COMMUNITY 

Health Nursing  Mission of CHN

 “The utilization of the nursing process in the  Health Promotion

different levels of clientele-individuals, families,  Health Protection
population groups and communities, concerned  Health Balance
with the promotion of health, prevention of  Disease prevention
disease and disability and rehabilitation.”  Social Justice
(Maglaya, et al)
 Goal: “To raise the level of citizenry by helping  
communities and families to cope with the
discontinuities in and threats to health in such a Philosophy of CHN
way as to maximize their potential for high-level
wellness” (Nisce, et al)  “The philosophy of CHN is based on the worth
 A learned practice discipline with the ultimate and dignity of man.”(Dr. M. Shetland)
goal of contributing as individuals and in
collaboration with others to the promotion of  
the client’s optimum level of functioning thru’ Basic Principles of CHN
teaching and delivery of care (Jacobson)
 A service rendered by a professional nurse to 1. Thecommunity is the patient in CHN,
IFCs, population groups in health centers, the family is the unit of care and there are four
clinics, schools , workplace for the promotion of levels of clientele: individual, family, population
health, prevention of illness, care of the sick at group (those who share common
home and rehabilitation (DR. Ruth B. Freeman) characteristics, developmental stages and
common exposure to health problems – e.g.
  children, elderly), and the community.
Public Health  2. In CHN, the client is considered as
anACTIVE partner NOT PASSIVE recipient of care
 “Public Health is directed towards assisting 3. CHN practice is affected by developments in
every citizen to realize his birth rights and health technology, in particular, changes in
longevity.” “The science and art of preventing society, in general
disease, prolonging life and efficiency through 4. The goal of CHN is achieved through multi-
organized community effort for: sectoral efforts
5. CHN is a part of health care system and the
larger human services system.
1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal Roles of the PUBLIC HEALTH NURSE 
hygiene
4. The organization of medical and nursing services  Clinician,who is a health care provider, taking
for the early diagnosis and preventive treatment care of the sick people at home or in the RHU
of disease  Health Educator,who aims towards health
5. The development of a social machinery to promotion and illness prevention through
ensure every one a standard of living, adequate dissemination of correct information; educating
for maintenance of health to enable every people
citizen to realize his birth right of health and  Facilitator,who establishes multi-sectoral
longevity (Dr. C.EWinslow) linkages by referral system
 Supervisor,who monitors and supervises the
  performance of midwives
 Health Advocator,who speaks on behalf of the
client
 Advocator,who act on behalf of the client
 Collaborator,who working with other health  September 6-12, 1978 – First International
team member Conference on PHC in Alma Ata, Russia (USSR)
The Alma Ata Declaration stated that PHC was
*In the event that the Municipal Health Officer the key to attain the “health for all” goal
(MHO) is unable to perform his duties/functions or is  October 19, 1979 – Letter of Instruction (LOI)
not available, the Public Health Nurse will take 949, the legal basis of PHC was signed by Pres.
charge of the MHO’s responsibilities. Ferdinand E. Marcos, which adopted PHC as an
approach towards the design, development and
Other Specific Responsibilities of a Nurse, spelled implementation of programs focusing on health
by the implementing rules and Regulations of RA development at community level.
7164 (Philippine Nursing Act of 1991) includes: 
Rationale for Adopting Primary Health Care 
 Supervision and care of women during
pregnancy, labor and puerperium  Magnitude of Health Problems
 Performance of internal examination and  Inadequate and unequal distribution of health
delivery of babies resources
 Suturing lacerations in the absence of a  Increasing cost of medical care
physician  Isolation of health care activities from other
 Provision of first aid measures and emergency development activities
care
 Recommending herbal and symptomatic meds…  
etc.
Definition of Primary Health Care
In the care of the families: 
 An essential health care made universally
 Provision of primary health care services accessible to individuals and families in the
 Developmental/Utilization of family nursing community by means acceptable to them,
care plan in the provision of care through their full participation and at cost that
the community can afford at every stage of
development.
In the care of the communities: 
 A practical approach to making health benefits
within the reach of all people.
 Community organizing mobilization, community  An approach to health development, which is
development and people empowerment carried out through a set of activities and whose
 Case finding and epidemiological investigation ultimate aim is the continuous improvement
 Program planning, implementation and and maintenance of health status
evaluation
 Influencing executive and legislative individuals  
or bodies concerning health and development
Goal of Primary Health Care
 
