TOPRANK REVIEW ACADEMY

NOTES ON COMMUNITY HEALTH NURSING REVIEW

By Sir JV Gasmin
SETTING: Community
FACILITIES: Rural Health Unit (RHU) and Barangay Health Station (BHS)

FOCUS: Health Promotion and Disease Prevention

Role: Educator
Function: Generalist

CLIENTS:

1. Individual
- ENTRY POINT
- Services / Interventions are Individualized
- Client / Patient

2. Family
- UNIT OF CARE / FOCUS OF SERVICE
- Example Services: Responsible Parenthood and Family Planning
-
3. Population Group
- AGGREGATES → Common Environmental Characteristics
- Sectoral Groups → Example: People With Disability (PWDs) Senior Citizen, LGBTQIA+ Community,
Pregnant Woman, Group of Smokers
- Example Services: Smokers → Smoking Cessation Program

4. Community
- ENTIRE CLIENT
- Example Services: Sanitation Program → Aedes Control Program (Dengue Control Program ) → 4 O’clock
Habit

CE WINSLOW: PUBLIC HEALTH DEFINITION

→ Science and Art of preventing diseases, prolonging life, promoting health and efficiency thru organized
community effort of
C-Control of Communicable Disease
H- Health Education
O – Organization of Medical and Nursing Services
S -Sanitation of the Environment
E – Early Diagnosis and preventive treatment of Diseases
→ Enable Every Citizen to Realize His Birthright to Health and Longevity

LILIAN WALD (1867 – 1940) : Coined the term Public Health Nursing
: 1893 the the Henry St. Settlement in New York, USA
GEORGE PURDOM: Public Health involves survival of human species and all phases of human development (from
womb to tomb)

PRIMARY GOAL CHN:

→ Self-Reliance in Health

ULTIMATE GOAL CHN : According to Nisce

→ “To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats
to health in such a way as to maximize their potential for high-level wellness”

PHILOSOPY PHN: Margareth Shetland

→ “Grounded on the worth and dignity of every individual.”

The philosophy of public health nursing, as suggested by Margaret Shetland, is grounded on the worth and dignity
of every individual, reflecting a commitment to treating all people with respect and care in the pursuit of health equity

DEFINITION OF CHN:

W.H.O.(3) : World Health Organization - Expert Committee of Nursing

→ Combines (1)Skills of Nursing, (2) Public health and some phases of (3) Social Assistance
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→ Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and
functions as part of the total public health program for the promotion of health, the improvement of the conditions in
the social and physical environment, rehabilitation of illness and disability

Ruth B FREEMAN: (F)reeman = (F)rofessional Nurse

→ A service rendered by a professional nurse with communities, groups, families, individuals at home, in health
centers, in clinics, in schools, in place of work for the promotion of Health, prevention of illness, care of the sick at
home and rehabilitation

Margareth J. JACOBSON: JAC(O)BS(O)N = “O”L”O”F

→ Achievement of Optimum Level of functioning (OLOF) through teaching and delivery of care
→ A learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others
to the promotion of the client’s optimum level of functioning thru’ teaching and delivery of care

John Joseph HANLON: (H)anlon = (H)ighest Attainment of PMS

→ Attainment of highest level of physical, mental, and social well being at a given place and time

Salvacion BAILON-REYES: Bail(O)-n = (O)utside of Purely Curative

→ Field of nursing practice where services are delivered outside of purely curative institution

Araceli MAGLAYA: Mother of Family Health Nursing in PH

→ Utilization of nursing process to benefit the individual, family and community.
→ “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.

FIELD OF COMMUNITY HEALTH NURSING PRACTICE

A. Home – Public Health Nursing (RA 7305)
Clinic – Magna Carta for Public Health Workers
B. School – School Health Nursing (RA 124)
C. Workplace – Occupational Health Nursing (PD 442)

Emerging Field of CHN Practice

D. Home Health Care
- Providing Nursing Care to Clients in their own residence by a Private Duty Nurse
- Recovery and Rehabilitation
E. Hospice Home Care
- Nursing care rendered to Terminally Ill Patients
- Improve Quality of life
F. Faith Community Health Nursing (Parish Nursing)
- Combination of Nursing care and Spiritual Care
- Health Promotion and Holistic Care
G. Correctional Nursing
- Subset of Forensic Nursing
- Maintenance of Safe Environment, promotion of health among inmates, care is negotiated and provided
with recognition of safety and security issues
H. Entrepreneurship Nursing
- Encouraging nurses to pursue independent practice and establish single or collaborative health care
related business
- Ex: Child Wellness Clinics, Maternity Clinics

ROLES OF COMMUNITY HEALTH NURSE

1. Educator – Increase the Knowledge, Skills and attitude of the client / patient towards self-reliance with the
use of IEC (Information, Education and Communication) Materials Ex: Health Teaching in the health center

2. Advocate (Influencer) - working in behalf of the client towards self-reliance

Ex: HIV Awareness Campaign / Volunteer in a HIV Screening Program

3. Counselor – listening and giving feedback with the use of therapeutic communication
Ex: RPFP – Responsible Parenthood and Family Planning
4. Change Agent (Catalyst) – Educator + Counselor = towards change in Behavior
Ex: Lifestyle Modification Program for Non Communicable Diseases Hypertensives on a Diet
5. Care Provider – Providing nursing care to the client (has symptoms but not yet confirm)
Ex: Attending to a Child with Fever
6. Clinicians – Providing direct nursing care to the Sick and Ill
Ex: Attending to a Child with Dengue

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 7. Hospice Care Provider (Palliative Care) – Providing nursing care to terminally ill patients
Ex: Home Care / Rehabilitative Care for Stroke patient
8. Manager – Staffing, Directing, Controlling. Responsible in the implementation of the Local health Services
in the Rural Health Unit. Ex: Public Health Nurse as a Manager in the RHU
9. Supervisor – Providing Administrative Support by means of overseeing people
Ex: Midwife submitting monthly reports to the Public Health Nurse (FHSIS)
10. Trainer – Providing technical support by means of Training
Ex: PHN conducting a train the trainor program for the Brgy Health Workers
11. Health Monitor – Casefinding / Contact tracing → Detecting deviations from Normal Health
Ex: Contact Tracing of COVID – 19 Clients
12. Researcher – Conducting studies to improve Nursing Service
Ex: COPAR/ Community Diagnosis
13. Role Model - Doing what is being taught; Ex: Smoking Cessation Program
14. Coordinator – Facilitating Collaborations with other Government and Non Government Organization. Ex:
Monitoring of 4Ps Beneficiary in the RHU
15. Organizer – ensuring peoples participation in the Health Events and Activities of the RHU
Ex: Brgy Assembly

COMMUNITY HEALTH NURSING

COMMUNITY
- Types of Community
- Aspects of Community
- Types of Family
- Task of Family

Types of Community

1. Rural → Agricultural
Other Names: Far Flung Area, GIDA → Geographically Isolated and Disadvantage Area
➔ Located outside of cities, these communities tend to have fewer people, more open spaces, and
may rely on agriculture, farming, or natural resources for livelihoods.

2. Urban → Industrialized
Other Names: Cities and 1st Class Municipalities
➔ These are located in cities or densely populated areas, typically with well-developed
infrastructure, including roads, buildings, and public services.

3. Suburban → Located at the City Side / State Side

→ refers to areas located on the outskirts of a city or town. These areas are typically residential
and are adjacent to or within commuting distance of a larger urban center.
→ Majority of the Land are Agricultural but the Industries are also available in the Urban Area

4. Rurban → Semi – Agricultural ; Semi – Industrial

➔ Situated between urban and rural areas, suburban communities often feature residential
neighborhoods with proximity to urban areas for work or commerce.
➔ “Rurban is a combination of "rural" and "urban" and refers to areas that exhibit characteristics of
both rural and urban environments. Rurban communities are typically located on the outskirts of
cities or in regions where urbanization is beginning to spill over into more traditionally rural areas.

5. Metropolitan → Highly Industrialized Cities; 3 Metros: Metro Manila, Metro Cebu and Metro Davao.
➔ often referred to as a metropolis, is a large, densely populated urban area that typically consists
of a central city and its surrounding suburbs, exurbs, and other urbanized areas. These areas are
characterized by significant economic, political, cultural, and social influence.

Aspects of Community → S C P G

1. Social
→ Interactions and Communication of the people in the Community; Relations of the people in the
community; Neighborhood
→ Communities are built on interpersonal relationships and social interactions. These relationships
can range from close family ties to broader friendships, and they help create a sense of belonging and
social cohesion.
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 2. Cultural
→ Behaviors, Traditions, Norms of the Community
→ Culture is a cornerstone of community identity. Communities may share common rituals, festivals,
and celebrations that reflect their collective history, religion, or ethnicity.
→ Common languages or dialects are essential for effective communication and fostering a sense of
unity. The way people communicate within a community reflects its cultural makeup.
→ Members of a community often identify with their cultural heritage, which might include specific
customs, food, art, music, and other expressions of culture.

