Expanding Fields of Community

and Public health nursing

By:
Meniano, Xyra Shaine B.
Sapinoso, Aprille Zellene D.
BSN-3B
Learning Objectives:
● Describe Public health as a field of practice
● Enumerate the Standards of Public health practice
● Discuss the nature and scope of Occupational Health
Nursing
● Explain the value of School Health Nursing for both students
and personnel
● Identify emerging fields of community and public health
nursing
Public Health Nursing
● Public health nursing may be defined as a field of professional
practice in nursing and in public health in which technical
nursing, interpersonal, analytical, and organizational skills are
applied to problems of health as they affect the community.
(Freeman, 1963)
● Traditionally, “public health nursing” was seen as a subspecialty
nursing practice generally delivered within “official” or
governmental agencies. In contrast, “community health nursing”
was considered to be a broader and more general specialty area
that encompassed many additional subspecialties (e.g., school
nursing, occupational health nursing, forensic nursing, home
health).
Public Health Nursing (continuation..)
● In 1980, the American Nurses Association (ANA) defined
community health nursing as “the synthesis of nursing practice
and public health practice applied to promoting and preserving
the health of populations”.
● Thus, the American Public Health Association (APHA) defined
public health nursing as “the practice of promoting and protecting
the health of populations using knowledge from nursing, social,
and public health sciences”.
Occupational Health Nursing
● Occupational Safety and Health- “the promotion and
maintenance of the highest degree of physical, mental,
and social well-being of workers in all occupations.”
● Occupational Health Nursing is defined by the AAOHN as
“the specialty practice that focuses on the promotion,
prevention, and restoration of health within the context of
a safe and healthy environment. It includes the prevention
of adverse health effects from occupational and
environmental hazards. It provides for and delivers
occupational and environmental health and safety
programs and services to clients.”
● Occupational Health Nursing derives its theoretical, conceptual, and
factual framework from a multidisciplinary base. Elements of this
multidisciplinary base include the following:

❖ Nursing Sciences- to provide the context for health care delivery and
recognize the needs of individuals, groups and populations within the
framework of prevention, health promotion, and illness and injury care
management, including the risk assessment, risk management, and risk
communication.
❖ Medical Science- specific to treatment and management of occupational
health illness and injury, integrated with nursing health surveillance
activities.
❖ Occupational health sciences
-
❖ Epidemiology- to study health and illness trends and characteristics of the
worker population, investigate work-related illness and injury episodes,
and apply epidemiological methods to analyze and interpret risk data to
determine causal relationships and participate in epidemiological
research.
❖ Business and economic theories, concepts, and principles- for strategic
and operational planning for valuing quality and cost effective services,
and for management of occupational health and safety programs.
❖ Social and behavioral sciences- to explore influences of various
environments (e.g., work and home), relationships and lifestyle factors on
worker’s health and determine the interactions affecting worker health.
❖ Environmental Health- to systematically examine interrelationship

between the worker and the extended environment as a basis for the
development of prevention and control strategies.

❖ Legal and ethical issues- to ensure compliance with regulatory

mandates and contended with ethical concerns that may arise in

competitive environments.
Evolution of Occupational Health Nursing in the
Philippines
November 11, 1950 ● Mrs. Magdalena Valenzuela of DOH, instituted the Industrial
Nursing Unit (INU) of the Philippine Nurses Association.
● Ms. Peria Gorres of the Philippine Manufacturing Company
(PMC) served as the first chairperson.

August 19, 1964 ● Ms. Anita Santos of Jardine Davies was elected as first
president.

November 12, 1996 ● Ms. Santos’ education programs and constitutions and
by-laws governing the association was approved.

June 5-6, 1970 ● The first annual convention was held.

