Community Health Nursing 1 PDF

Western Mindanao State University COLLEGE OF NURSING Zamboanga City COMMUNITY HEALTH NURSING 1 Overview of Public Health Nursing in the Philippines A HANDOUT SHIRLEY M. NOLLEDO, R.N.,M.N. Level 2 Faculty **I. Global and National Health Status** **Global Health Status -**Studies describe the...

Western Mindanao State University COLLEGE OF NURSING Zamboanga City COMMUNITY HEALTH NURSING 1 Overview of Public Health Nursing in the Philippines A HANDOUT SHIRLEY M. NOLLEDO, R.N.,M.N. Level 2 Faculty **I. Global and National Health Status** **Global Health Status -**Studies describe the state of **global health** by measuring the burden of disease -- the loss of **health** from all causes of illness and deaths worldwide.. \- WHO 2018 Collecting and comparing health data from across the globe is a way to describe health problems, identify trends and help decision-makers set priorities. Studies describe the state of global health by measuring the burden of disease -- the loss of health from all causes of illness and deaths worldwide. They detail the leading causes of deaths worldwide and in every region, and provide information on more than 130 diseases and injuries across the world. Latest Links: https://borgenproject.org/healthcare-in-the-philippines/\#:\~:text=The%20country%20has%20a%20high,%2C%20Malaria%20and%20HIV%2FAIDS. **II. Definition and Focus** A. **Terms** **Community** - is a social unit with commonality such as norms, religion, values, customs, or identity. Communities may share a sense of place situated in a given geographical area or in virtual space through communication platforms.  - **Wikipedia** - The definition of community is all the people living in an area or a group or groups of people who share common interests. **Health** - is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. - **WHO** - the state of being free from illness or injury. - **Dictionary** **Nursing** - encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings.  **It** includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. - **WHO** - the profession or practice of providing care for the sick and infirm. - **Dictionary** **Public Health** - Science and Art of Preventing Disease, Prolonging Life, Promoting Health and efficiency through organized community effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to Enable Every Citizen to Realize His Birth right to Health and Longevity - Dr. C.E. Winslow - Art of applying Science in the Context of Politics so as to Reduce Inequalities in Health while ensuring the best health for the greatest number - WHO **Public Health Nursing** - Special Field of Nursing that combines the skills of nursing, public health, and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability. - WHO **Community Health Nursing** - Service rendered by a professional nurse with communities, groups, families, individuals at home, in health centers, in clinics, in schools, in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation. - Ruth B. Freeman - Nursing Practice in a wide variety of community services and consumer advocate areas, and in a variety of roles, at times including independent practice... community nursing is certainly not confined to public health nursing agencies. - Jacobson - The utilization of the Nursing Process in the Different Levels of Clientele-Individuals, Families, Population Groups and Community, concerned with the Promotion of Health, Prevention of Disease and Disability and Rehabilitation - Dr. Araceli Maglaya **III. The Standards of Public Health Nursing in the Philippines** A. **Public Health Nurses** - are found in various health settings and occupying various positions in the hierarchy. - are assigned in rural health units, city health centers, provincial health offices, regional health offices, and evening the national office of the Department of Health. - are also assigned in public schools and in the offices of government agencies providing health care services. - occupy a range of positions from Public Health Nurse I to Nurse Program Supervisors to Chief Nurse in public health settings. - uses various tools and procedures necessary for her to properly practice her profession and deliver basic health service. - uses nursing process in her practice and is adept in documenting and reporting accomplishments through records and reports. - technically competent in various nursing procedures conducted in settings where she is assigned B. **Qualifications and Functions of A Public Health Nurse** The standards of Public Health Nursing in the Philippines developed by the National League of Philippine government Nurses in 2005 described the qualification and functions of a Public Health Nurse. - **Qualifications :** - must be professionally qualified and licensed to practice in the area of public health nursing. - Must possess personal qualities and "people skills" that would allow her practice to make a difference in the lives of these people. - **Functions** - Functions in accordance with the dominant values of public health nurses, within the ethico-legal framework of the nursing profession, and in accordance with the needs of the clients and available resources for health care. - Functions of PHN are consistent with the Nursing Law 2002 and program policies formulated by the DOH and local government health agencies. They are related to management, supervision, provision of nursing care, collaboration and coordination, health