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Subject: NCM 104A - Community Health Nursing 1

A.Y.: 2026-2027, First Semester
Instructor: Mrs. AILYN S. HALIDEN-SUBAHANI RM,RN
Time: 8:00–10:00 MTW
Course/Year: BSN 2
DATE: August - December
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LESSON I

OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

Introduction

Nursing is a profession aimed at helping the population

achieve better health thru their own hands. As a science, it relies
heavily on an understanding that the keywords genuine
development is investing on health and healthcare of peoples
regardless of age, gender, religion and color (Sumile, 2018). Health
is a shared reality. It should be the concern of all people. Health
enables people to achieve their full potential. It is for this reason
why nurses in the community should have a deeper understanding
of health both as a concept as reality.

Public Health Nursing in the Philippines evolved alongside the

institutional development of the Department of Health, the
government agency mandated to protect and promote people's
health and the biggest employer of health workers including public
health nurses. Historical accounts show that as far back as the
1900s, nurses working in the communities were already given the
title Public Health Nurses.

In the same manner that the Department of Health and the

public health system have evolved into what it is now in response to
the challenges of the times, so has Public Health Nursing practice
been influenced by the changing global and local health trends.
These global and country health imperatives brought public health
nursing into new frontiers and have positioned nurses to emerge as
leaders in health promotion and advocacy.

In the light of the changing national and global health

situation and the acknowledgment that nursing is a significant

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 contributor to health, the Public Health Nurse is strategically
positioned to make a difference in the health outcomes of
individuals, families and communities cared for.

Objectives

On completion of this chapter, the learner will be able to;

1. Discuss the definition of health;

2. Uphold health as a human right;
3. Enumerate the various models of health;
4. Explain and give examples of the determinants of health and
disease;
5. Describes how the social determinants of health impact nursing
practice in the community; and
6. Apply one health concept as a framework to community health
nursing practice.
7. Define the key concepts of community and public health nursing.
8. Explain the various principles underpinning the practice of
community health nursing.
9. Identify the myriad roles and functions of the nurse in the
community and public health nursing; and
10. Discuss the various public health interventions applied in
practice.

A. GLOBAL AND NATIONAL HEALTH SITUATIONS

Global Health Situations:

 Demographic Shifts:
Globally, population growth, particularly in developing countries,
puts strain on resources and infrastructure, impacting health
service delivery.
 Infectious Diseases:
While there have been improvements in some areas, infectious
diseases like hepatitis, HIV, and emerging diseases remain a
concern. The COVID-19 pandemic highlighted the vulnerability of
health systems globally.
 Non-Communicable Diseases (NCDs):
NCDs like heart disease, cancer, and diabetes are rising globally,
posing a significant burden on healthcare systems.

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  Child and Maternal Mortality:
While there have been improvements, high rates of child and
maternal mortality persist in many regions, particularly in low-
income countries.

 Health Inequities:
Global health inequities exist, with marginalized and vulnerable
populations disproportionately affected by health issues.

National Health Situations in the Philippines:

 Population Growth and Density:
The Philippines has a large and growing population, with high
population density, especially in urban areas, which can lead to
increased disease transmission and challenges in healthcare
access.
 Poverty and Inequality:
Poverty and inequality continue to be significant issues, impacting
health outcomes and access to healthcare services.
 Leading Causes of Mortality:
Heart disease, pneumonia, and cancer are leading causes of death
in the Philippines.
 Maternal and Child Health:
While there have been improvements in maternal and child health,
challenges remain, including high rates of maternal mortality and
infant mortality.

Communicable Diseases:
The Philippines still grapples with infectious diseases, including
tuberculosis, dengue fever, and HIV/AIDS.
 Non-Communicable Diseases (NCDs):
NCDs are also a growing concern in the Philippines, with rising
rates of diabetes, hypertension, and other chronic diseases.
 Health System Fragmentation:

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 The Philippine health system is decentralized, with both the
Department of Health and local governments playing roles. This
can sometimes lead to fragmentation and inefficiencies in service
delivery.
 Health Workforce Shortages:
There are shortages of healthcare professionals, particularly in
rural areas, impacting access to care.

