maintained.
Reference:

ENDEMIC OCCURRENCE
Example:
SCHISTOSOMIASIS
is endemic in Leyte
and Samar
Reference:
National League of Philippine Government Nurses. (2007).
Public Health Nursing in the Philippines (10th ed.).
National League of Philippine Government Nurses.

ENDEMIC OCCURRENCE
Example:
FILARIASIS is endemic
in Sorsogon
Reference:
National League of Philippine Government Nurses. (2007).
Public Health Nursing in the Philippines (10th ed.). National
League of Philippine Government Nurses.

EPIDEMIC
OCCURRENCE
Unusually large number of occurrences in a relatively short period of
time
There is a disproportionate relationship between the number of cases
and the period of occurrence. The more the acute is the disproportion,
the more urgent and serious is the problem
The number of cases is not in itself necessarily big or large, but such
number of cases when compared with the usual number of cases may
constitute an epidemic in a given locality, as long as that number is so
much more than the usual number in that locality.
Reference:

EPIDEMIC
OCCURRENCE
Example
BIRD’S FLU
There has been no cases of
Bird’s Flu in any area of the
country, so that an occurrence
of few cases in a given area in
a given time would constitute
a bird’s flu epidemic.
Reference:

PANDEMIC OCCURENCE
It is the simultaneous occurrence
of epidemic of the same disease
in several countries.
It is another pattern of occurrence
from an international perspective
Example:
COVID-19
Reference:

WHAT MAKES EPIDEMIC AMONG THE
MOST INTERESTING AND
MEANINGFUL AMONG THE PATTERN
OF OCCURRENCES OF DISEASE?
It demands immediate effective action
The immediate action includes epidemiological
investigation – emergency epidemiology as well
as control
Reference:

FACTORS CONTRIBUTORY TO EPIDEMIC
OCCURRENCE
AGENT FACTORS
• The result of the introduction of the new disease agent into the
population
• It may also result from changes in the number of living
microorganisms in the immediate environment or from their growth
in some favorable culture medium
HOST FACTORS
• They are related to lower resistance as a result of exposure to the
elements during flood or other disaster, to relaxed supervision of
water and milk supply or sewage disposal, or to changed habit of
eating.
• It may be related to change in immunity and susceptibility to
population density and movement, crowding, to sexual habits,
personal hygiene or to changes in motivation as a result of health
education
ENVIRONMENTAL FACTORS
• Changes in the physical environment: temperature, humidity, rainfall
may directly or indirectly influence equilibrium of agent and host
Reference:

PHILIPPINE HEALTH SITUATION

DEMOGRAPHIC PROFILE OF THE
PHILIPPINE
Current population is 112,737,622 as of August
26, 2022
Philippines ranks number 13th in the world by
population in the list of 235
countries/territories
Philippines is ranked 7th among 51 countries in
Asia
Reference:
UN (World Population Prospects 2019). (2021, August 23). Philippines population 2021 - StatisticsTimes.com. Statisticstimes.com.
https://statisticstimes.com/demographics/country/philippines-population.php#:~:text=The%20population%20of%20Philippines%20is%20projected%20at%20111%2C046%2C913

PHILIPPINE
Reference:
Demographics of the Philippines. (2022, August 26). Wikipedia. https://en.wikipedia.org/wiki/Demographics_of_the_Philippines#Vital_statistics

PHILIPPINE
Reference:
Vayola, J. (2022, February 23). Topic: Demographics of the Philippines. Statista; Statistica Research Department. https://www.statista.com/topics/5799/demographics-in-
the-philippines/#dossierKeyfigures

PHILIPPINE
Reference:
Britannica. (2019). Philippines - Resources and power | Britannica. In Encyclopædia Britannica. https://www.britannica.com/place/Philippines/Resources-and-power

DEMOGRAPHIC PROFILE OF THE PHILIPPINE
The population density is high, but the distribution of the population is
uneven.
Parts of Metro Manila have a population density that is more than 100
times that of some outlying areas such as the mountainous area of
northern Luzon.
The birth rate remains significantly higher than the world average, as
well as the average for the Southeast Asian region.
Reference:

PHILIPPINE
The Mortality rate in the early 21st century was considerably lower
than it had been a few decades earlier in the latter part of the 20th
century, particularly among infants, children under the age of five
years, and mothers.
There was also a generally steady increase in average life expectancy.
The improvement in health is credited to better prenatal care and the
services of more trained midwives, doctors, and nurses; improved
housing, sanitation, and social security benefits; the provision of
health services to government employees; the increasing number of
medical and nursing school graduates; and the requirement that a
medical graduate render rural service.
Reference:

