CHN-UPDATED-LECTURE PDF Community Health Nursing Syllabus

NCM 113 COMMUNITY HEALTH NURSING COURSE SYLLABUS COURSE CODE : NCM 113 COURSE TITLE : Community Health Nursing 2 (Population Groups and Community as Clients) PRE – REQUISITE : NCM 104 CO – REQUISITE : NCM 111, NCM 112, NCM 114 COURSE CREDIT : 2 Units Lecture CONTACT HOU...

NCM 113 COMMUNITY HEALTH NURSING COURSE SYLLABUS COURSE CODE : NCM 113 COURSE TITLE : Community Health Nursing 2 (Population Groups and Community as Clients) PRE – REQUISITE : NCM 104 CO – REQUISITE : NCM 111, NCM 112, NCM 114 COURSE CREDIT : 2 Units Lecture CONTACT HOURS/SEMESTER : 2 Units Lecture Hours (54hours) and 2 Units (102hours) Related Learning Experiences COURSE DESCRIPTION : This course covers the concepts and principles in the provision of basic care in terms of health promotion, health maintenance and disease prevention with population groups and community as clients. Topics include Community Health and Development Concepts; working with groups toward community development; community health nursing process; related laws in public health nursing; and health statistics and epidemiology.  LEVEL 3 OUTCOMES NURSING PROGRAM OUTCOMES At the end of third year, given groups of clients – individuals, families, population groups, and communities with health problems and special needs, the learners will demonstrate safe, appropriate and holistic care utilizing the nursing process and can assume first level entry positions in any field of nursing. Apply knowledge of principles and concepts of relevant sciences in medical-surgical nursing. Utilize the nursing process in providing safe, humane, appropriate and holistic care to clients. Demonstrate skills in perioperative nursing. Conduct research with an experienced researcher. Justify the value of evidence-based practice in nursing. Apply ethico-legal and moral principles in professional decision making. Communicate effectively in writing, speaking, and presenting using culturally appropriate language. Display behaviour of an independent learner who is critical, creative and focused. Exhibit enhancing qualities as a responsible citizen and as a Filipino.  Conduct research with an experienced researcher. Justify the value of evidence-based practice in nursing. Apply ethico-legal and moral principles in professional decision making. Communicate effectively in writing, speaking, and presenting using culturally appropriate language. Display behaviour of an independent learner who is critical, creative and focused. Exhibit enhancing qualities as a responsible citizen and as a Filipino. Community is a collection of people who interact with one another and whose common interest or characteristics gives them a sense of unity and belonging. - A community is a group of people in defined geographical area with common goal and objective and the potential for interacting with one another. The Three Features of a Community: 1. Location: every physical community carries out its daily existence in a specific geographical location. The health of the community is affected by this location, including the placement of the service, the geographical features… 2. Population: consists of specialized aggregates, but all of the diversed people who live with in the boundary of the community. 3. Social system: the various parts of communities’ social system that interact and include the heath system, family system, economic system and educational system. Population-focused nursing care means providing care based on the greater need of the majority of the population. The greater need is identified through COMMUNITY DIAGNOSIS. Primary goal of community health nursing -To enhance the capacity of individuals, families and communities to cope with their health needs CHN is a community-based practice -The nurse has to conduct community diagnosis to determine nursing needs and problems. “Public health services are not given free of charge.” - people pay indirectly for public health services. Community health services, including public health services, are pre-paid services, though taxation, for example. The goal of Public Health according to C.E. Winslow -For people to attain their birthrights of health and longevity. According to Winslow, all public health efforts are for people to realize their birthrights of health and longevity. The most prominent feature of public health nursing -Public health nursing focuses on preventive, not curative, services. The catchment area in PHN consists of a residential community, many of whom are well individuals who have greater need for preventive rather than curative services. According to Margaret Shetland, the philosophy of public health nursing is based on The worth and dignity of man. This is a direct quote from Dr. Margaret Shetland’s statements on Public Health Nursing. -Margaret Shetland is grounded on the worth and dignity of every individual, self reflecting a commitment to treating all people with respect and care in the pursuit of health equity Mission of the Department of Health -Ensure the accessibility and quality of health care -R.A. 7160 mandates devolution of basic services from the national government to local government units empowering the people and promote their self-reliance. People empowerment is the basic motivation behind devolution of basic services to LGU’s.  Supervisory function of the public health nurse -Providing technical guidance to the midwife. The nurse provides technical guidance to the midwife in the care of clients, particularly in the implementation of management guidelines, as in Integrated Management of Childhood Illness. According to Freeman and Heinrich, community health nursing is a developmental service. Health education and community organizing are necessary in providing community health services. The community health nurse develops the health capability of people through health education and community organizing activities. Communities of Place 1. Urban community – An urban community is a place-based community that has its own unique structure and needs. Urban communities are densely-populated and often rely upon peripheral communities to provide food and materials, while they offer services to other communities in return. 2. Suburban community – Suburban communities are less dense than urban and often have high numbers of families and children. Their interests may be focused on family planning, education, and cost of living pressures. 3. Rural community – Rural communities are often oriented around agrarian lifestyles and have unique concerns such as access to healthcare and services despite the fact they’re far from service providers. They also tend to, on average, have a higher degree of conservative political leaning due to the need to rely on self and neighbor over government. 4. Neighborhood – A neighborhood may be a small subset of any of the above communities of place. It refers to a small group of people who live in very close proximity and may share local services such as shops or a local elementary school. 5. Suburb – Suburbs are bigger than neighborhoods but smaller than cities, and may have a local government uniting them or shared interests in a particular hospital or small business community that serves the whole suburb. 6. National community – Benedict Anderson referred to nations as ‘imagined communities’. They’re groups of people who will never see all of their compatriots face-to-face but have a shared sense of identity and purpose built up by mass media and governmental institutions that promote a nationalistic worldview. 7. Global community – The global community encompasses everyone in the world Communities of Interest 8. Subcultures – Subcultural communities cohere around common beliefs and interest that are distinct from the beliefs and interests of the dominant culture in which they live. For example, we could think of the surfing community, gaming community, and so on. 9. Countercultures – Like subcultures, countercultures sit within a dominant culture but are distinct cultural groups. But unlike subcultures, countercultures are oppositional to the dominant culture. For example, hippies, the Amish, and cult groups are countercultural community groups. 10. Sporting communities – Sporting communities cohere around a common interest in a shared sport. They often develop their own practices, events, and phrases. For example, the global football community share the football world cup as their peak event.  Identity-based Communities 11. Religious communities – Religious communities cohere around spiritual beliefs and practices. They may come together to worship, but also act as networks of support groups around the world. For example, if you move cities, you will be able to connect with branches of people within your religion in the new city who can act as your new support network. 12. Virtual communities – A virtual community gets together online. In the digital age, people increasingly form identities and support networks online based upon common interests rather than through nationalistic and regional identity features. 13. Ethnic group – People with a shared ethnicity have common history, practices, cultures, and beliefs. This leads them to naturally coming together to engage in their cultural practices as a coherent community group.  Communities of Need 14. Disabled community – As with all communities of need, disabled people come together to share their common experiences, advocate for their shared needs, and support one another. 15. Deaf community – A subset of the disabled community, the deaf community is a well-known community who come together out of shared need and interest. For example, deaf people can come together because they share a language – sign language (although there are many!) – and there is even a distinct deaf culture with shared social norms. 16. Elderly community – We see elderly communities coming together to share a common experience of aging. Often, these communities both allow for shared medical resources and a joyous sense of active community-building in the final quarter of life. 17. Migrant and expat communities – Migrants often come together in new countries to support one another. They may have shared language and culture, but also shared experiences, that draw them together. Communities of Practice 18. Professional community – Professional communities are groups of people who share a profession or expertise. These groups often advocate for their profession, set minimum standards and engage in shared professional development and ongoing learning. 19. Guilds and associations – Guilds and associations are similar to professional communities, but may not necessarily be connected to a profession. They may be connected to a hobby such as woodworking or birdwatching. 20. Business communities – Generally referred to as ‘the business community’, this is a group of people who advocate for businesspeople and entrepreneurs. They may share experiences running businesses and advocate for legal changes that make running a business easier, less bureaucratic, or more efficient. 21. Economic communities – Economic communities are larger-scale than business communities and linked to nation-state economies. It may be, for example, APEC – the Asia-Pacific Economic Community – which is essentially a trade bloc with lowered tariffs and standardized trade agreements. Similarly, we have the European Economic Community. Health is defined as a state of physical, mental and social well being not merely the absence of disease or infirmity (WHO, 1948). Health, in its holistic philosophy differs greatly from that of the acute care settings. In 2009, researchers publishing in The Lancet Trusted Source defined health as the ability of a body to adapt to new threats and infirmities. Health Belief Model The Health Belief Model addresses the relationship between a person's beliefs and behaviors. The Health Belief Model (HBM) was developed in the early 1950s by social scientists at the U.S. Public Health Service in order to understand the failure of people to adopt disease prevention strategies or screening tests for the early detection of disease. Later uses of HBM were for patients' responses to symptoms and compliance with medical treatments. The HBM suggests that a person's belief in a personal threat of an illness or disease together with a person's belief in the effectiveness of the recommended health behavior or action will predict the likelihood the person will adopt the behavior. 