3. Political → Organization of the Community; Leadership and Government

4. Geographical
→ Boundaries and Territories A community is often defined by its geographical location, such as a
neighborhood, town, or region. Boundaries may be physical (rivers, mountains) or man-made (roads,
city limits)
→ The natural environment, such as access to water, land, and natural resources, plays a significant
role in shaping the lifestyle and economy of the community. Communities that depend on agriculture,
for example, will be shaped by the land's fertility.
→ The built environment—roads, buildings, transportation systems, and utilities—helps facilitate the
functioning of a community and influences how people live, work, and interact.

“The aspects of a community are interconnected and form a complex system of relationships, services,
and structures that contribute to the well-being of its members. Whether through social bonds, shared
values, economic activities, or access to resources, communities are essential to providing individuals
with a sense of belonging, support, and opportunity. The strength of a community lies in its ability to
adapt to change, meet the needs of its members, and promote cooperation and resilience.”

What is Family?
Allen – People put together by Birth, Adoption, Marriage,or by Choice
Johnson – Social unit interacting with larger society
Friedman – Two or more persons who are joined together by bonds of sharing and emotional closeness who
identify themselves as being part of the family

Legal Mandate: EO 209 – Family Code of the Philippines

Type of Family

1. Nuclear – This is a traditional family structure consisting of two parents (a mother and father) and their
children living together in one household.

2. Extended –An extended family includes relatives beyond the nuclear family, such as grandparents, aunts,
uncles, and cousins, all living together or maintaining close relationships.

3. Dyad – “Empty nesters” A family where the couple does not have children, either by choice or due to infertility
or other reasons.

4. Blended – A family formed when one or both parents have children from previous marriages or relationships,
and then marry or cohabit with another person who may also have children from another relationship.

5. Compound – has more than one spouse, 2 or more spouses; in Philippine Setting – Only Muslims can have a
compound type of Family, the male spouse must have the right resources (mayaman)

6. Cohabitating – “live – in”; not bounded by marriage; A family where two individuals live together in a
committed relationship without being married, often with children from previous relationships or their own.

7. Single Parenting – Solo Parenting - A family headed by one parent (either mother or father) raising one or
more children. This can result from divorce, separation, or the death of a partner.

8. Alternative Family – Homosexual Families; in PH setting, “there is no same sex union/ marriage; A family
structure where the parents are a couple of the same gender, raising children together, either biological
(through assisted reproductive methods) or adopted.

Grandparent Family:
• In this family structure, grandparents take on the primary role of raising their grandchildren,
often due to the inability or absence of the biological parents.

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 Foster Family:
• A family that temporarily takes in children who cannot live with their biological parents due to
various circumstances, such as abuse, neglect, or abandonment.

Adoptive Family:
• A family where parents legally adopt one or more children who are not biologically their own.
Communal Family:
• A non-traditional family structure where a group of people, unrelated by blood or marriage,
live together and share responsibilities such as parenting and household chores

STAGES AND TASK OF A FAMILY

1. Beginning Stage (Couple or Newly Married)
• Tasks:
o Establishing a relationship between partners.
o Managing finances and household responsibilities.
o Developing communication and problem-solving skills.
o Planning and preparing for future family life (e.g., career development, living arrangements).
o Establishing boundaries with extended family and friends.
2. Childbearing Stage (Parenthood Begins)
• Tasks:
o Adjusting to the role of parenthood, including the birth and care of the first child.
o Developing a balance between the couple relationship and parenting responsibilities.
o Meeting the emotional, physical, and financial needs of the child.
o Establishing routines and schedules that accommodate the new baby’s needs.
o Strengthening family bonds and support networks.
3. Preschool Stage (Early Childhood)
• Tasks:
o Managing the challenges of raising toddlers and young children.
o Encouraging development of basic skills and behaviors in children.
o Providing appropriate emotional and physical care, ensuring a secure attachment.
o Adjusting to shifts in family roles as children grow and gain independence.
o Developing educational plans and preparing for early schooling.
4. School-age Stage (Middle Childhood)
• Tasks:
o Supporting children’s education, extracurricular activities, and social development.
o Managing schedules that include school, homework, and social events.
o Teaching values, discipline, and responsibility.
o Enhancing communication with children as they grow more independent.
o Maintaining a balance between work, family time, and personal needs.
5. Adolescent Stage (Teenage Years)
• Tasks:
o Navigating the challenges of adolescence, including independence and identity formation.
o Supporting teenagers through academic pressures, social issues, and emotional development.
o Maintaining open lines of communication with teens while allowing them more autonomy.
o Helping adolescents with career planning, higher education, and future goals.
o Managing conflicts as parents and children negotiate new roles in the family dynamic.
6. Launching Stage (Young Adults Leave the Home)
• Tasks:
o Adjusting to an "empty nest" as children leave for college, work, or other independent living situations.
o Shifting the focus back to the marital relationship and redefining the roles of the parents as a couple.
o Providing emotional and financial support to young adult children as needed.
o Letting go and supporting the independence of adult children while maintaining a healthy
relationship.
o Reevaluating family priorities and life goals.
7. Middle-Aged Stage (Empty Nesters and Early Retirement)
• Tasks:
o Adjusting to a quieter home life after children have left and exploring new roles and hobbies.
o Maintaining a strong partnership and working on personal goals and interests.
o Providing support to aging parents or other extended family members.
o Planning for retirement, healthcare, and future financial stability.
o Reflecting on accomplishments and changes, preparing for the later stages of life.
8. Aging Stage (Retirement and Later Life)
• Tasks:
o Adjusting to retirement, managing leisure time, and establishing new routines.
o Maintaining health and managing potential physical limitations.
o Preparing for end-of-life issues, including wills, funeral arrangements, and legacy planning.

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 o Supporting and coping with the loss of a spouse or other loved ones.
o Reinforcing relationships with children and grandchildren while navigating generational differences.

General Tasks Across All Stages:

• Building Family Identity: Throughout every stage, families work to develop a sense of shared identity,
values, traditions, and practices.
• Effective Communication: Maintaining open, honest, and supportive communication is critical at all
stages to foster strong family bonds and handle conflicts.
• Adaptation: Families must adapt to changes in life circumstances, such as moves, health changes, financial
changes, or transitions in roles and responsibilities.
The specific tasks in each stage vary by culture, individual family dynamics, and life circumstances, but these
general stages and tasks provide a useful framework for understanding how families evolve over time.

HEALTH
- Determinants of Health (Eco System of Health)
- Levels of Prevention
- Health Care Delivery System
- Primary Health Care

DETERMINANTS OF HEALTH
Clients: Individual, Family, Population and Community
Outcome: Optimum Level of Functioning

1. Political – Safety, Oppression, Empowered

- Leadership and Governance; Basic Health care must free, Health must accessible
2. Behavior - Culture, Norms, Traditions, Ethnic Customs
- Health Seeking behavior
3. Heredity – Genes / Endowment → Defects, Strengths, Risk, Familial
- Namamanang sakit
4. Health Care Delivery System → Promotive, Preventive, Curative and Rehabilitative
5. Environmental – Sanitation and Hygiene → Pollution – Air, Water, Noise, Radiation
Environmental Sanitation → Approved Type of Water Facility, Approved Type of Excreta Systems, Following
the proper Garbage Disposals and Food Sanitation → 4 Rights in Food Preparations
6. Socio – Economic → Employment; Source of income of the family; Education and Educational attainment,
Housing → Location of the House, Materials used in the House → Roof, Walls, Floors.

LEVEL OF PREVENTION

LEVEL 1 – PRIMARY: (P)re-sickness/(P)re-Disease

→ Prevention of Problems before they occur
Activities: Health Education; Safety, Nutrition, Earthquake Drills, Fire Drills, Water Purifications
Immunization; (P)recautionary Measures (Airborne/ Droplet), (P)PE (Personal Protective Equipment)

LEVEL 2 – SECONDARY: (S)akit (S)intomas (S)creening

→ Early Detection (Diagnosis) and Interventions
Activities: 1st Aid, Referral to a Facility, Casefinding, Contact tracing, Investigations, Reporting
Ex: Mammogram, BP Screening, Newborn Screening, Diagnostics Test, Providing Interventions

LEVEL 3 – TERTIARY: (T)apos na ang sakit! (T)ahanan (T)herapy

→Correction and Prevention of Deterioration of a disease state
Activities: Rehabilitation; (T)herapy
Ex: Stroke Patient attending Physical Therapy Sessions (Setting: Discharge from the Hospital) Teaching a DM Patient
how to use Insulin injections, referral of patient with spinal cord injury to Occupational and Physical Therapy

HEALTH CARE DELIVERY SYSTEM - DEPARTMENT OF HEALTH

Prior 1987: Ministry of Health

1987 Constitution: Department of Health

1999 – 2004: ESTRADA and MACAPAGAL – ARROYO

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 Goal: Health Sector Reform Agenda
Secretary: Dr. Romualdez: 1998 – 2001 Dr. Dayrit: 2001 – 2005
2005 – 2010: MACAPAGAL – ARROYO
Fourmula One for Health
Secretary: Dr. Duque 2005 - 2010 and Dr. Cabral 2010
Goal: BEM
Better Health Outcome
Equitable Health Care Financing
More Responsive Health System

