The document discusses community health nursing and public health nursing. It defines community health nursing as focusing on promoting and preserving the health of entire communities by providing nursing care to individuals, families, and groups within the context of the community. Public health nursing is described as combining nursing skills with public health and social assistance to promote health, improve living conditions, rehabilitate illness/disability, and be part of overall public health programs. The roles of community health nurses are also outlined.

2. It is synthesis of nursing practice and public
health practice applied to promoting and
preserving the health of populations (ANA,
1980)

3. Focus of the community health nursing is the
community as a whole, with nursing care of
individuals, families, and groups being
provided within the context of promoting and
preserving the health of the community
(Association of Community Health Nursing
Educators, 1990)

4. According to Ruth B. Freeman, it refers to a
service rendered by professional nurse with
communities, groups, families, 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

6.  Individuals
 Family
 Population Group
 Community

7.  School Nursing
 Occupational Health Nursing
 Community Mental Health Nursing
 Public Health Nursing

8. It is a philosophy of care in which the care is
provided as clients and their families move
among various service providers outside of
hospitals.

9.  It is a special field of nursing that combines the
skills of nursing, public health and some phases
of social assistance (WHO)
 Functions as part of the total public health
programme for the promotion of health, the
improvement of the conditions in the social and
physical environment, rehabilitation of illness
and disability.
 According to Dr. C.E Winslow, Public Health is

10. the science and art of:
 Preventing diseases
 Prolonging life
 Promoting health and efficiency

11. Refers to the nurses in the local/national health
departments or public schools whether their official
position title is Public Health Nurse or Nurse or
School nurse.

12.  Planner/Programmer
 Nursing Care Provider
 Manager/Supervisor
 Community Organizer
 Service Coordinator
 Health Educator/Counselor/Trainer
 Health Monitor
 Role Model
 Change Agent
 Reporter/Recorder/Statistician
 Researcher

13. Department of Health
Vision: The DOH is the leader and staunch
advocate and model in promoting Health for
ALL in the Philippines
Mission: Guarantee equitable, sustainable,
and quality health for all Filipinos, specially
the poor and shall lead the quest for
excellence in health

14. Goal:
Health Sector Reform Agenda (HSRA)
 Health Sector reform is the overriding goal
of DOH

15.  FOURmula ONE for Health
› Goals of the FOURmula ONE for Health
Better Health Outcomes
More responsive health systems
Equitable health care financing

16. › Four Elements of the Strategy
1. Health Financing
 To foster greater, better & sustained investments in
health.
2. Health Regulation
 To ensure the quality & affordability of health goods
& services.
3. Health Service Delivery
 To improve & ensure the accessibility & availability
of basic & essential health care.
4. Good Governance
 To enhance health system performance at the
national and local levels.

17.  RA 7160 – Local Government Code
› All structures, personnel, and budgetary
allocations from the provincial health level down
to the barangays were DEVOLVED to the Local
Government Units to facilitate health service
delivery

19. • WHO: PHC was declared in the ALMA ATA
CONFERENCE (USSR) in September 6-12,
1978, as a strategy to community health
development.
• Philippines: Adopted through LOI 949
signed by President Marcos on October 19,
1979 with the theme-
“Health in The Hands of the People by 2020”

21. Characterized by the partnership and
empowerment of the people that shall
permeate as the core strategy in the
effective provision of essential health
services that are community-based,
accessible, acceptable, and sustainable
at a cost which the community and the
government can afford.

22. PHC
Community-
Based
Accessible
Affordable
Acceptable Sustainable

23. ducation for health
ocally Endemic and Communicable Disease
Control and Treatment
xpanded Program on Immunization
aternal and Child Health and Family Planning
ssential Drugs
Utrition
reatment (Medical & Emergency Care)
anitation of the Environment
E
L
E
M
E
N
T
S

24.  Active community participation
 Intra and inter - sectoral linkages
 Use of appropriate technology
 Support mechanism made available

25. 1. Village / Barangay Health Workers
 Refers to trained community health workers
or health auxiliary volunteer or a traditional birth
attendant or healer
2. Intermediate Level Health Workers
 General medical practitioners or their assistants
 E.g. Public Health Nurse, Rural Sanitary
Inspectors and Midwives

26. PRIMARY LEVEL
Health Promotion and
Illness Prevention
SECONDARY LEVEL
Prevention of
Complications thru
Early Dx and Tx
TERTIARY LEVEL
Prevention of Disability,
etc.
Provided at –
► Health care/RHU
► Brgy. Health Stations
►Main Health Center
►Community Hospital
and Health Center
►Private and Semi-
private agencies
► When hospitalization
is deemed
necessary and referral is
made to emergency (now
district), provincial or
regional or private
hospitals
► When highly-
specialized medical care
is necessary
► Referrals are made to
hospitals and medical
center such as PGH,
PHC, POC, National
Center for Mental Health,
and other gov’t private
hospitals at the municipal
level