2 components of health-related behavior are: 1) the desire to avoid illness, or conversely get well if already ill; and, 2) the belief that a specific health action will prevent, or cure, illness. There are six constructs of the HBM: 1.Perceived susceptibility - This refers to a person's subjective perception of the risk of acquiring an illness or disease. There is wide variation in a person's feelings of personal vulnerability to an illness or disease. 2.Perceived severity - This refers to a person's feelings on the seriousness of contracting an illness or disease (or leaving the illness or disease untreated). There is wide variation in a person's feelings of severity, and often a person considers the medical consequences (e.g., death, disability) and social consequences (e.g., family life, social relationships) when evaluating the severity. 3.Perceived benefits - This refers to a person's perception of the effectiveness of various actions available to reduce the threat of illness or disease (or to cure illness or disease). The course of action a person takes in preventing (or curing) illness or disease relies on consideration and evaluation of both perceived susceptibility and perceived benefit, such that the person would accept the recommended health action if it was perceived as beneficial. 4. Perceived barriers - This refers to a person's feelings on the obstacles to performing a recommended health action. There is wide variation in a person's feelings of barriers, or impediments, which lead to a cost/benefit analysis. The person weighs the effectiveness of the actions against the perceptions that it may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time-consuming, or inconvenient. 5. Cue to action - This is the stimulus needed to trigger the decision- making process to accept a recommended health action. These cues can be internal (e.g., chest pains, wheezing, etc.) or external (e.g., advice from others, illness of family member, newspaper article, etc.). 6. Self-efficacy - This refers to the level of a person's confidence in his or her ability to successfully perform a behavior. This construct was added to the model most recently in mid-1980. Self-efficacy is a construct in many behavioral theories as it directly relates to whether a person performs the desired behavior. Health Promotion Model - is a framework that explains the factors that motivate individuals to engage in behaviors that promote their health. It focuses on the interaction between individuals and their physical and social environments when trying to improve their health. - Nola Pender's health promotion model (HPM) is one of the widely used models to plan for and change unhealthy behaviors and promote health - Defines health as “a positive dynamic state not merely the absence of disease”. - The process of empowering individuals and communities to make healthy lifestyle choices to improve overall health and wellness. The Health Belief Model is a theoretical model that can be used to guide health promotion and disease prevention programs. It is used to explain and predict individual changes in health behaviors. It is one of the most widely used models for understanding health behaviors. Breast Cancer Awareness Month is an annual campaign that uses the Health Belief Model to inform audiences about breast cancer. During the month of October, organizations may offer free screenings and education to raise public awareness and identify early cases of breast cancer. Basic Human Needs Model This theory created by Abraham Maslow is based on how humans are inspired to satisfy their needs in a hierarchical order. Starting from the bottom going upwards, the five needs are physiological, safety, love and belonging, esteem, and self-actualization. The following are the five levels of hierarchy explained. 1. Physiological Needs Physiological needs are the most basic of Maslow’s hierarchy. These are the essentials people need for physical survival. Examples include air, food, drink, shelter, clothing, warmth, sleep, and health. If you fail to meet these needs, your body cannot function properly. Physiological needs are considered the most essential because you can't meet the other needs until your physiological ones are fulfilled. The motivation at this level comes from a person’s instinct to survive. 2. Safety Needs Once you meet your physiological needs, you need to need a safe and secure environment. Safety and security needs are associated with the need to feel safe and secure in your life and environment. Safety needs are obvious starting from childhood. When these needs are not met, children naturally react with fear and anxiety. These needs also involve the desire for order, predictability, and control. Examples of safety needs include emotional security, financial security (social welfare and employment), law and order, social stability, freedom from fear, health, and well-being. 3. Love and Belonging Needs This is the third and the last of the lower needs in Maslow's hierarchy of needs. It involves the need to feel a sense of belonging and acceptance. It's motivated by the natural instinct of humans to interact. This hierarchy level involves romantic relationships and connections to family and friends. It also includes the need to feel that you belong to a social group. In addition, this need includes feeling loved and feeling love toward others. If you fail to meet these needs, you may experience loneliness and depression. 4. Esteem Needs This is the first of the higher needs in the hierarchy of needs. Esteem needs are motivated by the desire to feel good about yourself. Feeling of being valued by others.  There are two categories of esteem needs: Self-esteem: -which is feeling confident and good about yourself, and respect - which is feeling valued by other people and knowing that they recognize your achievements. When your esteem needs are not met, you may feel unimportant, less confident, unprotected, and incompetent. According to Maslow, respect and reputation are vital for children and adolescents and come before real self-esteem or dignity. 5. Self-Actualization Needs Self-actualization needs are the highest level on Maslow's pyramid of needs. These needs include realizing your potential, self- fulfillment, self-development, and peak experiences. self-actualization is the desire to accomplish all that you can and unleash all your potential. Different individuals may have different ideas of self-actualization since your desires differ from other people’s. Maslow’s theory states that reaching the self-actualization level is difficult. The reason is that people are focused on satisfying the more urgent needs in the hierarchy of needs first.  Holistic health- it is about caring for the whole person — providing for your physical, mental, spiritual, and social needs. It's rooted in the understanding that all these aspects affect your overall health, and being unwell in one aspect affects you in others. “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This statement from the preamble to the World Health Organization’s constitution, adopted in 1946, illustrates its belief in holistic health from its very formation. The Health Belief Model addresses the relationship between a person's beliefs and behaviors. The Health Promotion Model is more complex than the Health Belief Model in that it notes that each person has unique personal characteristics and experiences that affect subsequent actions. The Basic Human Needs Model is based on the theory that all people share basic human needs, and the extent to which basic needs are met is a major factor in determining a person's level of health. The Holistic Health Model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy. Education is important but is not the sole determinant of change. Physical health implies a mechanistic functioning of the body. A person who has good physical health is likely to have bodily functions and processes working at their peak. WHAT CONTRIBUTE TO GOOD HEALTH? Looking after physical health and well-being also involves reducing the risk of an injury or health issue, such as: minimizing hazards in the workplace using contraception when having sex practicing effective hygiene avoiding the use of tobacco, alcohol, or illegal drugs taking the recommended vaccines for a specific condition or country when traveling  Mental health means the ability to think clearly and coherently and has to do with your thinking and feeling and how you deal with your problem. According to the U.S. Department of Health & Human Services, Trusted Source mental health refers to a person’s emotional, social, and psychological well-being. Mental health is as important as physical health as part of a full, active lifestyle. Good mental health is not only categorized by the absence of depression, anxiety, or another disorder. It also depends on a person’s ability to: enjoy life bounce back after difficult experiences and adapt to adversity balance different elements of life, such as family and finances feel safe and secure achieve their full potential Social health refers to the ability to: Make and maintain relationship with others. Interact well with people and the environment. Factors for good health Good health depends on a wide range of factors: Genetic factors A person is born with a variety of genes. In some people, an unusual genetic pattern or change can lead to a less-than-optimum level of health. People may inherit genes from their parents that increase their risk for certain health conditions. Environmental factors Environmental factors play a role in health. Sometimes, the environment alone is enough to impact health. Other times, an environmental trigger can cause illness in a person who has an increased genetic risk of a particular disease. Access to healthcare plays a role, but the WHO suggest that the following factors may have a more significant impact on health than this: where a person lives the state of the surrounding environment genetics their income their level of education employment status It is possible to categorize these as follows: The social and economic environment: This may include the financial status of a family or community, as well as the social culture and quality of relationships. The physical environment: This includes which germs exist in an area, as well as pollution levels. A person’s characteristics and behaviors: A person’s genetic makeup and lifestyle choices can affect their overall health. Steps that can help people attain wellness include: eating a balanced, nutritious diet from as many natural sources as possible engaging in at least 150 minutes of moderate to high-intensity exercise every week, according to the American Heart Association screening for diseases that may present a risk learning to manage stress effectively engaging in activities that provide purpose connecting with and caring for other people maintaining a positive outlook on life defining a value system and putting it into action  The World Health Organization (WHO) defines health inequity as “systematic differences in the health status of different population groups.” This means that certain groups experience worse health and increased difficulty accessing healthcare as a result of the systems that influence their lives. Is it the same as health inequality or disparity? Although they sound similar, the terms health inequity and health inequality are different. Inequity refers to unfair and avoidable inequalities that are not inevitable or natural but the product of human behavior. Inequality, on the other hand, simply refers to the uneven distribution of resources.  