Expanding Fields of Community and Public Health Nursing

Expanding Fields of Community
and Public Health Nursing
By:
ROMMEL LUIS C. ISRAEL III
BY; ROMMEL LUIS C. ISRAEL III
1

Learning Objectives:
Describe
Public health
as a field of
practice
1
Enumerate the
Standards of
Public health
practice
2
Discuss the
nature and
scope of
Occupational
Health Nursing
3
Explain the value
of School Health
Nursing for both
students and
personnel
4
Identifyemerging
Fields of
community and
public health
nursing
5
2

Public Health Nursing
may be defined a s a field of
professional practice in nursing and
in public health in which technical
nursing, interpersonal, analytical, and
organizational skills are applied to
problems of health as they affect the
community. (Freeman, 1963)
Traditionally, “public health nursing” was
seen as a subspecialty nursing practice
generally delivered within “official”
or governmental agencies. In contrast,
“community health nursing” was
considered to be a broader and more
general specialty area that encompassed
many additional subspecialties (e.g.,
school nursing, occupational health
nursing, forensic nursing, home
health).
3

Public Health Nursing (continuation..)
In 1980, the American
Nurses Association (ANA)
deﬁned community health
nursing as “the synthesis of
nursing practice and public
health practice applied to
promoting and preserving the
health of populations”.
Thus, the American Public
Health Association (APHA)
deﬁned public health nursing
as “the practice of promoting
and protecting the health of
populations using knowledge
from nursing, social, and
public health sciences”.
4

5

6

7

Occupational
Health
Nursing
●
- “the promotion and
maintenance of the
highest degree of
physical, mental, and
social well-being of
workers in all
occupations.”
8

Occupational
Health Nursing
●
is deﬁned by the American
Association of Occupational
Health Nurses (AAOHN) as:
“the specialty practice that focuses on the
promotion, prevention, and restoration of health within
the context of a safe and healthy environment. It
includes the prevention of adverse health effects
from occupational and environmental hazards. It
provides for and delivers occupational and
environmental health and safety programs and
services to clients.”
BY; ROMMEL LUIS C. ISRAEL III 9

● Occupational Health Nursing derives its theoretical,
conceptual, and factual framework from a
multidisciplinary base. Elements of this
multidisciplinary base include the following:
❖ Nursing Sciences- to provide the context for health care delivery
and recognize the needs of individuals, groups and populations
within the framework of prevention, health promotion, and illness
and injury care management, including the risk assessment, risk
management, and risk communication.
❖ Medical Science- speciﬁc to treatment and management of
occupational health illness and injury, integrated with nursing
health surveillance activities.
❖ Occupational health
sciences
-

❖ Epidemiology- to study health and illness trends and characteristics
of the worker population, investigate work-related illness and injury
episodes, and apply epidemiological methods to analyze and
interpret risk data to determine causal relationships and
participate in epidemiological
researc
h.
❖ Business and economic theories, concepts, and
principles
- for
strategic
and operational planning for valuing quality and cost effective
services, and for management of occupational health and safety
programs.
❖ Social and behavioral
sciences
- to explore inﬂuences of
various
environments (e.g., work and home), relationships and lifestyle
factors on worker’s health and determine the interactions affecting
worker health.
11

❖ Environmental Health- to systematically examine
interrelationship
between the worker and the extended environment as a basis for
the development of prevention and control strategies.
❖ Legal and ethical issues- to ensure compliance
with regulatory mandates and contended with ethical
concerns that may arise in
competitive
environments.
12

Evolution of Occupational Health Nursing in the
Philippines
November 11, 1950 ● Mrs. Magdalena Valenzuela of DOH, instituted the Industrial
Nursing Unit (INU) of the Philippine NursesAssociation.
● Ms. Peria Gorres of the Philippine Manufacturing Company
(PMC) served as the first chairperson.
August 19, 1964 ● Ms.Anita Santos of Jardine Davies was elected as first
president.
November 12, 1996 ● Ms. Santos’ education programs and constitutions and
by-laws governing the association was approved.
June 5-6, 1970 ● The first annual convention was held.