27. 1. Primary Prevention
• Focuses on health promotion and disease
prevention
EXAMPLES
Immunization
Promotion of Healthy Lifestyle (Proper Diet & Exercise)

28. 2. Secondary Prevention
• Focuses on early detection of disease and
prompt treatment for individual experiencing
health problems
EXAMPLES
Breast - Self Examination
Diagnostic Test (AFB test)
Cancer Signs & Symptoms (CAUTION US)

29. 3. Tertiary Prevention
• Rehabilitation (prevent further disability)
• Restore client’s optimum level of functioning
EXAMPLES
Mental Health
Crutch Walking
Physical Therapy

30. › The study of distribution of disease or physiologic
condition among human population s and the factors
affecting such distribution
› The study of the occurrence and distribution of health
conditions such as disease, death, deformities or
disabilities on human populations

31.  Epidemic
› a situation when there is a high incidence of new
cases of a specific disease in excess of the
expected.
› when the proportion of the susceptible are high
compared to the proportion of the immunes
 Epidemic potential
› an area becomes vulnerable to a disease upsurge
due to causal factors such as climatic changes,
ecologic changes, or socio-economic changes

32.  Endemic
› habitual presence of a disease in a given geographic
location accounting for the low number of both
immunes and susceptible
e.g. Malaria is a disease endemic at
Palawan.
› the causative factor of the disease is constantly
available or present to the area.
 Sporadic
› disease occurs every now and then affecting only a
small number of people relative to the total
population
› intermittent
 Pandemic
› global occurrence of a disease

33.  Assessment
› This provides:
 An estimate of the degree to which a family, group
or community is achieving the level of health
possible for them.
 Identifies specific deficiencies or guidance needed
 Estimates the possible effects of nursing
interventions

34. › Health Deficit
 A gap between actual and achievable health
status.
 Failure in health maintenance
 Already developed the disease or disability,
developmental lag.
› Health Threat
• Condition that promote disease or injury and
prevent people from realizing their health
potential

35. › Wellness Potential
 This refers to states of wellness and the likelihood
for health maintenance or improvement to occur
depending on the desire of the family
› Foreseeable Crisis
 Anticipated periods of unusual demand on the
individual/family in terms of resources and
adjustments.

36.  Planning
› Goal Setting
 Initial step
 Declaration of purpose / intent that gives essential
direction to action
› Constructing a Plan of Action
 Choosing from among the possible courses of action
 Selecting the appropriate types of nursing intervention
 Identifying appropriate and available resources
› Developing an Operational Plan
 Establish priorities, phase, and coordinate activities
 Development of evaluation parameters is done in the
planning stage

37.  Implementation
› Involves various nursing interventions which have
been determined by the goals / objectives that have
been previously set
› Carrying out of nursing procedures
› Documentation is done at this phase
 Evaluation
› Three Classic Frameworks
 Structural elements – monitoring status
 Process elements – systematic documentation of
results
 Outcome elements – analysis of effectiveness of care
provided

38.  Planning
› Includes assisting the organization in
establishing a vision for the future.
› Deciding what must be done and what
organization wants to achieve.
 Organizing
› Helps to determine how a manager implements
planning to achieve the stated goals
 Major Concerns:

39.  Analysis of the systems
 Analysis of functions
 Assigning job responsibilities
 Implementation

40.  Directing
› Includes conveying to the workers that has
occurred in the planning and organizing phases.
 Coordinating
› Linking people on the health care team together
to function in such a way that objectives are
achieved
 Controlling
› Process that measures and corrects the activities
of the people and establishes standards so that
objectives are met

41.  Steps:
 Establishing standards
 Measuring performance criteria
 Correcting deviations from normal
 Evaluating
› Involves upon actions to determine their
effectiveness in order to make decisions
regarding future action
› Documenting the progress by comparing
achievements against a performance standard

42.  Clinic Visit
 Blood Pressure Measurement
 Home Visit
 Bag Technique
 Vital Statistics
› Refers to the systematic study of vital events
such as births, illnesses, marriages, divorces,
separation and deaths.