Health inequity is due to human-made systems and structures that privilege certain groups and underserve or actively oppress others. This occurs through the unequal distribution of power and resources. EXAMPLES: racism, which distributes more power and resources to one race over another, typically meaning that historically marginalized racial or ethnic groups — such as Black, Indigenous, Latinx, Asian, and Pacific Islander people — receive fewer resources sexism, which privileges one gender over another, meaning that in most cases, men have more privileges than women and other gender identities classism, which gives unfair advantage to those with wealth and social status and disadvantages those with less  ableism, which values able-bodied people and devalues people with mental or physical disabilities What are the root causes of health inequity? Lower life expectancy Average life expectancy can vary dramatically depending on the region a person is born in. Socioeconomic background has a huge influence on this. Higher rates of mental ill-health Inequity can also lead to chronic stress, which affects both mental and physical health. For example, the Youth Risk Behavior Study 2009–2019 found that young people in the United States who are gay, lesbian, or bisexual experience higher levels of bullying and sexual violence than heterosexual people. This has lead to an increase in rates of mental ill-health and suicide. Wellness is a lifestyle aimed at achieving physical, emotional, intellectual, spiritual and environmental well being. The use of wellness measures can increase stamina, energy and self – esteem, then enhance quality of life. Models of Health There are various models of the concept of health. Some models are based narrowly on the presence or absence of definable illness. Others are based more conceptually on health beliefs, wellness and holism. A. Clinical Model (Dunn, 1961) In this model, health is interpreted as the absence of signs and symptoms of disease or injury; thus the opposite of health is disease. Dunn defined, in this model, “health as a relatively passive state of freedom from illness, and a condition of relative homeostasis.” Illness is therefore, something that happens to a person. B. Host –Agent – Environment Model (Leavell, 1965) This model helps to identify the cause of an illness. In this model: Host: Refers to the person (or group) who may be at risk for or susceptible to an illness. Agent: is any factor (internal or external) that can lead to illness by its presence. Environment: refers to those factors (physical, social, economic, emotional, spiritual) that may create the likelihood or the predisposition for the person to develop disease. C. Health Belief Model (HBM) (Rosenstock, 1974 as Modified by Stone 1991). - There is a relationship between a person’s belief and actions. Factors that influence persons belief’s: ƒ - Personal expectation in relation to health and illness - ƒEarlier experience with illness or health - ƒAge and development state - Health beliefs are person’s ideas, convictions and attitudes about health and illness. They may be based on factual information, misinformation, commonsense or myths, or reality or false expectations. - Health beliefs usually influence health behavior this influence can be positive or negative Health Belief Model (HBM) Addresses relationship between persons belief and behavior Provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies. Components in HBM First component (Individual Perception) Individual’s perception of susceptibility to illness: e.g. family like with coronary health disease (CHD), after link is recognized particularly if one parent or both siblings have died in the 4th decade from myocardial infections (MI).  Second component (Modifying Factors) Individual’s perception of the seriousness of the illness. This perception is influenced and modified by demographic and socio- psychological variables, perceived threat of the illness and cues to action. Third component (Likelihood of Action) The likelihood that the person will take preventive action results from the person’s perception of the benefits of and barriers to taking action. The preventive action may include: Lifestyle modification/change, increased adherence to medical therapies or search for medical advice or treatment.  Implication of HBM to Nursing Helps nurses to understand factors influencing client’s Perception Beliefs and Behaviors Plan care that will most effectively assist client in maintaining or restoring health and preventing illness. D. High – Level Wellness Model (Dunn, 1961) According to Dunn (1961), health recognized as an ongoing process toward the person’s highest potential functioning. This process involves the person, family, and Community. Dunn described high level wellness as the experience of the person alive with the glow of good health, alive to the tips of their fingers with energy to burn, tingling with vitality – at times like this the world is a glorious place.  This process involves the person, family, and Community. Dunn described high level wellness as the experience of the person alive with the glow of good health, alive to the tips of their fingers with energy to burn, tingling with vitality – at times like this the world is a glorious place. E. Holistic Health Model Holism is seen as a “new” model of health, but actually it is not new at all. Holism has been a major theme in the humanities, western political tradition and major religions throughout history. Holism is a different approach to health is that acknowledges and respects the interaction of a person’s mind, body and spirit within the environment. Holism is derived from the Greek holos (whole), was first used by South African philosopher Jan Christian Smuts (1926) in Holism and Evolution.  Holism is based on the belief that people (or even their parts) cannot be fully understood if examined solely in pieces apart from their environment. People are seen as every changing systems of energy. Health and illness Rather than focusing on curing illnesses, community based nursing care focuses on promoting health and preventing illness. This holistic philosophy therefore differs greatly from that of the acute care setting. The prevention focus is a key concept of community based nursing. Prevention is conceptualized on three levels: Primary prevention level Secondary prevention level Tertiary prevention level Promotion of health It includes all efforts that seek to move people closer to optimal well-being or higher level of wellness. It is the combination of educational and environmental supports for action and condition of living conducive to health. Treatment of disorders It focuses on the illness end of continuum and is the remedial aspects of community health practice. This is practiced by: a. Direct service to people with health problems; E.g. home visit for elderly peoples, chronic illness, etc b. Indirect service; e.g. assisting people with health problem to obtain treatment and referral. c. Development of program to correct unhealthy condition; e.g. alcoholism, drug abuse, etc.  Rehabilitation It involves efforts which seek to reduce disabilities, as much as possible, and restore functions; e.g. stroke rehabilitation. Evaluation It is the process by which the practice is analyzed, judged, and improved according to established goals and standards. It helps to solve problems and provides direction for future health care planning. Research It is a systematic investigation which helps to discover facts affecting community health and community health practices, solve problems, and explore improved methods of health services  Health – illness continuum The wellness- illness continuum (Travis and Ryan 1988) is a visual comparison of high – level wellness and traditional medicine’s view of wellness. At the neutral point, there are no signs or symptoms of disease. A person moving toward the left experiences a worsening state of health. CONCEPTS OF COMMUNITY HEALTH NURSING Basic Principles of CHN The community is the patient in CHN, the family is the unit of care. Four levels of clientele: 1. Individual 2. Family 3. Population group (those who share common characteristics, developmental stages and common exposure to health problems – e.g. children, elderly) 4. Community What is the concept of community health nursing approaches? Community health nursing is a population-focused, community- oriented approach aimed at health promotion of an entire population, and prevention of disease, disability and premature death in a population.  Nurses are advocates for patients and must find a balance while delivering patient care. There are four main principles of ethics: autonomy- Each patient has the right to make their own decisions based on their own beliefs and values. This is known as autonomy. beneficence- Beneficence means performing a deed that benefits someone. justice- implies that patients have a right to fair and impartial treatment. non-maleficence- means refraining from doing something that harms or injures someone. Community Health Nursing It is defined as the synthesis of nursing and public health practice applied to promoting and protecting the health of population. It is a specialized field of nursing that focuses on the health needs of communities, aggregates, and in particular vulnerable populations.  It is a practice that is continuous and comprehensive directed towards all groups of community members. It combines all the basic elements of professional, clinical nursing with public health and community practice. It Community Health Nursing 19 synthesizes the body of knowledge from public health science and professional nursing theories to improve the health of communities. Key features of community health nursing - people, location, and social system - and how they affect a particular community in the Philippines. It analyzes how the people feature, specifically different education levels and socioeconomic statuses, have led to a high rate of tuberculosis in the neighborhood. It also notes how the urban location and pollution sources negatively impact health, and that the social system in the community is not very cohesive. In conclusion, it stresses the need for tuberculosis assistance and the healthcare system to properly address the community's problems. Characteristics of Community health Nursing Six important characteristics of community health nursing It is a specialty field of nursing Its practice combines public health with nursing it is population focused.  