promotion and education training and research. ***1. Management Function*** - the management function of the public health nurse is inherent in her practice. - The nurse, in whatever setting and role has been trained to lead and manage. - Objectives set for work being done can only be achieved through the execution of the five management functions of planning, organizing, staffing, directing and controlling. - This function is performed when she organizes the "nursing service" of the local health agency. - Managing the nurses and their activities - Program management. This is a function where the PHN actually excels in. - A program manager is responsible for the delivery of the package of services provided by the program to the target clientele. - Reports on program accomplishments is a documentation of her management skills. ***2. Supervisory Function*** - PHN is the supervisor of the midwives and other auxillary health workers in the catchment area. - Formulates a supervisory plan and conducts supervisory visits to implement plan. - Conducts supervisory visits using a supervisory checklist - During the visit the PHN identifies together with the supervisee any issue or problem encountered and addresses them accordingly. - Coaching - Enhancement of training for the supervisee - Report of the encounter is given to the supervisee and kept in her personal file for future reference. ***3. Nursing Function*** - An inherent function of the nurse - Her practice as a nurse is based on the science and art of caring - hPublic health nursing is caring for individuals, families and communities toward health promotion and disease prevention - PHN are expected to provide nursing care - PHN uses her knowledge and skill in the nursing process. She does assessment, plans, and implements care, and evaluates outcomes. - Establishes rapport with her client: individual, family or community - Home visits - Referral of patients to appropriate levels of care ***4. Collaborating and coordinating Function*** - Brings activities or group activities systematically into proper relation or harmony with each other. - Care coordinators for communities and their members - Actively involved both socially and politically to empower individuals, families and communities as an entity to initiate and maintain health promoting environments. - Establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector, NGOs, people's organizations to address health problems. - Identifies persons, groups, organizations, other agencies and communities whose resources are available within and outside the community and which can be tapped in the implementation of individuals, family and community health care. ***5. Health Promotion and Education Function*** - Activities goes beyond health teachings and health information campaigns. - Understands that health is determined by various factors such as physical and political environment, socio-economic status, personal coping skills and many other circumstances, and it is inappropriate to blame or credit a person's health to himself alone because he is unlikely to control many of these factors. - Understanding the multidimensional nature of health will enable her to plan and implement health promoting interventions for individuals and communities. - Uses her skills in advocacy for the creating of a supportive environment through policies and reengineering of the physical environment for healthier actions. - As an educator, the nurse provides clients with information that allows them to make healthier choices and practices. - Health education is a major component of any public health program. - PHN are expected to teach on a daily basis as part of their practices. ***6. Training Function*** - Initiates the formulation of staff development and training programs for midwives and other auxillary workers - Does training needs assessment for these health workers, designs the training program and conducts them in collaboration with other resource persons. - Also does evaluation of training. - PHN participates in the training of nursing and midwifery affiliates in coordination with the faculty of colleges of nursing and midwifery. - Participates in teaching, guidance and supervision of student affiliates for their RLEs in the community setting. - Health promotion calls for the active participation of the community. - Mobilize communities for health actions. - Community organizing is a means of mobilizing people to solve their own problems. Through this, people learn that their problems have social causes and fighting back is a more reasonable, dignified approach than passive acceptance and personal alienation. **IV. Basic Principles of CHN** A. **Evolution of Nursing** +-----------------------------------+-----------------------------------+ | 1898 | Department of Health was first | | | established as Department of | | | Public Works, Education and | | | Hygiene. | +===================================+===================================+ | 1912 | - The Fajardo Act (Act | | | No. 2156) created Sanitary | | | Divisions. | | | | | | - The President of Sanitary | | | Division took charge of two | | | or three municipalities. | | | Where there are no physicians | | | available, male nurses were | | | assigned to perform the | | | duties of the President, | | | Sanitary Division. | | | | | | - Philippine General Hospital | | | (PGH), then under the Bureau | | | of Health sent four nurses to | | | Cebu to