43.  Family Health
› Maternal Health Program
1. Antenatal Registration
Preanatal Visits Period of Pregnancy
1st Visit As early in pregnancy as possible
2nd Visit During 2nd trimester
3rd Visit During 3rd trimester
Every 2 Weeks After 8th month of pregnancy until delivery

44. 2. Tetanus Toxoid Immunization
Vaccine Interval Protection Duration
TT1 As early as
possible during
pregnancy
--- ---
TT2 After 4 weeks 80% 3 years
TT3 After 6 months 95% 5 years
TT4 After 1 year 99% 10 years
TT5 After 1 year 99% Lifetime

45. 3. Micronutrient Supplementation
Vitamins Dose Schedule
Vitamin A 10, 000 IU Twice a week starting
on the 4th month of
pregnancy
Iron / Folic Acid 60mg/400ug tablet Daily (Starting 5th
month of pregnancy up
to 2 months
postpartum)

46. 4. Treatment of Diseases and Other Conditions
5. Clean and Safe Delivery
6. Health Teachings
• Birth registration
• Importance of breastfeeding
• Newborn screening within 48 hours up to 2
weeks after birth
• Schedule when to return for consultation for
post-partum visits
1st visit – 1st week postpartum preferably 3-5
days
2nd visit – 6 weeks postpartum

47. 7. Support to Breastfeeding
8. Family Planning Counseling
• Proper spacing of birth (3 to 5 years interval)

48.  Female Sterilization
 Male Sterilization
 Pill
 Male Condom
 Injectables
 Lactating Amenorrhea Method (LAM)
 Mucus/Billings Method
 Basal Body Temperature
 Sympto-thermal Method
 Abstinence

49. Goal: To reduce morbidity and mortality rates (for children 0-9
yrs)
Programs:
• Infant & Young Child Feeding
• Newborn Screening
• Expanded Program on Immunization
• Management of Childhood Illnesses
• Micronutrient Supplementation
• Dental Health
• Early Child Development
• Child Health Injuries

50.  Milk Code (EO 51)
› Products covered by Milk Code consist of breast
milk substitutes, including infant formula, other
milk products, foods and beverages, including
bottle-fed complementary foods.
 Rooming-In and Breastfeeding Act of 1992
(RA 7600)
› To promote rooming-in and to encourage, protect
& support the practice of breastfeeding

51.  Food Fortification Law (RA 8976)
› The law requires a mandatory food fortification of
staple foods --- rice, flour, edible oil and sugar
and a voluntary food fortification of processed
food or food products.

52. Vaccine Minimum Age at
1st Dose
Doses Interval
BCG At birth 1
DPT 6 weeks 3 4 weeks
OPV 6 weeks 3 4 weeks
HEPA B At birth 3 6 weeks from 1st
dose
8 weeks from 2nd
dose
MEASLES 9 months 1

53. Vaccine Dosage Route Site
BCG 0.05 mL ID Right deltoid
region
DPT 0.5 mL IM Upper outer
portion of thigh
(Vastus Lateralis)
OPV 2-3 drops Oral Mouth
HEPA B
0.5 mL IM
Upper outer
portion of thigh
(VL)
MEASLES 0.5 mL SQ Outer portion of
upper arm

55. Bawang-anti cholesterol
Ulasimang-Bato-lowers uric acid
Bayabas- antiseptic; diarrhea
Lagundi- cough, asthma, and colds
Yerba Buena- toothache, pain, and arthritis
Sambong- renal calculi
Ampalaya- diabetes mellitus
Niyog-niyogan- anti-helminthic
Tsaang-Gubat- diarrhea
Akapulko- fungal infection
RA 8423: utilization
of medicinal plants as
alternative for high cost
medications

57.  COPAR or Community Organizing
Participatory Action Research is a vital
part of public health nursing. COPAR aims to
transform the apathetic, individualistic and
voiceless poor into dynamic, participatory
and politically responsive community.

58.  A process by which a
community identifies its needs
and objectives, develops
confidence to take action in
respect to them and in doing so,
extends and develops
cooperative and collaborative
attitudes and practices in the
community (Ross 1967).

59.  a collective, participatory, transformative,
liberate, sustained and systematic process of
building people's organizations by mobilizing
and enhancing the capabilities and
resources of the people for the resolution of
their issues & concerns towards effecting
change in their existing oppressive and
exploitative conditions (National Rural CO
Conference 1994 )

60.  A continuous and sustained process of
educating the people to understand and
develop their critical awareness of their existing
condition, working with the people collectively
and efficiently on their immediate and long-term
problems, and mobilizing the people to develop
their capability and readiness to respond and
take action on their immediate needs towards
solving their long-term problems (CO: A manual
of experience, PCPD).

61.  The sequence of steps whereby members of
a community come together to critically
assess to evaluate community conditions
and work together to improve those
conditions.