it emphasizes on wellness and other than disease or illness it involves inter-disciplinary collaboration it promotes client’s responsibility and self-care Community settings nursing care takes place in a wide variety of settings which includes promoting health, preventing illness, maintaining health, restoration, coordination, management and evaluation of care of individuals, families, and aggregates, including communities (Lancaster, S.). CHARACTERISTICS 1.Promotion of health and prevention of disease 2.Comprehensive, general, continual, and not episodic 3.Levels of clientele –individuals, families and population groups 4.The nurse and the client have greater control in making decisions related to healthcare and they collaborate as equals 5.The nurse recognizes the impact of different factors on health and has a greater awareness of his/her client’s lives and situations What is the framework of community health nursing? The framework provides guidance on the core functions, roles and areas of work of community health nurses in the health-care system, classification of the population targets, competencies of nurses working in the community, and the participatory teaching and learning process. FRAMEWORK FOR COMMUNITY HEALTH NURSING 1. Health care delivery system 2. The clients 3. Health 4. Economic, sociocultural, political and environmental factors CLIENTS OF COMMUNITY HEALTH NURSES Individual Family Population Group Community Community location means a public or private elementary or secondary school, a church, a public library, a public playground, or a public park. A social system is a relational bond of personal or environmental roles that are a part of a whole, larger community. This social system also includes a larger society that works together and functions as a connection between community organizations and larger institutions. The main premise of a social system is to fulfill the needs of the larger unit of society. Communities, schools, religious buildings, and businesses are all examples of the units of society. Families, a local chamber of commerce, a preschool, or a specific religious group is the social system. Roles of Community Health Nursing Clinician Educator Advocate Managerial Collaborator Leader Researcher A. Clinician role /direct care provider The clinician role in the community health means that the nurse ensures that health services are provided, not just to individuals and families but also to groups and population. For community health nurses the clinician role involves certain emphasis different from basic nursing, i.e. – Holism, health promotion, and skill expansion.  Health Promotion focus on wellness: The community health nurse provides service along the entire range of the wellness – illness continuum but especially emphasis on promotion of health and prevention of illness. B. Educator role It is widely recognized that health teaching is a part of good nursing practice and one of the major functions of a community health nurse (Brown, 1988). The educator role is especially useful in promoting the public’s health for at least two reasons. The educator role: - Has the potential for finding greater receptivity and providing higher yield results. - Is significant because wider audience can be reached. The emphases throughout the health teaching process continue to be placed on illness prevention and health promotion. C. Advocate role The issue of clients’ rights is important in health care today. Every patient or client has the right to receive just equal and humane treatment. Managerial role As a manager the nurse exercises administrative direction towards the accomplishment of specified goals by assessing clients’ needs, planning and organizing to meet those needs, directing and controlling and evaluating the progress to assure that goals are met.  Nurses serve as managers when they oversee client care, supervise ancillary staff, do case management, manage caseloads, run clinics or conduct community health needs assessment projects. E. Case management Case management refers to a systematic process by which the nurse assesses clients’ needs, plans for and co-ordinates services, refers to other appropriate providers, and monitors and evaluates progress to ensure that clients multiple service needs are met. F. Collaborator role Community health nurses seldom practice in isolation. They must work with many people including clients, other nurses, physicians, social workers and community leaders, therapists, nutritionists, occupational therapists, psychologists, epidemiologists, biostaticians, legislators, etc. as a member of the health team (Fairly 1993, Williams, 1986).  The community health nurse assumes the role of collaborator, which means to work jointly in a common endeavor, to co-operate as partners.  In general—community health nurses directly help people make the best use of the systems in place, while public health nurses focus on improving those systems. PUBLIC HEALTH NURSING The practice of nursing in local/national health departments (which includes health centers and rural health units and public schools Implementers of the local government units’ mandate in promoting and protecting the health of their constituents. A public health nurse is a registered nurse (RN) who advocates for positive changes in population health. This exciting career gives nurses the opportunity to work directly within communities to educate people and give them the tools they need to improve their health outcomes. In general, the responsibilities of public health nurses include: Recording and analyzing aggregate medical data Evaluating the health of patients and creating treatment plans Monitoring patients for any changes in condition Delivering top-quality care alongside physicians Educating patients about available support services and helping them access care  Emphasizing primary prevention in order to avoid disease or injury before it occurs Working with public health officials to help underserved communities gain access to care Developing a relationship with patients and following up to track progress Referring patients to other providers as needed Assessing health trends in communities Managing budgets of public health programs Qualities of a Public Health Nurse The best public health nurses are excellent communicators and critical thinkers, and they are able to juggle multiple priorities. Nurses in this field tend to be enthusiastic and have a genuine interest in protecting community health. Public health nursing is a great role for anyone who enjoys problem-solving, working with a network of professionals, impacting lives, and influencing change. What Does a Public Health Nurse Do? The role of a public health nurse is to promote public wellness. In this capacity, nurses focus on helping underserved and at-risk individuals gain access to the care they need. The main goal of public health nurses is to help prevent disease and reduce health risks at the population level through evidenced-based care and education. OCCUPATIONAL HEALTH NURSING Assisting workers in all occupations to cope with actual and potential stresses in relation to their work and work environment. Primarily geared at helping workers attain and maintain optimum level of physical and psychological functioning. In labor code, if a company has more than 50 workers, the service of a full time nurse should be provided.  Has a bachelor’s degree in nursing and a registered nurse in the Philippines Has at least 5 years experience in general nursing service administration Has masters degree in nursing Member of a good standing of the accredited professional organization of nurses Function: 1.Emergency and palliative care Palliative care is specialized medical care providing physical, emotional and spiritual support for people living with chronic conditions or serious illness. Palliative care helps people manage physical symptoms and emotional stressors and focuses on patient's goals for care, values and what's important to them. 2. Family planning 3. Counseling 4. Immunization 5. Environmental sanitation 6. Work safety 7. Disaster prevention and control 8. Orientation of new employees 9. Dissemination of health information /health education 10. Administrative SCHOOL NURSING Prevent health problems that could hinder students’ learning and performance of their developmental tasks Promote the health of school personnel and pupil/students. Functions: 1. Health and nutrition assessment, screening, and case- finding 2. Treatment of common ailments and attending to emergency cases 3. Counseling and health education 4. Nursing procedures 5. Supervision of health and safety of the school 6. Referrals and follow-ups of pupils and personnel STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES NURSING SERVICE Separate and distinct unit of the local health agency/unit which is composed of nurses, midwives and auxiliaries such as barangay health workers, nursing aides and volunteers Organization and Management A nursing service is organized in a local health agency to ensure the effective delivery of nursing services and nursing component of public health programs. The nursing service is headed by a qualified chief nurse (RA 9173) Standards of Public Health Nursing in the Philippines Data collection/Assessment PHN collects comprehensive data pertinent to the health status of populations (individualized to population, assess health literacy, determine barriers and limitations, prioritize risks, evidence- based practice). Population Diagnosis and Priorities PHN analyzes the assessment data to determine the diagnoses or issues(derives comprehensive population diagnoses/priorities, validates the diagnoses or concerns agencies and/or organizations, identifies actual or potential risks, documents). Outcomes Identification PHN identifies expected outcomes for a plan specific to the problem or situation (involves population/other professionals/organizations/stakeholders, culturally appropriate, consider beliefs and values/benefits and risks, costs/social policies, incorporate knowledge of available resources/environmental factors/ethical, legal, privacy considerations, reflect long term commitment to population, modify as needed and document). Planning PHN develops a plan that prescribes strategiesand alternatives to attain expect outcomes(population- focused plans and prioritization of determinants of health/health assets/concerns/needs/risks, address promotion, improvement, and restoration of health/prevention of illness, injury, or disease/alleviation of suffering/emergency preparedness and response, wellness across lifespan, partnerships, applying current regulations, ecological consideration, document, integrate trends). Implementation PHN implements the identified plan (partnerwith individuals/families/groups/communities, applies evidence-based strategies/activities/outcome measures, provide holistic care, incorporate systems and population resources, consider cultural diversity and major health problems when implementing, integrate ecological perspective, monitor implementation, collaborate with others, accommodate different styles of communication, integrate traditional and complementary health practices, document, use technology to measure, record, and retrieve data). Evaluation PHN evaluates progress toward attainment of outcomes (systematic/ongoing/criterion- based evaluation of programs, collaborate with target population/stakeholders, apply epidemiological and scientific methods to determine effectiveness, use info technology, ongoing assessment data usage, disseminate the evaluation results, monitor and assure appropriate use of programs, document results).  