 HEALTH FOR ALL FILIPINOS by the year 2000
 
AND HEALTH IN THE HANDS OF THE PEOPLE by
Primary Health Care the year 2020.
Overview  An improved state of health and quality of life
for all people attained throughSELF RELIANCE.
 May 1977 -30th World Health Assembly decided
that the main health target of the government  
and WHO is theattainment of a level of health Key Strategy to Achieve the Goal: 
that would permit them to lead a socially and
economically productive life by the year 2000.  Partnership with and Empowerment of the
people– permeate as the core strategy in the
 effective provision of essential health services  The health services should be present where the
that are community based, accessible, supposed recipients are. They should make use
acceptable, and sustainable, at a cost, which the of the available resources within the
community and the government can afford. community, wherein the focus would be more
on health promotion and prevention of illness.
 
Objectives of Primary Health Care 2. Community Participation (COPAR)

 Improvement in the level of health care of the  The heart and soul of PHC
community
 Favorable population growth structure 3.People are the center, object and subject of
 Reduction in the prevalence of preventable, development.
communicable and other disease.
 Reduction in morbidity and mortality rates  Thus, the success of any undertaking that aims
especially among infants and children. at serving the people is dependent on people’s
 Extension of essential health services with participation at all levels of decision-making;
priority given to the underserved sectors. planning, implementing, monitoring and
 Improvement in Basic Sanitation evaluating. Any undertaking must also be based
 Development of the capability of the on the people’s needs and problems (PCF, 1990)
community aimed at self- reliance.  Part of the people’s participation is the
 Maximizing the contribution of the other partnership between the community and the
sectors for the social and economic agencies found in the community; social
development of the community. mobilization and decentralization.
 In general, health work should start from where
  the people are and building on what they have.
Example: Scheduling of Barangay Health
Mission Workers in the health center

 To strengthen the health care system by      Barriers of Community Involvement

increasing opportunities and supporting the
conditions wherein people will manage their 
own health care. o Lack of motivation
o Attitude
  o Resistance to change
Two Levels of Primary Health Care Workers o Dependence on the part of community
people
o Lack of managerial skills
1. Barangay Health Workers– trained community
health workers or health auxiliary volunteers or
traditional birth attendants or healers. 4. Self-reliance
2. Intermediate level health workers-include the
Public Health Nurse, Rural Sanitary Inspector  Through community participation and
and midwives. cohesiveness of people’s organization they can
generate support for health care through social
  mobilization, networking and mobilization of
local resources. Leadership and management
Principles of Primary Health Care skills should be develop among these people.
Existence of sustained health care facilities
1. 4 A’s = Accessibility, Availability, Affordability & managed by the people is some of the major
Acceptability, Appropriateness of health indicators that the community is leading to self
services. reliance.
5. Partnership between the community and the the government and ongoing program of the
health agencies in the provision of quality of DOH
life.
4. Maternal and Child Health and Family Planning
 Providing linkages between the government and
the nongovernment organization and people’s  The mother and child are the most delicate
organization. members of the community. So the protection
of the mother and child to illness and other risks
6. Social Mobilization would ensure good health for the community.
The goal of Family Planning includes spacing of
 It enhances people participation or governance, children and responsible parenthood.
support system provided by the Government,
networking and developing secondary leaders. 5. Environmental Sanitation and Promotion of
Safe Water Supply
7. Decentralization
 Environmental Sanitation is defined as the study
 This ensures empowerment and that of all factors in the man’s environment, which
empowerment can only be facilitated if the exercise or may exercise deleterious effect on
administrative structure provides local level his well-being and survival. Water is a basic
political structures with more substantive need for life and one factor in man’s
responsibilities for development initiators. This environment. Water is necessary for the
also facilities proper allocation of budgetary maintenance of healthy lifestyle. Safe Water
resources. and Sanitation is necessary for basic promotion
of health.
 
