Overview of Public Health Nursing in the Philippines PDF

**OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES** **Public health nursing practice** has been impacted by changing global and local health trends, much as the [Department of Health and the public health system have changed] to become what they are now [in response to the challenges of the ti...

**OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES** **Public health nursing practice** has been impacted by changing global and local health trends, much as the [Department of Health and the public health system have changed] to become what they are now [in response to the challenges of the times]. These national and international health imperatives have [opened up new avenues for public health nursing] and prepared nurses for leadership roles in **advocacy** and **health promotion**. A **WHO** report that recognizes the important role the nursing workforce plays in [achieving health outcomes--] especially those related to the Millenium Development Goals-- validates this perception. **PHN** in the Philippines plays a crucial role in **promoting** and **maintaining** the overall well-being of communities across the country. By understanding the [**global** and **national health landscape**], public health nurses work tirelessly to [address pressing issues and empower individuals to lead healthier lives] **GLOBAL & COUNTRY HEALTH IMPERATIVES** 1. [Shifts] in demographic and epidemiological trends in diseases, including the [emergence and re-emergence of new diseases] and in the [prevalence of risk] and [protective factors]. 2. [New technologies] for communication and information health care, 3. Existing and emerging environmental hazards some associated with globalization 4. Health reforms **8 MILLENIUM DEVELOPMENT GOALS (MDGs)** **(United Nations, 2000)** 1. 2. 3. 4. 5. 6. 7. 8\. Develop a global partnership for development *\*Except for goals 2 & 3,* all the MDGs are health or health-related. **Health** is essential to the achievement of these goals and is a **[major contributor]** to the [overarching goal of poverty reduction]. **SUSTAINABLE DEVELOPMENT GOALS (SDGs)** In order to achieve these goals, the [participation of ] [***all members of the society*** from *both* developing & developed countries is **required**] IMG\_256 **PUBLIC HEALTH** "**science and art** of preventing disease, prolonging life, promoting health & efficiency through **organized community effort** for the: 1. sanitation of the environment, 2. control of communicable diseases, 3. the education of individuals in personal hygiene, 4. the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, 5. Development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, *so organizing these benefits as to enable every citizen to realize his **birthright of health and longevity**."* **-(Dr. C.E. Winslow)**  **POLITICAL** - all about power/ influence/ leadership Politics greatly **influence** the social climate in which people live. **Political jurisdictions** have the power and authority to regulate the environment. Examples are [safety, oppression and people empowerment]. [Increased crimes] and the [lack of safety in streets] and even in the homes are **major concerns of society**. [Oppression] *(pang-aapi)* especially of the poor, [differential treatment] in various classes of society affects health. **BEHAVIORAL** A person's level of functioning is affected by certain [habits] that he/she has. These maybe in the form of [smoking, intake of alcohol drinks, substance abuse and lack of exercise]. The people's [lifestyle], [health care and child rearing practices] are shaped, to a large extent, by their culture and ethnic heritage. **HEREDITY** Understanding of genetically influenced diseases is increased through knowledge about the [nature of genetic materials and about the process by which genetic traits are transmitted]. **HEALTH CARE DELIVERY SYSTEM** The **availability** and **accessibility** of curative and rehabilitative services also affect peoples' health. **ENVIRONMENTAL INFLUENCES** Examples of these are [communicable diseases due to poor sanitation], [poor garbage collection], [smoking], [air pollution] and [utilization of chemicals] such as pesticides. [Cutting of trees] has brought about floods and drought. [Uncontrolled dumping] of organic wastes, detergents, and pesticides including industrial wastes, continue to threaten man's supply of food, his drinking water and his health in general. **SOCIO-ECONOMIC INFLUENCE** Families from the [**lower income groups** are the ones mostly served in public health services and by the community health nurses]. This is because, people from the lower income groups tend to have proportionately greater number of illnesses and health problems than those in the higher income group. However, the **middle and upper income group** have also very pressing health problems such as [drug abuse and life-style diseases]. **DEFINITION AND FOCUS** - **PUBLIC HEALTH** "[art of applying science in the context of **politics**] so as to [reduce inequalities] in health while [ensuring the best health for the greatest number]." *\*It points to the fact that public health is a **core element of government's attempts** to **improve** and **promote** the **health** and **welfare** of their citizens* It further presented the **core business of public health** as: 1. Disease Control 2. Injury Prevention 3. Health Protection 4. Healthy public policy including those in relation to environmental hazards such as in the workplace, housing, food, water, etc. 5. Promotion of health and equitable health gain *\*The core business of public health cannot be achieved without [**proper delivery** of **essential public health functions**] which* **[Yach]** *described as* *"a set of fundamental activities that address the determinants of health, protect a population's health and treat diseases.