2010 – 2016 – AQUINO

Goal: Universal Health Care “Kalusugan Pangkalahatan” AO 36
Secretary: Dr. Ona 2010 - 2014 and Dr. Garin 2014 - 2016
Goals: BRF
Better Health Outcome
Responsive Health System
Financial Risk Protection
Elements:
Health Financing
Health Service Delivery
Health Regulation
Good Governance
Human Resources for Health
Health Information

2016 – 2022 – DUTERTE

Philippine Health Agenda
Goal: All for health towards health for all – Dr Ubial July 2016 – Oct 2017
Goal: Fourmula one plus for Health Nov. 2017 – 2022
2022 – MARCOS
4 Point Agenda – Dr. Vergeire 2022
8 Point Agenda – Dr. Herboda 2023 – Present

DEPLOYMENT PROGRAMS
NARS Under the Macapacal – Arroyo
Nurses Assigned in Rura; Service projects -Just a Training; will be given a Certificate
-Given a stipend of 8,000PhP
Contract: 6 months; Non Renewable
RN Heals Under the Aquino Administrations
Registered Nurses for Health Enhancement and Combination and training and employments
Local Service Projects Certificate of Employment and Training
Salary: 8,000Php
Contact: 12 months; Non Renewable

NDP Under Duterte

Nurses Deployment Program Employment Opportunities for Nurses
Certificate of Employment and Completion – PHN II
Contract: 6 months; Renewable
Salary Grade: SG 15 to SG 16

LEGAL MANDATE:
[Link] 1987 Constitution, Article II, Section 15
2. Executive Order 102 → LEA
3. Republic Act 7160 → LGU CODE

E.O 102 “Roles and Functions of the DOH signed by President Estrada

L.E.A.
LEADER IN HEALTH
ENABLER and CAPACITY BUILDER
ADMINISTRATOR

The DOH has 1 Secretary and 9 Undersecretary

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LGU Code: RA 7160 → Devolution and Decentralization

→Refers to the act by which the National Government confers Power and Authority upon the various local
government units to perform specific functions and responsibilities, including the provisions and delivery of basic
health services

Creation of the Local Health Board

• Chairman – Local Chief Executive (Mayor) The MHO will serve as the Vice Chair
• Proposing to the Sangguniang annual budgetary allocations for the operation and maintenance of health
facilities and services within the province/city/ municipality
• Serving as the advisory committee to the Sangguniang on health matters and
• Creating Committees that shall advise local health agencies on various matters related to health services
operations

Creation of the Inter Local Health Zone

• Improved health status and coverage of public health intervention of the zone population
• Access by everyone in the zone to qualify care and
• Efficiency in the operations of the Inter Local Health Services

Components of the Inter Local Health Zone

1. PEOPLE: 100,000 – 500,000

2. BOUNDARIES: Clear boundaries between ILHZ establish accountability and responsibility of health service
providers
3. HEALTH FACILITIES: Integrated Health System and district and provincial hospital serves as the central
referral hospital
4. HEALTH WORKERS: This includes all workers Public and Private, Volunteer health workers from NGOs
and community based organizations

Component #3: Level of Health Care Delivery in the Philippines

Primary Municipal Health Office, Rural Health Unit and Brgy Health Centers
Hospitals
Secondary Provincial Health Office, District Hospitals, Emergency Hospitals and Provincial
Tertiary National Hospital, Medical Center, Specialized Hospital, Regional Hospital

CATEGORIES OF HEALTH CARE FACILITY

PRIMARY CARE FACILITY • -First contact Health Facility

• - Health Center, Out-Patient Clinic, Dental Clinic, Lying-In

CUSTODIAL CARE FACILITY • - Long Term Care including food and shelter
• -Psychiatric Facilities, Rehabilitation Centers, Nursing Homes

DIAGNOSTICS AND THERAPEUTIC • -Diagnosis and Treatment

FACILITY • -Lab Facilities, Drug Testing, HIV and Blood Services Facility

SPECIALIZED OUT-PATIENT • -Highly specialized procedures

FACILITY • -Dialysis Centers, Cancers Centers – radiation and
chemotherapy. Ambulatory Surgical Facilities

Component #4 : Health Care Workers

1 Midwife : 5, 000
1 Nurse: 10,000
1 Dentist: 50,000
1 Physician: 20,000
1 Sanitary Inspector: 20,000
1 MedTech: 20,000
1 PT: 20,000

1 RHU: 20,000
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 1 BHS: 5,000

DEPARTMENT OF HEALTH

VISION: Filipinos are among the healthiest people in Asia by 2040.

MISSION: To promote healthy settings, and steer the development of an effective, resilient, equitable, and people-
centered health system for Universal Health Care.

HEALTH SECTOR GOALS → A.B.S.

▪ Access to all levels of care → comprehensive access to culturally-sensitive and gender-responsive health
services at primary, secondary, and tertiary levels
▪ Better health outcomes → reduced health inequities, improved health metrics, life expectancy and quality of
life.
▪ Stronger health systems strengthened infrastructure, capacity, and resilience, that proactively anticipates
and responds to health needs and crises,

The following lists the eight (8) action agenda items and their corresponding strategic objectives, organized under
three (3) major categories:
1) Para sa Bawat Pilipino
Ensuring that every Filipino achieves the highest level of health by providing safe, high-quality, and patient-
centered services, utilizing modern technology for efficient service delivery
2) Para sa Bawat Komunidad
Empowering communities and addressing determinants of health through health promotion, preparing them for
crises, and fostering mental health and well-being, ensuring that each community thrives in the face of challenges
3) Para sa Bawat Health Worker at Institusyon
Prioritizing health care workers’ welfare and rights, and strengthening our health institutions against the threat of
pandemics.

Para sa BawatPilipino (For Every Filipino):

1. Bawat Pilipino, ramdam ang kalusugan
Strategic Objective: Mainstream and strengthen the primary health care approach, ensuring that every Filipino has
access to comprehensive health services without experiencing financial hardship.

2. Ligtas, dekalidad at mapagkalingang serbisyo

Strategic Objective: Ensure the provision of high-quality, safe, and people-centered services, which include access
to affordable medicines, across the lifestages.

3. Teknolohiya para sa mabilis na serbisyo

Strategic Objective: Leverage diggital health and technology for efficient and accessible health service delivery.

Para sa Bawat Komunidad (For Every Community):

4. Handa sa Krisis
Strategic Objective: Ensure a responsive and resilient health system and communities that can effectively prevent,
prepare for, respond to and recover from public health emergencies and crises.
Para sa Bawat Komunidad (For Every Community): Empowering communities and addressing determinants of
health through health promotion, preparing them for crises, and fostering mental health and well-being, ensuring
that each community thrives in the face of challenges

5. Pag-iwas sa sakit
Strategic Objective: Address determinants of health and improve healthy behaviors through the promotion of
health-enabling settings, implementation of healthy public policies, and enhancementofhealth literacy.

6. Ginhawa ng isip at damdamin

Strategic Objective: Enhance Filipinos’ well-being and ensure quality mental health services.

Para_sa Bawat Health Worker at Institusyon (For Every Health Worker and Institution):
7. Kapakanan at karapatan ng health workers
Strategic Objective: Ensure an adequate, competent, and committed health workforce by providing fair
compensation, decent work conditions, and opportunities for career development.

8. Proteksyon sa anumang pandemya

Strategic Objective: Strengthen health systems and structures to prevent, manage, and recover from disease
outbreaks and potential pandemics.