PHILIPPINE
The demand for health care continues to
outstrip available resources; a large number
of trained medical professionals emigrate,
particularly to the United States, and many
of the poorest people still rely on the
services of practitioners of traditional
medicine and unlicensed midwives.
Reference:

PHILIPPINE HEALTH
SITUATION
The Philippines has made significant investments and
advances in health in recent years. Rapid economic
growth and strong country capacity have contributed to
Filipinos living longer and healthier. However, not all the
benefits of this growth have reached the most vulnerable
groups, and the health system remains fragmented.
Reference:
HEALTH SITUATION. (n.d.). Retrieved August 26, 2022, from https://apps.who.int/iris/bitstream/handle/10665/136828/ccsbrief_phl_en.pdf

PHILIPPINE HEALTH
SITUATION
Health insurance now covers 92% of the population. Maternal and
child health services have improved, with more children living
beyond infancy, a higher number of women delivering at health
facilities and more births being attended by professional service
providers than ever before. Access to and provision of preventive,
diagnostic and treatment services for communicable diseases have
improved, while there are several initiatives to reduce illness and
death due to noncommunicable diseases (NCDs).
Reference:

PHILIPPINE HEALTH
SITUATION
Despite substantial progress in improving the lives and
health of people in the Philippines, achievements have not
been uniform and challenges remain.
Deep inequities persist between regions, richand the poor,
and different population groups. Many Filipinos continue
to die or suffer from illnesses that have well-proven, cost-
effective interventions, such tuberculosis, HIV and dengue,
or diseases affecting mothers and children.
Reference:

PHILIPPINE HEALTH
SITUATION
Many people lack sufficient knowledge to make
informed decisions about their own health.
Rapid economic development, urbanization, escalating
climate change, and widening exposure to diseases
and pathogens in an increasingly global world increase
the risks associated with disasters, environmental
threats, and emerging and re-emerging infections
Reference:

PHILIPPINE HEALTH
SITUATION
COOPERATION FOR HEALTH
The global vision of the world in 2030, spelled out in
the Sustainable Development Goals, aligns with the
Philippines’ 25-year vision AmBisyon Natin 2040.
There is an ongoing process of integrating SDGs into
AmBisyon Natin 2040 and into national, sectoral and
subnational plans and frameworks
Reference:

PHILIPPINE HEALTH SITUATION
WHO supportsthe Government of the Philippines to
foster well-being through action by the health sector
and across sectors.
WHO convenes platforms for health involving multiple
stakeholders and in addressing the social, economic
and environmental determinants of health.
Reference:

PHILIPPINE HEALTH
SITUATION
WHO also takes the lead in coordinating with
other health partners to ensure all stakeholders
are aware of health issues and activities in the
country.
Reference:

FUNCTIONS OF THE EPIDEMIOLOGY
NURSE
1. Implement public health surveillance
2. Monitor local health personnel conducting disease surveillance
3. Conduct and/or assist other health personnel in outbreak
investigation
4. Assist in the conduct of rapid surveys and surveillance during
disasters
5. Assist in the conduct of surveys, program evaluations, and
other epidemiologic studies
6. Assist in the conduct of training course in epidemiology
7. Assist the epidemiologist in preparing the annual report and
financial plan
8. Responsible for inventory and maintenance of epidemiology
and surveillance unit (ESU) equipment
Reference:
National League of Philippine Government Nurses. (2007). Public Health Nursing in the Philippines (10th ed.). National League of Philippine Government
Nurses.

SPECIFIC ROLE OF THE NURSE DURING
EPIDEMIOLOGICAL INVESTIGATIONS
1. Maintains surveillance of the occurrence of notifiable disease
2. Coordinates with other members of the health team during the disease
outbreaks
3. Participates in case findings and collection of laboratory specimens
4. Isolates cases of communicable disease
5. Renders nursing care, teaches and supervises giving of care
6. Performs and teach household members method, concurrent and terminal
disinfection
7. Gives health teaching to prevent further spreads of disease to individual and
families
8. Follow up cases and contacts
9. Organizes, coordinates and conducts community health education
campaign/meetings
10. Refers cases when necessary
11. Coordinates with other concerned community agencies
12. Accomplishes and keeps records and reports and submits to proper
office/agency.
Reference:
National League of Philippine Government Nurses. (2007). Public Health Nursing in the Philippines (10th ed.). National League of Philippine
Government Nurses. By ROMMEL LUIS C. 271