 Environmental Factors:
Environmental factors, such as pollution and sanitation issues, also
contribute to health problems.

Impact on Public Health Nursing:

 Direct Patient Care:

Public health nurses provide direct care to individuals and families

in communities, including immunizations, prenatal care, and
management of chronic diseases.
 Health Promotion and Disease Prevention:
Public health nurses play a crucial role in promoting healthy
behaviors, preventing disease, and educating communities on
health issues.
 Community Engagement:
Public health nurses work with communities to identify health
needs and develop solutions, fostering community participation in
health programs.
 Health Policy and Advocacy:
Public health nurses can advocate for policies that improve health
outcomes and promote health equity.
 Research and Evaluation:
Public health nurses contribute to research and evaluation efforts
to improve the effectiveness of public health programs.

HEALTH: key concept in nursing

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 Nursing is a profession aimed at helping the population achieve
better health thru their own hands. As a science, it relies heavily on
an understanding that the key towards genuine development is
investing on health and healthcare of people regardless of age, sex,
gender, religion, and color. (Sumile, 2018).

is traditionally defining as the art of science of caring.

Its body of knowledge is grounded on the works of nursing
theorists and philosophers, foremost of whom is the mother of
Modern Nursing herself, Florence Nightingale.

Florence Nightingale’s definition:

a means of ensuring that people are placed in an optimum

healing and wellness. Thus, nursing becomes an act modifying
and manipulating the environment.
Virginia Henderson wrote that:

“the unique function of the nurse is to assist the individual, sick

or well, in the performance of those activities contributing to
health or its recovery (or peaceful death) that he would perform
unaided if he had the necessary strength, will or knowledge. And
to do this in such a way as help him gain independence rapidly as
possible” (Burggraf, 2012).

Health is a shared reality. It should be the concern of all people and

it enables people to achieve their full potential. Health is a complex
reality and Its definition is evolving.

The early, classic definition of health by the World Health

Organization (WHO) set a trend toward describing health in social
term rather than in medical terms.

The WHO (1958) define health as a “state of complete physical,

mental, and social wellbeing, not merely the absence of a
disease or infirmity."
 In the mid-1980s, the WHO expanded the definition of health
to emphasize recognition of the social implications of health.
Thus health is:

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  The extent to which an individual or group is able, on the one
hand, to realize aspirations and satisfy needs; and on the other
hand, to change or cope with the environment. Health, is
therefore, seen as a resource for everyday life, not the objective
of living; it is a positive concept emphasizing social and personal
resources, and physical capacities (WHO, 1986, p.7).

The nursing literature contains many varied definitions of health.

For example:
 health has been defined as “a state of well-being in which the
person is able to use purposeful, adaptive responses and
processes physically, mentally, emotionally, spiritually and
socially” (Murray, Zentner, & Yakimo, 2009, p.53);

 “The individuals total well-being, the regular patterns of people

and their environments that results in maintaining wholeness and
human integrity” (Roy, 2009, p. 3); “realization of human
potential through goal directed behavior, competent self-care,
and satisfying relationship with others” (Pender, Murdaugh, &
Parsons, 2011, p. 22); and state of physical, mental,

 spiritual, and social functioning that realizes a person’s potential

and experienced within a developmental context” (Greiner, 2014,
p.3).

HEALTH AS A HUMAN RIGHT

Essential to WHO identity and directive is the right of every human

to health. As stated by Dr. Ghebreyesus, WHO director general, in
2017; The enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human being
without distinction of race, religion, political belief, economic or
social condition” (World Health Organization, 2017).
 Health as one of the primary rights of individual is well known
and accepted. And health as a human right is grounded in the
Universal Declaration of Human Rights (UDHR)
 UDHR was proclaimed by the United Nations General assembly in
Paris on December 10, 1948.
 UDHR is a significant record in the history of human rights and it
did set that fundamental human rights be universally protected.