6. Nutrition and Promotion of Adequate Food
 
Supply
Elements of Primary Health Care
 One basic need of the family is food. And if food
1. Education for Health is properly prepared then one may be assured
healthy family. There are many food resources
 Is one of the potent methodologies for found in the communities but because of faulty
information dissemination. It promotes the preparation and lack of knowledge regarding
partnership of both the family members and proper food planning, Malnutrition is one of the
health workers in the promotion of health as problems that we have in the country.
well as prevention of illness.
7. Treatment of Communicable Diseases and
2. Locally Endemic Disease Control Common Illness

 The control of endemic disease focuses on the  The diseases spread through direct contact pose
prevention of its occurrence to reduce a great risk to those who can be infected.
morbidity rate. Example Malaria Control and Tuberculosis is one of the communicable
Schistosomiasis Control diseases continuously occupies the top ten
causes of death. Most communicable diseases
3. Expanded Program on Immunization are also preventable. The Government focuses
on the prevention, control and treatment of
 This program exists to control the occurrence of these illnesses.
preventable illnesses especially of children
below 6 years old. Immunizations on 8. Supply of Essential Drugs
poliomyelitis, measles, tetanus, diphtheria and
other preventable disease are given for free by
 This focuses on the information campaign on  Essential National Health Research (ENHR) is an
the utilization and acquisition of drugs. integrated strategy for organizing and managing
 In response to this campaign, the GENERIC ACT research using intersectoral, multi-disciplinary
of the Philippines is enacted. It includes the and scientific approach to health programming
following drugs: Cotrimoxazole, Paracetamol, and delivery.
Amoxycillin, Oresol, Nifedipine, Rifampicin, INH
(isoniazid) and Pyrazinamide,Ethambutol,  
Streptomycin,Albendazole,Quinine
Four Cornerstones/Pillars in Primary Health Care 

Major Strategies of Primary Health Care

1. Active Community Participation
2. Intra and Inter-sectoral Linkages
1. Elevating Health to a Comprehensive and 3. Use of Appropriate Technology
Sustained National Effort. 4. Support mechanism made available

 Attaining Health for all Filipino will require  

expanding participation in health and health
related programs whether as service provider or  
beneficiary. Empowerment to parents, families
and communities to make decisions of their Bag technique-a tool making use of public health
health is really the desired outcome. bag through which the nurse, during his/her home
 Advocacy must be directed to National and visit, can perform nursing procedures with ease and
Local policy making to elicit support and deftness, saving time and effort with the end in view
commitment to major health concerns through of rendering effective nursing care.
legislations, budgetary and logistical
Public health bag – is an essential and indispensable
considerations.
equipment of the public health nurse which he/she
has to carry along when he/she goes out home
2. Promoting and Supporting Community visiting. It contains basic medications and articles
Managed Health Care which are necessary for giving care.

 The health in the hands of the people brings the  

government closest to the people. It
necessitates a process of capacity building of Rationale: To render effective nursing care to clients
communities and organization to plan, and /or members of the family during home visit.
implement and evaluate health programs at Principles
their levels.
1. The use of the bag technique should minimize if
3. Increasing Efficiencies in the Health Sector not totally prevent the spread of infection from
individuals to families, hence, to the
 Using appropriate technology will make services community.
and resources required for their delivery, 2. Bag technique should save time and effort on
effective, affordable, accessible and culturally the part of the nurse in the performance of
acceptable. The development of human nursing procedures.
resources must correspond to the actual needs 3. Bag technique should not overshadow concern
of the nation and the policies it upholds such as for the patient rather should show the
PHC. The DOH will continue to support and effectiveness of total care given to an individual
assist both public and private institutions or family.
particularly in faculty development, 4. Bag technique can be performed in a variety of
enhancement of relevant curricula and ways depending upon agency policies, actual
development of standard teaching materials. home situation, etc., as long as principles of
avoiding transfer of infection is carried out.
4. Advancing Essential National Health Research
   Test tube holder
 Medicines
Special Considerations in the Use of the Bag o betadine
o 70% alcohol
1. The bag should contain all necessary articles, o ophthalmic ointment (antibiotic)
supplies and equipment which may be used to o zephiran solution
answer emergency needs. o hydrogen peroxide
2. The bag and its contents should be cleaned as o spirit of ammonia
often as possible, supplies replaced and ready
o acetic acid
for use at any time.
o benedict’s solution
3. The bag and its contents should be well
protected from contact with any article in the
home of the patients. Consider the bag and it’s      Note: Blood Pressure Apparatus and Stethoscope
contents clean and /or sterile while any article are carried separately.
belonging to the patient as dirty and
contaminated.
4. The arrangement of the contents of the bag
should be the one most convenient to the user
to facilitate the efficiency and avoid confusion.
5. Hand washing is done as frequently as the
situation calls for, helps in minimizing or
avoiding contamination of the bag and its
contents.
6. The bag when used for a communicable case
should be thoroughly cleaned and disinfected
before keeping and re-using.