Occupational health strategies: assessment and
control hazards in the workplace
● Health Hazards are the elements in the work environment
that can cause work-related disease to the worker.
● Safety Hazards are the unsafe conditions or unsafe acts
that signiﬁcantly increase the risk of worker to be injured.
● The occupational health team may categorize identiﬁed
health
hazards in the workplace as follows:
❖ Administrative control- refers to the development
and
implementation of policies, standards, trainings, job
design, and the like.

❖ Engineerin
g
- refers to the adaptation of
chemical, or technological improvements to the
physical exposure of workers to hazards of the
workplace.
❖ Material
Provisio
n
- refers to providing the workers with
supplies or supplements that can decrease their
exposure or susceptibility to occupational hazards.
❖ Supplementation- To decrease the exposure and
increase the resistance to infections.
15

17

Framework and Scope of Occupational Health
Nursing Practice
In the Philippines, Rule 1965.04 of the Amended OSHS published by DOLE (1996)
stipulated the expected duties and functions to be performed by occupational
health nurses, as
follows
: 1. Organizing and administering a health service program integrating occupational
safety in the absence of a physician; otherwise these activities of the nurse
shall be in accordance with the physician.
2. Providing nursing care to injured or ill workers.
3. Participating in health maintenance examination. If a physician is not
available, performing work activities that are within the scope allowed by the
nursing profession, and if more extensive examinations are needed, referring the

4.Participating in health maintenance of
occupational health and safety by giving
suggestions in the improvement of working
environment affecting the health and well-being of the
workers.
5.Maintaining a reporting and records system and,
if a physician is not available, preparing and
submitting an annual medical report, using the
prescribed form to the employer as required by this
standard.
19

Levels of Prevention in Occupational Health Nursing
• In the are of primary prevention, the occupational health
nurse is involved in both health promotion and disease
prevention.
• O’Donnell (2009) describes health promotion as:
• “The art and science of helping people discover the synergies
between their passions and optimal health in order to give
them more motivation and support to change their lifestyle. It
is about achieving the necessary balance between the
physical, emotional, social, spiritual and intellectual health.
Lifestyle change can be facilitated through a combination
of learning experiences that enhance awareness, increase
motivation, and build skills and, most important, through the
creation of opportunities that open access to environments that
make positive health practices the easiest choice”
❖ Primary Prevention
20

Secondary Prevention - aimed at early diagnosis, early
treatment
interventions, and attempts to limit disability. The focus on
this level of prevention is on identiﬁcation of health
needs, health problems, and employees at risk.
➔ As with primary prevention, the occupational health nurse
uses a number of different secondary prevention
strategies (Rogers,
2003)
.
➔ The occupational health nurse can offer health
screenings which are designed for early detection of
disease, at the worksite with relative ease and at minimal
cost.

❖ Tertiary
Prevention
On a tertiary level, the occupational health nurse plays a key
role in the rehabilitation and restoration of the worker to an
optimal level of functioning based on the limitations imposed
by the disability or illness.
➔ Although the occupational health nurse is often independent,
and most of the time is the only healthcare provider in an
organization he or she usually works with other occupational
health and safety specialists who may or may not be employed
by the company.
22

● Toxicologist- studies and identiﬁes the toxic properties of agents
used in
work which the workers might be exposed to.
● Industrial hygienist- prevents occupational injuries and evaluates
safety practices and protocols in the workplace.
● Ergonomist- design specialist who helps promote healthy
interface of humans and their tools.
● Epidemiologist- conducts research studies on the patterns of
disease and injuries in the workforce.
23

SKILLS AND COMPETENCIES FOR OCCUPATIONAL HEALTH NURSING
Although clinical and emergency care remains an important tenet of occupational health nursing, the
current and future practice must focus on a proactive approach with the goal of preventing illness and injury,
and promoting health. The Occupational Health Nurse must the possess competencies necessary to recognize
and evaluate potential and existing health hazards in the workplace.
Examples of some of the numerous skills and competencies, according to the nine (9) defined areas of
competence:
1. Clinical and Primary Care
2. Case Management
Safety Education
3. Workforce, Workplace, and Environmental Issues
4. Legal and Ethical Responsibilities
5. Management and Administration
6. Health Promotion and Disease Prevention
7. Occupational and Environmental Health and
8. Research
9. Professionalism
24