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The Millennium Development Goals (MDGs) were a set of 8 international development goals established following
the Millennium Summit of the United Nations in 2000, with a target date of 2015.
1. Eradicate Extreme Poverty and Hunger
• Goal: To halve the proportion of people living on less than $1.25 a day and to achieve full and productive
employment and decent work for all.
• Targets:
o Reduce by half the proportion of people living in extreme poverty.
o Achieve full and productive employment and decent work for all.
o Reduce by half the proportion of people who suffer from hunger.
2. Achieve Universal Primary Education
• Goal: To ensure that all children, boys and girls alike, can complete a full course of primary schooling.
• Targets:
o Ensure that all boys and girls complete a full course of primary education.
3. Promote Gender Equality and Empower Women
• Goal: To eliminate gender disparity in primary and secondary education, preferably by 2005, and at all levels
of education no later than 2015.
• Targets:
o Eliminate gender disparity in primary and secondary education.
o Increase the proportion of women in wage employment in the non-agricultural sector.
o Improve women’s political participation.
4. Reduce Child Mortality
• Goal: To reduce by two-thirds the mortality rate of children under five years of age.
• Targets:
o Reduce the under-five mortality rate by two-thirds.
o Improve child health through immunization and better health services.
5. Improve Maternal Health
• Goal: To reduce the maternal mortality ratio by three-quarters.
• Targets:
o Reduce maternal mortality by three-quarters.
o Achieve universal access to reproductive health services.
6. Combat HIV/AIDS, Malaria, and Other Diseases
• Goal: To halt and begin to reverse the spread of HIV/AIDS, malaria, and other diseases.
• Targets:
o Halt and reverse the spread of HIV/AIDS.
o Achieve universal access to treatment for HIV/AIDS for those who need it.
o Halt and begin to reverse the incidence of malaria and other major diseases (such as tuberculosis).
7. Ensure Environmental Sustainability
• Goal: To integrate the principles of sustainable development into country policies and programs, and reverse
the loss of environmental resources.
• Targets:
o Incorporate sustainable development into policies and reverse environmental resource loss.
o Reduce biodiversity loss, achieving a significant reduction in the rate of loss.
o Improve the lives of at least 100 million slum dwellers by 2020.
8. Develop a Global Partnership for Development
• Goal: To develop a global partnership for development, focusing on issues such as trade, debt relief, access
to affordable essential drugs, and access to new technologies.
• Targets:
o Develop an open, rule-based, predictable, nondiscriminatory trading and financial system.
o Address the special needs of the least developed countries, landlocked countries, and small island
developing states.
o Deal comprehensively with developing countries’ debt problems through national and international
measures.
o Provide access to affordable essential drugs in developing countries.
o Make available the benefits of new technologies, particularly information and communications.
o
"Poverty Every Girl's Child Must Fight, HIV Save Environment Globally."
This corresponds to the 8 MDGs:
1. Poverty (Eradicate extreme poverty and hunger)
2. Education (Achieve universal primary education)
3. Gender Equality (Promote gender equality and empower women)
4. Child Health (Reduce child mortality)
5. Maternal Health (Improve maternal health)
6. Fight HIV/AIDS (Combat HIV/AIDS, malaria, and other diseases)
7. Help Environment (Ensure environmental sustainability)
8. Seek Partnership (Develop a global partnership for development)

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The 17 Sustainable Development Goals (SDGs) were adopted by all United Nations Member States in 2015 as part
of the 2030 Agenda for Sustainable Development
1. No Poverty
• Goal: End poverty in all its forms everywhere.
• Objective: Eradicate extreme poverty, ensure equal access to resources, and improve the lives of people living
in poverty.
2. Zero Hunger
• Goal: End hunger, achieve food security, improve nutrition, and promote sustainable agriculture.
• Objective: Ensure that everyone has access to sufficient and nutritious food, especially vulnerable
populations, and support sustainable farming practices.
3. Good Health and Well-Being
• Goal: Ensure healthy lives and promote well-being for all at all ages.
• Objective: Reduce maternal and child mortality, combat diseases like HIV/AIDS, improve mental health, and
promote universal health coverage.
4. Quality Education
• Goal: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.
• Objective: Provide free primary and secondary education, improve skills for employment, and ensure equal
access to education for all.
5. Gender Equality
• Goal: Achieve gender equality and empower all women and girls.
• Objective: Eliminate violence and discrimination, ensure equal participation in leadership and decision-
making, and ensure equal access to opportunities.
6. Clean Water and Sanitation
• Goal: Ensure availability and sustainable management of water and sanitation for all.
• Objective: Provide clean drinking water and sanitation services to all, promote water conservation, and
ensure sustainable water management.
7. Affordable and Clean Energy
• Goal: Ensure access to affordable, reliable, sustainable, and modern energy for all.
• Objective: Expand the use of renewable energy, increase energy efficiency, and ensure energy access to
underserved populations.
8. Decent Work and Economic Growth
• Goal: Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and
decent work for all.
• Objective: Encourage economic growth, create jobs, ensure fair wages, and improve working conditions.
9. Industry, Innovation, and Infrastructure
• Goal: Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation.
• Objective: Enhance infrastructure, support innovation and technology development, and promote sustainable
industrialization.
10. Reduced Inequality
• Goal: Reduce inequality within and among countries.
• Objective: Promote social, economic, and political inclusion, ensure equal opportunities, and reduce
disparities between nations and regions.
11. Sustainable Cities and Communities
• Goal: Make cities and human settlements inclusive, safe, resilient, and sustainable.
• Objective: Improve housing, ensure access to basic services, reduce urban sprawl, and enhance sustainability
in urban areas.
12. Responsible Consumption and Production
• Goal: Ensure sustainable consumption and production patterns.
• Objective: Promote resource efficiency, reduce waste, encourage sustainable business practices, and ensure
environmentally friendly production processes.
13. Climate Action
• Goal: Take urgent action to combat climate change and its impacts.
• Objective: Mitigate climate change, reduce carbon emissions, and promote sustainable practices to limit
global warming and its effects.
14. Life Below Water
• Goal: Conserve and sustainably use the oceans, seas, and marine resources for sustainable development.
• Objective: Protect marine ecosystems, reduce pollution, and ensure sustainable use of marine resources.
15. Life on Land
• Goal: Protect, restore, and promote sustainable use of terrestrial ecosystems, manage forests sustainably,
combat desertification, halt and reverse land degradation, and halt biodiversity loss.
• Objective: Conserve biodiversity, restore ecosystems, and promote sustainable land use practices.
16. Peace, Justice, and Strong Institutions
• Goal: Promote peaceful and inclusive societies for sustainable development, provide access to justice for all,
and build effective, accountable, and inclusive institutions at all levels.
• Objective: Strengthen institutions, ensure access to justice, promote human rights, and reduce violence and
corruption.
17. Partnerships for the Goals

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 • Goal: Strengthen the means of implementation and revitalize the global partnership for sustainable
development.
• Objective: Foster global partnerships, enhance international cooperation, and mobilize resources to achieve
the SDGs.
"People Everywhere Gain Confidence, Even For Smart Innovation, Caring Institutions, Peaceful
Partnerships."
This corresponds to the 17 SDGs as follows:
1. People – No Poverty
2. Everywhere – Zero Hunger
3. Gain – Good Health and Well-Being
4. Confidence – Quality Education
5. Even – Gender Equality
6. For – Clean Water and Sanitation
7. Smart – Affordable and Clean Energy
8. Innovation – Decent Work and Economic Growth
9. Caring – Industry, Innovation, and Infrastructure
10. Institutions – Reduced Inequality
11. Peaceful – Sustainable Cities and Communities
12. Partnerships – Responsible Consumption and Production
13. Smart – Climate Action
14. Innovative – Life Below Water
15. Caring – Life on Land
16. Institutions – Peace, Justice, and Strong Institutions
17. Partnerships – Partnerships for the Goals

PRIMARY HEALTH CARE

Primary Care Primary Health Care

At Community Level -Health in the Hands of the People
-1st Level of Care -Total Approach
-Provision of Interventions to cure specific -Active Community Paricipation
Disease -Partnership
-Improve Health in the Community
-Access to Basic Health

Primary Health Care Remember M.I.D.W.I.F.E.

Multi-sectoral policies
Integrated Health Services
Determinants of health (physical, mental and social health and wellbeing)
Whole-of Government Approach (PHC Aim)
Interventions that encompass the entire life-course
Focusing on Equity
Empowering individuals, communities for increased participation in health.

History of Primary Health Care

Old Goal: Health in the Hands of the people by year 2000
1997 - PHC Movement
Sept. 6 – 12 1978 – PHC Meeting in Alma Ata, USSR
Oct. 19, 1979 – PHC is Adapted in the Philippines via LOI 949 signed by Pres. F. Marcos, Sr
October 2018 – PHC Meeting in Astana, Kazakhstan

Traditional Cornerstones / Pillars → I love USA

Inter and Intra Sectory Linkages

Use of Appropriate technology
Support Mechanism Made Available
Active Community Participation

Core Values of Primary Health Care → SSSER

1. Social Justice
2. Solidarity
3. Self Reliance
4. Equity (Most Important)
5. Respect to Human Dignity / Human Rights

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GOAL: Ensure all people provided access to Health

PHILOSOPY: Health Care Workers to rally behind the communities to assume responsibility for their health

STRATEGY: Collaborations of Private and Public

ELEMENTS / COMPONENTS OF PHC

“ESSENTIALS”

Essential Medicines / Drugs

Sanitation
Safe Water Supply
Endemic Disease Control and Management
Nutrition
Treatment to Simple Conditions
Immunization
Access for mother and child Health Serives
Learning thru Health Education

PHC Advocates the 5 A’s

Accessible
Available
Affordable
Acceptable
Appropriate

Determinants of Success of PHC

[Link] and Capacity Building
-Community must actively participate
-Shared Leadership and Participatory Governance
-Community Organizing is also done to identify Potential Leader

2. Human Resources for Health

-Multidisciplinary Approach hence the need for skill mix to address health needs of the people is crucial to the
efficient implementation of PHC

3. Financing
-Access of people to essential health services
-Philhealth -> No Balance Billing Policy
-RA 10351 -> Sin Tax Law
-RA 10963 -> TRAIN Law

4. Technology
-In the context of PHC it must be viewed as a means to help the public maintain, restore and promote their
Optimum Level of Functioning
-Ensure that the people from all walks of life enjoy the highest possible level of wellness, access to available
services and technology provided