UDHR Article 25.1 declares: “Everyone has the right to standard of

living adequate for the health and well-being of himself and his
family, including food, clothing, housing and medical care and
necessary social services” (United Nations, UDHR, 1948).

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 In an extensive write-up by the International Covenant on Economic,
Social, and Cultural Rights about the right to health in international
human rights law, it is stated that: “Health is a fundamental Human
right indispensable for the exercise of other human rights. Every
human being is entitled to the enjoyment of the highest attainable
standard of health conducive to living life in dignity. The realization
of the right to health maybe pursued through numerous,
complementary approaches, such as the formulation of health
policies, or the implementation of health programmes developed by
the World Health Organization (WHO) or the adoption of legal
instruments” (United Nations, CESCR, 2000)

THE RIGHT TO HEALTH:

According to the committee on economic, Social and Cultural Rights,

(United Nations, CESCR, 2000) the right to health Consists of
interconnected and indispensable components:

1. Availability – requires that operational public health and channels

of service delivery, products and services as well as programs be
adequate for all.

2. Accessibility – entails that health facilities, services and goods

must be made possible and obtainable to everyone. Being non-
discriminatory, physically accessible, economically accessible
(affordable) and information accessible are the four
intersecting features of accessibility.
3. Acceptability – correspond to respect for the medical ethics,
being culturally appropriate and gender sensitive.
4. Quality – implies that the health facilities, commodities and
service must be in accordance with scientific and medical
standards. Quality health service need to be safe, effective,
people centered, timely, equitable, integrated and efficient.

At the national level, Article II Section II and 15 of the 1987

Philippine Constitution, affirms health as a fundamental
human right and recognizes the obligation of the state to
protect and promote the right to health of all Filipinos

(Republic of the Philippines’ Official Gazette, 1987). With this

particular provision, the Department of Health (DOH) was
established to lead the health

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 sector towards assuring quality health care in promoting and
protecting the health of all Filipinos.

Today, the DOH works hand in hand with various sectors to

achieve its vision of “Filipinos are among the healthiest
people in Southern Asia by 2022, and in Asia by 2040”
(Department of Health, 2017).

MODELS OF HEALTH:
To guide nurses in understanding health as a concept, Smith (1983),
as cited by Edelman and Kudzma (2018) developed the following
models of health.

1. Clinical Model
Health is the absence of signs and symptoms of disease and illness
refers to its presence.

2. Role Performance Model

The individuals’ ability to perform societal roles defines what health
is in this model.

3. Adaptive Model
Health is a dynamic state. An individual is considered to be healthy
if he/she was able to adjust positively to social, mental, and
psychological changes.

4. Eudemonistic Model
An elevated level of wellness suggests optimal health and illness is
reflected by a lack of vitality.

DETERMINANTS OF HEALTH AND DISEASE

1. Biology – an individual genetic makeup, family history, and

any physical and mental health problems developed in the
course of life.
 Aging, diet, physical activity, smoking, stress, alcohol or drug
abuse, injury, violence, or a toxic or infectious agent may
produce illness or disability, changing an individual biology.
2. Behaviors – are the individual’s responses to internal stimuli
and external conditions.

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 One’s biology may affect behavior; if a person has a lifestyle
related disease like hypertension or diabetes, he or she may
choose to begin an exercise regimen and to eat more
healthfully.
3. Social Environment – includes interactions and relationship
with family, friends, co-workers, and other in the community.
Social Institutions, such as law enforcement, religious
communities, schools and other government agencies, are
also part of the social environment, as well as housing,
safety, public transportation, and availability of resources.
4. Physical Environment - is what is experienced by the senses –
what is smelled, seen, touched, heard, and tasted.

If there are poisonous or infectious substances in the

environment, this is certainly a negative influence on health.
If the environment is sanitary with areas to recreate and play,
this is a good influenced on health.

5. Policies and Interventions – can have a profound effect on the

health on individuals, groups, and communities.
Positive effects such as policies against smoking in public
places, seatbelt and child restraints law, litter ordinances, and
enhanced health care promote health care.