take of mothers and | | | their babies. | | | | | | - St. Paul's Hospital School of | | | Nursing in Intramuros, also | | | assigned two nurses to do | | | home visiting in Manila and | | | gave nursing care to mothers | | | and newborn babies from the | | | outpatient obstetrical | | | service of the PGH. | +-----------------------------------+-----------------------------------+ | 1914 | \- School nursing was rendered by | | | a nurse employed by the Bureau of | | | Health in Tacloban, Leyte. | | | | | | \- Reorganization Act No. 2462 | | | created the Office of General | | | Inspection. | | | | | | \- Dr. Rosario Pastor a lady | | | physician was headed the Office | | | of District Nursing. | | | | | | \- Two graduate Filipino nurses, | | | Mrs. Casilang Eustaquia and Mrs. | | | Matilde Azurin were employed for | | | Maternal and Child Health and | | | Sanitation in Manila under an | | | American nurse, Mrs. G.D. | | | Schudder. | +-----------------------------------+-----------------------------------+ | 1919 | \- The first Filipino nurse | | | Supervisor under the Bureau of | | | Health, Miss Carmen del Rosario | | | was appointed. She succeeded Miss | | | Mabel Dabbs. | +-----------------------------------+-----------------------------------+ | 1923 | \- Two government Schools of | | | Nursing were established: | | | Zamboanga General Hospital School | | | of Nursing in Mindanao and Baguio | | | General Hospital in Northern | | | Luzon. These schools were | | | primarily intended to train | | | non-Christian women and prepare | | | them to render service among | | | their people. | | | | | | \- Four more government School of | | | Nursing were establish: one in | | | Southern Luzon (Quezon Province) | | | and three in the Visayan Islands | | | of Cebu, Bohol and Leyte. | +-----------------------------------+-----------------------------------+ | 1927 | \- The Office of District Nursing | | | under the Office of General | | | Inspection, Philippine Health | | | Service was abolished and | | | supplanted by the Section of | | | Public Health Nursing. Mrs. | | | Genara de Guzman acted as | | | consultant to the Director of | | | Health on nursing matters. | +-----------------------------------+-----------------------------------+ | 1928 | \- First convention of nurses was | | | held followed by yearly | | | conventions until the advent of | | | World War II. Pre-service | | | training was initiated as a | | | pre-requisite for appointment. | +-----------------------------------+-----------------------------------+ | 1930 | \- The Section of Public Health | | | Nursing was converted into | | | Section of Nursing. The Section | | | of Nursing was transferred from | | | the Office of General Services to | | | the Division of Administration. | | | This Office covered the | | | supervision and guidance of | | | nurses in the provincial | | | hospitals and the government | | | schools of nursing. | +-----------------------------------+-----------------------------------+ | 1933 | \- Reorganization Act No. 4007 | | | transferred the Division of | | | Maternal and Child Health of the | | | Office of Public Welfare | | | Commission to the Bureau of | | | Health. | | | | | | \- Mrs. Soledad A. Buenafe, | | | former Assistant Superintendent | | | of Nurses of the Public Welfare | | | Commission was appointed as | | | Assistant Chief Nurse of the | | | Section of Nursing, Bureau of | | | Health. | +-----------------------------------+-----------------------------------+ | 1941 | \- Bureau of Health were | | | transferred to the new | | | department. | | | | | | \- Dr. Mariano Icasiano became | | | the first City Health Officer of | | | Manila. | | | | | | \- An office of Nursing was | | | organized with Mrs. Vicenta C. | | | Pnce. As Chief Nurse and Mrs. | | | Rosario A. Ordiz as Assistant | | | Chief Nurse. | +-----------------------------------+-----------------------------------+ | Dec 8. 1941 | \- World War II broke out, public | | | health nurses in Manila were | | | assigned to devastated areas to | | | attend to the sick and the | | | wounded. | +-----------------------------------+-----------------------------------+ | 1942 | \- A group of public health | | | nurses, physicians and | | | administrators from the Manila | | | Health Department went to the | | | internet camp in Capas, Tarlac to | | | receive sick prisoners of war | | | repleased by the Japanese Army. | | | | | | \- They were confined at San | | | Lazaro Hospital and 68 Public | | | Health Nurses were assigned to | | | help the hospital staff take care | | | of them. | | | | | | - | +-----------------------------------+-----------------------------------+ | July 1942 | \- 31 nurses who were taken | | | prisoners of war by the Japanese | | | army and confined at the Bilibid | | | Prison in Manila were released to | | | the Director of the Bureau of | | | Health, Dr. Eusebio Aguilar who | | | acted as their guarantor. | | | | | | \- Many public health nurses | | | joined the guerillas or went to | | | hide in the mountains during | | | World War II. | +-----------------------------------+-----------------------------------+ | February | \- Post war records of the Bureau | | | of Health showed that there were | | 1946 | 308 public health nurses and 38 | | | supervisors compared to pre-war | | | when there were 556 public health | | | nurses and 38 supervisors. | | | | | | \- Mrs. Genera M. de Guzman, | | | Technical Assistant in