ASTANA DECLARATION

“Strengthening Primary Health Care is the most inclusive, effective and efficient approach to enhance people’s
physical and mental health, as well as social well-being and that the PHC is a cornerstone of a sustainable health
system for universal health coverage (UHC) and health related Sustainable Development Goals.” WHO, 2018

Date: October 25 – 26, 2018; Astana Kazakhstan

-40 years after Alma Ata Declaration
“from Alma Ata towards Universal Health coverage and the sustainable development goals, reaffirming the 1978
goals”
Goal: Health and Well-being for All, leaving no one behind

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NURSING
- Activities in CHN
- Procedures in CHN
- Methodologies in CHN

CHN ACTIVITIES: Family Nurse Contact

• Home Visit
• Clinic Visit
• Group Conference
• Telephone Contact
• Written Communication

CHN PROCEDURES:
• Bag Technique
• Benedicts Test
• Heat and Acetic Acid Test

CHN METHODOLOGIES:
• Family Health Nursing
• Community Diagnosis
• Community Organizing (Maglaya)
• Community Organizing Participatory Action Research (Sr. Jimenez)
• Recording and Reporting System
• Demography

Family – Nurse Contact

These are methods of how the Nurse or any Health Care Workers to contact or communicate with the Family
a. Group Conference
b. Telephone Contact
c. Written Communication
d. Clinic Visit
e. Home Visit

Group Conference - Provides an opportunity for an initial contact between the nurse and target families of the
community. Opportunity to share experiences and practical solutions
Sectoral / Population Group / Aggregate
Example: Nursing Mother Class on Breastfeeding

Telephone Contact - Landline / Mobile Phone, provides an easy access between the nurse and the family.
Information transmitted to this is limited and assessment still requires face to face contact. Assessment is subjective
to the client
Example: Tele-consult / Tele-Medicine

Written Communication - Used to give specific information to the family. One way method, this contact requires
literacy and interest. Ineffective to people who cannot read and cannot write

Clinic Visit - the patient visits the Health Center/clinic to avail of the services thereto offered by the facility primarily
for consultation on matters that ailed them physically.
1. Registration
- Greet and Ask for the Chief Complaint
- Get the Initial Data Base (IDB) Pertinent Information: Name, Age, Brgy
- Get the Treatment Record
- Get the Vital Signs
- Should there be an Emergency Case, this steps will not be followed.
2. Waiting Time → Principle of “1st come, 1st served”
3. Triage → Prioritization of Client/ Patient
PROGRAM BASED – Manageable by the Nurse and Midwife
(Cases can be manage without the presence of a Medical Doctor)
Ex: Immunization and Integrated Management on Childhood Illnesses
NON PROGRAM BASED – Manageable only by the Medical Doctor
Ex: Non Communicable Diseases such as Diabetes and Hypertension
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 EMERGENCY – First Aid and Referral
Ex: Vehicular Accidents , Stroke, Stub Wounds

4. Clinical Evaluation – Medical Check – up Proper

Registered Nurses → Focus on Nursing Process → Assess, Diagnoses, Plan, Implement, Evaluate

5. Laboratory → Referral to the Medical Technologist

6. Referral System – (2 Way Referral System)

Why do Referral? Answer: Due to lack of Medical Resources (Medications, Manpower, Labs)
BHS → RHU (In Large Cities: RHU to RHU)
RHU → HOSPITAL
7. Prescription / Dispensing of Medicine → Done by the Midwife or the Nurse
8. Health Education → Focus is on Increasing the Knowledge Skills and Attitude of the Patient / Client
➔ We teach the NCP to the Client / Patient
➔ Follow up → This can Clinic Visit or Home Visit

Phases of Clinic Visit

1. Pre-Consultation Phase
2. Medical Examination Phase
3. Nursing Intervention Phase
4. Post Consultation Phase

- Health Teaching is the most important activity

- Main Goal: Promotion of Health
- Components of Health Teaching in the Clinic: IEC (Information, Education, Communication)
- Criteria of Health Teaching in the Clinic: SKA (Skills, Knowledge and Attitude)

Home Visit - is a family-nurse contact which allows the health worker to assess the home and family situations in
order to provide the necessary nursing care and health related activities.

Purpose of Home Visit → Remember GHAME

• Give Nursing care

• Health Teaching
• Assess living condition
• Make use referral system
• Establish close relationship

Components of Home Visit → Remember PIE – SWS

• Plan – Essential tool in achieving precise and appropriate Interventions

• Implement – Nurse : Family Partners
A. Socialization Phase
B. Working / Professional Phase
C. Summary Phase
• Evaluate – Audit Family Situation

Principles involved in preparing for a home visit

→ When we plan to go on a home visit, it is necessary to assemble the records of the patients and list the names to
be visited, study the case and have a written nursing care plan.

• Available information must be used

• Essential NEEDS is the PRIORITY
• Involve Family in Planning
• Objectives / Purpose
• U-ng Plan dapat Flexible (RN/ Family)

Guidelines to consider regarding the frequency of home visits

The schedule of the visit may vary according to the need of the patient or family for nursing care, but one has to
consider the following factors:
• Past Services must be Checked
• Utilize resources of the Family/ Agency
• TRUST → Acceptance of the Family (Most Important Guideline)
• Agency’s Policy must be followed
• Needs of the Family → PRIORITY

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Phases of Home Visit

• Pre Visit – Preparation in the RHU

– Assess and Diagnosis
• In-home Phase – Home; Plan & Implementation of the RN and Family
• Post Visit – Either at Home or RHU
– the RN Evaluates

Steps in conducting Home Visits

1. Greet the patient/ Client and introduce yourself
2. State the purpose
3. Observe the patient and determine the health needs
4. Put the PHN Bag in a convenient place then proceed to perform the procedure → bag technique
5. Perform the nursing care needed and give health teachings
6. Record all important data, observation and care rendered
7. Make Appointment for a Return Visit

CHN Procedures
• Bag Technique
• Benedicts Test
• Heat and Acetic Acid Test
The Bag Technique
→Tool used by the nurse to enable her/him to perform nursing procedures with ease and deftness, to save time and
effort, with the end view of rendering effective nursing care to the clients / Patient

The Public Health Bag

→Essential and Indispensable equipment of the Nurse.

Principles of Bag Technique – MiSS C

M: Minimize or Prevent the Spread of Infection

S: Saving Time and Effort
S: Show Effectiveness of Total Care
C: Can be performed in a variety of ways depending on the agency's policy and home situation

Important points to consider In the use of the bag

1. The bag should contain all the necessary articles, supplies and equipment’s that will be used to answer emergency
needs.
2. The bag and its contents should be cleaned very often, the supplies replaced, and ready for use anytime
3. The bag and its contents should be well protected from contact with any article in the patient's home. Consider
the bag and its contents clean and sterile, while articles that belong to the patients as dirty and contaminated.
4. The arrangement of the contents of the bag should be the one most convenient to the user, to facilitate efficiency
and avoid confusion.

"CLEAN"
Where each letter stands for:
• C: Contains all necessary articles, supplies, and equipment for emergency needs.
• L: Lasts through frequent cleaning, with supplies replaced and ready for use anytime.
• E: Ensures protection from contact with patient’s personal items, maintaining cleanliness and sterility.
• A: Arrangement of contents should be convenient to the user, to ensure efficiency.
• N: Neat and organized to avoid confusion during use.

FRONT OF THE BAG RIGHT REAR LEFT REAR BACK OF THE BAG
• Thermometers • 2 Test Tube 1 • Medicine Glass • 70% Alcohol
• Tape Measure Holder • Baby Scale • Betadine
• Adhesive Plaster • Medicine • Bandage Scissor Solution
• Cotton Applicator Dropper • Rubber Suction • Hydrogen
• Alcohol Lamp Peroxide

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 CENTER OF THE BAG TOP PILE POCKET OF THE BAG • Terramycin
• 2 Pairs of Forceps • Hand towel in a • Surgical Gloves Ointment
• 1 Surgical Scissor plastic bag • Waste Paper • Zephiran
• Sterile Dressing • Soap in Soap Dish Receptacle Solution
• Roller Bandage • Apron • Spirit of
• Syringes • Plastic / Linen Ammonia
(5ml/2ml) lining • Acetic Acid
• Hypodermic • Benedicts
Needles Solution
• Sterile Cord • Liquid Soap
Clamp • Cotton in Sterile
• Kidney Basin Water

Benedict’s test is a chemical test that can be used to check for the presence of reducing sugars in a given analyte.
Therefore, simple carbohydrates containing a free ketone or aldehyde functional group can be identified with this
test. The test is based on Benedict’s reagent (also known as Benedict’s solution), which is a complex mixture of
sodium citrate, sodium carbonate, and the pentahydrate of copper(II) sulfate.

The procedure for Benedict’s test is:

→ 5 mL of Benedict's reagent into a clean, dry test tube.
→ 8 – 10 drops of the liquid sample into the test tube.
→ Heat for approximately 3 minutes in a heated water bath.
→ Formation precipitate.