Occupational health strategies: assessment and
control hazards in the workplace
● Health Hazards are the elements in the work environment that
can cause work-related disease to the worker.
● Safety Hazards are the unsafe conditions or unsafe acts that
significantly increase the risk of worker to be injured.
● The occupational health team may categorize identified health
hazards in the workplace as follows:
❖ Administrative control- refers to the development and
implementation of policies, standards, trainings, job
design, and the like.
❖ Engineering- refers to the adaptation of physical,
chemical, or technological improvements to limit the
exposure of workers to hazards of the workplace.
❖ Material Provision- refers to providing the workers with
supplies or supplements that can decrease their exposure
or susceptibility to occupational hazards.
❖ Supplementation- To decrease the exposure and increase
the resistance to infections.
 Framework and Scope of Occupational Health
Nursing Practice
In the Philippines, Rule 1965.04 of the Amended OSHS published by DOLE (1996) stipulated
the expected duties and functions to be performed by occupational health nurses, as
follows:
1. Organizing and administering a health service program integrating occupational safety
in the absence of a physician; otherwise these activities of the nurse shall be in
accordance with the physician.
2. Providing nursing care to injured or ill workers.
3. Participating in health maintenance examination. If a physician is not available,
performing work activities that are within the scope allowed by the nursing profession,
and if more extensive examinations are needed, referring the same to a physician.
4. Participating in health maintenance of occupational
health and safety by giving suggestions in the
improvement of working environment affecting the health
and well-being of the workers.

5. Maintaining a reporting and records system and, if a

physician is not available, preparing and submitting an
annual medical report, using the prescribed form to the
employer as required by this standard.
Levels of Prevention in Occupational Health Nursing

❖ Primary Prevention
In the are of primary prevention, the occupational health nurse is involved in both
health promotion and disease prevention.
O’Donnell (2009) describes health promotion as:
“The art and science of helping people discover the synergies between their
passions and optimal health in order to give them more motivation and
support to change their lifestyle. It is about achieving the necessary balance
between the physical, emotional, social, spiritual and intellectual health.
Lifestyle change can be facilitated through a combination of learning
experiences that enhance awareness, increase motivation, and build skills
and, most important, through the creation of opportunities that open access
to environments that make positive health practices the easiest choice”
❖ Secondary Prevention- aimed at early diagnosis, early treatment
interventions, and attempts to limit disability. The focus on this
level of prevention is on identification of health needs, health
problems, and employees at risk.
➔ As with primary prevention, the occupational health nurse uses
a number of different secondary prevention strategies (Rogers,
2003).
➔ The occupational health nurse can offer health screenings
which are designed for early detection of disease, at the
worksite with relative ease and at minimal cost.
❖ Tertiary Prevention
On a tertiary level, the occupational health nurse plays a key role in
the rehabilitation and restoration of the worker to an optimal level
of functioning based on the limitations imposed by the disability or
illness.
➔ Although the occupational health nurse is often independent, and
most of the time is the only healthcare provider in an organization
he or she usually works with other occupational health and safety
specialists who may or may not be employed by the company.
● Toxicologist- studies and identifies the toxic properties of agents used in

work which the workers might be exposed to.

● Industrial hygienist- prevents occupational injuries and evaluates safety

practices and protocols in the workplace.

● Ergonomist- design specialist who helps promote healthy interface of

humans and their tools.

● Epidemiologist- conducts research studies on the patterns of disease and

injuries in the workforce.

 SKILLS AND COMPETENCIES FOR OCCUPATIONAL HEALTH NURSING

Although clinical and emergency care remains an important tenet of occupational health nursing, the
current and future practice must focus on a proactive approach with the goal of preventing illness and injury,
and promoting health. The Occupational Health Nurse must the possess competencies necessary to recognize
and evaluate potential and existing health hazards in the workplace.