Nursing of | | | the Department of Health and | | | concurrent President of the | | | Filipino Nurses Association | | | recommended the creation of a | | | Nursing Office in the Department | | | of Health. | | | | | | Oct. 7, 1947 | | | | | | \- Executive Order No. 94 | | | organized government offices and | | | created the Division of Nursing | | | under the Office of the Secretary | | | of Health. This was implemented | | | on | +-----------------------------------+-----------------------------------+ | December 16, 1947 | \- Mrs. Genara de Guzman was | | | appointed as Chief of the | | | Division, with three Assistant: | | | Miss Annie Sand for Nursing | | | Education; Mrs. Magdalena C. | | | Valenzuela for Public Health | | | Nursing and Mrs. Patrocinio J. | | | Montellano for Staff Education. | | | | | | \- At the Bureau of Health, the | | | Section of Nursing Supervision | | | took over the functions of the | | | former Section of Nursing. - Mrs. | | | Soledad Buenafe was appointed | | | Chief and Miss Marcela Gabatin, | | | Assistant Chief. | | | | | | \- Mrs. Genara de Guzman was | | | appointed as Chief of the | | | Division, with three Assistant: | | | Miss Annie Sand for Nursing | | | Education; Mrs. Magdalena C. | | | Valenzuela for Public Health | | | Nursing and Mrs. Patrocinio J. | | | Montellano for Staff Education. | | | | | | \- At the Bureau of Health, the | | | Section of Nursing Supervision | | | took over the functions of the | | | former Section of Nursing. - Mrs. | | | Soledad Buenafe was appointed | | | Chief and Miss Marcela Gabatin, | | | Assistant Chief. | +-----------------------------------+-----------------------------------+ | 1948 | \- The first training Center of | | | the Bureau of Health was | | | organized in cooperation with the | | | Pasay City Health Department. | | | This was housed at the Tabon | | | Health Center located in a | | | marginalized part of the city. It | | | was later renamed as Doña Marta | | | Health Center. | | | | | | \- Physicians and nurses | | | undergoing pre-service and | | | in-service training in public | | | health/public health nursing as | | | well as nursing student on | | | affiliation were assigned to the | | | above training center. | +-----------------------------------+-----------------------------------+ | 1950 | \- The Rural Health Demonstration | | | and Training Center (RHDTC) was | | | established by the Department of | | | Health through the initiative of | | | Dr. Hilario Lara, Dean, institute | | | of Hygiene, now College of Public | | | Health, University of the | | | Philippines. | | | | | | \- The WHO/UNICEF assisted | | | project used health centers of | | | the Quezon City Health | | | Department, which were located in | | | the rural areas of the city. | | | | | | \- Dr. Amansia S. Mangay (Mrs. | | | Andres Angara), a Doctor of | | | Public Health Graduate form | | | Harvard was chosen tobe the Chief | | | of the RHDTC. | | | | | | \- Dr. Antonio V. Acosta, former | | | Physician of the Manila Health | | | Department was Medical Training | | | Officer. | +-----------------------------------+-----------------------------------+ | 1953 | \- The Office of Health Education | | | and Personnel Training was | | | established with Dr. Trinidad | | | Gomez as Chief | | | | | | \- Philippine Congress approved | | | Republic Act No. 1082 or the | | | Rural Health Law. It created the | | | first 81 Rural Health Units. | +-----------------------------------+-----------------------------------+ | 1957 | \- Republic Act 1891 was approved | | | amending Sections Two, Three, | | | Four, Seven and Eight of R.A. | | | 1082 :Strengthening Health and | | | Dental Services in the Rural | | | Areas and Providing Funds | | | thereto." | +-----------------------------------+-----------------------------------+ | 1958-1965 | \- Republic Act 977 passed by | | | Congress in 1954 was implemented. | | | This abolished the Division of | | | Nursing. However, it created | | | nursing positions at different | | | levels in the health | | | organization. Miss Annie Sand was | | | appointed Nursing Consultant | | | under the Office of the Secretary | | | of Health. | | | | | | \- The Department of Health | | | National League of Nurses, Inc. | | | was founded by Miss Annie Sand in | | | 1961. She became its first | | | President and Adviser. | | | | | | \- The Reorganization Act with | | | implementing details embodied in | | | Executive Order 288, series of | | | 1959 de-centralized and | | | integrated health services. | | | | | | \- The reorganization of 1959 | | | also merged two Bereaus in the | | | Department of Health. The Bureau | | | of Health was merged with the | | | Bureau of Hospitals to form the | | | Bureau of Health and Medical | | | Services. | +-----------------------------------+-----------------------------------+ | 1967 | \- In the Burea of Disease | | | Control, Mrs. Zenaida Panlilio -- | | | Nisce was appointed as Nursing | | | Program Supervisor and served as | | | consultant on the nursing aspects | | | of the 5 special diseases: TB, | | | Leprosy, Venereal Disease, | | | Cancer, Filariasis, and Mental | | | Health. | +-----------------------------------+-----------------------------------+ | 1974 | \- The Project Management Staff | | | was organized as part of | | | Population II of the Philippine | | | Government with Dr. Francisco | | | Aguilar as Project Manager. | +-----------------------------------+-----------------------------------+ | 1975 | \- The roles of the public health | | | nurse and the midwife were | | | expanded. 2000 midwives were | | | recruited and trained to serve in | | | the rural areas. | +-----------------------------------+-----------------------------------+ | 1987-1989 | \- Executive Order No. 119 | | | reorganized the Department of | | | Health and created several | | | offices and services within the | | | Depratment of Health. | +-----------------------------------+-----------------------------------+ | 1990-1992 | \- Department Order No. 29 | | | designated Mrs. Neila F. Hizon, | | | Nurse VI, then President of the | | | National League of Philippine | | | Government Nurses, as Nursing | | | Adviser. She was detailed at the | | | Office Public Health Services. As | | | Nursing Adviser, matters | | | affecting nurses and nursing are | | | referred to her. | +-----------------------------------+-----------------------------------+ | May 24, 1999 | \- Executive Order No. 102 was | | | signed by President Joseph | | | Ejercito Estrada, redirecting the | | | functions and operations of the | | | Department of Health. | +-----------------------------------+-----------------------------------+ | 2005-2006 | \- The development of the | | | Rationalization Plan to | | | streamline the bureaucracy | | | further was started and is in the | | | last stages of finalization. | +-----------------------------------+-----------------------------------+ B. **Philosophy of CHN** - A philosophy is defined as a system of beliefs that provides a basis for a guide action. A philosophy provides the direction and describes the whats, the whys, and the hows of activities within a profession. - CHN Practice is guided by the following beliefs: **H**umanistic values of the nursing profession upheld **U**nique and distinct component of health care **M**ultiple factors of health considered **A**ctive participation of clients encouraged **N**urse considers availability of resources **I**nterdependence among health team members practiced **S**cientific and up-to-date **T**asks of CHN vary with time and place **I**ndependence or self-reliance of the people is the end goal **C**onnectedness of health and development regarded - The Community is the patient in CHN; The Family is the Unit of Care; and there are four levels of clientele: Individual, Family, Population Group (those who share common characteristics, developmental stages, and common exposure to health problems---e.g. children, elderly), and the Community - In CHN, the client is considered as an Active Partner, not a passive recipient of care. - CHN Practice is affected by developments in Health Technology, in Particular, Changes in Society, in General. - The goal of CHN is achieved through Multi-Sectoral Efforts - CHN is a part of the Health Care System and the larger Human Services System **V. Roles of the Public Health Nurse** A. **Roles of the CHN** - ***Clinician or Health Care Provider:*** utilizes the nursing process in the care of the client in the home setting through home visits and in public health care facilities; conducts referral of patients to appropriate levels of care when necessary - ***Health Educator:*** utilizes teaching skills to improve the health knowledge, skills and attitude of the individual, family and the community and conducts health information campaigns to various groups for the purpose of health promotion and disease prevention - ***Coordinator and collaborator:*** establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector, non-government organizations and people's organizations to address health problems - ***Supervisor:*** monitors and supervises the performance of midwives and other auxiliary health workers; also initiates the formulation of staff development and training programs for midwives and other auxiliary health workers as part of their training function as supervisors - ***Leader and Change Agent:*** influences people to participate in the overall process of community development - ***Manager:*** organizes the nursing service component of the local health agency or local government unit; also, as program manager, the PHN is responsible for the delivery of the package of services provided by the health program to target clientele - ***Researcher:*** participates in the conduct of research and utilizes research findings in practice B. **Responsibilities of the CHN** - Be a part in developing an overall health plan, its implementation and evaluation for communities. - Provide quality nursing services to the four levels of clientele - Maintain coordination/linkages with other health team members, NGO/ government agencies in the provision of public health services - Conduct researches relevant to CHN services to improve provision of health care - Provide opportunities for professional growth and continuing education for staff development C. **Specialized Fields of CHN** - ***Community Mental Health Nursing:*** a unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, psychology, community networks, and the basic sciences - ***Occupational Health Nursing:*** the application of nursing principles and procedures conserving the health of workers in all occupation - ***School Health Nursing:*** the application of nursing theories and principles in the care of the school population References: Maglaya, A.S., Nursing Practice in the Community, 5^th^ Edition, Argonauta Corporation, 2009. *SMNOLLEDOCHN12021*