Contents of the Bag

 Paper lining
 Extra paper for making bag for waste materials
(paper bag)
 Plastic linen/lining
 Apron
 Hand towel in plastic bag
 Soap in soap dish
 Thermometers in case [one oral and rectal]
 2 pairs of scissors [1 surgical and 1 bandage]
 2 pairs of forceps [ curved and straight]
 Syringes [5 ml and 2 ml]
 Hypodermic needles g. 19, 22, 23, 25
 Sterile dressings [OS, C.B]
 Sterile Cord Tie
 Adhesive Plaster
 Dressing [OS, cotton ball]
 Alcohol lamp
 Tape Measure
 Baby’s scale
 1 pair of rubber gloves
 2 test tubes
 for the specific case (e.g.)
thermometer, kidney basin,
cotton ball, waste paper bag) and accessible.
place at one corner of the work
Steps/Procedures area.

Actions Rationale To prevent

8. Place waste paper bag outside
contamination of clean
of work area.
area.
1. Upon arriving at the client’s
home, place the bag on the table
or any flat surface lined with To give comfort and
To protect the bag from security, maintain
paper lining, clean side out 9. Close the bag.
contamination. personal hygiene and
(folded part touching the table).
Put the bag’s handles or strap hasten recovery.
beneath the bag.
To prevent
10. Proceed to the specific
2. Ask for a basin of water and a To be used for contamination of bag
nursing care or treatment.
glass of water if faucet is not handwashing. and contents.
available. Place these outside the To protect the work
work area. field from being wet.
11. After completing nursing care To protect caregiver and
or treatment, clean and prevent spread of
3. Open the bag, take the alcoholize the things used. infection to others.
linen/plastic lining and spread To make a non-
over work field or area. The contaminated work field
12. Do handwashing again.
paper lining, clean side out or area.
(folded part out).
13. Open the bag and put back all
articles in their proper places.
4. Take out hand towel, soap dish
and apron and the place them at
To prepare for
one corner of the work area 14. Remove apron folding away
handwashing.
(within the confines of the from the body, with soiled
linen/plastic lining). sidefolded inwards, and the
clean side out. Place it in the bag.
5. Do handwashing. Wipe, dry Handwashing prevents
with towel. Leave the plastic possible infection from 15. Fold the linen/plastic lining,
wrappers of the towel in a soap one care provider to the clean; place it in the bag and
dish in the bag. client. close the bag.

6. Put on apron right side out and 16. Make post-visit conference
To protect the nurses’
wrong side with crease touching on matters relevant to health To be used as reference
uniform. Keeping the
the body, sliding the head into care, taking anecdotal notes for future visit.
crease creates aesthetic
the neck strap. Neatly tie the preparatory to final reporting.
appearance.
straps at the back.

17. Make appointment for the For follow-up care.

7. Put out things most needed To make them readily next visit (either home or clinic),
     Steps:
taking note of the date, time and
purpose.      Preparatory Phase

1. site selection
  2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data
collection
6. finalize sampling design and methods
7. make a timetable
After Care 
Implementation Phase
1. Before keeping all articles in the bag, clean and
alcoholize them.
1. data collection
2. Get the bag from the table, fold the paper lining
2. data organization/collation
( and insert), and place in between the flaps and
3. data presentation
cover the bag.
4. data analysis
5. identification of health problems
  6. prioritization of health problems
Evaluation and Documentation  7. development of a health plan
8. validation and feedback
1. Record all relevant findings about the client and
members of the family. Evaluation Phase
2. Take note of environmental factors which affect Biostatistics
the clients/family health.
3. Include quality of nurse-patient relationship.
 DEMOGRAPHY – study of population size,
4. Assess effectiveness of nursing care provided.
composition and spatial distribution as affected
by births, deaths and migration.
 