SOCIAL DETERMINANTS OF HEALTH (SDH)

 Are conditions in which people are born, grow, live work and age.
 Might also be circumstantial elements such as housing, work
conditions and access to recreational activities.
 Circumstances that influence how an individual will develop
sickness, what risk factors they are exposed to, how they access
services and how they utilize the appropriate services.
 Shaped by distribution of money, power, and resources at global,
national and local levels. (CSDH, 2008).
 SDH may also include occupation, circumstances affecting the
way in which people work, income, culture, religion, education,
racial and gender discrimination (Forget and Lebel, 2001).

According to Philippines Health Statistics (PHS), the Philippines

total population in 2015 is 100,979,303. There was 47% increase
in the population from 1995-2015.
In the same PHS series, the morbidity and mortality rates were
presented;

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  Hypertension is second on the list of ten (10) leading cause of
morbidity with 601,173 cases and a rate of 595.3 per 100,000
populations.
 The 2015 Crude Death Rate (CDR) per one thousand
populations was computed at 5.6 deaths; a total of 560,605
deaths registered in 2015.
For several years, disease of the heart had been consistently the
leading cause of deaths among Filipinos.
 It is continuously rising in number due to lifestyle and other
social determinants.
 Hearth diseases include: (Department of Health, Epidemiology
Bureau, 2015)
a) Acute rheumatic fever
b) Chronic rheumatic hearth diseases
c) Hypertensive diseases
d) Ischemic heart diseases

The 2015 statistics also showed that majority of the deaths from
the ten leading causes of mortality were unattended by a
physician or any allied health officer in anytime during the course
of their illness or injury.

Report showed that 69,2% of Filipinos who died from pulmonary

diseases such as;
pneumonia and 71.6% from chronic lower respiratory diseases were
commonly not seen by a health practitioner anytime during their
illness or injury (Department of Health, Epidemiology Bureau, 2015).

Across all region in the Philippines, it is only in the National

Capital Region where at least 54.1% of its deaths were attended
by medical doctor at the time of death than not.
 However, it is still unacceptably low considering that NCR is a
highly urbanized region here both public and private health
facilities are geographically accessible to people.
 Unaffordable health cost in the country maybe somehow
evident in the reported deaths without the attention of a
medical doctor (Department of Health, Epidemiology Bureau,
2015).

All these statistics reflect the general living condition in the

country as well as the severe disproportion of funding for
preventive services and socio economic opportunities.
 Indigenous people and cultural minorities have poorer overall
health status compared to those who belong to the upper
socioeconomic bracket.

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  This clearly shows the strong relationship between the health
and socioeconomic conditions and this echoes the need for a
multisectoral approach.

Health care professional should focus attention on promoting

healthy lifestyle, providing preventive and primary care,
expanding and ensuring access to cost effective and technology
appropriate care, participating in coordinated and
interdisciplinary care, and involving patient and families in the
decision-making process.

Public health nurses must work in partnership with colleagues in

managed care settings to improve community health and the
partners may need to develop new community assessment
strategies to augment epidemiological methods that often mask
the context or meaning of the human experience of vulnerable
population.

A. PUBLIC HEALTH, AND COMMUNITY HEALTH DEFINITION &

FOCUS

Public Health

The classic definition of public health comes from Dr. C.E. Winslow.
He defines public health as the "science and art of preventing
disease, prolonging life, promoting health and efficiency through
organized community effort for the sanitation of the environment,
control of community infections, the education of individuals in
personal hygiene, the organization of medical and nursing services
for the early diagnosis and preventive treatment of disease, and the
development of the social machinery which will ensure to every
individual in the

community a standard of living adequate for the maintenance of

health; organizing these benefits in such as to enable every citizen
to realize his birthright of health and longevity", (Winslow, 1920 as
cited in Kemper, 2015).

A strong knowledge base is essential to competently address the

myriad needs and concerns of the people in the community. This
includes a background on Mother and Child Health Nursing, Adult
Health Nursing, Mental Health and Psychiatric Nursing, and Public
Health Nursing.