* **Essential public health functions:** 1. Health situation monitoring and analysis 2. Epidemiological surveillance/ disease prevention and control 3. Development of policies and planning in public health 4. Strategic management of health systems and services for population health gain 5. Regulation and enforcement to protect public health 6. Human resources development and planning in public health 7. Health promotion, social participation and empowerment 8. Ensuring the quality of personal and population based health services 8. Research, development and implementation of innovative public health solutions *\*For these public health functions to be adequately delivered, [a well defined], [coordinated public health system or infrastructure] must be put in place* - **PUBLIC HEALTH NURSING** "**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 public health programme** for the : 1. promotion of health, 2. the improvement of the conditions in the **social and physical environment**, 3. rehabilitation of illness and disability *-The World Health Organization Expert Committee of Nursing defined Public Health Nursing* **Public Health Nursing in the Philippines:** PHN use their nursing skills in the [application of public health functions and social assistance] **within the context of public health programs** designed to promote health and prevent diseases - **COMMUNITY HEALTH NURSING** It refers to "a **service** rendered by a professional nurse with [communities, groups, families, individuals at home, in health centers, in clinics, in schools, in places of work] for the 1. promotion of health, 2. prevention of illness, 3. care of the sick at home and rehabilitation" **-Ruth B. Freeman** **CHN** is broader than public health nursing because [it encompasses "nursing practice in a wide variety of community services and consumer advocate areas, and in a variety of roles, at times including independent practice... community nursing is certainly not confined to public health nursing agencies.]" -**Jacobson** **PHN** was coined by **Lillian Wald** when she was director of Henry Street Settlement in New York City to denote a service that was available to all people. However, as federal, state and local governments increased their involvement in the delivery of health services, the term public health nursing [became associated with "public" or government agencies] and in turn with the care of the poor people. The phrase community health nursing emerged out of an interest in reaffirming (confirm) the original thrust (main concept/ idea) of public health nursing: [Nursing for the health of the entire public/ community versus nursing only for the public who are poor]. In a move to redefine the practice of public health nursing in the Philippines, the **National League of Philippine Government Nurses** came up with the [Standards of Public Health Nursing in the Philippines 2005]. The Standards differentiated public health nursing and community health nursing only in one are: setting of work as dictated by funding. Standards of Public Health Nursing in the Philippines 2005 Public Health Nurses (PHNs) refer 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. **Public Health Nursing**- [ practice of nursing in] national and local government health departments (which includes health centers and rural health units), and public schools. It is **community health nursing practice** in the public sector **The Evolution of Public Health Nursing in the Philippines** Public health nursing has played a vital role in shaping healthcare in the Philippines. This SECTION will explore the historical development and key milestones of this important field The following events, laws and activities make up history of community health nursing in the Philippines **1901** Act No. **157** of the **Philippine Commission** [created a Board of Health of the Philippines which also acted as the] **Board of Health for the City of Manila**. Subsequently, Act No. **309** [created] **Provincial and Municipal Boards of Health** **1905** Act No. **1407** **(Reorganization Act)** [abolished the Board Health and its functions] and [activities were taken over by the **Bureau of Health** under the **Department of Interior** ] **1906** **District Health Offices** headed by **District Health Officers** had [jurisdictions over health districts] **1912** **The Fajardo Act (Act No. 2156)** created **Sanitary Divisions**. The President of the Sanitary Division (forerunners of the present Municipal Health Officers) took charge of two or three municipalities. Where there were no physicians available, male nurses were assigned to perform the duties of the President, Sanitary Division. In the same year the PGH, then under the Bureau of Health sent four nurses to Cebu to take care of mothers and their babies. The St. Paul\'s Hospital School of Nursing in lntramuros, also assigned two nurses to do home visiting in Manila and gave nursing care to mothers and newborn babies from the outpatient obstetrical service of the PGH **1914** School nursing was rendered by a Filipino nurse employed by the