National Epidemiology Center of DOH, PSA and local
health centers/offices/departments- provide morbidty,
mortality and other health status related data
Local Health Centers/offices/departments-are
responsible for collecting morbidity, mortality data and
forward to higher levels
A. C.E. Winslow – Public Health is science and art of
1. preventing of disease
2. Prolonging life
3. promoting health and efficiency through organized
community effort
Public Health – through organized community effort
- Connotes, organized, legislated, and tax
supported efforts
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 solutions
Health Promotion and Levels of Prevention
Health Promotion- activities enhance resources directed
at improving well being
Disease prevention – activities protect people
Leavell and Clark’s Three Level of Prevention
1. Primary Prevention – directed at preventing a problem
before it occurs
- health teaching health education
2. Secondary Prevention- early detection
-problem has begun but before signs and symptoms
appear and titingnan if sinong mga risk factors
3.Tertiary Prevention- have experienced disease and
limits disability and rehabilitation
Community Based Nursing- application of the nursing
process
-setting specific and the emphasis is on acute and chronic
care and includes practice
CHN VS Community Based Nursing
CHN – emphasizes preservation and protection of health
-primary client is the community
Community Based Nursing – emphasizes on managing
acute and chronic
- Primary clients are the individual and family
Population-focused Nursing
-concentrates on specific groups of people regardless
of geographical location
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
Population-focused nursing
CHN 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
Individual – focus in the clinic or health center
Population- focused approach
The intervention wheel – propose in the late 1990s
by nurses from the Minnesota Department of Health
to describe the breath and scope of public health
nursing practice
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
1. Surveillance- monitors health events
2. Outreach- locates populations of interests ex.
Dental mission
3. Screening – identifies individuals with risk factors
\secondary prevention
4. Case Finding – identifies risk factors and connects
them
5. Referral and Follow UP – assists individuals
6. Case Management – optimizes self care
capabilities
7. Delegated Functions- direct care tasks
8. Health Teaching – communicates facts
9. Counselling – establishes interpersonal
relationships to enhance their capacity for self care
and coping
10. Consulation – seeks infos
11. Collaboration – commits two or more persons
12. Coalition Building – develops alliances
13. Community Organizing – identify common
problems or goals
14. Advocacy – pleads someones cause
15. Social Marketing – utilizes commercial marketing
16. Policy Development and Enforcement – place
issues on decision makers
Emerging Fields of CHN in the PH
HOME HEALTH CARE –providing nursing care to
individualsin their own places to minimize the effects
of illness and disability
HOSPICE HOME CARE – homecare renderd to the
terminally ill. Pallative Care is particularly important
ENTREPRENURSE – project by the DOLE in collab with
Board of Nursing in the PH DOH. PNA to promote
nurse entrepreneurship
It aims to:
1. Reduce the cost of healthcare for the countries
indigent population by bringing primary health care
services to poor rural communities
2. Maximize employment opportunities
3. Utilize the countries unemplyed human resources
Main Purpose of ENTREPRENURSE – deliver home
health care services
Competency Standards in CHN
1. SAFE AND QUALITY NURSING CARE- knowledge of
health\illness or status of the client
2. Management of resources and environment –
organization of workload
3. Health Education – assessment of client’s learning
needs
4. Legal Responsibility – adherence to the nursing
laws
5. Ethico-moral Responsibility – respect for the rights
of the client responsibility and accountability for own
decisions
6. Personal and Professional Development – I
dentification of own learning needs
7. Quality Improvement – data gathering for quality
improvement
8. research – research based formulation of solutions
9. Records Management – accurate and updated
documentation
10. Communication – uses therapeutic
communication techniques
11. Collaboration and Teamwokr – establishment of
collaborative relationships
READ THE ACT ACT ACT
Millennium Development Goals (MDG’s) – adopted