Examples of some of the numerous skills and competencies, according to the nine (9) defined areas of
competence:

1. Clinical and Primary Care 6. Health Promotion and Disease Prevention

2. Case Management 7. Occupational and Environmental Health and
Safety Education
3. Workforce, Workplace, and Environmental Issues 8. Research
4. Legal and Ethical Responsibilities 9. Professionalism
5. Management and Administration
 LEGISLATION and OCCUPATIONAL HEALTH

Being a staunch advocate in the promotion of occupational health and safety, DOLE has
consistently implemented and enforced policies and practices to meet its goals. It possesses
legislative and rule-making powers with regard to the following laws and standards:

● Presidential Decree (PD) 442- Philippine Labor Code

● The Administrative Code on Enforcement of Safety and Health Standards
● The Occupational Safety and Health Standards (OSHS)
● Executive Order 307- Creating the Occupational Safety and Health Center (OSHC) under the Employees
Compensation Commission
● PD 626-Employees Compensation and State Insurance Fund
● Hazard-specific laws regarding antisexual harassment
● RA 9165-Comprehensive Drugs Act of 2002
● RA 6969- Toxic Substance Act
● RA 9231- Special Abuse, Exploitation and Discrimination Act
● R.A. No. 11058- Strengthening Compliance with Occupational Safety and Health personnel in workplaces as
shown on (Fig. 3.1)
 SCHOOL HEALTH NURSING

School-aged children and adolescents face increasingly difficult challenges

related to health. Education and Health are interrelated. As early as 1950, the World Health
Organization (WHO) Expert Committee on School Health Services noted that, “to learn
effectively, children need good health”. There are more teachers than health professionals in
the country (Philippines). Generally, the school nurse visits four to six schools per month,
with each visiting lasting for 3 days or more, depending on the type of school, location and
population. For the rest of the month, teachers, who also serve as school health guardians,
provide primary care as necessary, such as detection of obvious health problems and
administration of first aid. Thus, the School Nurse is responsible for planning and conducting
training programs for teachers on health and nutrition.
 HISTORICAL DEVELOPMENT OF SCHOOL HEALTH SERVICES

The definition of school health and what a school health program should be
have evolved markedly in the past 50 yrs. Traditionally, School health programs were
defined as covering:

1. School health services

2. School health education

3. A healthy school environment to include both physical and psychosocial aspects of environment
(WHO, 1997)

In the Philippines, the first school health program required by law consisted
mostly of school health services with the passage of Republic Act 124 in 1947. Entitled as
“An Act to Provide for Medical Inspection of Children Enrolled in Private Schools, Colleges
and Universities in the Philippines”.
 HISTORICAL DEVELOPMENT OF SCHOOL HEALTH SERVICES CONT.

With the changing roles and responsibilities of schools came a redefinition of school health
programs in the 1980s. The evolving roles of the school nurse and the school children and the other
members of the school community resulted in the expansion of the school health program to eight
components. In addition to the first three components, there are five more components have been
included, namely (WHO,1997):

1. Health promotion for school personnel

2. School-community project and outreach

3. Nutrition and food safety

4. Physical education and recreation

5. Mental health, counseling and social supports

 HISTORICAL DEVELOPMENT OF SCHOOL HEALTH SERVICES

School nursing covers the entire scope of the eight components of school health programs.
The National Association of School Nurses (in the United States) defines it as advances the well-being,
academic success, and life-long achievement of students.

In the Philippines, a holistic approach to strengthen health and nutrition among school
children is the concept embodied by the Redesigned Approach in School Health Nursing (RASHN),
officially adopted through the Department of Education, Culture and Sports (DECS) Memorandum No.
37, series 1991.

The Department of Education (DepEd) Order No.43, s. 2011 on the subject Strengthen the
School Health and Nutrition Programs for the achievement of the Education for All (EFA) and
Millennium Development Goals (MDGs) seeks to strengthen the School Health and Nutrition Program
(SHNP) through a seamless alignment of SHNP activities with other key school programs, thus the
title Integrated School Health and Nutrition Program (ISHNP).
 SCHOOL HEALTH SERVICES

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

1. Comprehensive School Health Education (GRADES K-12)

- This is a planned, sequential, K-12 curriculum that addressed the physical, mental,
emotional and social dimensions of health.

2. Physical Education and Activity

- This is planned, sequential K-12 curriculum that provides cognitive content and
learning experiences in a variety of activity areas such as basic movement skills.

3. Nutritional Services

- These provide access to a variety of nutritious and appealing meals that

accommodate the health and nutrition needs of all students.

4. School Health Services

- These are services provided for students to appraise, protect and promote health.
 EIGHT COMPONENTS OF SCHOOL HEALTH PROGRAMS CONT.

5. School Counseling, Psychological, and Social Services

- These services provided to improve student’s mental, emotional, and social health.

6. Health and Safe Environment

- This refers to the physical and aesthetic surroundings and the psychosocial climate
and culture of the school.

7. Student, Family and Community Involvement in School

- This pertains to an integrated school, parent, and community approach for enhancing
the health and well-being of students.

8. Health Promotion for School Staff

- This provides opportunities for school staff to improve their health status through activities
such as health assessment, health education health-related fitness activities.
 SCHOOL HEALTH NURSING PRACTICE

· School Nursing is a specialty area in healthcare practice. School nurses need

education in specific areas, such as growth and development, public health, mental
health nursing, case management, program management, family theory, leadership
and cultural sensitivity to effectively perform their roles.

· For entry into school nursing, it is recommended that nurses hold a minimum
of a bachelor’s degree. School nurses must be able to identify and access professional
development to maintain competency in the care of children and adolescents.

· School Nurses function in many roles including care provider, student advocate,
educator, community liaison, and case manager. Additional skills needed by school
nurse include independently and to delegate care. Table 3.5 presents examples of
prevention and the roles of the nurse in the school setting.
 STANDARD OF SCHOOL HEALTH NURSING PRACTICE

School nurses play an important role in all levels of prevention

through assessment, planning, intervention and evaluation (Table 3.6)
 EMERGING FIELDS OF COMMUNITY AND PUBLIC HEALTH
NURSING IN THE PHILIPPINES

Public health, Occupational health, and School health are established and
recognized fields of practice of community health nursing in diseases, such as diseases of
the heart and the vascular system, cancer, diabetes, and pulmonary and renal conditions,
inflict a heavy burden on the client and health care system. Nurses engaged to the
following care:

● Home Health Care: This practice involves providing nursing care to individuals and
families in their own places of residence mainly to minimize the effects of illness and
disability.
● Hospice Home Care: This is a home care specifically rendered to the terminally ill.
 EMERGING FIELDS OF COMMUNITY AND PUBLIC HEALTH
NURSING IN THE PHILIPPINES CONT.

EntrepreNurse was launched in 2013 to help mainstream the concept of Entrepreneurship in Nursing
among nurses, this is a project initiated by the Department of Labor and Employment (DOLE), in collaboration
with the Professional Regulatory Board of Nursing of the Philippines, Philippines Nurses Association and other
Stakeholders to promote nurses’ entrepreneurship by introducing home health care industry in the Philippines. It
aims to:

1. Reduce the cost of health care for the country’s indigent population by bringing primary health
care services to poor rural community.

2. Maximize employment opportunities for the country’s unemployed nurses

3. Utilize the country’s Millennium Development Goals on the maternal and Child Health (DOLE,
2013)

DOLE enjoined the organization of Cooperative Development Authority to register nurses’ cooperatives and
EMERGING FIELDS OF COMMUNITY AND PUBLIC HEALTH
NURSING IN THE PHILIPPINES CONT.

● Faith Community Nursing or Parish Nursing is the of the art and science of
nursing combines with spiritual care.

● Correctional Nurse is a specialized subset of forensic nursing.

● Entrepreneurship in Nursing is recently gaining momentum in the field of

health care practice among nurses.
SUMMARY:

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

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