Universidad De Dagupan

Arellano St., Dagupan City

      School of Health Sciences-Nursing Department

NCM 104- Community Health Nursing I (Care of Individuals, Family and

Community) (Lecture)

Academic Year 21-22

Chapter 1: Fundamentals of Community Health Nursing

Community Health Nursing

● “The utilization of the nursing process in the different levels of clientele-individuals, families,
population groups and communities, concerned with the promotion of health, prevention of disease
and disability and rehabilitation.” – Maglaya, et.al

● Major goal of CHN- preserve the health of the community and surrounding population by focusing
on health promotion and health maintenance of individual, family and group within community.

● A specialized field of nursing practice that focuses on a group of people with common interests
living together within a territory or geographical boundary – COMMUNITY

● Community health is part of the paramedical and medical intervention/approach which is

concerned on the health of the whole population that aims health promotion, disease prevention
and management of factors affecting the health

● Public health nursing is the term used before for community health nursing.

Global or umbrella term; broader and more general specialty area that encompasses subspecialties that
include public health nursing, school nursing, occupational health nursing, and other developing fields of
practice, such s home health, hospice care, and independent nurse practice.

-“the synthesis of nursing practice and public health practice applied to promoting and preserving health
of the populations (ANA, 1980)

Basic Principles of CHN

● The community is the patient in community health nursing, the family is the unit of care and
there are four levels of clientele: individual, family, population group, 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.
3 Elements in CHN

Science of Public Health

Public Health Nursing Skills

Social Assistance Functions

What is Public Health Nursing?

The synthesis of public health and nursing practice PHC according to FREEMAN (1963):

- Public Health Nursing may be defined as the 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. These skills are applied in concert with those of other persons
engaged in health care, through comprehensive nursing care of families and other groups and through
measures for evaluation or control of threats to health, for health education of the public and for the
mobilization of the public for health action.

PHC according to ANA (1996):

- “the practice of promoting and protecting the health of populations using knowledge from nursing, social
and public health sciences”

- “population-focused”, with the goals of promoting health and preventing disease and disability for all
people through the creation of conditions in which people can be healthy.

Objectives of Public Health (CODES)

C – ontrol of Communicable Disease

O – rganization of Medical and Nursing Services

D – evelopment of Social Machineries

E – ducation of IFC on personal hygiene

S – anitation of the environment

Roles and Functions of a Community Health Nurse

● Planner/Programmer

-Identifies needs, priorities, and problems of individuals, families, and communities

-Formulates municipal health plan in the absence of a medical doctor

-Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned
staff personnel

-Provides technical assistance to rural health midwives in health matters.

● Provider of Nursing Care

-Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace

-Develops the family’s capability to take care of the sick, disabled, or dependent member

● Community Organizer

- Motivates and enhances community participation in terms of planning, organizing, implementing, and
evaluating health services

-Initiates and participates in community development activities

● Coordinator of Services

- Coordinates with individuals, families, and groups for health related services provided by various
members of the health team

- Coordinates nursing program with other health programs like environmental sanitation, health education,
dental health, and mental health

● Trainer/Health Educator

- Identifies and interprets training needs of the RHMs, Barangay Health Workers (BHW), and hilots

- Conducts training for RHMs and hilots on promotion and disease prevention

- Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health
and health related services
-Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education purposes

- Conducts pre-marital counseling

● Health Monitor

Detects deviation from health of individuals, families, groups, and communities through contacts/visits
with them

● Role Model

-Provides good example of healthful living to the members of the community

● Change Agent

- Motivates changes in health behavior in individuals, families, groups, and communities that also include
lifestyle in order to promote and maintain health

● Researcher

- Participates in the conduct of survey studies and researches on nursing and health-related subjects

- Coordinates with government and non-government organization in the implementation of

studies/research

● Recorder/Reporter/Statistician

- Prepares and submits required reports and records

- Maintain adequate, accurate, and complete recording and reporting

- Reviews, validates, consolidates, analyzes, and interprets all records and reports

- Prepares statistical data/chart and other data presentation

Standards of Public/Community Health Nursing Practice in the Philippines

Republic Act 9173 (The Philippine Nursing Act of 2002)

Article VI, Section 28.