during the world summit in September 2000
THE 3 DAY SUMMIT HELD ON 6-8 SEPTEMBER 2000 AT NY
WAS THE LARGEST EVER GATHERING OF WORLD LEADER
- They agreed to achieve a set of concrete,
measurable
- The millenium development goals are the world’s
time bound and quantified targets
Goal 1: Eradicate Extreme poverty and hunger
Goal 2: Achieve universal primary education
Goal 3: Promote Gender Equality and Empower
Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6 Combat HIV/AIDS. MALARIA AND OTHER
DISEASES
Goal 7 Ensure environmental sustainability
Goal 8 A global partnership for development
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
Sentrong Sigla Movement
Goal – Quality Health
Objective better and more effective collaboration
between doh and lgus
Pillars
quality assurance -ongoing process of improving
health care services
grants and technical assistance
awards – sentrong sigla movement seal
health promotion – health education
Aquino Health Agenda
– achieving universal health care for all Filipinos
- Kalusugan pangkalahatan
- AO No. 2010-0036
Objective: To achieve universal healthcare
CHAPTER 2 THEORETICAL FOUNDATIONS OF
COMMUITY HEALTH NURSING
FLORENCE NIGHTINGALE – first nurse to formulate a
conceptual foundation for practice
Environmental theory – clean water chuchu
The goal of theory is to improve nursing practice by
acting as a guide
GENERAL SYSTEMS THEORY –
Input – food water energy environment
Output – health conditions / health practices
Feedback – ex. A nurse’s feedback to a mother that
her child is underweight makes the mother more
aware of her childs needs and allows her to take an
action
Social Learning Theory – people learn from one
another
Health Belief Model – individual beliefs
- Perceived susceptibility, perceived severity,
perceived benefits, cues to action, self efficacy
*Milio’s Framework for Prevention – needs are
greater than resources
Penders Health Promotion Model – explores many
biopsychosocial factors
The Transtheoritical Model – changes
- Assumption that behavior change takes place
over time and progresses through stages
Precede – Proceed Model – model for community
assessment
Precede – before or predisposing, reinforcing and
enabling constructs in educational diagnosis and
evaluation
Proceed – stands for policy, regulatory and
organizational constructs that based on precede
Predisposing Factors – peoples characteristics that
motivates
Enabling Factors – conditions in people and the
environment
Reinforcing Factors – feedback given by support
persons
CHAPTER 3 PRIMARY HEALTH CARE
September 6-12, 1978 – first international
conference for PHC at Alma Ata, USSR, Russia
L.O.I 949 – legal basis for PHC in the pH
- 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, counselling, 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
Education for Health
Locally Endemic disease control
Expanded program for immunization
Maternal and child health including responsible
parenthood
Essential drugs
Nutrition
Treatment of Communicable and non communicable
diseases
Safe water and sanitation
4A’S
ACCESSIBILITY – distance or travel time required to
get to a health care facility
- Home must be within 30 min from the brgy.
Health stations
AFFORDABILITY – consideration of the individual can
afford the services
- In the PH, government insurance is covered
through PHILHEALTH
ACCEPTABILITY – compatible with the culture and
traditions of the population
AVAILABILITY – health service are offered in health
care facilities or is provided on a regular and
organized manner
Ex.
BOTIKA NG BAYAN – ensures the availability of and
accessibility of affordable essential drugs. It sells
lowpriced generic home remedies
Ligtas sa Tigdas sa Pinas 0 mass door to door measles
immunization
- Target – 9 months to below 8 yrs
2 Support Mechanism
3 Major Resources
1. People
2. Government
3. Private Sectors NGO CHURCH
4. Multisectoral Approach
Intra sectoral linkages – two way referral sys.
- Communication, cooperation and collaboration
with the health sectors.
Inter sectoral linkages – between the health sector
and other sectors like education, agriculture and
local gov. officials
5. Community Participation – process in which
people identify problems and needs and assumes
responsibilities
6. Equitable distribution of health resources – 2 DOH
programs to ensure equitable distribution
distribution
DOCTOR TO THE BARRIO DTTB PROGRAM –
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
RA 8423 – traditional and alternative medicine act of
1997 – TAMA ACT JUAN FLAVIER