Evaluates responses of clients to Evaluates responses of clients to interventions to note progress toward interventions to note progress toward goal achievement, revise data base, goal achievement, revise data base, diagnoses and plan. diagnoses and plan. Evaluate effectiveness, accessibility, Evaluate effectiveness, accessibility, and quality of personal and population-and quality of personal and population- based health services. based health services. Coordination of Care PHN coordinates care delivery(promotes policies/programs/services, facilitate communication, conducts surveillance, connects populations with needed services, implements follow-up referrals, documents coordination of care). Health Teaching and Health Promotion PHN employs multiple strategies to promote and a safe environment (appropriate health education related to available resources/developmental needs/healthy lifestyle choices and behaviors/health promotion, disease prevention, risk-reduction strategies/multiple determinants of health; evidence-based health promotion appropriate to situation, anticipatory guidance, intended effects and potential adverse effects of proposed policies/programs/services, obtaining feedback and evaluation, use of appropriate technology. Regulatory Activities PHN participates in applications of public health laws, regulations, and policies (describes the structure/function/jurisdictional authority of organizational units, educate affected populations, support public health policies/ programs/resources, monitors and inspects regulated entities, collect information, assist with addressing noncompliance with laws, emergency preparedness) Evidenced-based Practice and Research PHN integrates evidence and research findings into practice (utilize the best current evidence, engage in research, implement research protocols, critically analyze/interpret results, share research activities). Indulges in research to contribute to theory Indulges in research to contribute to theory and practice in community health nursing and practice in community health nursing Research for new insights and innovate solutions to health problems, solutions to health problems. DEFINITION OF TERMS: The following terms and concepts were used in this report and were defined as follows: ATTENDED - refers to the cases given medical care at any point in time during the course of the illness which directly caused death. Medical care may either be provided directly by a medical doctor or indirectly by allied health care providers, i.e., nurses and midwives who are under the direct supervision of a medical doctor. Otherwise, case is categorized as “death unattended”. BIRTH ORDER – is the numerical order of a child in relation to all previous pregnancies of the mother. BIRTH WEIGHT - is the first weight of the fetus or newborn obtained after birth. CRUDE BIRTH RATE (CBR) - is a measure of one characteristic of the natural growth or increase of a population. CRUDE DEATH RATE (CDR) – is measure of one mortality from all causes which may result in a decrease of population. CRUDE or GENERAL RATES - These rates are referred to the total living population. It must be presumed that the total population was exposed to the risk of the occurrence of the event. DEATH – is the permanent disappearance of all evidence of life at any time after live birth has taken place (postnatal cessation of vital functions without capability of resuscitation). FETAL DEATH – is the death prior to the complete expulsion or extraction of a product of conception from its mother, irrespective of the duration of pregnancy; The death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. FETAL DEATH RATE (FDR) - Measures pregnancy wastage. Death of the product of conception prior to its complete expulsion, irrespective of duration of pregnancy. INCIDENCE RATE (IR) - Measures the frequency of occurrence of the phenomenon during a given period of time. Deals only with new cases.  Morbidity means being in a state of illness, whereas mortality refers to death Incidence is the number of new cases (morbidity or mortality) usually expressed as a proportion, during a specified time period Prevalence is the total number affected in the population, again usually expressed as a proportion. INFANT MORTALITY/DEATH – is the death of an infant under one year of age. INFANT MORTALITY RATE (IMR) - Measures the risk of dying during the 1st year of life. It is a good index of the general health condition of a community since it reflects the changes in the environmental and medical conditions of a community. LATE FETAL DEATH – is the death of fetus with 28 or more completed weeks of gestation. LIVE BIRTH – is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such birth is considered liveborn. MATERNAL MORTALITY/DEATH – is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. MATERNAL MORTALITY RATE (MMR) - It measures the risk of dying from causes related to pregnancy, childbirth and puerperium. It is an index of the obstetrical care needed and received by the women in a community. NEONATAL DEATH – is the death among live births during the first 28 completed days of life. NEONATAL DEATH RATE (NDR) - Measures the risk of dying during the 1st month of life. May serve as index of the effects of prenatal care and obstetrical management on the newborn. PLACE OF OCCURRENCE - refers to the place where the vital event took place. PREVALENCE RATE (PR) - Measures the proportion of the population which exhibits a particular disease at a particular time. This can only be determined following a survey of the population concerned. Deals with total (old and new) number of cases. PROPORTIONATE MORTALITY (PM) - Shows the numerical relationship between deaths from a cause (or groups of causes), age (or groups of age) etc. and the total number of deaths from all causes in all ages taken together. Not a measure of risk of dying. PROPORTIONATE MORTALITY (PM) - RATE - In Vital Statistics, a rate shows the relationship between a vital event and those persons exposed to the occurrence of said event, within a given area and during a specified unit of time. It is evident that the persons experiencing the event (the numerator) must come from the total population exposed to the risk of same event (the denominator). RATIO - It is used to describe the relationship between two (2) numerical quantities or measures of events without taking particular considerations to the time or place. These quantities need not necessarily represent the same entities, although the unit of measure must be the same for both numerator and denominator of the ratio. SPECIFIC DEATH RATE - Describes more accurately the risk of exposure of certain classes or groups to particular diseases. SPECIFIC RATE - The relationship is for a specific population class or group. It limits the occurrence of the event to that portion of the population definitely exposed to it. TOTAL FERTILITY RATE (TFR) – refers to the number of children a woman would have by the time she reaches age 50 under a given fixed fertility schedule. It is sometimes referred to as completed family size. It is the average number of births per 100 females aged 15-49 years. USUAL RESIDENCE – refers to the place where the person/deceased habitually or permanently resides.  Attack rate Percentage of the population that contracts the disease in an at risk population during a specified time interval In epidemiology, the attack rate is the proportion of an at-risk population that contracts the disease during a specified time interval. It is used in hypothetical predictions and during actual outbreaks of disease. An at-risk population is defined as one that has no immunity to the attacking pathogen, which can be either a novel pathogen or an established pathogen. It is used to project the number. The overall attack rate refers to the total number of new cases divided by the total population: Attack Rate (%) = No. of new cases of disease during time interval / Population at risk at start of time interval x 100 Centers for Disease Control and Prevention: Principles of Epidemiology in Public Health Practice, Third Edition – An Introduction to Applied Epidemiology and Biostatistics FORMULA OF VITAL HEALTH INDICATORS Attack Rate (AR) No. of persons acquiring a disease registered in a given year A R = -------------------------------------------------- x 100 No. exposed to same disease in same year  Mortality rate A mortality rate is a measure of the frequency of occurrence of death in a defined population during a specified interval. Morbidity and mortality measures are often the same mathematically; it’s just a matter of what you choose to measure, illness or death.  The formula for the mortality of a defined population, over a specified period of time, is: Deaths occurring during a given time period ---------------------------------------------------------------- x100 Size of the population among which the deaths occurred (number of people in the population) Example: Suppose in a town 300 death were recorded, the towns population before the deaths was 700. Calculate the towns mortality rate Case Fatality Ratio(CFR) No. of registered deaths from a specific disease for a given year CFR = ----------------------------------------------------- x 100 No. of registered cases from same specific disease in same year Example of CFR No. of deaths during a specific period after heart disease onset Divide by Persons with heart disease during that period PROPORTIONATE MORTALITY HEART DISEASE No of deaths from heart disease 100/500=0.2=20% ---------------------------------------------X 100 Total Deaths Crude Birth Rate (CBR) Total No. of live births registered in a given calendar year CBR = --------------------------------------------- ---------------- x 1,000 Estimated population as of July 1 of same year Crude Death Rate (CDR) Total no. of deaths registered in a given calendar year CDR = --------------------------------------------- ---------------- x 1,000 Estimated population as of July 1 of same year Fetal Death Ratio Total no. of fetal deaths registered in a given calendar year FDR = ------------------------------------------------------ x 1,000 Total no. of live births registered of same year Fetal Death Rate Total no. of fetal deaths registered in a given calendar year FDR = --------------------------------------------------- ---------- x 1,000 Total no. of births (livebirths and fetal deaths) registered of same year Incidence Rate (IR) No. of new cases of a particular disease registered during a specified period of time I R = ---------------------------------------------------- x 100,000 Population at risk Infant Mortality Rate (IMR) Total no. of deaths under 1 year of age registered in a given calendar year IMR = --------------------------------------------------------- x 1,000 Total no. of registered live births of same calendar year Maternal Mortality Rate (MMR) Total no. of deaths from maternal causes registered for a given year MMR = ------------------------------------------------------- ------ x 1,000 Total no. of women under reproductive age Neonatal Death Rate (NDR) No. of deaths under 28 days of age registered in a given calendar year NDR = ------------------------------------------------------x 1,000 No. of live births registered of same year Prevalence Rate (PR) No. of new and old cases of a certain disease registered at a given time PR= -----------------------------------------------------X100 No. of registered deaths from all causes, all ages in same year Proportionate Mortality (PM) No. of registered deaths from a specific cause or age for a given calendar year P M = ------------------------------------------------- x 100 No. of registered deaths from all causes, all ages in same year Specific Death Rate (SDR) Deaths in specific class or group registered in a given calendar year SDR= ---------------------------------X100,000 Death Rate Estimated population as of July 1 in same specified class or group of said year(estimated midyear population) Example of SDR Disease Specific Mortality Rate No. of deaths from lung cancer -----------------------------------------X 1000 No. of people with lung cancer@ midyear 2,800 lung cancer deaths -----------------X 1000 =280 per 100,000 population 1,000,000 Another Example of SDR: Age Specific death rate Total number of deaths in a specified age group --------------------------------------------------------X 1000 Mid-year population of the specified age group Examples: No. of deaths from a specific cause registered in a given calendar year Cause-specific = -------------------------------------------- ---- x 100,000 Death Rate Estimated population as of July 1st of same year No. of deaths in a particular age group registered in a given calendar year Age-specific = ----------------------------------------------- ----- x 100,000 Death Rate Estimated population as of July 1st in same age group of same year Death Rate Estimated population as of July 1st in same age group of same year No. of deaths of a certain sex registered in a given calendar year Sex-specific = ----------------------------------------- ------------ x 100,000 Death Rate Estimated population as of July 1 in same sex for same year The Philippine Health Statistics (PHS) series is the Department of Health’s (DOH) annual publication that compiles statistics on vital health events. It provides comprehensive summary of the country’s current statistics on natality and mortality based on registration. It also summarizes morbidity data collected from the field health offices nationwide. Thus, the PHS is a secondary data source for these vital health events. The PHS is a product of the collaborative and coordinated efforts of the Philippine Statistics Authority (PSA), this Department and our partners from the local health units.  