LEGISLATION and OCCUPATIONAL HEALTH
Being a staunch advocate in the promotion of occupational health and safety, DOLE has
consistently implemented and enforced policies and practices to meet its goals. It possesses
legislative and rule-making powers with regard to the following laws and standards:
● Presidential Decree (PD) 442- Philippine Labor Code
● The Administrative Code on Enforcement of Safety and Health Standards
● The Occupational Safety and Health Standards (OSHS)
● Executive Order 307- Creating the Occupational Safety and Health Center (OSHC) under the Employees
Compensation Commission
● PD 626-Employees Compensation and State Insurance Fund
● Hazard-specific laws regarding antisexual harassment
● RA 9165
● RA 6969
-Comprehensive Drugs Act of 2002
- Toxic Substance Act
● RA 9231- Special Abuse, Exploitation and Discrimination Act
● R.A. No. 11058- Strengthening Compliance with Occupational Safety and Health personnel in workplaces as
shown on (Fig. 3.1)
25

26

SCHOOL HEALTH NURSING
• School-aged children and adolescents face increasingly
difficult challenges related to health.
• Education and Health are interrelated.
• As early as 1950, the World Health Organization (WHO)
Expert Committee on School Health Services noted that,
“to learn effectively, children need good health”.
• There are more teachers than health professionals in the
country (Philippines).
27

SCHOOL HEALTH NURSING
• Generally, the school nurse visits four to six schools per
month, with each visiting lasting for 3 days or more,
depending on the type of school, location and population.
• For the rest of the month, teachers, who also serve as school
health guardians, provide primary care as necessary, such
as detection of obvious health problems and administration
of first aid.
• Thus, the School Nurse is responsible for planning and
conducting training programs for teachers on health and
nutrition.
28

HISTORICAL DEVELOPMENT OF SCHOOL HEALTH SERVICES
The definition of school health and what a school health program should be
have evolved markedly in the past 50 yrs. Traditionally, School health programs were
defined as covering:
1. School health services
2. School health education
3. A healthy school environment to include both physical and psychosocial aspects of environment
(WHO, 1997)
In the Philippines, the first school health program required by law consisted
mostly of school health services with the passage of Republic Act 124 in 1947. Entitled as
“An Act to Provide Medical Inspection of Children Enrolled in Private Schools,
CollegesUniversities in the Philippines”.
29

HISTORICAL DEVELOPMENT OF SCHOOL HEALTH SERVICES CONT.
With the changing roles and responsibilities of schools came a redefinition of school health
programs in the 1980s. The evolving roles of the school nurse and the school children and the other
members of the school community resulted in the expansion of the school health program to eight
components. In addition to the first three components, there are five more components have been
included, namely (WHO,1997):
1. Health promotion for school personnel
2. School-community project and outreach
3. Nutrition and food safety
4. Physical education and recreation
5. Mental health, counseling and social supports
30

HISTORICAL DEVELOPMENT OF SCHOOL HEALTH SERVICES
School nursing covers the entire scope of the eight components of school health programs.
The National Association of School Nurses (in the United States) defines it as advances the well-being,
academic success, and life-long achievement of students.
In the Philippines, a holistic approach to strengthen health and nutrition among school
children is the concept embodied by the Redesigned Approach in School Health Nursing (RASHN),
officially adopted through the Department of Education, Culture and Sports (DECS) Memorandum No.
37, series 1991.
The Department of Education (DepEd) Order No.43, s. 2011 on the subject Strengthen the
School Health and Nutrition Programs for the achievement of the Education for All (EFA) and
Millennium Development Goals (MDGs) seeks to strengthen the School Health and Nutrition Program
(SHNP) through a seamless alignment of SHNP activities with other key school programs, thus the
title Integrated School Health and Nutrition Program (ISHNP).

SCHOOL HEALTH SERVICES
Most authorities agree that comprehensive school health programs should include
eight components (Fig.3.2). DepEd order No.43, s.2011 directs the integration of School Health
Nursing Program (SHNP) with the annual and medium-term development plans of
region/divisions and with school improvement plans, ensuring administrative and financial
support.
32

EIGHT COMPONENTS OF SCHOOL HEALTH PROGRAMS:
1. Comprehensive School Health Education (GRADES K-12)
- This is a planned, sequential, K-12 curriculum that addressed the physical, mental,
emotional and social dimensions of health.
2. Physical Education and Activity
- This is planned, sequential K-12 curriculum that provides cognitive content and
learning experiences in a variety of activity areas such as basic movement skills.
3. Nutritional Services
- These provide access to a variety of nutritious and
accommodate the health and nutrition needs of all students.
4. School Health Services
appealing meals that
- These are services provided for students to appraise, protect and promote health.
33