Bureau of Health in Tacloban, Leyte. **1915** The Bureau of Health was renamed Philippine Health Service with a Director of Health as its head. The service was placed under the Dept of Public Instruction with the Vice-Governor General as the Dept Secretary. Reorganization **Act No. 2462** created the Office of General Inspection. The Office of District Nursing was organized under this Office. It was headed by a lady physician, Dr. Rosario Pastor who was also a nurse. This Office was created due to increasing demands for nurses to work outside the hospital, and the need for direction, supervision and guidance of public health nurses Two graduate Filipino nurses, **Mrs. Casilang Eustaquio and Mrs. Matilde Azurin** were employed for Maternal and Child Health and Sanitation in Manila under an American nurse, **Mrs. G. D. Schudder** **1916 - 1918** **Miss Perlita Clark** took charge of the public health nursing work. Her staff was composed of: - one American nurse supervisor, - one American dietitian, - 36 Filipino nurses working in the provinces and - one nurse and one dietitian assigned in two Sanitary Divisions. **1917** Four graduate nurses paid by the City of Manila were employed to work in the City Schools. Provinces that could afford to carry out school health services were encouraged to employ a district nurse **1918** The office of Miss Clark was abolished due to lack of funds. **1919** The first Filipino nurse supervisor under the Bureau of Health, **Miss Carmen del Rosario** was appointed. She [succeeded Miss Mabel Dabbs]. She had a staff of 84 PHNs assigned in [five health stations]. There was a [gradual increase of public health nurses and expansion of services]. **1923** Two government Schools of Nursing were established: 1. **Zamboanga General Hospital School of Nursing** in [Mindanao] and 2. **Baguio General Hospital** in [Northern Luzon]. These schools were primarily intended to train non-Christian women and prepare them to render service among their people. In later years, four more government Schools of Nursing were established: - [one] in **southern Luzon (Quezon Province}** and - [three] in the **Visayan Islands of Cebu, Bohol** and **Leyte**. **July 1, 1926** **Miss Carmen Leogardo** resigned and **Miss Genara S. Manongdo**, a [ranking supervisor of the American Red Cross, Philippine Chapter] was appointed in her place **1927** The Office of District Nursing under the [Office of General Inspection, Philippine Health Service] was abolished and supplanted by the **Section of Public Health Nursing**. **Mrs. Genara de Guzman** acted as consultant to the Director of Health on nursing matters. **1928** The first convention of nurses was held followed by yearly conventions until the **advent of World War II**. [Pre-service training was initiated as a pre-requisite] for appointment. **1930** Section of Public Health Nursing was converted into Section of Nursing due to [pressing need for guidance] not only in public nursing services but also in hospital nursing and nursing education. The [**Section of Nursing** was **transferred** from the **Office of General Services** to the **Division of Administration**]. This Office covered the supervision and guidance of nurses in the provincial hospitals and the two government schools of nursing. **1933** **Reorganization Act No. 4007** transferred the **Division of Maternal and Child Health of the Office of Public Welfare Commission** to the **Bureau of Health**. **Mrs. Soledad A. Buenafe**, former Assistant Superintendent of Nurses of the Public Welfare Commission was appointed as Assistant Chief Nurse of the Section of Nursing, Bureau of Health. **1941** Activities and personnel including six public health members of the Metropolitan Division, Bureau of Health were transferred to the new department. **Dr. Mariano lcasiano** became the first City Health Officer of Manila. An Office of Nursing was organized with **Mrs. Vicenta C. Ponce** as [Chief Nurse] and **Mrs. Rosario A. Ordiz** as [Assistant Chief Nurse]. They occupied these positions [until their retirement]. **Dec. 8, 1941** When **World War II** broke out, **PHNs** in Manila were assigned to devastated areas to attend to the sick and the wounded. **1942** A [group of **PHNs, physicians** and **administrators** from the **Manila Health Department** went to the **internment camp in Capas, Tarlac**] to receive sick prisoners of war released by the Japanese army. They were confined at San Lazaro Hospital and [68 National Public Health Nurses were assigned to help the hospital staff take care of them]. **July 1942** 31 nurses who were taken prisoners of war by the Japanese army and confined at the Bilibid Prison in Manila were released to the then Director of the Bureau of Health, **Dr. Eusebio Aguilar** who [acted as their **guarantor**]. Many public health nurses joined the guerillas or went to hide in the mountains during **World War II**. **February1946** **[Post war]** records of the Bureau of Health showed that there were: **308** public health nurses and **38** supervisors compared to **[pre-war]** when there were: **556** public health nurses and **38** supervisors. In the same year **Mrs. Genera M. de Guzman**, Technical Assistant in Nursing of the Department of Health and concurrent President of the Filipino Nurses Association recommended the creation of a Nursing Office in the Department of Health **October 7, 1947** **Executive Order No. 94** reorganized **government offices** and created the **Division of Nursing** under