62.  Refers to a particular group of community
members that work together for a common
health and health related goals.

63.  Community working to solve its own problem.
 Direction is established internally and externally.
 Development and implementation of a specific
project that is important than the development
of the capacity of the community to establish
the project.
 Consciousness raising involves perceiving
health and medical care within the total
structure of society.

64.  COPAR is an important tool for community
development and people empowerment as this
helps the community workers to generate
community participation in development
activities.
 COPAR prepares people/clients to eventually
take over the management of a development
programs in the future.
 COPAR maximizes community participation and
involvement; community resources are
mobilized for community services.

65. 1. People, especially the oppressed, exploited
and deprived sectors are open to change,
have the capacity to change and are able to
bring about change.
2. COPAR should be based on the interests of
the poorest sectors of the society.
3. COPAR should lead to a self-reliant
community and society.

66.  Integration
 Social Investigation
 Tentative program planning
 Groundwork
 Meeting
 Role Play
 Mobilization or action
 Evaluation
 Reflection
 Organization

67.  COPAR has four phases namely: Pre-Entry
Phase, Entry Phase, Organization-building
phase, and sustenance and strengthening
phase.

68.  Is the initial phase of the organizing process
where the community organizer looks for
communities to serve and help. Activities
include:

69.  Preparation of the Institution
› Train faculty and students in COPAR.
› Formulate plans for institutionalizing COPAR.
› Revise/enrich curriculum and immersion
program.
› Coordinate participants of other departments.
 Site Selection
› Initial networking with local government.
› Conduct preliminary special investigation.
› Make long/short list of potential communities.
› Do ocular survey of listed communities.

70.  Criteria for Initial Site Selection
› Must have a population of 100-200 families.
› Economically depressed. No strong resistance from
the community.
› No serious peace and order problem.
› No similar group or organization holding the same
program.
 Identifying Potential Municipalities
› Make long/short list of potential municipalities
 Identifying Potential Community
› Do the same process as in selecting municipality.
› Consult key informants and residents.
› Coordinate with local government and NGOs for
future activities.

71.  Choosing Final Community
› Conduct informal interviews with community
residents and key informants.
› Determine the need of the program in the
community.
› Take note of political development.
› Develop community profiles for secondary data.
› Develop survey tools.
› Pay courtesy call to community leaders.
› Choose foster families based on guidelines

72.  Identifying Host Family
› House is strategically located in the community.
› Should not belong to the rich segment.
› Respected by both formal and informal leaders.
› Neighbors are not hesitant to enter the house.
› No member of the host family should be moving
out in the community.

73.  Sometimes called the social preparation
phase. Is crucial in determining which
strategies for organizing would suit the
chosen community. Success of the activities
depend on how much the community
organizers has integrated with the
community.

74.  Guidelines for Entry
› Recognize the role of local authorities by paying
them visits to inform their presence and activities.
› Her appearance, speech, behavior and lifestyle
should be in keeping with those of the
community residents without disregard of their
being role model.
› Avoid raising the consciousness of the
community residents; adopt a low-key profile.

75.  Activities in the Entry Phase
› Integration. Establishing rapport with the people in
continuing effort to imbibe community life.
 living with the community
 seek out to converse with people where they usually
congregate
 lend a hand in household chores
 avoid gambling and drinking
› Deepening social investigation/community
study
 verification and enrichment of data collected from initial
survey
 conduct baseline survey by students, results relayed
through community assembly

76.  Core Group Formation
› Leader spotting through sociogram.
 Key Persons. Approached by most people
 Opinion Leader. Approached by key persons
 Isolates. Never or hardly consulted

77.  Entails the formation of more formal
structure and the inclusion of more formal
procedure of planning, implementing, and
evaluating community-wise activities. It is at
this phase where the organized leaders or
groups are being given training (formal,
informal, OJT) to develop their style in
managing their own concerns/programs.

78.  Key Activities
› Community Health Organization (CHO)
 preparation of legal requirements
 guidelines in the organization of the CHO by the
core group
 election of officers
› Research Team Committee
› Planning Committee
› Health Committee Organization
› Others
› Formation of by-laws by the CHO

79.  Occurs when the community organization has
already been established and the community
members are already actively participating in
community-wide undertakings. At this point, the
different committees setup in the organization-
building phase are already expected to be
functioning by way of planning, implementing
and evaluating their own programs, with the
overall guidance from the community-wide
organization.

80.  Key Activities
› Training of CHO for monitoring and implementing
of community health program.
› Identification of secondary leaders.
› Linkaging and networking.
› Conduct of mobilization on health and
development concerns.
› Implementation of livelihood projects.