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 Hierarchy of nursing science (in pyramid)
I. Community and Public Health Nursing
II. Mental Health and Psychiatric Nursing
III. Mother and Child Health Nursing
IV. Adult Health Nursing

DEFINITION OF COMMUNITY AND PUBLIC HEALTH NURSING

(CPHN)

Key concept of community and public health nursing:

1. The community as a client

 The community is often viewed as a group of people living in
a particular area with common beliefs, values, and
traditions.
2. Health as a goal
 Health is more than a state of wellbeing.
 It is a multi-dimensional reality that includes socio economic,
environmental, and even political factors.
3. Nursing as a means to achieve its aims
 Nursing is traditionally defined as the art of caring.

COMMUNITY HEALTH NURSING

Is defined as a specialized field of nursing practice that renders

care to individuals, families, and communities; focusing on core
of community health nursing practice health promotion and
disease prevention (core of community health nursing
practice) through people empowerment.

Janet Heinrich and Ruth Freeman’s definition:

“an area of human services directed toward developing and

enhancing the health capabilities of people – either singly, as
individuals, or collectively as groups and communities.”

 Community Health Nursing is the synthesis of nursing

and public health practice applied to promote and protect
the health of population. It combines all the basic elements of

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 professional, clinical nursing with public health and
community practice (Mengitsu, 2006).

It combines all the basic elements of professional, clinical nursing

with public and community practice (Mengitsu, 2006).

This entails that the practice of this field covers various

population groups like children and workers.
 Subfields of community health nursing include:
a. Occupational Health Nursing
b. School Health Nursing
c. Correctional Nursing

PUBLIC HEALTH NURSING

May be defined as a field of professional practice in nursing and in

public health in which technical nursing, interpersonal, analytical,
and organizational skills applied to problems of health as they affect
the community.

Traditionally, “public health nursing” was seen as subspecialty

nursing practice generally delivered within “official” or government
agencies; while “community health nursing” was considered to
be a broader and more general specialty area that encompass many
additional subspecialties (e.g., School Health Nursing, Occupational
Health Nursing, forensic nursing, home health).

 In 1980, the American Nurses Association (ANA) defined

Community Health Nursing as the “synthesis of nursing
practice and public health practice applied to promoting and
preserving the health of the populations” (ANA, 1980, p. 2).

 Some nursing writers will continue to use community health

nursing as a global or umbrella term and public health nursing
as component or subset and others use the term
interchangeably.

Characteristics and Features of Community and Public

Health Nursing (CPHN)

1. CPHN is developmental. People are imbued with human rights

and this includes right to health.

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 2. CPHN is multidisciplinary. Health needs of our clientele is varied.
It ranges from sanitation, food safety, control of non-
communicable diseases, and infection.
3. CPHN is ecology oriented. The largest portion of the healthcare
system is community based and that care is provided in the
natural environment of people.
4. CPHN promotes social justice. Health is a human right and all
people should enjoy access to healthcare.
5. CPHN values consumer involvement. Patients in
community/public health are not merely are not merely
consumers or end-users of health care service.
6. CPHN uses prepayment mechanism. Services provided by public
health system are not given for free.
7. CPHN focuses on preventive service. Nurses on the field provided
healthcare to a wide range of clientele afflicted by both acute
and chronic conditions.
8. CPHN offers comprehensive care. The old adage that nursing is
caring from womb to tomb is a reality in public health.

Universal ethical principles (Guide for Nurses):

 Responsibilities for health rests primarily on people and

not on agencies or professionals.
 Fundamental commitment of community and public health
nurse is to adhere to the tenets of social justice (common
good and not merely to be fair for all).
1. Obligation to do good and avoid harm (beneficence and
normaleficence).
2. Truthful communication (veracity).
3. Honoring commitment to duty and standards (fidelity).
4. To respect self-determination (autonomy) of individuals in making
an informed choice.