The statistical data on births, deaths and population estimates were provided by the PSA and data on notifiable diseases for morbidity tabulation were collected through the DOH’s Field Health Service Information System (FHSIS).  The data from these two sources were summarized, analyzed, interpreted and presented in tables and graphs for a more meaningful and useful information.  The PHS is intended to be one of the data sources which can be used by health authorities at various levels of the health sectors as their basis for planning, implementation and assessment of health programs and services. These data can also be utilized to assess costs of health care, develop and improve health interventions, or identify targets for health programs.  These are also important tools not only for planning but also for monitoring and evaluation of health programs. Likewise, statistical data in this publication can also be beneficial to the researchers, academicians and local government executives.  However, due to difference in source and data collection procedures, resulting in some limitations, caution in interpretation of data is highly recommended. Natality and Mortality Statistics Effective March 1973 a collaborative program was drawn with the National Statistics Office (NSO), now known as PSA as per RA 10625, otherwise known as the Philippine Statistical Act of 2013, whereby that Office shall provide basic tabulation on births and deaths. Summary tables on births, deaths, infant and fetal deaths were taken from the said Office. The basis of the registration of vital events regarding births and deaths is Republic Act No. 3753 otherwise known as the Civil Registry Law. By virtue of Commonwealth Act 591, the Administrator of NSO will be the concurrently Civil Registrar General with all local civil registrars under his supervision.  In the cities, the local civil registrars are also the officials designated in their respective city charters, generally the City Health Officers, while in regular municipalities and municipal districts, the municipal treasurers and municipal district treasurers act as local civil registrar respectively.  Each vital event is registered in the office of the civil registrar of the locality where the event occurred and a copy of each document is sent to the Office of the Civil Registrar General of the PSA for processing and archiving. Statistics were obtained from Death Certificate (Municipal Form No. 103) and Certificate of Live Birth (Municipal Form No. 102).  Statistics were obtained from Death Certificate (Municipal Form No. 103) and Certificate of Live Birth (Municipal Form No. 102). The Vital Statistics Division of the PSA consolidates and tabulates total counts of registered live births and deaths.  Fetal and infant deaths have separate tables for deaths by cause, while, causes of maternal death were taken from deaths by age group and by cause. By virtue of a Data Product Agreement between the PSA and DOH, the former furnishes the DOH electronic data files upon submission and approval of the Data Product Agreement Form for Data Requests.  The DOH then generates statistical tables from the data files, computes rates and percentages of different indicators significant to the needs of its various clients and stakeholders. Some tables come with graphs and textual description for better understanding and utilization of data.  Notifiable Disease Statistics The data on Notifiable Diseases were based on information submitted by health personnel of different Rural Health Units (RHUs), City Health Offices (CHOs) or Municipal Health Offices (MHOs) and Provincial Health Offices (PHOs).  The Republic Act No. 11332 also known as the “ Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act” mandates all public and private physicians, allied medical personnel, professional societies, hospitals, clinics, health facilities, laboratories, institutions, workplaces, schools, prisons, ports, airports, establishments, communities, other government agencies, and NGOs to accurately and immediately report notifiable diseases and health events of public health concern as issued by the DOH.  The Epidemiology Bureau (EB) of DOH will then prepare a Morbidity Statistics as part of the Field Health Service Information System (FHSIS) Annual Report.  Epidemiology is the study of populations to monitor the health of the population, understand the determinants of health and disease in communities, and investigate and evaluate interventions to prevent disease and maintain health. Epidemiology focuses on populations, whereas clinical medicine focuses on the diagnosis and treatment of disease in individuals.  Epidemiology studies populations to determine the causes of health and disease in communities and to investigate and evaluate interventions that will prevent disease and maintain health. Nurses are a key part of the interdisciplinary team in community settings and often use epidemiology to look at health and at disease causation and how to both prevent and treat illness.  Nurses use epidemiology in the community to examine factors that affect the individual, family, and population group because it is more difficult to control these factors in the community than in the hospital. Community health nurses who conduct education classes, organize health fairs and address student health issues are using prevention strategies.  Risk refers to the probability that an event will occur within a specified time period. A population at risk is the population of persons for whom there is some finite probability (even if small) of that event occurring. Incidence rates and proportions measure the rate of new case development in a population and provide an estimate of the risk of disease.  An incidence rate quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk that experiences the event over some period of time. The population at risk is considered to be persons without the event or outcome of interest but who are at risk of experiencing it.  People who already have the disease or outcome of interest are excluded from the population at risk for this calculation because they already have the condition and are no longer at risk of developing it. Demography, statistical study of human populations, especially with reference to size and density, distribution, and vital statistics (births, marriages, deaths, etc.). vital rates, relative frequencies of vital occurrences that affect changes in the size and composition of a population. Principal among vital rates are the crude birth rate and the crude death rate; i.e., annual numbers of births or of deaths per 1,000 population, based on the midyear population estimate. The difference between these two rates is the rate of natural increase (or decrease, if deaths exceed births). birth rate, frequency of live births in a given population, conventionally calculated as the annual number of live births per 1,000 inhabitants.  The crude birth rate (CBR) and crude death rate (CDR) are statistical values that can be used to measure the growth or decline of a population. The crude birth rate and crude death rate are both measured by the rate of births or deaths respectively among a population of 1,000. The CBR and CDR are determined by taking the total number of births or deaths in a population and dividing both values by a number to obtain the rate per 1,000.  For example, if a country has a population of 1 million, and 15,000 babies were born last year in that country, we divide both the 15,000 and 1,000,000 multiply by 1,000 to obtain the rate per 1,000. Thus the crude birth rate is 15 per 1,000.  The crude birth rate is called "crude" because it does not take into account age or sex differences among the population. In our hypothetical country, the rate is 15 births for every 1,000 people, but the likelihood is that around 500 of those 1,000 people are men, and of the 500 who are women, only a certain percentage are capable of giving birth in a given year.  Birth Trends Crude birth rates of more than 30 per 1,000 are considered high, and rates of less than 18 per 1,000 are considered low. The global crude birth rate in 2016 was 19 per 1,000. In 2016, crude birth rates ranged from 8 per 1,000 in countries such as Japan, Italy, Republic of Korea, and Portugal to 48 in Niger. The CBR in the United States continued trending down, as it did for the entire world since peaking in 1963, coming in at 12 per 1,000. By comparison in 1963, the world's crude birth rate hit more than 36.  In 2021, a total of 1,364,739 live births were registered, which is equivalent to a crude birth rate (CBR) of 12.4 or 12 births per thousand population. The number of registered live births showed a generally decreasing trend. A decrease of -23.8 percent in the registered live births was noted in the past ten years, from 1,790,367 in 2012 to 1,364,739 in 2021. The highest rate of decline was noted in 2021 with -10.7 percent.  On the average, 3,739 babies were born daily, which translates to 156 babies born per hour or approximately three (3) babies born per minute In 2021, more males (711,434 or 52.1% share) were born than females (653,305 or 47.9% share), resulting in a sex ratio at birth of 109 males per 100 females.  Chart and table of the Philippines fertility rate from 1950 to 2024. United Nations projections are also included through the year 2100.The current fertility rate for Philippines in 2024 is 2.431 births per woman, a 0.94% decline from 2023. The fertility rate for Philippines in 2023 was 2.454 births per woman, a 1.01% decline from 2022. The fertility rate for Philippines in 2022 was 2.479 births per woman, a 1% decline from 2021. The fertility rate for Philippines in 2021 was 2.504 births per woman, a 1.03% decline from 2020.  Philippines - Birth Rate, Crude Crude birth rate indicates the number of live births occurring during the year, per 1,000 population estimated at midyear. Subtracting the crude death rate from the crude birth rate provides the rate of natural increase, which is equal to the rate of population change in the absence of migration.  Chart and table of the Philippines birth rate from 1950 to 2024. United Nations projections are also included through the year 2100.The current birth rate for Philippines in 2024 is 19.378 births per 1000 people, a 1.03% decline from 2023.  The birth rate for Philippines in 2023 was 19.579 births per 1000 people, a 1.01% decline from 2022. The birth rate for Philippines in 2022 was 19.778 births per 1000 people, a 1% decline from 2021. The birth rate for Philippines in 2021 was 19.978 births per 1000 people, a 0.99% decline from 2020.  Death Trends The crude death rate measures the rate of deaths for every 1,000 people in a given population. Crude death rates of below 10 are considered low, while crude death rates above 20 per 1,000 are considered high.  Birth, Marriage, and Death Statistics for 2023 (Provisional, as of 30 June 2024) Release Date: Friday, August 30, 2024 The data on the number of births, marriages, and deaths (vital events) presented in this regular monthly release were obtained from the vital events registered, either timely or belatedly, at the appropriate Office of the City/Municipal Civil Registrar throughout the country and subsequently submitted for encoding to the Office of the Civil Registrar General through the Provincial Statistical Offices (PSOs) of the Philippine Statistics Authority (PSA).  Philippines - Death Rate, Crude Crude death rate indicates the number of deaths occurring during the year, per 1,000 population estimated at midyear. Subtracting the crude death rate from the crude birth rate provides the rate of natural increase, which is equal to the rate of population change in the absence of migration.  It has been falling around the world (and dramatically in developing economies) due to longer life spans brought about by a better food supplies and distribution, better nutrition, better and more widely available medical care (and the development of technologies such as immunizations and antibiotics), improvements in sanitation and hygiene, and clean water supplies. Much of the increase in world population over the last century overall has been attributed more to longer life expectancies rather than an increase in births.  infant mortality rate, measure of human infant deaths in a group younger than one year of age. It is an important indicator of the overall physical health of a community. High infant mortality rates are generally indicative of unmet human health needs in sanitation, medical care, nutrition, and education.  To compute a given year’s infant mortality rate in a certain area, one would need to know how many babies were born alive in the area during the period and how many babies who were born alive died before their first birthday during that time.  The number of infant deaths is then divided by the number of infant births, and the results are multiplied by 1,000 so that the rate reflects the number of infant deaths per 1,000 births in a standardized manner. Alternately, the rate could be multiplied by 10,000 or 1,000,000, depending on the desired comparison level.  There are a number of causes of infant mortality, including poor sanitation, poor water quality, malnourishment of the mother and infant, inadequate prenatal and medical care, and use of infant formula as a breast milk substitute.  Women’s status and disparities of wealth are also reflected in infant mortality rates. In areas where women have few rights and where there is a large income difference between the poor and the wealthy, infant mortality rates tend to be high.  Contributing to the problem are poor education and limited access to birth control, both of which lead to high numbers of births per mother and short intervals between births. High-frequency births allow less recovery time for mothers and entail potential food shortages in poor families.  When women are educated, they are more likely to give birth at later ages and to seek better health care and better education for their children, including their daughters.  Poor sanitation and water quality In least-developed countries (LDC) a primary cause of infant mortality is poor quality of water. Drinking water that has been contaminated by fecal material or other infectious organisms can cause life- threatening diarrhea and vomiting in infants. A lack of clean drinking water leads to dehydration and fluid volume depletion.  Breast Feeding controversies The use of infant formula has come under attack in both developing countries and LDCs as well as in the industrialized world. Many forms of infant formula start as powders that must be mixed with water to be used.  The World Health Organization (WHO) has questioned the use of breast milk substitutes in poor families, particularly in areas where clean water is not available, because it may increase the risk of infant death.  Low birth weight is the single most significant characteristic associated with higher infant mortality. In industrialized countries, low birth weights are characteristic of premature births. However, in LDCs they more frequently occur at full term, because of a lack of adequate maternal nutrition or because of malaria, measles, or other infectious diseases, such as HIV.  For a full-term infant, low birth weight is a weight less than 2,500 grams (5 pounds 8 ounces) at birth or a weight that is one standard deviation or more below the weight expected for that age in a reference population.  Chances of survival for a premature birth vary greatly depending on the available resources. Premature infants (born at less than 37 weeks gestation) have a higher risk of death not only because of low birth weight but also because their respiratory and digestive systems are not fully mature.  Prenatal care Good prenatal care has been linked to reduced infant mortality. Ideally, prenatal care should begin as early in the pregnancy as possible, with visits to a health care provider every 4 weeks during the first 28 weeks of pregnancy, every 2 to 3 weeks for the next 8 weeks, and weekly thereafter until delivery. Using this formula, the appropriate number of prenatal visits for a 39- week pregnancy is 12. Maintaining such a schedule requires time, effort, and—most important—access to a system of affordable health care, which is lacking in many LDCs and even in some industrialized countries.  Race and infant mortality The United States may be regarded as having several infant mortality rates: one for the white population, one for the Asian population, one for Native Americans, and another for African Americans. African American babies are nearly two and a half times more likely to die before their first birthday than are white babies. According to the U.S. Center for Disease Control, infant mortality among African Americans in 2014 occurred at a rate of 10.93 deaths per 1,000 live births, nearly twice the national average of 5.82. Preterm delivery with low birth weight is the leading cause of infant death for African American infants, occurring at a rate that is more than three times greater than that for white Americans. Sudden infant death syndrome (SIDS) is more than twice as common among American Indian and Alaska Natives than it is among non-Hispanic whites. Those differences stem from differences in health access, poverty, and other effects of racism. Rates of infant mortality among Chinese and Japanese Americans tend to be the lowest of all U.S. ethnic groups.  Conclusion To lower infant mortality rates in LDCs, basic needs must be met: clean water, good sanitary conditions, adequate nutrition, education, and family planning are paramount. Health interventions designed to prevent preterm delivery and to improve prenatal care may also improve infant mortality rates. Communities can play an important part in this campaign by encouraging women to seek prenatal care in the first trimester of pregnancy and by making care available. In industrialized countries the focus must also include eliminating disparities in access to health care.  Mortality The risk of death for both sexes is high immediately after birth, diminishing during childhood and reaching a minimum at 10 to 12 years of age. The risk then rises again, until at late ages it surpasses that of the first year of life. The expectation of life at birth is the most efficient index of the general level of mortality of a population.  life expectancy, estimate of the average number of additional years that a person of a given age can expect to live. The most common measure of life expectancy is life expectancy at birth. Life expectancy is a hypothetical measure. It assumes that the age-specific death rates for the year in question will apply throughout the lifetime of individuals born in that year. The estimate, in effect, projects the age-specific mortality (death) rates for a given period over the entire lifetime of the population born (or alive) during that time. The measure differs considerably by sex, age, race, and geographic location. Therefore, life expectancy is commonly given for specific categories, rather than for the population in general. For example, the life expectancy for white females in the United States who were born in 2003 is 80.4 years.  Demography is the statistical study of human populations. Demography examines the size, structure, and movements of populations over space and time. It uses methods from history, economics, anthropology, sociology, and other fields. Demography is useful for governments and private businesses as a means of analyzing and predicting social, cultural, and economic trends related to population. Epidemiology is the study of the occurrence and characteristics of illness within a population.  epidemiology, branch of medical science that studies the distribution of disease in human populations and the factors determining that distribution A variety of tools, including mortality rates and incidence and prevalence rates, are used in the field of epidemiology to better understand the characteristics of disease within and across populations.  A great pioneer in the field of epidemiology was English physician John Snow- the father of epidemiology Snow became interested in the cause and spread of cholera epidemics that periodically occurred in London. Because of his study methods and insight, Snow is generally regarded as the father of modern epidemiology.  Epidemiological models Epidemiologists often use models to explain the occurrence of disease. One commonly used model views disease in terms of susceptibility and exposure factors. In order for individuals to develop a disease, they must be both susceptible to the disease and exposed to the disease.  For example, for a person to develop measles (rubeola), a highly infectious viral disease that was once common among children, the individual must be exposed to a person who is shedding the measles virus (an active case) and must lack immunity to the disease. Immunity to measles may be derived from either previously having had the disease or from having been vaccinated against it.  Another commonly used model, the epidemiologic triad (or epidemiologic triangle), views the occurrence of disease as the balance of host, agent, and environment factors. The epidemiologic triangle considers the extent of the host's exposure to the agent, the virulence of the agent, and the host's genetic or immunological susceptibility to the agent.  The host is the actual or potential recipient or victim of the disease. Hosts have characteristics that either predispose them to or protect them from disease. Those characteristics may be biological (e.g., age, sex, and degree of immunity), behavioral (e.g., habits, culture, and lifestyle), or social (e.g., attitudes, norms, and values).  The agent is the factor that causes disease. Agents may be biological (e.g., bacteria and fungi), chemical (e.g., gases and natural or synthetic compounds), nutritional (e.g., food additives), or physical (e.g., ionizing radiation).  The environment includes all external factors, other than the host and agent, that influence health. The environment may be categorized as the social environment (e.g., economic, legal, and political), the physical environment (e.g., weather conditions), or the biological environment (e.g., animals and plants).  To illustrate the epidemiologic triad, a case of lung cancer may be considered. The host is the person who developed lung cancer. He or she may have had the habit of smoking for many years. The agents are the smoke and the tars and toxic chemicals contained in the tobacco. The environment may have been the workplace where smoking on the job was permitted and sites where cigarettes or other tobacco products were readily available.  Web of causation Chronic disease is marked by a complexity of relationships among causal factors. The web of causation model illustrates the interrelationships. The person-place-time model organized epidemiologists' investigations of the disease pattern in the community.  The wheel model is an example of a model that stresses the multiplicity of host and environmental interactions  Definitions of disease occurrence What does Endemic mean? A disease outbreak is endemic when it is consistently present but limited to a particular region. This makes the disease spread and rates predictable. Malaria, for example, is considered endemic in certain countries and regions. Endemic is defined as the usual occurrence of a disease within a population.  Diseases that are constantly present (often at a low level) in a population within a particular geographic region are called endemic diseases. For example, malaria is endemic to Palawan.  Sporadic- appearing or happening at irregular intervals in time; occasional Examples of sporadic diseases include tetanus rabies and plague  epidemic is a sudden and great increase in the occurrence of a disease within a population. -also refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area. Diseases for which a larger than expected number of cases occurs in a short time within a geographic region Influenza is a good example of a commonly epidemic disease  Pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people. 10 Pandemics Throughout History 10. Antonine Plague (165 AD-180 AD) Also known as the Plague of Galen, it was an ancient pandemic that broke out across the Roman Empire, through Asia, all Roman cities in Italy, and Greece. Eventually, it reached Spain, Egypt, and North Africa among other areas. At the height of the pandemic, it killed 2,000 people per day. Many believe that it was caused by smallpox and measles  9. The Black Death (1347-1352) It was the deadly pandemic that swept through Europe and Asia among other continents and killed an estimated 25 million people in Europe. Aside from having fever and chills, those afflicted also had blood and pus seeping out of swellings all over the body. 8. Small Pox Pandemic (1870-1874) Before the world completely rid itself of this horrendous disease, it swept through continents killing three out of ten victims. Those who survived were left with deep scars which were even found in 3000-year-old mummies, showing that it ravaged ancient civilizations for thousands of years. But it was in 1870 during the Franco-Prussian war that smallpox spread throughout the world. From Europe, it reached Asia through America causing 500,000 deaths worldwide  7. Cholera (1871-1824) The first of seven cholera pandemics emerged in India in 1817. According to the World Health Organization cholera is an acute diarrheal infection caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae. Three years after it spread throughout India it reached different countries in Asia. In 1821 it was brought by British troops traveling from India even to countries outside Asia  6. Russian Flu of 1889 (1889-1890) Called the first-ever modern flu pandemic, the Russian flu which started in St. Petersburg, spread through Europe infecting even prominent world leaders. After a few months, it reached virtually every part of the planet. An estimated 1 million people died of the Russian flu  5. Spanish Flu (1918-1919) The Spanish flu of 1918 is considered the deadliest in history, infecting 1/3 of the world’s population and killing 20 to 50 million people worldwide. It came in three waves. The first wave was almost like the common flu and hit in the spring of 1918. The second wave that appeared in the fall of the same year was deadlier. It killed people within hours or a few days after the onset of symptoms. The third wave that came the following year was just as deadly and added more to the death toll  4. H3N2 Pandemic (1968) The 1968 flu pandemic was caused by the influenza H3N2 virus. Although relatively not as deadly, the virus was highly contagious that it spread throughout Southeast Asia within two weeks after it first emerged in Hong Kong in July 1968. By December the virus has reached The United States, United Kingdom, and other countries in Europe. It killed an estimated one million people  3. HIV/AIDS (1981) The first case of acquired immunodeficiency syndrome (AIDS) was reported in 1981. Since then HIV (Human Immunodeficiency Virus) has spread globally infecting more than 65 million people according to the Centers for Disease Control and Prevention. There is still no known cure for this sexually transmitted disease but there are already treatments that keep the virus under control allowing people to live longe  2. SARS (2002-2004) Severe Acute Respiratory Syndrome (SARS) was first reported in Guangdong, China in February 2003 although experts believe it started in China as early as November 2002. After a few months, it spread throughout countries in North America, South America, Europe, and Asia. It infected 8,098 people worldwide and killed 774 people. The disease caused high fever, body aches, and dry cough which then led to pneumonia in some cases.  1. COVID-19 Pandemic 2019 Coronavirus is believed to have originated in Wuhan in China, the virus spread throughout Europe, the rest of Asia, North America and virtually every part of the world within months since it emerged in late 2019. It inflicted over 2 million people and killed hundreds of thousands worldwide.  Centers for Disease Control and Prevention monitors notifiable diseases and publishes weekly updates in the morbidity and mortality  Ischemic heart diseases, neoplasms, and cerebrovascular diseases lead the causes of death in the Philippines  Characteristic Number of deaths Ischaemic heart diseases 124,437 Neoplasms or cancer 70,932 Cerebrovascular diseases 66,631 Diabetes mellitus 41,960 Pneumonia 41,306 Hypertensive diseases 36,756 Chronic lower respiratory diseases 24,230 Respiratory tuberculosis 21,483 Other heart diseases 20,220 Remainder of diseases of the genitourinary system 18,265  Preliminary figures for 2023 indicated that ischemic heart disease was the leading cause of death in the Philippines. The number of people who died from this illness was estimated at 124,437. Following this, cancer resulted in the deaths of about 71,000 people.  Eating habits Heart diseases have been linked to high meat consumption, among others. In the Philippines, pork has been the most consumed meat type, followed closely by chicken. While pork meat is typically produced domestically, the country also imports pork to supplement its supply. However, plant- based food has started gaining popularity among Filipinos. In fact, a 2024 survey revealed that 69 percent of surveyed Filipinos consumed plant-based products, including meat alternatives. Characteristic Number of deaths Hypertensive diseases 36,756 Chronic lower respiratory diseases 24,230 Respiratory tuberculosis 21,483 Other heart diseases 20,220  LIFE EXPECTANCY Human life expectancy is a statistical measure of the estimate of the average remaining years of life at a given age. The most commonly used measure is life expectancy at birth (LEB, or in demographic notation e0, where ex denotes the average life remaining at age x). Longevity may refer to especially long-lived members of a population, whereas life expectancy is defined statistically as the average number of years remaining at a given age. For example, a population's life expectancy at birth is the same as the average age at death for all people born in the same year  Various factors contribute to an individual's longevity. Significant factors in life expectancy include gender, genetics, access to health care, hygiene, diet and nutrition, exercise, lifestyle, and crime rates. Below is a list of life expectancies in different types of countries: Developed countries: 77–90 years (e.g. Canada: 81.29 years, 2010 est.) Developing countries: 32–80 years (e.g. Mozambique: 41.37 years, 2010 est.)  Population longevities are increasing as life expectancies around the world grow: Australia: 80 years in 2002, 81.72 years in 2010 France: 79.05 years in 2002, 81.09 years in 2010 Germany: 77.78 years in 2002, 79.41 years in 2010 Italy: 79.25 years in 2002, 80.33 years in 2010 Japan: 81.56 years in 2002, 82.84 years in 2010 Monaco: 79.12 years in 2002, 79.73 years in 2011 Spain: 79.06 years in 2002, 81.07 years in 2010 United Kingdom: 80 years in 2002, 81.73 years in 2010 United States: 77.4 years in 2002, 78.24 years in 2010  Why does life expectancy change based on your age? Life expectancy is the number of years on average a person is expected to live based on their age, gender and country. The Global Burden of Disease calculates life expectancy by using a country's mortality rates across age groups. Life expectancy may vary for people of different ages because it is calculated as the number of years a person is expected to live given they have already reached a certain age.  Chart and table of Philippines life expectancy from 1950 to 2024. United Nations projections are also included through the year 2100. The current life expectancy for Philippines in 2024 is 71.79 years, a 0.18% increase from 2023. The life expectancy for Philippines in 2023 was 71.66 years, a 0.18% increase from 2022. The life expectancy for Philippines in 2022 was 71.53 years, a 0.18% increase from 2021. The life expectancy for Philippines in 2021 was 71.41 years, a 0.18% increase from 2020. EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES The public health nursing in the Philippines comes from the caregiving provided by women, priest and herb doctors during the pre-colonial Philippines. In this time women didn’t have much opportunity to be formally educated in schools, this trend continued during the Spanish colonial era. During the American period in the Philippines they were given the chance to become educated as nurses, guided by their American nurse and missionary mentors, until nursing became a full-pledged profession in the Philippines, a professional career not only for modern-day women in the country but also for men in the Philippines as male nurses. Here are the sequence of change were the public health nursing evolved. Pre-Spanish Era Before 1565 Ancient Filipinos regarded health as a harmonious relationship with the environment, both natural and supernatural. Early Filipinos were good physicians who used medical herbs. When the first Spanish explorers reached our shores, what they discovered was far more than such mysticism and superstition. The Spanish historian Miguel de Loarca report that the natives were “good physicians and had a remedy for every poison.” Spanish Regime (1565-1898) 1565 Hospital Real De Manila-The very first hospital in the Philippines (established mainly to care for the Spanish King’s soldiers, but also admitted Spanish civilians; founded by Gov. Francisco de Sande). 1577-1578 The first Franciscan missionary, Bro. Juan Clemente took pity on the numerous beggars who flocked to the gates of the convent; he concocted medications and salves to apply to their wounds. It started public health services through dispensary in Intramuros for the indigent. In 1578, two wards of nipa and bamboo were constructed by Clemente called Hospital de los Indios Naturales, more popularly known as Hospital de Naturales. The friars cared for the sick while also tending to their spiritual needs. 1603- Hospital de la Misericordia- after the firethe original site of the Hospital de Naturales is turned over to the Brotherhood of Santa Misericordia. It was built for the care of the sick servants and slaves of the Spaniards. Hospital of San Gabriel-the priests built a modest-sized building behind the convent and called it the Hospital de San Pedro Martir to accommodate the growing number of sick it was created for the Chinese whom fell sick and died in poverty and abondonment San Lazaro Hospital- The reconstruction of the Hospital de Naturales (founded by Brother Juan Clemente and was administered for many years by the Hospitalliers of San Juan De Dios; built exclusively for patient with leprosy).