 Sources: Census– complete enumeration of the
  population

Community Diagnosis  2 Ways of Assigning People

 A process by which the nurse collects data 1. De Jure– People were assigned to the place
about the community in order to identify factors where assigned to the place they usually live
which may influence the deaths and illnesses of regardless of where they are at the time of
the population, to formulate a community census.
health nursing diagnosis and develop and 2. De Facto– People were assigned to the place
implement community health nursing where they are physically present at are at the
interventions and strategies. time of census regardless, of their usual place of
residence.
2 Types:
Components 
Comprehensive Community Diagnosis   Problem-Oriented Community Diagnosis
1. Population size
2. Population composition
§  aims to obtain general information about the §  o Age Distribution
community need o Sex Ratio
o Population Pyramid
 o Median age– age below which 50% of the  
population falls and above which 50% of
the population falls. The lower the median  
age, the younger the population (high
Mortality Rate
fertility, high death rates).
1. Crude Death Rate 
o Age – Dependency Ratio– used as an index
of age-induced economic drain on human _Total # of death in a given calendar year_                   
resources X 1000
o Other characteristics:   Estimated population as of July 1 of the same
calendar year
7.
o occupational groups  
o economic groups
o educational attainment 2. Infant Mortality Rate
o ethnic group
8. Population Distribution Total # of death below 1 yr in a given calendar
o Urban-Rural– shows the proportion of year             X 1000
people living in urban compared to the Estimated population as of July 1 of the same
rural areas calendar year
o Crowding Index– indicates the ease by
 
which a communicable disease can be
transmitted from 1 host to another
susceptible host. 3. Maternal Mortality Rate
o Population Density– determines congestion Total # of death among all maternal cases in a
given calendar year        X 1000
of the place
Estimated population as of July 1 of the same
calendar year
Vital Statistics
 
 The application of statistical measures to vital
events (births, deaths and common illnesses)  
that is utilized to gauge the levels of health,
illness and health services of a community. Morbidity Rate

Types of Vital Statistics 1. Prevalence Rate

Total # of new & old cases in a given calendar
Fertility Rate  year                    X 100
Estimated population as of July 1 of the same
1. Crude Birth Rate calendar year

Total # of livebirths in a given calendar year                 

X 1000
  Estimated population as of July 1 of the same given 2. Incidence Rate
year
Total # of new cases in a given calendar year_           
  X 100
     Estimated population as of July 1 of the same
2. General Fertility Rate calendar year

Total # of livebirths in a given calendar year          X  

1000
                 Total number of reproductive age 3. Attack Rate
Total # of person who are exposed to the disease         global occurrence of a disease
X 100
    Estimated population as of July 1 of the same   
calendar year
  Steps in Epidemiological Investigation:
 
  1. Establish fact of presence of epidemic
2. Establish time and space relationship of the
Epidemiology 
disease
3. Relate to characteristics of the group in the
 the study of distribution of disease or community
physiologic condition among human population 4. Correlate all data obtained
s and the factors affecting such distribution 5. Role of the Nurse
 the study of the occurrence and distribution of
health conditions such as disease, death,
 Case Finding
deformities or disabilities on human populations
 Health Teaching
 Counseling
1. Patterns of disease occurrence
 Follow up visit

     Epidemic
 

 A situation when there is ahigh incidence of new  

cases of a specific disease in excess of the
expected. Expanded Program on Immunization
 when the proportion of the susceptible are high
Principles of EPI
compared to the proportion of the immunes

 Epidemiological situation
     Epidemic potential
 Mass approach
 Basic Health Service
 anarea becomes vulnerable to a
disease upsurge due to causal factors such as
The 7 immunizable diseases
climatic changes, ecologic changes, or socio-
economic changes
 Tuberculosis
     Endemic  Diptheria
 Pertussis
 Measles
 habitual presence of a diseasein a given
 Poliomyelitis
geographic location accounting for the low
 Tetanus
number of both immunes and susceptibles.E.g.
 Hepatitis B
Malaria is a disease endemic at Palawan.
 Thecausative factor of the disease is constantly
available or present to the area. Target Setting