Scope of Nursing. - A person shall be deemed to be practicing nursing within the meaning of this Act
when he/she singly or in collaboration with another, initiates and performs nursing services to individuals,
families and communities in any health care setting. It includes, but not limited to, nursing care during
conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood,
and old age. As independent practitioners, nurses are primarily responsible for the promotion of health
and prevention of illness. A members of the health team, nurses shall collaborate with other health care
providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation
of suffering, and when recovery is not possible, towards a peaceful death.

It shall be the duty of the nurse to: (a) Provide nursing care through the utilization of the nursing process.
Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self,
executing health care techniques and procedures, essential primary health care, comfort measures,
health teachings, and administration of written prescription for treatment, therapies, oral topical and
parenteral medications, internal examination during labor in the absence of antenatal bleeding and
delivery. In case of suturing of perineal laceration, special training shall be provided according to
protocol established;

(b) establish linkages with community resources and coordination with the health team; (c) Provide health
education to individuals, families and communities; (d) Teach, guide and supervise students in nursing
education programs including the administration of nursing services in varied settings such as hospitals
and clinics; undertake consultation services; engage in such activities that require the utilization of
knowledge and decision-making skills of a registered nurse; and (e) Undertake nursing and health human
resource development training and research, which shall include, but not limited to, the development of
advance nursing practice;

Health and Community

What is HEALTH?

WHO- “a state of complete physical, mental and social well-being and not merely the absence of disease
or infirmity.”

Murray- “a state of well-being in which the person is able to use purposeful, adaptive responses and
processes physically, mentally, emotionally, spiritually, and socially.”

Pender- “actualization of inherent and acquired human potential through goal-directed behavior,
competent self-care, and satisfying relationship with others.”

Orem- a state of person that is characterized by soundness or wholeness of developed human structures
and of bodily and mental functioning.”
Health and Community

What is COMMUNITY?

is seen as a group or collection of locality-based individuals, interacting in social units and sharing
common interests, characteristics, values, and/ or goals.

Allender- “a collection of people who interact with one another and whose common interests or
characteristics form the basis for a sense of unity or belonging

Lundy and Janes- “a group of people who share something in common and interact with one another,
who may exhibit a commitment with one another and may share geographic boundary.”

Clark- “a group of people who share common interests, who interact with each other, and who function
collectively within a defined social structure to address common concerns.”

Shuster and Goeppinger- “a locality-based entity, composed of systems of formal organizations reflecting
society’s institutions, informal groups and aggregates.”

Maurer and Smith (2009)- Two main types of communities:

a. Geopolotical communities- also called as territorial communities.

- are most traditionally recognized.

- defined or formed by both natural and man-made boundaries and include

barangays, municipalities, cities, provinces, regions and nations.

b. Phenomenological communities- also called as functional communities.

- refer to relational, interactive groups, in which the place or setting is more

abstract, and people share a group perspective or identity based on culture,

values, history, interest and goals.

Determinants of Health

1. Income and social status- higher income and social status are linked to better
health. The greater the gap between the richest and poor health, the greater differences in health.

2. Education- low education levels are linked with poor health, more stress and

lower self-confidence.

3. Physical environment- safe water and clean air, healthy workplaces, safe

houses communities and roads all contribute to good health.

4. Employment and working conditions- people in employment are healthier,

particularly those who have control over their working conditions.

5. Social support networks- greater support from families, friends and

communities is linked to better health.

6. Culture- customs and traditions, and the beliefs of the family and community

all affect health.

7. Genetics - inheritance plays a part in determining lifespan, healthiness and

the likelihood of developing illnesses.

9. Personal behavior and coping skills - balanced eating, keeping active, smoking,

drinking and how we deal with life’s stresses and challenges all affect health.

10. Health services - access and use of services that prevent and treat disease

influences health.

11. Gender - men and women suffer from different types of diseases at different ages.

Indicators of Health and Illness

National Epidemiology Center of DOH, PSA and local health centers/ offices/departments- provide
morbidity, mortality and other health status related data.

Local health centers/ offices/ departments- are responsible for collecting morbidity and mortality data and
forwarding the information to the higher lever of health, such as Provincial Health office.

Nurses should participate in investigative efforts to determine what is precipitating the increased disease
rate and work to remedy the identified threats or risks.
Definition and Focus of Public Health and Community Health

Definition of public health according to:

a. C. E. Winslow - “Public health is the science and art of (1) preventing disease,

(2) prolonging life, and (3) promoting health and efficiency through organized

community effort for:

1. sanitation of the environment,

2. control communicable infections,

3. education of the individual in personal hygiene,

4. organization of medical and nursing services for the early diagnosis and

preventive treatment of disease, and

5. “development of the social machinery to ensure everyone a standard of

living adequate for the maintenance of health, so organizing these

benefits as to enable every citizen to realize his birthright of health and longevity.”(Hanlon)

Definition and Focus of Public Health and Community Health

Public health - key phrase definition: “through organized community effort”. - connotes, organized,
legislated, and tax-supported efforts that serve all people through health departments or related
governmental agencies.

9 Essential public health functions according to WHO Regional Office for the Western Pacific:

1. Health situation monitoring and analysis

2. Epidemiological surveillance/ disease prevention and control

3. Development of policies and planning in public health

4. Strategic management of health systems and services for population health gain

5. Regulation and enforcement to protect public health

6. Human resources development and planning in public health

7. Health promotion, social participation and empowerment

8. Ensuring the quality of personal and population-based health service

9. Research, development, and implementation of innovative public health solution

Preventive Approach to Health

Health Promotion and Levels of Prevention

Health promotion- activities enhance resources directed at improving well-being.

Disease prevention- activities protect people from disease and effects of disease.

Leavell and Clark’s Three Levels of Prevention

1. Primary prevention- relates to activities directed at preventing a problem

before it occurs by altering susceptibility or reducing exposure for susceptible

individuals.

2. Secondary prevention- early detection and prompt intervention during the

period of early disease pathogenesis.

- implemented after a problem has begun but before signs and symptoms appear

and targets populations who have risk factors (Keller).

3. Tertiary prevention- targets populations that have experienced disease or injury

and focuses on limitations of disability and rehabilitation.

-AIM: reduce the effects of disease and injury and to restore individuals to their optimum level of
functioning.

Community-based Nursing

application of the nursing process in caring for individuals, families and group where they live, work go to
go school or they move through the health care system
- setting-specific, and the emphasis is on acute and chronic care and includes practice areas such as
home health nursing and nursing in outpatient or ambulatory setting.

CHN vs. Community-based Nursing

CHN – emphasizes preservation and protection of heath

- the primary client is the community

Community-based Nursing

- Emphasizes on managing acute and chronic - the primary clients are the individual and the family

Population-focused Nursing

-concentrates on specific groups of people and focuses on health promotion and disease prevention,
regardless of geographical location (Baldwin et al., 1998)

Focused-practice includes:

1. focuses on the entire population

2. is based on assessment of the populations’ health status

3. considers the broad determinants of health

4. emphasizes all levels of prevention

5. intervenes with communities, systems, individuals and families - goal: promote healthy communities

Population-focused Nursing

CHN practice requires the ff. types of data for scientific approach and population:

1. the epidemiology or body of knowledge of a particular problem and its solution

2. information about the community

Family – basic unit of care in CHN

Individual –focus in the clinic or health center

Population-Focused Approach

The Intervention Wheel

proposed in the late 1990s by nurses from the Minnesota Department of Health to describe the breadth
and scope of public health nursing practice; recognized as a framework for community and public health
practice - consist of 17 health interventions are grouped into 5 wedges.

3 Important Elements:

1. It is population-based

2. It contains 3 levels of practice (Community, systems and individual/family)

3. It identifies and defines 12 public health interventions

Community Health Interventions

Surveillance – monitors health events

Disease and other health event investigation – systematically gathers and analyzes data regarding
threats to the health of populations

Outreach – locates populations of interests or populations at risk

Screening – identifies individuals with unrecognized health risk factors

Case finding – identifies risk actors and connects them with resources

Referral and follow-up – assists individuals and families, families, groups, organizations ad communities
to identify and access necessary resources

Case management – optimizes self-care capabilities of individuals and families

Delegated functions – direct care tasks that the nurse carries out

Health teaching – communicates facts, ideas and skills that change knowledge, attitudes values,
behaviors and practice
Counseling – establishes an interpersonal relationships; with the intention of increasing or enhancing their
capacity for self-care and coping

Consultation – seeks information and generates optional solutions to perceived problems

Collaboration – commits two or more persons or an organization

Coalition building – develops alliances among organizations

Community organizing – helps community groups to identify common problems or goals mobilizes
resources and develop and implement strategies

Advocacy – pleads someone’s cause or acts on someone’s behalf

Social marketing – utilizes commercial marketing principles for programs

Policy development and enforcement – place issues on decision makers’ agendas, acquires plan of
resolution

EMERGING FIELDS OF CHN IN THE PHILIPPINES

HOME HEALTH CARE – this practice involves providing nursing care nursing care to individuals and
families in their own places of residence mainly to minimize the effects of illness and disability.

HOSPICE HOME CARE – homecare rendered to the terminally ill. Palliative care is particularly important.

ENTREPRENURSE

- A project initiated by the Department of Labor and Employment (DOLE), in

collaboration with the Board of Nursing of the Philippines, Department of Health, Philippines Nurses
Association and other stakeholders to promote nurse entrepreneurship by introducing a home health care
industry in the Philippines.

Entreprenurse aims to:

1. Reduce the cost of health care for the countries indigent population by bringing

primary health care services to poor rural communities

2. Maximize employment opportunities for the countries unemployed nurses

3. Utilize the countries unemployed human resources for health for the delivery of

public health services and the achievement of the country’s Millenium

Development Goals (MDG) on maternal and child health, (DOLE, 2013)

MAIN PURPOSE OF ENTRPRENURSE

- To deliver home health care services

COMPETENCY STANDARDS IN CHN

1. Safe and Quality Nursing Care

-knowledge of health/illness status of the client, sound decision making; safety,

comfort, privacy, administration of meds and health therapeutics and nursing process.

2. Management of resources and environment

- organization of workload; use of financial resources for client care; mechanism to ensure

proper functioning of equipment and maintenance of a safe environment

3. Health Education

- assessment of client’s learning needs; development of health education plan and

learning materials and implementation and evaluation of health education plan

4. Legal Responsibility

- adherence to the nursing laws as well as to national, local and organizational policies

including documentation of care given to clients.

5. Ethico-moral Responsibility

- respect for the rights of the client; responsibility and accountability for own decisions and

actions; and adherence to the international and national codes of ethics for nurses
6. Personal and Professional Development

- identification of own learning needs, pursuit of continuing education; involvement in

professional image; positive attitude towards change and criticism

7. Quality Improvement

- data gathering for quality improvement; participation in nursing rounds; identification and

reporting of solutions to identifies problems related to client care.

8. Research

- research-based formulation of solutions to problems in client care and dissemination and

application of research findings

9. Records Management

- accurate and updated documentation of client care while observing legal imperatives

and record keeping

10. Communication

- uses therapeutic communication techniques, identifies verbal and nonverbal cues,

responds to client needs, while using formal and informal channels of communication and

appropriate information technology

11. Collaboration and Teamwork

- establishment of collaborative relationship with colleagues and other members of health

Team

HISTORY OF PUBLIC HEALTH AND PUBLIC HEALTH NURSING IN THE PHILIPPINES

● 1577 - Franciscan Friar Juan Clemente opened medical dispensary in Intramuros for the indigent
● 1690 – Dominican Father Juan de Pergero worked toward installing a water system in San Juan
del Monte and Manila
● 1805 – smallpox vaccination was introduced by Francisco de Balmis, the personal physician of
King Charles IV of Spain
● 1876 – first medicos titulares were appointed by the Spanish government
 ● 1888 - 2-year courses consisting of fundamental medical and dental subjects was first offered in
the University of Santo Tomas. Graduated were known as “cirujanosministrantes” and serve as
male nurses and sanitation inspectors
● 1901 – United States Philippines Commission, through Act 157, created the Board of Health of
the Philippine Islands with a Commissioner of the Public Health as its chief executive officer (now
the Department of Health)
● Fajardo Act of 1912 – created sanitary divisions made up of one to four municipalities. Each
sanitary division had a president who had to be a physician
● 1915 - the Philippine General hospital began to extend public health nursing services in the
homes of patients by organizing a unit called Social and Home Care services Asociacion
Feminista Filipina (1905) – Lagota de Leche was the first center dedicated to the service of the
mothers and babies
● 1947 – the Department of Health was reorganized into bureaus: quarantine, hospitals that took
charge of the municipal and charity clinics and health with the sanitary divisions under it.
● 1954 – Congress passed RA 1082 or the Rural Health Act that provided the creation of RHU in
every municipality
● RA 1891 – enacted in 1957 amended certain provisions in the Rural Health Act. Created 8
categories of rural health units corresponding to the population size of the municipalities
● RA 7160 (Local Government Code) – enacted in 1991, amended that devolution of basic health
services including health services, to local government units and the establishment of a local
health board in every province and city of municipality

Millennium Development Goals (MDGs) – adopted during the world summit in September 2000

FOURmula One (F1) for Health, 2005 and Universal Health Care in 2010 – agenda launched in 1999

Elements of HRSA (FOURmula One)

1. Health financing
2. Health Regulation
3. Health Service Delivery
4. Good Governance

Universal Health Care – aims to achieve the health system goals of better health outcomes, sustained
health financing, and responsive health system that will provide equitable access to health care
Chapter 2: Theoretical Foundations of Community Health Nursing

Historical Perspectives on Nursing Theory

● Florence Nightingale was the first nurse to formulate a conceptual foundation for nursing
practice.
● She believed that clean water, clean linen, access to adequate sanitation and a quiet
environment would improve health outcomes.
● Other early nursing theories were extremely narrow and depicted health care situations that
involved only one nurse and one patient. Noticeably, the family and other health care
professionals were absent from the context of the theories.
● From 1980 onwards, several nursing theorists including, Dorothy Johnson, Sister Callista Roy,
Imogene King, Betty Neuman and Jean Watson have included community perspectives in their
definition of health.

How Theory Provides Direction to Nursing

The goal of theory is to improve nursing practice by acting as a guide.

General Systems Theory

The General Systems Theory is the basis, in part, of several nursing theories.

● It is applicable to the different levels of the community health nurse’s clientele: individuals,
families, groups or aggregates and communities.
● The client is considered as a set of interacting elements that exchange energy, matter or
information with the external environment to exist (Katz and Kahn, 1966; von Bertalanffy, 1968)
● This theory is useful when analyzing interrelationships of the elements within the client and the
environment
● The Family Environment constitutes everything outside its boundaries that may affect it; the
family home and the community and its institutions make up the immediate environment and
should be considered in the assessment of family health status.
● The family gets inputs of matter (food, water), energy, and information from the environment
● Outputs are material products, energy and information that result from the family’s processing of
inputs.
● Feedback is the information from the environment directed back to the system, it allows the
system to make the necessary adjustments for better functioning.
● Subsystems are the components of a system that interact to accomplish their own purpose.
(Family members)
● Suprasystems are a bigger system composed of families who interrelate with and affect one
another. (Families)

Output examples are health practices and the health status of the family members.

Feedback example: a nurse’s feedback to a mother that her child is

underweight makes the mother more aware of her child’s needs and

allows her to take action

Social Learning Theory

● It is based on the belief that learning takes place in a social context; people learn from one
another and learning is promoted by modeling or observing other people.
● It assumes that all personas are thinking beings that are capable of making decisions and acting
according to expected consequences of their behavior.
● The environment affects learning but learning outcomes depend on the learner’s individual
characteristics.

Application of the theory can be done by:

Catching the person’s attention with different strategies

Promoting retention of learning

Providing opportunities for reproduction or imitation of the procedures

Motivating the person by explaining the benefits possible by practicing the

behavior

The Health Belief Model

● Initially proposed in 1958, the model provides the basis for much of the practice of health
education and promotion today.
● This model found that information alone is rarely enough to motivate people to act for their
health. Individuals must know what to do and how to do it before they can take action.
● Key elements of the Health Belief Model focus on individual beliefs about health conditions,
which predict individual health-related behaviors. The model defines the key factors that
influence health behaviors as an individual's perceived threat to sickness or disease (perceived
susceptibility), belief of consequence (perceived severity), potential positive benefits of action
(perceived benefits), perceived barriers to action, exposure to factors that prompt action (cues
to action), and confidence in ability to succeed (self-efficacy).

HBM Example: the cue to action in the prevention of dengue fever may be provided through an
information campaign. This makes the people in a barangay aware of the disease and that everyone is
susceptible to the possibly fatal disease. The HBM would be used by the nurse to help clients in making
behavior modifications to avoid dengue.
Milio’s Framework for Prevention

● Milio (1976) proposed that health deficits often result from an imbalance between a population’s
health needs and its health sustaining resources.
● She stated that diseases associated with excess occurred in affluent societies (obesity) and
diseases that result from inadequacies in food, shelter and water afflict the poor. Therefore, poor
people in affluent societies experience the least desirable combination of factors.
● Personal and societal resources affect the range of health promoting or health damaging choices
available to individuals. Personal resources include the individual’s awareness, knowledge and
health beliefs. Money and time are also personal resources.
● She proposed that most human beings make the easiest choices available to them most of the
time. Health promoting choices must be more readily available and less costly than health
damaging options for individuals to gain health.
● This theory is broader than the HBM, it includes economic, political and environmental health
determinants rather than just the individual’s perceptions.
● This theory encourages the nurse to understand health behaviors in the context of their societal
milieu.
● Health promoting choices must be more readily available and less costly than health damaging
options for individuals to gain health.

Pender’s Health Promotion Model

● The model explores many biopsychosocial factors that influence individuals to pursue health
promotion activities.
● The model depicts complex multidimensional factors which people interact with as they work to
achieve optimum health.
● Pender’s model focuses on three areas: individual characteristics and experiences, behavior-
specific cognitions and affect, and behavioral outcomes. The theory notes that each person has
unique personal characteristics and experiences that affect subsequent actions. The set of
variables for behavior specific knowledge and affect have important motivational significance. 
● Pender's health promotion model defines health as “a positive dynamic state not merely the
absence of disease.” Health promotion is directed at increasing a client's level of well-being. It
describes the multi-dimensional nature of persons as they interact within the environment to
pursue health

The Transtheoretical Model

● This model combines several theories of intervention. It is based on the assumption that
behavior change takes place over time, and progresses through stages
● Each stage is stable and is open to change; Meaning one may stop in one stage, progress to the
next stage or return to a previous stage.
● Change is difficult. People may resist change for many reasons. Change may be unpleasant,
require giving up pleasure, be painful, stressful, etc.
● It explains an individual's readiness to change their behavior. It describes the process of
behavior change as occurring in stages.
PRECEDE-PROCEED Model

● It provides a model for community assessment, health education planning, and evaluation.

⮚ PRECEDE, which stands for predisposing, reinforcing and enabling

constructs in educational diagnosis and evaluation is used for community diagnosis.

⮚ PROCEED, stands for policy, regulatory, and organizational constructs in

education and environmental development, is a model for implementing

and evaluating health programs based on PRECEDE.

Predisposing factors: people’s characteristics that motivate them toward

health related behavior.

Enabling factors: conditions in people and the environment that facilitate

or impede health related behavior.

Reinforcing factors: feedback given by support persons or groups resulting

from the performance of health-related behavior

Chapter 3: Primary Health Care

HISTORY and OVERVIEW of PHC

SEPTEMBER 6-12, 1978 - first International Conference for PHC at Alma Ata, USSR, Russia

L.O.I. 949 - legal basis for PHC in the Philippines

- signed by Pres. Ferdinand Marcos

- THEME: Health in the Hands of the People by 2020

Definition - the essential care made universally accessible to individuals and families in the community
through their full preparation. Universal Goal - Health For All by the Year 2000
 - this is achieved through community and individual self-reliance.

PRIMARY CARE

- includes health promotion, disease prevention, health maintenance, counseling, patient education and
diagnosis and treatment of acute and chronic illness in different health settings.

PRIMARY HEALTH CARE

5 KEY ELEMENTS:

1. Reducing exclusion and social disparities in health (universal coverage).

2. Organizing health services around people’s needs and expectations (health service reforms).

3. Integrating health into all sectors (public policy reforms).

4. Pursuing collaborative models of policy dialogue (leadership reforms).

5. Increasing stakeholder participation.

8 Essential Health Services

E - Education for health

L - Locally endemic disease control

E - Expanded program for immunization

M - Maternal and child health including responsible parenthood

E - Essential drugs

N - Nutrition

T - Treatment of communicable and noncommunicable diseases

S - Safe water and sanitation

PRIMARY HEALTH CARE

KEY PRINCIPLES

1. 4 A’s

A. Accessibility - distance/travel time required to get to a health care facility/services.

- the home must be w/in 30 min. from the Brgy. health stations

B. Affordability - consideration of the individual, family, community and government can afford the
services

- the out-of-pocket expense determines the affordability of health care.

- in the Philippines, government insurance is covered through PhilHealth

C. Acceptability - health care services are compatible with the culture and traditions of the population.

D. Availability - is a question whether the health service are offered in health care facilities or is provided
on a regular and organized manner.

Examples:

⮚ Botika ng Bayan- ensures the availability and accessibility of

affordable essential drugs. It sells low-priced generic home remedies, OTC and

common antibiotics.

⮚ Ligtas sa Tigdas ang Pinas - mass door-to-door measles immunization campaign.

- target age: 9 months to below 8 y.o.

2. Support mechanism

there are 3 major resources:

1. People

2. Government

3. Private Sectors (e.g. NGO, church…)

3. Multisectoral approach

• Intra-sectoral linkages (Two - way referral sys.) — communication, cooperation and

collaboration within the health sectors.

• Inter-sectoral linkages - between the health sector and other sectors like education, agriculture and
local gvn. officials.

4. Community participation - a process in which people identify the problems and needs and assumes
responsibilities themselves to plan, manage, and control.

5. Equitable distribution of health resources- 2 DOH programs to ensure equitable distribution:

Doctor to the Barrio (DTTB) Program

- the deployment of doctors to municipalities that are w/o doctors.

- deployed to unserved, economically depressed 5th or 6th class municipalities for 2

years.

Registered Nurses Health Enhancement and Local Service (RN HEALS)

- training and program for unemployed nurse

- deployed to unserved, economically depressed municipalities for 1 year.

R.A. 8423 – Traditional and Alternative Medicine Act of 1997 –TAMA Act (Juan Flavier)
 

Alternative Health Care Modalities

Chapter 5 (Health Promotion, Risk Reduction & Capacity Building Strategies)

Alternative Health Care Modalities

CHAPTER 5: Health Promotion, Risk Reduction & Capacity Building Strategies

HEALTH PROMOTION - Green and Kreuter (1991)- any combination of health education and related
organizational, economic and environmental supports for behavior of individual, groups or communities
conducive to health

- Parse (1990)- Behavior that is motivated by the desire to increase wellbeing and to reach the best
possible health potential.

HEALTH PROTECTION - Parse (1990) behaviors in which one engages with the specific intent to
prevent disease, detect disease in the early stages or to maximize health within constraints of disease

HEALTH RISK- The probability that a specific event will occur in a given time frame

● Risk Assessment- conducted to determine health risks to individuals, groups and populations. A
systematic way of distinguishing the risks posed by potentially harmful exposures

Steps of risk assessment- Hazard Identification, risk description, exposure assessment and risk
estimation.

Risk factor- an exposure that is associated with a disease

3 Criteria for establishing a risk factor:

1. The frequency of the disease varies by category or amount of factor.

2. The risk factor must precede the onset of the disease.

3. The association of concern must not be due to any source of error.

Two types of Risks Factors:

- Modifiable Risk Factors- individual has some control

- Non- Modifiable Risk Factors- little or no control.

● Risk Reduction – a proactive process in which individuals participate in behaviors that enable
them to react to actual or potential threats to their health
 ● Risk communication- process through which public receives information regarding possible
threats to health

To improve the nutritional status of the population, nutrition and education is essential. The 10 Nutritional
Guidelines for Filipinos were developed to facilitate dissemination simple and practical messages to
encourage healthy diet and lifestyle.

1. Eat variety of foods everyday

2. Breast feed infants exclusively from birth to 4-6 months and give appropriate foods while continuing
breastfeeding

3. Maintain children’s normal growth through proper diet and monitor their growth regularly

4. Consume fish, lean meat, poultry or dried beans

5. Eat more vegetables, fruits and root crops

6. Eat foods cooked in edible/cooking oil daily

7. Consume milk and milk products and other calcium rich foods such as small fish and dark leafy
vegetables everyday

8. Use iodized salt but avoid intake of excessive intake of salty foods

9. Eat clean and safe food

10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid drinking
alcoholic beverages

Sleep is essential component of chronic disease prevention and health promotion.

Sleep Hygiene (National Sleep Foundation 2010)

1. Avoid caffeine and nicotine close to bedtime

2. Avoid alcohol as it can cause sleep disruptions

3. Retire and get up at the same time everyday

4. Exercise regularly but finish all exercise and vigorous activity at least 3 hours before bedtime

5. Establish a regular relaxing bedtime routine (a warm bath, reading a book)

6. Create a dark, quiet, cool sleep environment

7. As much as circumstances allow, have comfortable beddings

8. Use the bed for sleep only. Do not read, listen to music or watch TV in bed

9. Avoid large meals before bedtime

Smoking Cessation is an important step in achieving optimum health. The American Cancer Society
recommends the following Steps to Quit Smoking:

1. Make decision to quit.

2. Set a date to quit and choose a plan

3. Deal with withdrawal through. Avoid temptation

4. Staying off tobacco is a lifelong process. Remind yourself of the reasons why you quit

Alcohol Consumption

- Health authorities have defined moderation as not more than 2 drinks a day for the average sized
man and not more than 1 drink a day for the average size woman

Heavy Drinking- consuming more than 2 drinks/day on average for men and more than 1 drink per day
for women

Binge drinking- drinking 5 or more drinks on a single occasion for men / 4 or more drinks on a single
occasion for women

Excessive Drinking- can take the form of heavy drinking/ binge drinking/ both.

- Organized by the WHO, the 1st International Conference on Health Promotion was held at Ottawa,
Canada on November 17-21, 1986. It calls for a commitment to health promotion to achieve the goal of
Health for All by the year 2000 and beyond.

- The charter defines health promotion as the process of enabling people to increase control over and
improve their health. It is not just the responsibility of the health sector but goes beyond healthy lifestyles
to well-being.

3 basic strategies for Health Promotion

1. Advocacy for health to provide for the conditions and resources essential for health

2. Enabling all people to attain their full health potential

3. Mediating among the different sectors of society to achieve health.

5 priority action areas provides support for these 3 strategies:

1. Build Healthy Public Policy

2. Create Supportive Environments

3. Develop Personal Skills

4. Reorient Health Services

5. Moving into the Future

HEALTH EDUCATION- a process of changing people’s knowledge, skills and attitudes for health
promotion and risk reduction.

-The nurse participate in health education by empowering people so that they are able to achieve
optimum health and prevent disease by bringing out lifestyle changes and reducing exposure to health
risk in the environment

Basic principles that guide the Effective Nurse Educator (based on Knowles Theory on adult learning)

1. Message – send a clear/understandable message to the learner.

-Consider factors that may affect learner’s ability to receive and retain info.

2. Format- strategy must match the objectives

3. Environment –conducive environment for learning, therapeutic and supportive relationship with the
learner

4. Experience – organize positive and meaningful learning experience

5. Participation- engage learner in participatory learning by involving then in the discussion, solicit
feedback

6. Evaluation- use tools such as quizzes, individual conferences and return demonstration

Competency Based Training of Community/Barangay Health Workers

 ● An important aspect of the community in capacity building is the training of community health
workers (CHWs)
● CHWs embrace a variety of community health aides selected, trained, and working and carrying
out functions related to health care in the community where they reside.
● Their training does not constitute tertiary education. In the Philippines, CHWs are known as
Barangay Health Workers
● The Public Health Nurse participates in training volunteers who can work as BHWs.
● The goal of the training program is the volunteers’ development of competencies that will
enable them to provide primary care services to their own community or neighborhood.
● Requisite competencies of BHWs include communication, interpersonal, teaching,
organizational, and advocacy skills. They must also possess knowledge about community health
issues such as common illnesses and communicable diseases, and available resources
including referral system.
● They must also be trained in providing health care services such as basic health assessment
and simple remedies for common health reasons.
● The book Where There is No Doctor: A Village Home Health Care Handbook provides a
practical guide for BHWs and BHW training

Health assessment training must be included such as taking vital signs, physical assessment, and simple
differential diagnostic techniques. BHW training includes also evidence-based home remedies for
diarrhea, acute respiratory infections, and febrile conditions.

Prepared by:

Edberg S. De Guzman, MSN, RN, CNN

Brylle Adam Estrada, RN, MAN (inp)

CHN I (Lecture) Instructors

Approved by:

May Jacklyn Radoc-Samson, RN, LPT, MAN(c)

Dean, School of Health Sciences