VITAL STATISTICS
STATISTICS refers to a systematic approach of obtaining, organizing and
analyzing numerical facts so that conclusion may be drawn from them
VITAL STATISTICS refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation, and deaths
Statistics of disease (morbidity) and death (mortality) indicate the state of
health of a community and the success or failure of health work.
Statistics on population and the characteristics such as age and sex,
distribution are obtained from the Philippine Statistics Authority (PSA)
Births and Deaths are registered in the Office of The Local Civil Registrar of the
municipality or city. In cities, births and deaths are registered at the City
Health Department.
Reference:

USE OF VITAL STATISTICS
1.Indices of the health and illness
status of the community
2.Serves as basis for planning,
implementing, monitoring, and
evaluating community health
nursing programs and services
Reference:
National League of Philippine Government Nurses. (2007). Public Health Nursing in the Philippines (10th ed.).
National League of Philippine Government Nurses.

SOURCES OF DATA
1.Population Census
2.Registration of vital data
3.Health survey
4.Studies and researches
Reference:
Nurses.

HEALTH INDICATORS
CRUDE BIRTH RATE
- A measure of one characteristic of the natural growth or increase of a population
CBR = ______________________________________
Reference:
X
1000
Total number of live births registered
in a given calendar year
Estimated population as of July 1 of
same year

HEALTH INDICATORS
CRUDE DEATH RATE
- A measure of one mortality from all causes which may result in a decrease of
population
CDR = ______________________________________
Reference:
X
1000
Total number of live death registered
in a given calendar year
same year

HEALTH INDICATORS
INFANT MORTALITY RATE
- Measures the risk of dying during the first year of life
IMR = ______________________________________
Reference:
X
1000
Total number of death under 1 year of
age registered in a given calendar
year
Total number of registered live births
of same calendar year

HEALTH INDICATORS
MATERNAL MORTALITY RATE
- Measures the risk of dying from causes related to pregnancy, childbirth and
puerperium
MMR = ____________________________________
Reference:
X
1000
Total number of deaths from maternal
causes registered for a given
calendar year
of same year

HEALTH INDICATORS
FETAL DEATH RATE
- Measures the death of the product of conception prior to its complete expulsion,
irrespective of duration of pregnancy
FDR = ______________________________________
Reference:
X
1000
Total number of fetal deaths
registered in a given calendar year
on same year

HEALTH INDICATORS
NEONATAL DEATH RATE
- Measures the risk of dying the 1st month of life
NDR = ______________________________________
Reference:
X
1000
Number of deaths under 28 days of
age registered in a given calendar
year
Number of live births registered on
same year

HEALTH INDICATORS
SPECIFIC DEATH RATE
- Describes more accurately the risk of exposure of certain classes or groups to
particular diseases
SDR = ______________________________________
Reference:
X
1000
Deaths in specific class/group
Estimated population as of July 1 in
same specified clas/group of said
year

HEALTH INDICATORS
Example of SPECIFIC DEATH RATE
particular diseases
Cause of SDR = ______________________________________
Reference:
X
1000
Number of deaths from specific cause
registered in a given year
same year

HEALTH INDICATORS
particular diseases
Age SDR = ______________________________________
Reference:
X
1000
Number of deaths in a particular age
group registered in a given calendar
year
same age group of same year

HEALTH INDICATORS
particular diseases
Sex SDR = ______________________________________
Reference:
X
1000
Number of deaths of a certain sex
same for same year

HEALTH INDICATORS
INCIDENCE RATE
- Measures the frequency of occurrence of the phenomenon during a given period
of time
IR = ______________________________________
Reference:
X
1000
Number of new cases of a particular
disease registered during a specified
period of time
Estimated population as of July of
same year

HEALTH INDICATORS
PREVALENCE RATE
- Measures the proportion of the population which exhibits a particular disease at
a particular time
PR = ______________________________________
Reference:
X
1000
Number of new and old of a certain
disease registered at a given time
Total number of persons examined at
same given time

HEALTH INDICATORS
ATTACK RATE
- A more accurate measure of the risk of exposure
AR = ______________________________________
Reference:
X
1000
Number of persons acquiring a
disease registered in a given year
Number of exposed to same disease
in the same year

HEALTH INDICATORS
PROPORTIONATE MORTALITY (Death Ratio)
- Shows the numerical relationship between deaths from all causes (or group of
causes), age (or group of age), etc. And the total number of deaths from all causes in
all
ages taken together
PM = ______________________________________
Reference:
X
1000
Number of registered deaths from
specific cause or age for a given
calendar year
Number of registered deaths from all
causes, all ages in same year

HEALTH INDICATORS
ADJUSTED OR STANDARDIZED RATE
- To render the rates of 2 communities comparable, adjustments
for
the differences in age, sex, race, and any other factors which
influence vital events have to be made.
METHODS:
By applying observed specific rates to some standard population
By applying specific rates of standard population to
corresponding classes or groups of the local population
Reference:

HEALTH INDICATORS
CASE FATALITY RATION
- Index of a killing power of a disease and is influenced by incomplete reporting and
poor morbidity data
CFR = ______________________________________
Reference:
X
1000
Number of registered deaths from
specific disease for a given year
Number of registered cases from
same specific disease in same year

PRESENTATION OF DATA
LINE OR CURVED GRAPHS
Shows peaks, valleys, and seasonal trends. Also used to show the
trends of birth and death rates over a period of time
BAR GRAPHS
Represents or expresses a quantity in terms of rates or percentages of
a particular observation like causes of illness and deaths
AREA DIAGRAM (Pie Charts)
It shows the relative importance of parts to the whole
Reference:
Nurses.

FUNCTIONS OF THE NURSE
Collects data
Tabulates data
Analyzes and interprets data
Evaluates data
Recommends redirection and /or
strengthening of specific areas of health
programs as needed
Reference:
Nurses.

ALTERNATIVE HEALTH CARE
Legal Basis:
RA 8423 – Traditional and Alternative Medicine Act
* created the Philippine Institute of Traditional and
Alternative Health Care
** S A N T A L U B B Y **

S - Sambong
* anti-edema, diuretic, anti-urolithiasis
A - Ampalaya
* DM
N - Niyog-niyogan
* anti-helmintic
T- Tsaang Gubat
* diarrhea, stomachache, mouth wash
A - Akapulko (Bayabas-bayabasan)
* anti-fungal

L - Lagundi
* asthma, cough, fever, dysentery, skin diseases
U - Ulasimang Bato (Pansit-pansitan)
* lowers uric acid
B - Bawang
* lowers cholesterol levels, hypertension, toothache
B - Bayabas
* washing of wounds, diarrhea, gargle for toothache
Y - Yerba Buena
* pain, rheumatism, arthritis, headache, cough and
colds, swollen gums, toothache, menstrual and gas
pain, nausea, fainting, insects bites and pruritus

Reminders on the Use of Herbal Medicine
1. Avoid the use of insecticides.
2. Use a clay pot and remove cover while boiling at low
heat.
3. Use only the part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each sickness.
6. Stop giving in case with untoward reaction.
7. If signs and symptoms are not relieved after 2 or 3
doses, consult a doctor.

D O H
(Department of Health)
Vision:
- A leader, staunch advocate and model in promoting
health for all in the Philippines.
Mission:
- Guarantee equitable, sustainable and quality health for
all Filipinos, especially the poor and shall lead the quest for
excellence in health.

3 Roles and Functions of DOH:
- Executive Order 102
1. Leadership in health
- serves as an advocate in the adoption of health policies,
plans and programs to address national and sectoral
concerns.
2. Administrator of Specific Service
- administer health emergency responsive services
including referral and networking system.
3. Enabler and Capacity Builder
- innovates new strategies in health to improve the
effectiveness of health programs.

Overriding Goal of DOH:
- Health Sector Reform Agenda (HSRA)
Framework for its Implementation:
- FOURmula One for Health --- *Arroyo
- Universal HealthCare (Kalusugan Pangkalahatan)
---*Aquino ( Executive Order 36)
---Phil. Health Agenda (Pres. Duterte)
ALL FOR HEALTH TOWARDS HEALTH FOR ALL
Goals:
1. Financial Protection
2. Better Health Outcomes
3. ResponsivenessBy ROMMEL LUIS C. 299

Values:
1. Equitable and inclusive to all
2. Transparent and accountable
3. Uses resources efficiently
4. Provides high quality services
Strategies:
1. Advance quality, health promotion and primary care.
2. Cover all Filipinos against health-related financial risk.
3. Harness the power of strategic HRH development.
4. Invest in eHealth and data for decision-making.
5. Enforce standards, accountability and transparency.
6. Value all clients and patients, especially the poor, marginalized
and vulnerable.
7. Elicit multi-sectoral and multi-stakeholder support for health.

COMMUNITY HEALTH NURSING 1 & 2 (2023)

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