     Sporadic  Infants 0-12 months

 Pregnant and Post Partum Women
 disease occursevery now and then affecting only  School Entrants/ Grade 1 / 7 years old
a small number of people relative to the total
population Objectives of EPI
 intermittent

     Pandemic
  To reduce morbidity and mortality rates among
infants and children from six childhood  Weakened  Freeze dried-  Subcut
 Measles  1
immunizable disease virus 0.5ml aneous

Elements of EPI  

 Target Setting Administration of vaccines

 Cold chain Logistic Management- Vaccine
distribution through cold chain is designed to Schedule of Vaccines
ensure that the vaccines were maintained under
proper environmental condition until the time  Interval
of administration.  Vaccine  Age at 1st dose  Protection
between dose
 Information, Education and Communication
(IEC)
 Assessment and evaluation of Over-all  BCG is given at the
performance of the program earliest possible age
 Surveillance and research studies protects against the
 BCG  At birth   possibility of TB
infection from the
other family
  members

 
 An early start with
DPT reduces the
 # of  DPT  6 weeks  4 weeks
 Vaccine  Content  Form & Dosage  Route chance of severe
Doses
pertussis

 BCG Freeze dried

 The extent of
 Live
(Bacillus protection against
attenuated Infant-  1  ID  OPV  6weeks  4weeks
Calmette 0.05mlPreschool- polio is increased the
bacteria
Guerin) 0.1ml earlier OPV is given.

DT-  An early start of

weakened  @birth,6th Hepatitis B reduces
 DPT toxin  Hepa B  @ birth week,14th
(Diphtheri the chance of being
 liquid-0.5ml  3  IM week infected and
a Pertussis  
Tetanus) becoming a carrier.
P-killed
bacteria
 At least 85% of
measles can be
 OPV (Oral  Measles  9m0s.-11m0s.   prevented by
 weakened
Polio  liquid-2drops  3  Oral immunization at this
virus
Vaccine) age.

 Hepatitis  Plasma  6 months – earliest dose of measles given in

 Liquid-0.5ml  3  IM
B derivative case of outbreak
  9months-11months- regular schedule of o 6months- Regional Level
measles vaccine o 3months- Provincial Level/District Level
 15 months- latest dose of measles given o 1month-main health centers-with ref.
 4-5 years old- catch up dose o Not more than 5days- Health centers using
 Fully Immunized Child (FIC)– less than 12 transport boxes.
months old child with complete immunizations  Most sensitive to heat: Freezer (-15 to -25
of DPT, OPV, BCG, Anti Hepatitis, Anti measles. degrees C)
o OPV
Tetanus Toxiod Immunization o Measles
 Sensitive to heat and freezing (body of ref. +2 to
Schedule for Women +8 degrees Celsius)
o BCG
 Duration o DPT
 Minimum age o Hepa B
 Vaccine  % protected of
interval o TT
Protection
 Use those that will expire first, mark “X”;
3rdexposure- discard,
 TT1  As early as possible  0%  0  Transport-use cold bags let it stand in room
temperature for a while before storing DPT.
 Half life packs: 4hours-BCG, DPT, Polio, 8 hours-
 TT2  4 weeks later  80%  3 years measles, TT, Hepa B. FEFO (“first expiry and first
out”)
 TT3  6 months later  95%  5 years
 

 1year later/during  
 TT4  99%  10 years
next pregnancy
References:

 Public Health Nursing in the Philippines by Nitse

 1 year later/third
 TT5  99%  Lifetime
pregnancy Nursing Practice in the Community  by Araceli
Maglaya

 There is no contraindication to immunization Nursing Care of the Community by Zenaida Famorca

except when the child is immunosuppressed or
is very, very ill (but not slight fever or cold). Or if
the child experienced convulsions after a DPT or
measles vaccine, report such to the doctor
immediately.
 Malnutrition is not a contraindication for
immunizing children rather; it is an indication
for immunization since common childhood
diseases are often severe to malnourished
children.

Cold Chain under EPI

 Cold Chain is a system used to maintain potency

of a vaccine from that of manufacture to the
time it is given to child or pregnant woman.
 The allowable timeframes for the storage of
vaccines at different levels are: