COMMUNITY HEALTH NURSING NCM 104

I. Global and National Health Status

Global Health Status - health of the populations in the worldwide context; it has been defined as
"the area of study, research, and practice that places a priority on improving health and achieving
equity in health for all people worldwide".
WHO Definition
Collecting and comparing health data from across the globe is a way to describe health
problems, identify trends and help decision-makers set priorities.
Studies describe the state of global health by measuring the burden of disease – the loss
of health from all causes of illness and deaths worldwide. They detail the leading causes of
deaths worldwide and in every region, and provide information on more than 130 diseases and
injuries across the world.

Top 10 Most Common Health Issues in the Philippines

1.Physical Activity and Nutrition
2.Overweight and Obesity
3.Tobacco
4.Substance Abuse
5.HIV / AIDS
6.Mental Health
7.Injury and Violence
8.Environmental Quality
9.Immunization
10.Access to Health Care

1. Physical Activity and Nutrition

Research indicates that staying physically active can help prevent or delay certain diseases,
including some cancers, heart disease and diabetes, and also relieve depression and improve
mood. Inactivity often accompanies advancing age, but it doesn't have to. Check with your local
churches or synagogues, senior centers, and shopping malls for exercise and walking programs.
Like exercise, your eating habits are often not good if you live and eat alone. It's important for
successful aging to eat foods rich in nutrients and avoid the empty calories in candy and sweets.

2. Overweight and Obesity

Being overweight or obese increases your chances of dying from hypertension, type 2 diabetes,
coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory
problems, dyslipidemia and endometrial, breast, prostate, and colon cancers. In-depth guides and
practical advice about obesity are available from the National Heart Lung and Blood Institute of
the National Institutes of Health.
3.Tobacco

Tobacco is the single greatest preventable cause of illness and premature death in the U.S.
Tobacco use is now called "Tobacco dependence disease." The Centers for Disease Control and
Prevention (CDC) says that smokers who try to quit are more successful when they have the
support of their physician.

4. Substance Abuse

Substance abuse usually means drugs and alcohol. These are two areas we don’t often associate
with seniors, but seniors, like young people, may self-medicate using legal and illegal drugs and
alcohol, which can lead to serious health consequences. In addition, seniors may deliberately or
unknowingly mix medications and use alcohol. Because of our stereotypes about senior citizens,
many medical people fail to ask seniors about possible substance abuse.

5. HIV/AIDS

Between 11 and 15% of U.S. AIDS cases occur in seniors over age 50. Between 1991 and 1996,
AIDS in adults over 50 rose more than twice as fast as in younger adults. Seniors are unlikely to
use condoms, have immune systems that naturally weaken with age, and HIV symptoms (fatigue,
weight loss, dementia, skin rashes, swollen lymph nodes) are similar to symptoms that can
accompany old age. Again, stereotypes about aging in terms of sexual activity and drug use keep
this problem largely unrecognized. That’s why seniors are not well represented in research,
clinical drug trials, prevention programs and efforts at intervention.

6. Mental Health

Dementia is not part of aging. Dementia can be caused by disease, reactions to medications,
vision and hearing problems, infections, nutritional imbalances, diabetes, and renal failure. There
are many forms of dementia (including Alzheimer’s Disease) and some can be temporary. With
accurate diagnosis comes management and help. The most common late-in-life mental health
condition is depression. If left untreated, depression in the elderly can lead to suicide. Here’s a
surprising fact: The rate of suicide is higher for elderly white men than for any other age group,
including adolescents.

7. Injury and Violence

Among seniors, falls are the leading cause of injuries, hospital admissions for trauma, and deaths
due to injury. One in every three seniors (age 65 and older) will fall each year. Strategies to
reduce injury include exercises to improve balance and strength and medication review. Home
modifications can help reduce injury. Home security is needed to prevent intrusion. Home-based
fire prevention devices should be in place and easy to use. People aged 65 and older are twice as
likely to die in a home fire as the general population.
8. Environmental Quality

Even though pollution affects all of us, government studies have indicated that low-income,
racial and ethnic minorities are more likely to live in areas where they face environmental risks.
Compared to the general population, a higher proportion of elderly are living just over the
poverty threshold.

9. Immunization
Influenza and pneumonia and are among the top 10 causes of death for older adults. Emphasis on
Influenza vaccination for seniors has helped. Pneumonia remains one of the most serious
infections, especially among women and the very old

10. Access to Health Care

Seniors frequently don't monitor their health as seriously as they should. While a shortage of
geriatricians has been noted nationwide, URMC has one of the largest groups of geriatricians and
geriatric specialists of any medical community in the country. Your access to health care is as
close as URMC, offering a menu of services at several hospital settings, including the VA
Hospital in Canandaigua, in senior housing, and in your community.

Top 8 Most Common Health Issues in the World (WHO)

https://www.who.int/news-room/feature-stories/ten-threats-to-global-health-in-2019
1. Global influenza pandemic
The world will face another influenza pandemic – the only thing we don’t know is when it will
hit and how severe it will be. Global defences are only as effective as the weakest link in any
country’s health emergency preparedness and response system.
WHO is constantly monitoring the circulation of influenza viruses to detect potential pandemic
strains: 153 institutions in 114 countries are involved in global surveillance and response.
Every year, WHO recommends which strains should be included in the flu vaccine to protect
people from seasonal flu. In the event that a new flu strain develops pandemic potential, WHO
has set up a unique partnership with all the major players to ensure effective and equitable access
to diagnostics, vaccines and antivirals (treatments), especially in developing countries.

2. Fragile and vulnerable settings

More than 1.6 billion people (22% of the global population) live in places where protracted
crises (through a combination of challenges such as drought, famine, conflict, and population
displacement) and weak health services leave them without access to basic care.
Fragile settings exist in almost all regions of the world, and these are where half of the key
targets in the sustainable development goals, including on child and maternal health, remains
unmet. WHO will continue to work in these countries to strengthen health systems so that they are
better prepared to detect and respond to outbreaks, as w ell as able to deliver high
quality health services, including immunization.
3. Antimicrobial resistance
The development of antibiotics, antivirals and antimalarial are some of modern medicine’s greatest
successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of
bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time
when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhea, and
salmonellosis. The inability to prevent infections could seriously compromise surgery and
procedures such as chemotherapy.

Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease that causes around
10 million people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000 cases of
tuberculosis were resistant to rifampicin – the most effective first-line drug – and 82% of these
people had multidrug-resistant tuberculosis.Drug resistance is driven by the overuse of
antimicrobials in people, but also in animals, especially those used for food production, as well as
in the environment. WHO is working with
these sectors to implement a global action plan to tackle antimicrobial resistance by increasing
awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.

4. Ebola and other high-threat pathogens

In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of which
spread to cities of more than 1 million people. One of the affected provinces is also in an active
conflict zone. This shows that the context in which an epidemic of a high-threat pathogen like
Ebola erupts is critical – what happened in rural outbreaks in the past doesn’t always apply to
densely populated urban areas or conflict-affected areas. At a conference on Preparedness for
Public Health Emergencies held last December, participants from the public health, animal health,
transport and tourism sectors focused on the growing challenges of tackling outbreaks and health
emergencies in urban areas. They called for WHO and partners to designate 2019 as a “Year of
action on preparedness for health emergencies”. Who’s R&D Blueprint identifies diseases and
pathogens that have potential to cause a public health emergency but lack effective treatments and
vaccines. This watch list for priority research and development includes Ebola, several other
hemorrhagic fevers, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV)
and Severe Acute Respiratory Syndrome
(SARS) and disease X, which represents the need to prepare for an unknown pathogen that could
cause a serious epidemic.

5. Weak primary health care

Primary health care is usually the first point of contact people have with their health care system,
and ideally should provide comprehensive, affordable, community-based care throughout life.
Primary health care can meet the majority of a person’s health needs of the course of their life.
Health systems with strong primary health care are needed to achieve universal health coverage.
Yet many countries do not have adequate primary health care facilities. This neglect may be a
lack of resources in low- or middle-income countries, but possibly also a focus in the past few
decades on single disease programmed. In October 2018, WHO co-hosted a major global
conference in Astana, Kazakhstan at which all countries committed to renew the commitment to
primary health care made in the Alma-Ata declaration in 1978.
In 2019, WHO will work with partners to revitalize and strengthen primary health care in
countries, and follow up on specific commitments made by in the Astana Declaration.

6. Vaccine hesitancy
Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines –
threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one
of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a
year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.
Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are
complex, and not all of these cases are due to vaccine hesitancy. However, some countries that
were close to eliminating the disease have seen a resurgence. The reasons why people choose not
to vaccinate are complex; a vaccines advisory group to WHO identified complacency,
inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy.
Health workers, especially those in communities, remain the most trusted advisor and influencer
of vaccination decisions, and they must be supported to provide trusted, credible information on
vaccines. In 2019, WHO will ramp up work to eliminate cervical cancer worldwide by increasing
coverage of the HPV vaccine, among other interventions. 2019 may also be the year when
transmission of wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30
cases were reported in both countries. WHO and partners are committed to supporting these
countries to vaccinate every last child to eradicate this crippling disease for good.

7. Dengue
Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal and kill up to
20% of those with severe dengue, has been a growing threat for decades.A high number of cases
occur in the rainy seasons of countries such as Bangladesh and India. Now, its season in these
countries is lengthening significantly (in 2018, Bangladesh saw the highest number of deaths in
almost two decades), and the disease is spreading to less tropical andmore temperate countries
such as Nepal, that have not traditionally seen the disease. An estimated 40% of the world is at
risk of dengue fever, and there are around 390 million infections a year. WHO’s Dengue control
strategy aims to reduce deaths by 50% by 2020.

8. HIV
The progress made against HIV has been enormous in terms of getting people tested, providing
them with antiretrovirals (22 million are on treatment), and providing access to preventive
measures such as a pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take
antiretroviral to prevent infection). However, the epidemic continues to rage with nearly a million
people every year dying ofHIV/AIDS. Since the beginning of the epidemic, more than 70 million
people have acquired the infection, and about 35 million people have died. Today, around 37
million worldwide live with HIV. Reaching people like sex workers, people in prison, men who
have sex with men, or transgender people is hugely challenging. Often these groups are excluded
from health services. A group increasingly affected by HIV are young girls and women (aged 15–
24), who are particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa
despite being only 10% of the population.
 Public Health - is the science and art of preventing disease, prolonging life and
promoting health and efficiency through organized community effort for:
C.E. Winslow
1. the sanitation of the environment
2. the control of communicable infections
3. the education of the individual in personal hygiene
4. the organization of medical and nursing services for the early diagnosis and preventive
treatment of disease
5. Development of a social machinery to ensure everyone a standard of living, adequate for
maintenance of health to enable every citizen to realize his birth right of health and
longevity.
Focus: Prevention and promotion of population health at the national and local levels.

Community Health – extends the realm of public health to include organized health
efforts at the community level through both government and private efforts.

Public Health Nursing – the synthesis of public health and nursing practice. “The
practice of promoting and protecting the health of populations using knowledge from
nursing, social and public health sciences.” ANA 1996
Community Health Nursing - the synthesis of nursing practice and public health
practice applied to promoting and preserving the health of populations.
American Nurses Association (ANA 1980)

Evolution of Public Health Nursing in the Philippines

A. Community Health Nursing Historical Background in Philippines
 1577 – Franciscan Friar Juan Clemente opened a medical dispensary in Intramuros for the
indigent
 1690 – Dominican Father Juan de Pergero worked toward installing a water system in San
Juan del Monte (San Juan City, Manila) and Manila
 1805 – Dr. Francisco de Balmis (personal Physician of King Charles IV of Spain)
introduced smallpox vaccination
 1876 – first Medicos Titulares ( worked as provincial health officers) were appointed by
the Spain government.
 1901- Act 157, Board of Health of Philippines (eventually evolved as Department of
Health) was created – Commissioner of Public Health as its chief executive.
 1905- Act 1407, est. Bureau of Health, under Department of Interior
 1912- Fajardo Act (Act 2156) – created Sanitary Division, forerunner of present Municipal
Health Offices; President of Sanitary division took charge of 2 to 3 municipalities.
Philippine General Hospital sent 4 nurses to Cebu
 1914- School of Nursing rendered by Filipino Nurse employed by Bureau of Health in
Tacloban, Leyte
 1915- Philippine Health Service; Reorganization Act 2462 created. Office of Inspector
General and Office of District Nursing headed by Dr. Rosario Pastor, a nurse and physician
  1915-1918- Ms. Perlita Clark took charge of Public Health Nursing Works
 1919- 1st Filipino Nurse Supervisor was appointed, 84 PHN’s assigned in 5 health stations
 1927- Office of District Nursing abolished and changed to Section of Public Health
Nursing
 1930- Section for Nursing
 1941- Outbreak of war, PHN’s were assisted to take care of sick and wounded
 1942- 31 nurses as POW’s at Bilibid Prison, released to Director of Bureau and Health, Dr.
Eusebio Aguilar
 1948- 1st training center of Bureau of Health organized in cooperation with Pasay City
Health Department
 1950- Rural Health Demonstration and Training Center by DOH
 1958-1965- RA 977 abolished Division of Nursing
 Annie Sand= nursing consultant, Office of Secretary of Health
 Founded DOH National League of Nurses Inc.
 RA 977created 8 regional offices in country increased to 11 then to 16
 Code of 1991 (RA 7160) was passed and implemented which resulted to devolution or
the transferring of power and authority from the national to the local government units. It
was aimed to build the capacities for self-government and develop local government
units (LGU’s) as fully self-reliant communities.
 1990-1992 The Local Government
 Code of 1991 (RA 7160) was passed and implemented which resulted to devolution or
the transferring of power and authority from the national to the local government units.
 May 24, 1999- EO No. 102 was signed by Pres. Joseph E. Estrada , redirecting the
functions and operations of the DOH
 1999-2004 The Health Sector Reform Agenda (HSRA) was developed
 2005 A plan to rationalize or streamline the bureaucracy which includes the DOH was
developed

Roles and Responsibilities of a Community Health Nurse

ROLES OF COMMUNITY HEALTH NURSE
Seven major roles are:
1. Clinician
2. Educator
3. Advocate
4. Managerial
5. Collaborator
6. Leader
7. Researcher

The most familiar community health nurse role is that of clinician or provider of care. However,
giving nursing care takes on new meaning in the context of community health.
A. Clinician role /direct care provider
The clinician role in the community health
means that the nurse ensures that health
services are provided, not just to individuals
and families but also to groups and population.
For community health nurses the clinician role
involves certain emphasis different from basic
nursing, i.e. – Holism, health promotion, and skill expansion.
Holism: In community health, however, a holistic approach means considering the broad range
of interacting needs that affect the collective health of the client as a larger system. The client
is a composite of people whose relationships and interactions with each other must be
considered in totality.
Health Promotion focus on wellness: The community health nurse provides service along the
entire range of the wellness – illness continuum but especially emphasis on promotion of health
and prevention of illness. Expanded skills: the nurse uses many different skills in the
community health clinician role skill. In addition to physical care skill, recently skills in
observation, listening, communication and counseling became integral to the clinician role
with an increased emphasis on environmental and community wide considerations such as
problems with pollution, violence and crime, drug abuse, unemployment and limited funding
for health programs.

B. Educator role
It is widely recognized that health teaching is a part
of good nursing practice and one of the major
functions of a community health nurse (Brown,
1988). The educator role is especially useful in
promoting the public’s health for at least two reasons.
The educator role:
Has the potential for finding greater receptivity and
providing higher yield results.
Is significant because wider audience can be reached.
The emphases throughout the health teaching process
continue to be placed on illness prevention and health promotion.

C. Advocate role
The issue of clients’ rights is important in health care today. Every patient or client has the
right to receive just equal and humane treatment. However, our present health care system is
often characterized by fragmented and depersonalized services. This approach particularly
affected the poor and the disadvantaged. The community health nurse often must act as
advocate for clients pleading the cause or acting on behalf of the client group. There are times
when health care clients need someone to explain what services to expect and which services
they ought to receive.
 D. Managerial role
As a manager the nurse exercises administrative direction
towards the accomplishment of specified goals by assessing
clients’ needs, planning and organizing to meet those needs,
directing and controlling and evaluating the progress to
assure that goals are met. Nurses serve as managers when
they oversee client care, supervise ancillary staff, do case
management, manage caseloads, run clinics or conduct
community health needs assessment projects.
E. Case management
Case management refers to a systematic process by
which the nurse assesses clients’ needs, plans for and
co-ordinates services, refers to other appropriate
providers, and monitors and evaluates progress to
ensure that clients multiple service needs are met.

F. Collaborator role

Community health nurses seldom practice in isolation. They must work with many people
including clients, other nurses, physicians, social workers and community leaders, therapists,
nutritionists, occupational therapists, psychologists, epidemiologists, biostatisticians,
legislators, etc. as a member of the health team (Fairly 1993, Williams, 1986). The community
health nurse assumes the role of collaborator, which means to work jointly in a common
endeavor, to co-operate as partners.

G. Leader role
Community health nurses are becoming increasingly active
in the leader role. As a leader, the nurse directs, influences,
or persuades others to effect change that will positively affect
people’s health. The leadership role’s primary function is to
effect change; thus, the community health nurse becomes an
agent of change. They also seek to influence people to think
and behave differently about their health and the factors
contributing to it.

H. Research role
In the researcher role community health nurses engage in systematic investigation, collection
and analysis of data for the purpose of solving problems and enhancing community health
practice. Research literally means to search and/or to investigate, discover, and interpret facts.
All researches in community health from the simplest inquiry to the most epidemiological
study use the same fundamental process. The research process involves the following steps:

a. Identifying an area of interest

b. Specify the research question or statement
c. Review of literature
d. Identifying the conceptual frame work
e. Select research design
f. Collect and analyze data
g. Interpret the result
h. Communicate the findings

The community health nurse identifies a problem or question, investigates by collecting and
analyzing data, suggests and evaluates possible solutions and selects and or rejects all solutions
and starts the investigative process over again. In one sense, the nurse in gathering data for
health planning, investigates health problems in order to design wellness – promoting and
disease prevention for the community.

G. Other specific responsibilities of a Nurse spelled by the implementing rules and regulations of
R.A. 7164 (Phil. Nursing Act of 1991)
 Supervision and care of women during pregnancy, labor, and puerperium
 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of the physician
 Provision of first aid measures and emergency care
 Recommending herbal and symptomatic meds.
 In the care of the families:
1. provision of primary health care services
2. developmental/utilization of family nursing care plan in the provision of
care
 In the care of the communities:
1. Community organizing mobilization, community development, and people
empowerment
2. Case finding and epidemiological investigation
3. Program planning, implementation, and evaluation
4. Influencing executive and legislative individuals or bodies concerning
health and development
 In the event that the Municipal Health Officer (MHO) is unable to perform his duties/
functions or is not available, the Public Health Nurse will take charge of the MHO’s
responsibilities.

References:
Cuevas, Frances. Public Health Nursing in the Philippines. Publication Committee, National
League of Philippine Government Nurses Inc. , 10th Edition(2007)

Famorca, Zenaida. Nursing Care in the Community. Elsevier Mosby,(2013)