Color of the Precipitate g% of Reducing Sugar

Blue 0% - No Trace
Green 0.5% Traceable
Yellow 1% Low
Orange 1.5% Moderate
Red 2% High

Heat and Acetic Acid Test

1. Take 5-10ml clear urine in a test tube.

2. Boil the upper portion over a flame.
3. Compare the heated part with the lower part. Cloudiness or turbidity indicates the presence of either proteins
or phosphates/carbonates.
4. Add 2-4 drops of 10% glacial acetic acid and boil the upper portion again.
5. If turbidity is still present, protein is present in urine. If turbidity disappears, that is due to phosphates or
carbonates present in urine.

Grade the turbidity as follows:

▪ Negative : No cloudiness
▪ Trace: Barely visible cloudiness.
▪ 1+ : definite cloud without granular flocculation
▪ 2+ : heavy and granular cloud without granular flocculation
▪ 3+ : densed cloud with marked flocculation.
▪ 4+ : thick curdy precipitation and coagulation

CHN Methodologies
- Family Health Nursing
- Community Diagnosis
- Community Organizing
- Community Organizing Participatory Action Research
- Recording and Reporting
- Demography

FAMILY NURSING ASSESSMENT

First-Level Assessment
- Problems of the Family
- Tool Used: Initial Data Based (IDB) ex: Family Assessment Form

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 -
1. Family structure, characteristics and dynamics
- Family Composition, Demographic Data, Type of Family, Decision making patterns, Interpersonal
relationships, Health Beliefs
2. Socio-economic and Cultural Characteristics
- Occupation, Educational Attainment, Ethnic Background, Religious affiliation, Traditions
3. Home and Environment
- Housing and Sanitation facilities, kind of neighborhood, transportation facility
4. Health Status of each member
- Current and Past significant health condition, illness/es and nutritional and developmental status
5. Value and Practices on health promotion / maintenance and disease prevention
- Promotive and Preventive services, rest/sleep, exercise, relaxation, healthy lifestyle

First Level Assessment

-Existing potential family problems/ situation are determined

Typology of Nursing Problems

• Wellness Conditions
- Transition from a specific level of wellness to a higher level
- From Healthy to Healthier
- Ex: Balance Diet
• Health Threat
- Condition that are conducive (increase risk) to disease, accident/failure to attain ones potential
- Healthy but with positive risk
- Ex: Hazards
• Heath Deficit
- Instances of failure on health maintenance
- Diseases, Disorders, Disability, Developmental Problems
• Stress points / Foreseeable Crisis
- Anticipated periods of unusual demands on coping and adjustment
- School

Secondary Level of Assessment

-Performance of the family health risk
-recognition of the problem – Salience

Result (2nd Level)

-Inability
-Family Nursing Diagnosis Tool (NANDA): Family Level
-Family Coping Index

Planning
• Nature of Condition or Problem
• Modifiability
• Preventive Potential
• Salience

CRITERIA WEIGHT
Nature of the condition or 1
Problem presented

Wellness State 3
Health Deficit 3
Health Threat 2
Foreseeable Crisis 1

CRITERIA WEIGHT
Modifiability of the Condition 2
Or Problem

Easy Modifiable 2
Partially Modifiable 1
Not Modifiable 0

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 CRITERIA WEIGHT
Preventive Potential 1

High 3
Moderate 2
Low 1

CRITERIA WEIGHT
Salience 1

Condition or Problem, needing immediate attention 2

Condition or Problem not needing immediate attention 1
Not perceived as a problem or condition needing change 0

1. Decide on a score for each of the criteria

2. Divide the score by the highest possible score and multiply by the weight (score / highest score) X
Weight
3. Sum up the score for all the criteria. The highest score is 5, equivalent to the total weight

Formulation of Goals and Objectives of Care

-A goal is a broad desired outcome toward which behavior is directed
Ex: After Nursing intervention the family will be able to take care of the disabled family member competently
-SMART – Specific ,Measurable, Attainable, Realistic, Time-Bounded

Develop a Plan
-Family Nursing Care Plan

General Directions for the Nursing Interventions

1. Analyze with the Family the Current situation and determine choices and possibilities based on a lived
experience of meanings and concerns
2. Develop/ Enhance Family’s competencies as Thinkers, Doers and Feelers
3. Focus on Interventions to Help perform the Health Tasks
4. Catalyze Behavior Change through Motivation and Support

Focus on Interventions to help the Family Perform the Health task

1. Help the Family recognize the problem
2. Guide the family on how to decide on appropriate health actions to take
3. Develop the family’s ability and commitment to provide Nursing care to its members
4. Enhance the capability of the family to provide a Home Environment conducive to the Health Maintenance
and personal development
5. Facilitate the Family’s capability to utilize community resources for health care

Evaluation

Structure Inputs and Resources Adequacy Appropriateness

Process Procedure performed Effectiveness, Efficiency
Outcome Result Goals met, Unmet, Partially met

COMMUNITY DIAGNOSIS
• Aims to obtain general information about the community’s profile to determine the community’s strengths
and weaknesses, It is in knowing its profile, that the community can resolve its health problems and needs
• The process of Community Diagnosis consist of collecting, organizing, synthesizing, analyzing and
interpreting data. This process reflects the community health nurse competencies essential for assessment
and analysis in public health.

COMMUNITY DIAGNOSIS
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 • COMPREHENSIVE
• PROBLEM ORIENTED

DETERMINANTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS

A. Demographic Variables:
- Total population and geographical distribution including urban-rural index and population density
- Age and sex composition
- Household Size
- Selected vital indicators such as growth rate, crude birth rate, crude death rate and life expectancy at birth
- Patterns of migration
- Population projections

B. Socio-economic and Cultural Variables:

Social indicators
a. Educational level which may be indicative of poverty and may reflect on health perception
and utilization of the community
b. Housing conditions which may suggest health hazards (congestion, fire, exposure to elements)
Economic Indicators
A. Poverty level income
B. and underemployment rates
C. Proportion of salaried and wage earners to total economically active population
D. Types of industry present in the community
E. Occupation common in the community
F. Communication network, whether formal or informal, necessary for disseminating health
information or facilitating referral of clients to the health care system
G. Transportation system including road networks necessary for accessibility of the people to
healthcare delivery system

Environmental indicators
A. Physical, geographical, topographical characteristics
- land areas that contribute to vector problems
- terrain characteristics that contribute to accidents or pose as geohazard zones, land usage in
industry and climate/ season
B. water supply
- % population with access to safe, adequate water supply , source of water supply
C. waste disposal
- % population served by daily garbage collection system
- % population with safe excreta disposal system
- types of waste disposal and garbage disposal system
D. air, water and land pollution
- industries within the community having health hazards associated with it
- air and water pollution index

Cultural indicators
1. variables that may break up the people into groups within the community such as:
- ethnicity, social class, language, religion, race, political orientation
2. cultural beliefs and practices which affect health
3. concepts about health and illness

C. Health and Illness Patterns

- leading causes of mortality, morbidity, infant mortality maternal mortality
- leading causes of hospital admission

D. Health Resources
1. manpower resources
- categories of health manpower available
- geographical distribution of health manpower / manpower-population ratio
- distribution of health manpower according to health facilities (hospitals, rural health units,
etc)
- distribution of health manpower according to type of organization (government, non-government,
health units, private)
- quality of health manpower
- existing health manpower development/ policies
2. material resources
- health budget and expenditures

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 - sources of health funding
- categories of health institutions available in the community
- hospital bed – population ratio
- categories of health services available

E. Political/ Leadership Patterns

- it reflects the action-potential of the state and its people to address the health needs and problems of the community.
…it also mirrors the sensitivity of the government to the people’s struggle for better lives.)
1. power structures in the community (formal or informal)
2. attitudes of the people towards authority
3. conditions, events, issues that cause social conflict, upheavals, or that leads to social bonding or unification
4. practices, approaches that are effective in settling issues and concerns within the community.

STEPS IN COMMUNITY DIAGNOSIS

1. DETERMINING THE OBJECTIVES

• In stating the objectives, the following questions should be answered:

• To describe the prevailing disease conditions and health needs of the target population
• What is the present health condition of the people in the community?

• To explain the health behaviors or risk factors that give rise to the health problem.
• Why are people in the community in such condition?

• To provide the analyses related to the socio-economic, cultural and environmental factors that sustain
or allow for the perpetuation of the health problems of the target population
• What are the roots of these problems?