the Office of the [Secretary of Health]. This was implemented on **December 16, 1947**. **Mrs. Genara de Guzman** was appointed as Chief of the Division, with three Assistants: - Miss Annie Sand for Nursing Education; - Mrs. Magdalena C. Valenzuela for Public Health Nursing - Mrs. Patrocinio J. Montellano for Staff Education. The Nursing Division was placed directly under the Secretary of Health so that [nursing services can be **availed** of by the different bureaus and units] to help carry out their health programs. At the [**Bureau of Health, the Section of Nursing Supervision** *took over the functions* of the former **Section of Nursing**] **1948** The first training Center of the Bureau of Health was organized in cooperation with the **Pasay City Health Department**. This was housed at the Tabon Health Center located in a marginalized part of the city. It was later renamed as **Dona Marta Health Center**. The original training staff of the Center had - Dr. Trinidad A. Gomez as Center Physician; - Miss Marcela Gabatin as Nurse Supervisor; - Miss Constancia Tuazon, Mrs. Bugarin and Miss Ramos as Nurse Instructors. - Miss Zenaida Y. Panlilio, National Public Health Nurse, Bureau of Health, later joined the staff. **Physicians and nurses** [undergoing pre-service and in service training in public health/public health nursing as well as nursing students on affiliation] were assigned to the above training center **1950** The Rural Health Demonstration and Training Center (RHDTC) was established by the DOH through the initiative of **Dr. Hilario Lara**, [Dean, Institute of Hygiene], now **College of Public Health, University of the Philippines**. The **WHO/UNICEF** [assisted project used health centers of the Quezon City Health Department], which were located in the rural areas of the city. The **RHDTC** was used [as a laboratory for the field experiences] of graduate and basic students in medicine, nursing, health education, nutrition and social work. [Health workers from other countries also came to observe in the training center.] **Dr. Amansia S. Mangay (Mrs. Andres Angara)**, a [Doctor of Public Health graduate from **Harvard**] was chosen to be the Chief of the RHDTC. **Dr Antonio N. Acosta,** former Physician of the Manila Health Department was Medical Training Officer The **training staff of RHDTC** were [nurses] and had a [major] role in the [organization and implementation of training activities]. The first Supervising Training Nurse was **Miss Marta Obana**, with **Miss Jean Bactat, Mrs Mary Velono, and Mrs. Natividad B. Asuque** as Nurse Instructors. **1953** The **Office of Health Education and Personnel Training** (forerunner of Health Manpower Development and Training Service) was **established** with **Dr. Trinidad Gomez** as [Chief]. [**Four** nurse instructors were recruited], ***two*** from the **Manila Health Department**, **Mrs. Venancia Cabanos and Mrs. Damasa Torrejon** and ***two*** from the **Bureau of Health**, **Miss Zenaida Y. Panlilio and Miss Leonora M. Liwanag**, (the [first graduates of the Bachelor of Science in Nursing] degree from the **UP**, College of Nursing, to join the Bureau of Health) **Philippine Congress** approved **Republic Act No. 1082** or the **Rural Health Law**. It created the first **81 Rural Health Units**. Each unit had a physician, a public health nurse, a midwife, a sanitary inspector and a clerk driver. They were provided with transportation (jeep) by the UNICEF **1957** **Republic Act 1891** was approved amending Sections Two, Three, Four, Seven and Eight of R.A. **1082** \"Strengthening **Health and Dental** **Services** in the [Rural Areas and Providing Funds thereto].\" This second Rural Health Act [created 8 categories of rural health units] [based on **population**]. This resulted in additional number of positions for health workers including public health nurses and midwives. **1958-1965** **Republic Act 977** [passed by Congress in **1954**] was implemented. This abolished the Division of Nursing. However, it created nursing positions at different levels in the health organization. **Miss Annie Sand** was [appointed **Nursing Consultant**] under the Office of the Secretary of Health. [**The Department of Health National League of Nurses**, Inc. was founded by Miss Annie Sand in **1961**]. She became its first President and Adviser The **Reorganization Act** with implementing details embodied in **Executive Order 288, series of 1959** de-centralized and integrated health services. It created 8 Regional Health Offices in the country, which were [later increased to eleven and eventually seventeen]. The reorganization of 1959 also merged two Bureaus in the Department of Health. The **Bureau of Health** (in charge of [preventive programs]- Maternal and Child Health, Dental Health, Industrial or Occupational Health) was merged with the **Bureau of Hospitals** ([curative programs] and regulatory/licensing functions) to form the Bureau of Health and Medical Services. **1967** In the [Bureau of Disease Control], **Mrs. Zenaida Panlilio-Nisce** was appointed as Nursing Program Supervisor and [**served as consultant** on the nursing aspects of the **5 special diseases**:] TB, Leprosy, Venereal Disease, Cancer, Filariasis; and, Mental Health. She was involved in program planning, monitoring, evaluation and research. **Nov. 1971** **Mrs. Josefina A Mendoza**, Supervising Nurse Instructor, Office of Health Education and Personnel Training, succeeded Miss Annie Sand as Nursing Consultant **1974** The Project Management Staff was organized as part of Population Loan II of the Philippine Government with **Dr. Francisco Aguilar** as [Project Manager]. Experts on different fields of public health were recruited and Mrs. Nelida Castilio joined the PMS staff. Her position as Nursing Program Supervi\~or, Office of the Secretary of Health was taken over by Mrs. Zenaida Nisce, Nursing Program Supervisor, Bureau of Disease Control. Miss Julita Yabes, faculty member of the then Institute of Hygiene (now College of Public Health} University of the Philippines served as consultant on nursing matters in the Project Management Staff. **1975** As a result of the restructuring of the health care delivery system based on findings of the Operations Research (WHO Assisted) conducted in the province of Rizal in the early 70\'s, the **functions of the health team members** (Municipal Health Officer, Public Health Nurse, Rural Health Midwife, and Rural Sanitary Inspector} **were** **redefined**. The [ *roles* of the *public health nurse* and the *midwife* were expanded]. [**Two thousand** *midwives* were recruited and trained to serve in the rural areas] **1976-1986** The **Nursing Consultan**t and **Nursing Program Supervisor** of the **Office of the Secretary of Health** were **involved** in the **Rural Health Practice Program** which required medical and nursing graduates to serve for two months in the rural areas of the country [before their licenses could be issued by the Professional Regulation Commission]. When the number of **nursing graduates** reached over **12,000** per year, the [program was stopped]. By then, the objectives of the program that health services be made available in the rural areas of the country, and that the young medical and nursing graduates develop a liking for working in these remote underserved areas were partially attained. During the incumbency of **President Ferdinand Marcos**, **Mrs. Josefina Mendoza** as Nursing Consultant strongly and repeatedly recommended the creation of a Bureau of Nursing but unfortunately, the government was in the midst of streamlining its organization. The [envisioned Bureau of Nursing did not materialize] even if the President endorsed it to Mr. Armand Fabella who was in charge of the government reorganization **1986** **Reorganization of the Department of Health** during this period placed the position of **Nursing Consultant at the Bureau of Health** **arilJPMed1cal Serv1ces.** [It was later abolished when **Mrs. Mendoza** retired]. **Mrs. Zenaida Nisce** [remained as Nursing Program Supervisor of the Office of the Secretary of Health]. In addition to her duties she was made [Secretary, Task Force on Mental Health]. The other nursing positions at the Central Office were at the National Family Planning Service (NFPS). **1987-1989** **Executive Order No. 119** reorganized the Department of Health and created several offices and services within the Department of Health **1990-1992** The number of positions of Nursing Program Supervisors (Nurse VI) was increased as **there were 3 or more appointed in each service**. Aside from the usual services for mothers and children, [these nurses were involved in the following programs]: Expanded Program on Immunization, Control of Diarrheal Diseases and Control of Acute Respiratory Infections. In the **Non Communicable Disease Control Service (NCDCS)**, the **first two** Nursing Program Supervisors (Nurse VI) were **Mrs. Gloria Temelo and Miss Gilda Estipona** who were with the [cardiovascular and cancer control programs] respectively. **1989** **Mrs. Carmen Buencamino** joined the Occupational Health Division as Nurse VI. When these [three nurses retired] one after another, their positions were [taken over] by **Miss Ma. Thelma. Bermudez, Miss Frances Prescilla Cuevas and Mrs. Ma. Theresa Mendoza.** They were [involved in the **development of public health programs** for the **prevention and control** of cardiovascular diseases, cancer, diabetes and disabilities such as blindness and deafness, osteoporosis, asthma and smoking control]. The **3 nurses** at the NCDCS Mrs. Zenaida P. Nisce, Mrs. Carolina A. Ruzol and Mrs. Zenaida Recidoro participated in the **planning, training, monitoring, supervision and evaluation of diseases** as [leprosy, STD, rabies, filariasis and dengue hemorrhagic fever]. At the Community Health Service, the Nursing Program Supervisor **Mrs. Patrocinio Ferrera** was involved in the planning and monitoring of primary health care activities in the different regions. At the **Department of Health Administrative Service** there were [*4 Public Health Nurses and 1 Senior Public Health Nurse* assigned at the *Medical Examination Division and Infirmary (MEDI)*] formerly called **Physical Examination Division** **January 1999** Department Order No. 29 designated **Mrs. Nelia F. Hizon, Nurse VI**, then **President of the National League of Philippine Government Nurses**, as [Nursing Adviser]. She was detailed at the Office of Public Health Services. As Nursing Adviser, matters affecting nurses and nursing are referred to her. **May 24, 1999**. Executive Order No. 102 was signed by **President Joseph Ejercito Estrada**, redirecting the functions and operations of the Department of Health. Based on this Executive Order, [**most of the nursing positions** at the *Central Office* were either **transferred or devolved** to other *offices and services*]. **2005-2006** The development of the **Rationalization Plan** to streamline the bureaucracy further was started and is [in the last stages of finalization.] **Expanding Responsibilities** **Maternal and Child Health Nurses** focused on [improving] maternal and child health, [reducing] infant mortality rates and [promoting] prenatal and postnatal care. **Communicable Disease Control** Nurses played a crucial role in controlling the spread of infectious diseases through [vaccination campaigns and health education]. **Environmental Health** Nurses worked to improve sanitation, water quality, and living conditions in communities, promoting overall public health **Responding to Emerging Challenges** 1. **Disaster Response** Nurses mobilized to provide [emergency medical care] and [public health services] during natural disasters and calamities. 