EIGHT COMPONENTS OF SCHOOL HEALTH PROGRAMS CONT.
5. School Counseling, Psychological, and Social Services
- These services provided to improve student’s mental, emotional, and social health.
6. Health and Safe Environment
- This refers to the physical and aesthetic surroundings and the psychosocial climate
and culture of the school.
7. Student, Family and Community Involvement in School
- This pertains to an integrated school, parent, and community approach for enhancing
the health and well-being of students.
8. Health Promotion for School Staff
- This provides opportunities for school staff to improve their health status through activities
such as health assessment, health education health-related fitness activities.
34

· School Nursing is a specialty area in healthcare practice. School nurses need
education in specific areas, such as growth and development, public health, mental
health nursing, case management, program management, family theory, leadership
and cultural sensitivity to effectively perform their roles.
· For entry into school nursing, it is recommended that nurses hold a minimum
of a bachelor’s degree. School nurses must be able to identify and access professional
development to maintain competency in the care of children and adolescents.
· School Nurses function in many roles including care provider, student advocate,
educator, community liaison, and case manager. Additional skills needed by school
nurse include independently and to delegate care. Table 3.5 presents examples of
prevention and the roles of the nurse in the school setting.
SCHOOL HEALTH NURSING PRACTICE
35

36

STANDARD OF SCHOOL HEALTH NURSING PRACTICE
School nurses play an important role in all levels of prevention
through assessment, planning, intervention and evaluation (Table 3.6)
37

38

39

EMERGING FIELDS OF COMMUNITY AND PUBLIC HEALTH
NURSING IN THE PHILIPPINES
Public health, Occupational health, and School health are established and
recognized fields of practice of community health nursing in diseases, such as diseases of
the heart and the vascular system, cancer, diabetes, and pulmonary and renal conditions,
inflict a heavy burden on the client and health care system. Nurses engaged to the
following care:
● Home Health Care: This practice involves providing nursing care to individuals and
families in their own places of residence mainly to minimize the effects of illness and
disability.
● Hospice Home Care: This is a home care specifically rendered to the terminally ill.

NURSING IN THE PHILIPPINES CONT.
EntrepreNurse was launched in 2013 to help mainstream the concept of Entrepreneurship in
Nursing among nurses, this is a project initiated by the Department of Labor and Employment (DOLE), in
collaboration with the Professional Regulatory Board of Nursing of the Philippines, Philippines Nurses
Association and other Stakeholders to promote nurses’ entrepreneurship by introducing home health care
industry in the Philippines. It aims to:
1. Reduce the cost of health care for the country’s indigent population by bringing primary health
care services to poor rural community.
2.
Maximize employment opportunities for the country’s unemployed nurses
3. Utilize the country’s Millennium Development Goals on the maternal and Child Health (DOLE,
2013)
DOLE enjoined the organization of Cooperative Development Authority to register nurses’ cooperatives and
train them on cooperativism.

NURSING IN THE PHILIPPINES CONT.
● Faith Community Nursing or Parish Nursing is the of the art and science of
nursing combines with spiritual care.
● Correctional Nurse is a specialized subset of forensic nursing.
● Entrepreneurship in Nursing is recently gaining momentum in the field of
health care practice among nurses.
42

SUMMARY:
● Knowledge and skills enable community and public health nurses to work in diverse community
settings ranging from isolated rural area to the crowded urban ghetto. To meet the health needs of
the population, the community health nurse must work with many individuals and groups within the
community.
● Occupational safety and health is a discipline involved in the promotion and maintenance of the
highest degree of physical, mental, and social well-being of workers in all occupations.
● The role of the school nurse has changed dramatically since its inception and continues to evolve to
meet demands of school children, their parents, and communities in which they live. School Nurses
continue to reduce the number of days and the frequency with which students miss school due to
illness.
● Health Promotion and disease prevention remains the core of community and public health nursing
actions across all population groups in various settings whether in schools, workplaces, prisons, and
churches.
43

Expanding Fields of Community and Public Health Nursing

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