Roles of the community and public health nurse:

1. Healthcare Provider. Caring is the essence of nursing and has been

widely accepted.
2. Health Educator. Communicating information to help patients
make an inform choice regarding their health is a key activity in
public health work.

3. Program Implementer. Nurses working under local government

units deliver healthcare to the grassroots.

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 4. Community Organizer. Working with people in communities and
providing them ownership of their healthcare needs and to act
collectively on their issues is best captured by this of the nurse in
public health.
5. Manger/Leader. Community and Public health work deals with
completing claims specifically on utilization of limited resources.
6. Researcher/Epidemiologist. The nurse is regarded as the health
monitor of the community.
7. Client Advocate. The community/public health nurse takes a
proactive stance in ensuring that the right to health of the
population he/she works with is realized and protected.

FOUR Levels of Clientele in Community and Public Health

Nursing (CPHN):

The Philippine Nursing Law of 2002 (RA 9173) states that 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
perform nursing services to;
a) Individuals;
b) Families;
c) Groups; and
d) Communities

These levels represent different scopes of practice for nurses,

with each requiring tailored approaches to health promotion and
disease prevention.

1. Individuals:
This is the most basic level, focusing on the health needs of single
persons. Nurses address individual health concerns, provide
education, and promote healthy behaviors.
2. Families:
Families are considered the basic unit of care in community
health. Nurses work with families to address their collective health
needs, promote family health practices, and support healthy family
dynamics.
3. Population Groups:
This level involves focusing on specific groups of people who share
common characteristics, such as age, gender, or health

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 condition. Nurses work with these groups to address their unique
health needs and promote health within

the group. Examples include pregnant women, school children, or

elderly individuals.
4. Communities:
The community is the broadest level of clientele, encompassing all
individuals, families, and population groups within a defined
geographical area. Nurses work to improve the overall health of
the community by addressing community-wide health issues,
promoting healthy environments, and advocating for community
health.

Key Standards of Public Health Nursing Practice in the

Philippines:

 Assessment:
Gathering comprehensive health data about a population, including
demographics, health status, and risk factors.
 Diagnosis:
Analyzing the collected data to identify health problems and
prioritize needs within the community.
 Outcomes Identification:
Establishing clear, measurable, achievable, relevant, and time-
bound (SMART) goals for improving population health.
 Planning:
Developing strategies and interventions to achieve the identified
outcomes, considering available resources and community
context.
 Implementation:
Putting the planned interventions into action through direct care,
health education, community mobilization, and collaboration with
other stakeholders.
 Evaluation:
Assessing the effectiveness of the implemented interventions in
achieving the desired outcomes and making adjustments as
needed.

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  Coordination:
Working with other healthcare professionals, community leaders,
and organizations to ensure seamless delivery of services and
maximize impact.

 Health Promotion:
Educating the public about health issues, promoting healthy
lifestyles, and empowering individuals to take control of their
health.
 Ethics:
Practicing nursing with integrity, respecting the rights and dignity
of individuals and communities, and upholding professional
standards.
 Professional Development:
Continuously enhancing knowledge and skills through education,
training, and research to stay current with best practices.
 Leadership:
Demonstrating leadership in promoting public health, advocating
for policies that support health, and mentoring other nurses.
 Research:
Engaging in research activities to advance the field of public health
nursing and improve the quality of care.
 Quality Practice:
Ensuring that all nursing actions are evidence-based, efficient, and
contribute to positive health outcomes.
 Collaboration:
Working effectively with other disciplines and community members
to achieve shared health goals.
 Compliance with Laws and Policies:
Understanding and adhering to relevant public health laws,
regulations, and guidelines.

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 References:

Mary A. Nies et al., Adapted by: Sumile, E. Community and Public

Health Nursing, 2nd ed.

Maglaya, Araceli S., 2009. Nursing Practice in the Community, 5 th

ed.

Shines, D. et al., 2009, Community Health Nursing Health, 4 th ed.

Cuevas, R. et al., 2007, Public Health Nursing in the Philippines, 10 th

ed.

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