2. **Chronic Disease Management** Nurses adapted their skills to [address the growing burden of non-communicable diseases] like diabetes and hypertension. 3. **Pandemic Preparedness** Nurses played a critical role in the [country\'s response to global health crises], such as the COVID-19 pandemic. **Advancing the Profession** - **Education and Training** Nursing education programs expanded, incorporating public health principles and equipping nurses with the skills to serve communities. - **Professional Associations** The establishment of nursing organizations, such as the Philippine Nurses Association, facilitated the advancement of the profession. - **Policy Advocacy** Nurses advocated for legislation and policies that strengthened the role of public health nursing in the country. - **Research and Innovation** Nurses contributed to the development of evidence-based practices and pioneered new approaches to community-based healthcare **Serving Diverse Communities** - **Rural Outreach Nurses** expanded access to healthcare in remote and underserved areas, addressing the unique needs of rural populations. - **Urban Interventions** Nurses developed innovative approaches to address the health challenges faced by growing urban communities. - **Cultural Competence** Nurses embraced cultural diversity, adapting their practices to provide culturally sensitive and inclusive care. - **Health Equity** Nurses advocated for and worked to improve healthcare access and outcomes for marginalized and underserved populations. **Transforming Healthcare Delivery** 1. **Technological Integration** Nurses leveraged digital tools and technologies to enhance the reach and efficiency of public health services. 2. **Collaborative Partnerships** Nurses forged partnerships with other healthcare providers, government agencies, and community organizations to deliver comprehensive care. 3. **Holistic Approach** Nurses adopted a holistic perspective, addressing the physical, mental, and social needs of individuals and communities **Shaping the Future of Public Health** - **Empowering Communities** Nurses empower individuals and communities to take an active role in their own health and wellness. - **Interdisciplinary Collaboration** Nurses work closely with other healthcare professionals to deliver integrated and coordinated public health services. - **Evidence-Based Practice** Nurses contribute to the development and implementation of evidence-based public health interventions. - **Policy Influence** Nurses advocate for policies that support and strengthen the role of public health nursing in the Philippines **Roles & Responsibilities of a Community Health Nurse** **Community health nurses** play a vital role in promoting wellness and improving the health of [individuals, families, and entire communities]. Their responsibilities span a wide range of activities, from patient education to advocating for vulnerable populations. **PUBLIC HEALTH NURSING** The World Health Organization Expert Committee of Nursing defines public health nursing as 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 public health program for the promotion of health, the improvement of conditions in the social and physical environment, rehabilitation, and the prevention of illness and disability." **COMMUNITY HEALTH NURSING** **Jacobson** states that community health nursing is a learned practice discipline with the ultimate goal of contributing, as individuals and in collaboration with others, to the promotion of the client's optimum level of functioning through teaching and delivery of care. - a unique blend of nursing and public health practice woven into a human service that properly developed and applies which has a tremendous impact on human well-being. Its [responsibilities extend to the care and supervision of individuals and families] in their homes, in places of work, in schools and clinics. It is one of the basic services of health departments. The community health nurses as members of the health team, are expected to integrate within the context of family health care, the priority programs of the Department of Health. - a service rendered by a professional nurse with communities, 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. (An adaptation from Dr. Ruth B. Freeman's definition) **PHILOSOPHY OF CHN** According to **Dr. Margaret Shetland**, the philosophy of Community Health Nursing is based on "the worth and dignity of man." **CONCEPTS** Concepts basic to nursing are used in working with the clients: individuals, families, group and communities. Some concepts of community health nursing are: 1. The **primary focus** of CHN practice is on health promotion. The community health nurse, by the nature of his/her work, has the opportunity and responsibility for evaluating the health status of people and groups and relating them to practice. 2. Community health nursing practice is extended to benefit not only the individual but the whole family and community. 3. Community health nurses are generalist in terms of their practice through life's continuum-its full range of health problems and needs. 4. Contact with the client and/or the family may continue over a long period of time which include all ages and all types of health care. 5. The nature of community health nursing practice requires that current knowledge derived from the biological and social sciences, ecology, clinical nursing and community health organizations be utilized. 6\. The [dynamic process of assessing, planning, implementing and intervening], provide periodic measurements of progress, evaluation and a continuum of the cycle until the termination of nursing is implicit in the practice of CHN. **GOAL** The ultimate goal of community health services is to raise the level of health of the citizenry. To this end, the goal of CHN is to help communities and families to cope with the discontinuities in health and threats in such a way to maximize their potential for high level wellness, as well as to promote reciprocally supportive relationship between people and their physical and social environment. **OBJECTIVES** 1. To participate in the development of an over-all health plan for the community and in its implementation and evaluation. 2. To provide quality nursing services to individuals, families and communities utilizing as basis, the standards set for community health nursing practice. 3. To coordinate nursing services with various members of the health team, community leaders and significant others, government and non-government agencies/organization in achieving the aims of public health services within the community. 4. To participate in and/or conduct researches relevant to community health and community health nursing services and disseminate their results for improvement of health care. 5. To provide community health nursing personnel with opportunities for continuing education and professional growth through staff development. **PRINCIPLES** The following principles of Community Health Nursing were adapted from those formulated by **Mary S. Gardener** and by **Leahy, Cobb and Jones**. 1. Community Health Nursing is based on recognized needs of communities, families, groups and individuals. 2. The community health nurse must understand fully the objectives and policies of the agency she represents. 3. In Community Health Nursing, the family is the unit of service. 4. Community Health Nursing must be available to all regardless of race, creed and socio-economic status. 5. Health teaching is a primary responsibility of the community health nurse. 6. The community health nurse works as a member of the health team. 7. There must be provision for periodic evaluation of Community Health Nursing services.\ 8. Opportunities for continuing staff education programs for nurses must be provided by the Community Health Nursing agency. The community health nurse also has a responsibility for his/her own professional growth. 8. The community health nurse makes use of available community health resources. 9. The community health nurse utilizes the already existing active organized groups in the community. 10. There must be provision for educative supervision in Community Health Nursing. 11. There should be accurate recording and reporting in Community Health Nursing. **Competency Standard of Nursing Practice in the Philippines** 1. Safe and Quality Nursing Care 2. Management of resources and Environment 3. Health Education 3. Legal Responsibility 4. Ethico-moral Responsibility 5. Personal and Professional Development 6. Quality Improvement 7. Research 8. Record Management 9. Communication 10. Collaboration and teamwork **STANDARDS OF CARE** **STANDARD I/ ASSESSMENT**- The public health nurse assesses the health status of populations using data, community resources, identification, input from the population, and professional judgement. **STANDARD II/ DIAGNOSIS**- The public health nurse analyzes collected assessment data and partners with the people to attach meaning to those data and determine opportunities and needs. **STANDARD III/ OUTCOMES IDENTIFICATION**- The public health nurse participates with other community partners to identify expected outcomes in the populations in their health status. **STANDARD IV/ PLANNING**- The public health nurse promotes and supports the development of programs, policies, and services that provide interventions that improve the health status of populations. **STANDARD V/ ASSURANCE: ACTION COMPONENT OF THE NURSING PROCESS FOR THE PUBLIC HEALTH NURSING-** The public health nurse assures access and availability of programs, policies, resources, and services to the population. **STANDARD VI/ EVALUATION**- The public health nurse evaluates the health status of the population **CLIENT-ORIENTED ROLES** 1. **CAREGIVER**- Uses the nursing process to provide direct nursing intervention to individuals, families, or population groups. 2**. EDUCATOR**- Facilitates learning for positive health behavior change. 3\. **COUNSELOR**- Teaches and assists clients in the use of the problem solving process. 4\. **REFERRAL RESOURCE**- Links clients to services to meet identified health needs. 5\. **ROLE MODEL**- Demonstrates desired health-related behaviors. 6. **ADVOCATE**- Speaks or acts on behalf of clients who cannot do so for themselves. 7. **PRIMARY CARE PROVIDER**- Provides essential health services to promote health, prevent illness, and deal with existing health problems. 8. **CASE MANAGER**- Coordinates and directs the selection and use of health care services to meet client needs, maximize resource utilization, and minimize the expense of care **DELIVERY-ORIENTED ROLES** 1. **COORDINATOR/ CARE MANAGER** Organizes and integrates services to best meet client needs in the most efficient manner possible. 2\. **COLLABORATOR**- Engages in shared decision making regarding the nature of health problems and potential solutions to them. **3. LIAISON**- Provides and maintains connections and communication between clients and health care providers or among providers. **POPULATION-ORIENTED ROLES** 1. **CASE FINDER**- Identifies clients with specific health problems or conditions.-Geared toward awareness of population-level problems 2. **LEADER**- Influences clients and others to take action regarding identified health problems. 3. **CHANGE AGENT**- Initiates and facilitates change in individual or client behaviors or conditions or those affecting population groups. 4. **COMMUNITY DEVELOPER**- Mobilizes residents and other segments of the population to take action regarding identified community health problems or issues. 5. **COALITION BUILDER**- Promotes the development and maintenance of alliances of individuals or groups of people to address a specific health issue. 6. **RESEARCHER-** Conducts studies to explain health-related phenomena and to evaluate the effectiveness of interventions to control them. **COMMUNITY HEALTH NURSING** - **Care Coordination** Collaborating with healthcare providers to ensure seamless patient care and follow-up. - **Case Management** Assessing patient needs, developing care plans, and connecting them to community resources. - **Advocacy** Advocating for vulnerable populations and addressing social determinants of health **Preventive Care and Health Promotion** 1 **Immunizations-** Administering and educating about routine and seasonal vaccinations. 2 **Screenings-** Conducting health screenings for early detection of chronic conditions. 3 **Education-** Providing health education on topics like nutrition, exercise, and disease management. 4 **Outreach-** Organizing community-based health promotion events and initiatives **Community Engagement and Outreach** 1. **Needs Assessment-** Identifying community health needs and priorities through surveys and data analysis. 2. **Collaboration-** Building partnerships with community organizations and stakeholders. 3. **Empowerment-** Empowering community members to take an active role in their health and wellness. **Public Health Emergency Response** - **Disaster Preparedness** Developing emergency plans and training communities to respond to natural disasters or disease outbreaks. - **Crisis Intervention** Providing immediate medical care and psychological support during public health emergencies. - **Recovery Assistance** Coordinating long-term recovery efforts and connecting affected individuals to resources. - **Policy Advocacy** Advocating for policies and funding to strengthen community resilience and preparedness. **Cultural Competence and Diversity** - **Cultural Awareness** Understanding and respecting diverse cultural beliefs, practices, and traditions. - **Language Access** Providing language interpretation and translation services to ensure effective communication. - **Inclusive Approach** Tailoring care and services to meet the unique needs of diverse populations. - **Community Engagement** Building trust and fostering meaningful connections with diverse community members **Evidence-Based Practice and Research** 1. **Data Collection-** Gathering and analyzing community health data to identify trends and needs. 2. **Evidence Review-** Staying up-to-date with the latest research and best practices in community health. 3. **Program Evaluation-** Evaluating the effectiveness of community health programs and interventions **Interdisciplinary Collaboration** - **Physicians**- Ensure coordinated care and address complex medical needs. - **Social Workers**- Collaborate to address social determinants of health and connect patients to resources. - **Dietitians**- Provide expert guidance on nutrition and dietary interventions. - **Mental Health Professionals**- Work together to support the emotional and psychological well being of patients **Professional Development and Continuing Education** - **Lifelong Learning** Continuously seeking opportunities to expand knowledge and skills through workshops, conferences, and online courses. - **Certification and Licensure** Maintaining necessary certifications and licenses to ensure high-quality, evidence based care. - **Networking and Collaboration** Engaging with professional organizations and peers to share best practices and stay informed about industry trends **Ethical and Compassionate Care** 1. **Patient-Centered Approach-** Prioritizing the unique needs, preferences, and well-being of each patient. 2. **Ethical Decision**-Making Upholding professional standards and making decisions that prioritize the welfare of individuals and communities. 3. **Empathy and Compassion-** Demonstrating genuine care, understanding, and emotional support for patients and their families. 4. **Advocacy and Social Justice-** Advocating for marginalized and underserved populations to promote health equity