2. DEFINING THE STUDY POPULATION

 The defined objectives are the bases for determining the study population
 The nurse and the community diagnosis team identify the population group to be included in the study.
 May include the following:
◦ Entire population
◦ Focused on a specific population group
 Women of reproductive age- group (15-44 years old)
 Infants (0-12 months old)
 If a complete enumeration of the desired sample is not possible
 Sample or a subset of the target population

3. DETERMINING THE DATA TO BE COLLECTED

• Developing a data collection plan

Data collection plan uses the objectives to guide the data collectors to decide on the following:
o Data to be collected
o Methods of data collection
o Instruments/tools for data collection
o Possible sources of these data

Categorizing data collected:

 Primary data – directly obtained by the nurse specifically to answer the community
diagnosis objectives.
 Secondary data – existing data that were obtained by other people, which the nurse
can use to answer the community diagnosis objectives

The nurse considers the following characteristics of data collected

o Timeliness of data
o Completeness
o Accuracy
o Precision
o Relevance
o Adequacy

4. COLLECTING DATA

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METHODS IN COLLECTING DATA
1. OBSERVATION
▪ Obtaining information from subjects by observing their behavior and their environment.
▪ A useful method of collecting data when informants are unable to directly supply information or may likely
give inaccurate information.
▪ Ocular survey/windshield survey is a common approach to perform rapid appraisal of the community. It
consist of walking around the community appreciating what can be seen and perceived as the people go
along with their daily lives.
▪ Participant observation is practiced by the nurse by living with the community of their study

2. RECORDS REVIEW
▪ Data obtained by reviewing folders, files or books compiled by health or non-health agencies from the
government or other sources.
3. FOCUS GROUP DISCUSSION
 Use to elicit and explore opinions of people, determine their attitudes and
practices regarding a limited set of concepts.
 The participants are selected based on the variables that are being studied.
 Set the characteristics of the participant

4. INTERVIEW
▪ Involves asking and answering questions following a systematic procedure
Aimed: to gather first-hand information from the subject of inquiry.

Ways of conducting an interview

▪ Face-to-face interview - conducted in person
▪ Telephone interview – via telephone interview
▪ Key informant Interview (KII) – when a person known to be an expert or an authority on a specific subject is
interviewed.
Individual interview – takes place between a respondent and an interviewer. This is most useful when sensitive issues
are discussed.
▪ Group interview – consists of one interviewer and several participants, usually around 10-15 persons. This
allows the interviewer to gather data from a good number of people at the same time.

Ways of conducting an interview

▪ Structured interview – follows a list of questions called an interview schedule which becomes the “script” in
the conduct of interview.
▪ Unstructured interview – is useful in collecting qualitative data that seek to describe opinions or perceptions
of people focusing on particular issue, problem, or phenomenon

5. DEVELOPING OF INSTRUMENTS

 The instruments or tools that facilitate the nurse’s data-gathering activities vary in accordance of its use.
◦ Survey questionnaire – the form one uses to document the data collected.

Types of survey questionnaire

▪ Interview schedule – the interviewer reads out the question and records the respondent’s reply to the
questions.
▪ Self-completed or self-administered questionnaire – the respondents read the questions and write down their
responses.

 The instruments or tools that facilitate the nurse’s data-gathering activities vary in accordance of its use.
◦ Focus group discussion guide – serves to facilitate the direction and flow of exchange of ideas on
specific topics or concepts among the participants. The facilitator does not need to strictly adhere to
the sequence of the questions but makes certain that all concepts are exhaustively discussed.
◦ Key informant interview guide – helps give direction to the person doing the interview using a set of
prepared questions on a very specific subject.
◦ Observation checklist – is a list of data that are manifestations or indicators of a health need or
problem. It could also be indicators of health resources such as health facilities and presence of health
personnel and services

6. ACTUAL DATA GATHERING

 Pre-testing of the instruments is highly recommended.

 The data collectors must be given an orientation and training on how they are going to use the instruments
in data gathering.
 It is necessary to check the filled up instruments if information gathered were complete, accurate and reliable.

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  There’s a need to go back if there are data gaps or unreliability.

7. DATA COLLATION

The nurse and the team are putting together all facts and figures to generate information about the health status of
the community.

Types of generated data:

a. Numerical data – are those which can be counted
i. Age
ii. Number of communal toilets
b. Descriptive data – are those that can be described or that can reveal characteristics of observable
facts.
c. The Nurse must Determine the Data and Categorize the Responses / Data

DETERMINING THE DATA

Descriptive - data that can be described, and is qualitative in nature
Numerical - data that can be counted, and quantitative in nature

CATEGORIZING THE RESPONSES / DATA

Mutually Exclusive
e.g. sex, monthly income
Exhaustive
e.g. Family planning methods

Response 10: Bawal sa akin sabi ng doctor

Response 27: Nagtatrabaho ako
Response 30: Ayaw ni mister
Response 45: Masakit
Response 59: Masisira ang figure ko
Response 60: Medical reasons
Response 62: May sakit ako
Response 67: Modern at Convenient ang bottlefeeding
Response 75: Pagod ako pagkagaling sa trabaho
Response 77: Mas gusto ko ang magpasuso sa bote

Possible categories are:

Convenience: Response 67, 77
Medical: Response 10, 60, 62
Personal: Response 30, 45, 59
Economic/work: Response 27, 75

◦ CATEGORIES IN DATA COLLATION:

Mutually exclusive – choices do not overlap. This can be used both for numerical and descriptive data.

Gender:
- Male
- Female

Exhaustive categories – anticipate all possible answers that a respondent may give.
Family Planning method
- Natural: BBT, Cervical Mucus method, Symptothermal method
- Standard days method, Others (specify)
- Artificial: IUD, Pills, Injectable, Condom, Others (specify)
- Permanent: Tubal ligation, Vasectomy

WAYS OF CATEGORIZING RESPONSES

Fixed response data
Fixed response questions provide choices that the respondent will select from. These responses will serve as
categories for collating the responses
Data from open-ended questions
Categories are constructed from responses in randomly selected from questionnaires

WAYS OF CATEGORIZING RESPONSES

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 • Fixed response data
• Fixed response questions provide choices that the respondent will select from. These
responses will serve as categories for collating the responses
• Data from open-ended questions

Categories are constructed from responses in randomly selected from questionnaire

• Tallying the data – entering the responses into prepared tally sheets showing all possible
responses.
• Computer – a coding manual is needed where the responses are given numbers or codes.
• EPIINFO software - public domain statistical software for epidemiology developed by Centers
for Disease Control and Prevention (CDC) in Atlanta, Georgia (USA).

Response 10: Bawal sa akin sabi ng doctor

Response 27: Nagtatrabaho ako
Response 30: Ayaw ni mister
Response 45: Masakit
Response 59: Masisira ang figure ko
Response 60: Medical reasons
Response 62: May sakit ako
Response 67: Modern at Convenient ang bottlefeeding
Response 75: Pagod ako pagkagaling sa trabaho
Response 77: Mas gusto ko ang magpasuso sa bote

8. DATA PRESENTATION

 Data presentation varies depending on the type of data obtained.

 Descriptive Data are presented in narrative reports.
◦ Geographic data
◦ History of place
◦ Beliefs regarding illness and death
 Numerical Data are presented into table or graphs. These are useful in showing key information making it
easier to show comparisons, patterns and trends.
◦ Line graph – shows data trend or changes in data with time or age with respect to some other variable
◦ Bar Graph or pictograph – for comparisons of absolute or relative counts and rates between
categories.
◦ Histogram or Frequency polygon – graphic presentation of frequency distribution or measurement.
◦ Proportional or component bar graph or pie chart – shows breakdown of a group or total where the
number of categories is not too many
◦ Scattered diagram – correlation data for two variables.

9. DATA ANALYSIS

 Data are sorted, classified in terms of relatedness, and interpreted for any significance or implication. This
process aims to establish trends and patterns in terms of health needs and problems in the community.
 The magnitude and extent of the problems and their implication can be derived by comparing them with
standard values or norms.
 Problem tree analysis approach
◦ Cause and effects of health problems
 Data Analysis is the most crucial stage in Community Diagnosis. It involves quantification, description and
classification of data.
 Data are sorted, classified in terms of relatedness, and interpreted for any significance or implication. This
process aims to establish trends and patterns in terms of health needs and problems in the community.
 The magnitude and extent of the problems and their implication can be derived by comparing them with
standard values or norms.
 Problem tree analysis approach: Cause and effects of health problems

Facilitate the Discussion in order to deepen the analysis by posting questions such as:
▪ How are the main or central issues or problems related to see another?
▪ Which of the problems seem to be the most serious or needing urgent attention?
▪ Among the roots of the problems, which are the easiest to address? Which are the difficult?
▪ Which of the effects should not be allowed to continue?
▪ What could possibly happen if nothing is done?
▪ What should be done?

10. IDENTIFYING THE COMMUNITY HEALTH NURSING PROBLEMS

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 ▪ Health status problems - described in terms of increased or decreased Morbidity, Mortality, Fertility, Reduced
capability for wellness

▪ Health resources problems – described in terms of lack or absence of Manpower, Materials, Money,
Institutions necessary to solve health problems

▪ Health Related problems – described in terms of existence of social, economic, environmental and political
factors that aggravate the illness-inducing situation in the community.

11. PRIORITY SETTING

Nature of the condition/problem presented

Health status problems
Health resources problems
Health-related problems
Magnitude of the problem – refers to the severity of the problem which can be measured in terms of the proportion
of the population affected

Modifiability of the problem – refers to the probability of reducing, controlling or eradicating the problem.
Preventive potential – refers to the probability of controlling or reducing the effects posed y the problem
Social concern - refers to the perception of the population or the community as they are affected by the problem
and their readiness to act on the problem.

CRITERIA WEIGHT
Nature of the problem 1
health status 3
health resources 2
health-related 1

CRITERIA WEIGHT
Magnitude of the problem 3
75%-100% affected 4
50%-74% affected 3
25%-49% affected 2
<25% affected 1

CRITERIA WEIGHT
Modifiability of the problem 4
high 3
moderate 2
low 1
not modifiable 0

CRITERIA WEIGHT
Preventive potential 1
high 3
moderate 2
low 1

CRITERIA WEIGHT
Social Concern 1
Urgent community concern; expressed readiness 2
Recognized as a problem but not needing urgent attention
1
Not a community concern 0

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Community Participation
It recognizes people as the CENTER of any development effort. It is a process by which members of the
community:
• Develop the capability to assume greater responsibility for assessing their health needs and problems
• Plan and Act to implement their solutions
• Create and maintain organization in support of these efforts and
• Evaluate the effects and bring about necessary adjustments in goals and collective action
• “Mula sa tao, para sa tao.”

Community Organizing
• A Social Development methodology is utilized to facilitate the process of forming and sustaining SELF
RELIANT and SELF DETERMINING communities
• It is a work carried out by the nurse with the goal of Motivating, Enhancing and Seeking wider community
participation in DECISION MAKING in Activities.
• Emphasis on DECISION MAKING and PROBLEM SOLVING skills.

• It is a process whereby community members develop the capability to assess their health needs and
problems, plan and implement actions to solve these problems, put up and sustain organizational structures
which will support and monitor implementation of health initiatives by the people
• WHY IS THERE A NEED TO SUSTAIN HEALTH PROGRAM?
• SIMPLY, BECAUSE WE NEED TO SUSTAIN HEALTH OF THE PEOPLE.

A. Preparatory Phase
B. Organizational Phase
C. Education and Training Phase
D. Intersectoral Collaboration Phase
E. Phase Out

A. Preparatory Phase
“A.C.E”
A-REA SELECTION
C-OMMUNITY PROFILING
E-NTRY IN THE COMMUNITY

Area Selection:
Guide in Choosing and prioritizing areas for Community Health Development
- Is the Community in need of assistance?
- Do the Community members feel the need to work together to overcome a specific health problems?
- Are there concerned groups and organizations that the nurse can possibly work with?
- What will be counterpart of the community in terms of community support, commitment and human
resources?
- Also, Geographically Isolated and Disadvantage Area

Community Profiling:
- Once Area has been selected, look for a CONTACT PERSON
- The Contact Person must be known and accepted by the Community
- The Contact Person can help other people who can be depended upon to initiate activities. These people
will compose the Core Group who will assist the Nurse in the Community Profiling
- Community Profile provides a overview of Demographic Characteristics and health related services and
facilities, this will serve as the Initial Data Base, this can also help in determining the appropriate approach
and method of organizing.
-

Entry in the Community and Integration with the people:

- Before the actual entry into the community, basic information about the area in relation to the cultural
practices and lifestyle of the people must be known.
- Establishing rapport and integrating with the community is easier if the nurse is able to Understand,
Accept and Imbibe Community life.

Guidelines in Conducting Integration Work

1. Recognize the role and position of Local Authorities
2. Adapt a lifestyle in keeping with that of the community
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 3. Choose a modest dwelling which the people, especially the economically disadvantage will not hesitate to
enter
4. Avoid raising expectation of the people. Be clear with your objectives and limitations
5. Participate directly in production process
6. Make house calls and seek out people where they usually gather
7. Participate in some social activities

B. ORGANIZATIONAL PHASE
S-ocial Preparation
S-potting and Developing potential Leaders
C-ore Group Formation
S-etting up a Community organization

Social Preparation
• The Integration work paves the way for the nurse to be introduced into the community signals the start of
Social Preparation
• The nurse deepens and strengthens her ties with the people

SPOTTING AND DEVELOPING OF POTENTIAL LEADERS

• Nurse must Gain Trust and Respect of the Community
• Leaders are not necessarily to be Highly Educated or belonging to an Affluent Family
• Leaders must be able to Identify with, understand and articulate effectively the problems in the community.
• Willingness to work for the desired change

CORE GROUP FORMATION

This will serve as training ground for developing the potential leaders in:
• Democratic and Collective Leadership
• Planning and Assuming task for the formation of community wide organization
• Handling and resolving group conflicts
• Critical thinking and Decision – making process
• Ideally, Sectors are well represented

SETTING UP THE COMMUNITY ORGANIZATION

• It will facilitate wider participation and collective action on community problems
• The Nurse makes sure that there is Maximum Participation and Control by the members in all activities.
• Working committees will be created, like the Health Committee, the nurse will assist in laying out the plans

[Link] AND TRAINING PHASE

-The purpose of this phase is to strengthen the organization and develop its capability to attend to the community’s
basic health needs
C.T.H.
• Conducting Community Diagnosis
• Training of Community Health Workers
• Health Services and Mobilization
• Leadership Formation Activities

Conducting Community Diagnosis

- This is done to come up with profile of local health situation that will serve as basis of health programs and
services to be delivered to the community.
- The Nurse assist the people in developing a plan and in the actual conduct of community diagnosis.

Training of Community Health Workers

• The Community will decide who will be trained as Community Health Workers
• The Nurse facilitates the conduct of Training Needs Assessment (TNA)

Health Services and Mobilization

• The organization takes lead in undertaking activities that will solve the problems of the community
• Engage them into activities that test and strengthen collective spirit and build confidence

Leadership – Formation Activities

• The process of developing community Leaders in a Continuous and Sustained Process.
• Activities such as Meetings, Assessment, Planning, Implementation, Monitoring and Evaluation of
Activities.
• Mastering skills such as Organizing, Human Relations Development or Supervisory Skills
• Training may include: Financial and Project/ Program Management

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D. INTERSECTORAL COLLABORATION PHASE
• The need for resources-material, human, financial – will have to be sourced externally.
• Assistance and support in any form can be funneled into the organization through collaborations with other
organization and communities

E. PHASE OUT
The Nurse gradually prepares for turn-over of work and develops a plan for monitoring and subsequent follow up of
the organization’s activities until the community is ready for full disengagement and phase out

COPAR By Sr. Jimenez

1. PRE-ENTRY PHASE
2. ENTRY PHASE
3. COMMUNITY STUDY / DIAGNOSIS PHASE
4. COMMUNITY ORGANIZATION AND CAPABILITY BUILDING PHASE
5. COMMUNITY ACTION PHASE
6. SUSTENANCE AND STRENGTHENING PHASE

1. PRE-ENTRY PHASE
• Community Consultations / Dialogues
• Setting of issues/ considerations related to site selection
• Development of criteria for site selection
• Site Selection
• Preliminary social investigation
• Networking with LGU NGO and other departments

2. ENTRY PHASE
• Integration with the community
• Sensitization of the community / Information campaigns
• Continuing Social Investigation
• Core Group Formation
• Development of criteria for selection of CG members
• Defining the roles / functions / task of the CG
• Coordination / Dialogue / Consultation with other community organizations
• Self-Awareness and Leadership Training (SALT) / Action planning

[Link] STUDY/DIAGNOSIS PHASE (RESEARCH PHASE)

• Selection of the research team
• Training on data collection methods and techniques / capability-building
• Planning for the actual gathering data
• Data Gathering
• Training on data validation
• Community Validation
• Presentation of the community study / diagnosis and recommendations
• Selection of the research team
• Training on data collection methods and techniques / capability-building
• Planning for the actual gathering data
• Data Gathering
• Training on data validation
• Community Validation
• Presentation of the community study / diagnosis and recommendations

[Link] ORGANIZATION AND CAPABILITY BUILDING PHASE (Prioritization of Community

needs / problems for action)
• Community meetings to draw-up guidelines for the organization of the CHO
• Election of Officers
• Development of management systems and procedures including delineation of the roles
function and task of officers and members of the CHO

5. COMMUNITY ACTION PHASE

• Organization and training of community health workers
• Development of criteria for the selection of CHW
• Selection of CHW
• Training of CHW

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 • Setting – up linkages, network referrals systems
• Orientation to Health Services / Interventions schemes and Community Development
Projects
• Initial identification and implementation of resource mobilization schemes

6. SUSTENANCE AND STRENGTHENING PHASE

• Formulation and ratification of constitution and by laws
• Identification and Development of Secondary leaders
• Setting up and Institutionalization of financing scheme for community health program
/ activities
• Formalizing and institutionalization of linkages, networks and referral systems
• Development and implementation of viable management systems and procedures,
committees, continuing education / training of leaders, CHWs, Community residents
ROLES IN COPAR
1. PROJECT DIRECTOR – Command Responsibility (Head of School) (School President)
2. PROJECT MANAGER – Plans and Implements Staff Development, Supervises staff community and health
workers in the implementation of plan; prepare plan for exposure and immersion of students and faculty
(Dean)
3. COMMUNITY ORGANIZER – Coordinates with Barangay, Coordinates with project staff on planning and
implementation, Trains researchers, community leaders, Evaluates the program implementation (Students)
4. COORDINATOR OF STUDENT COMMUNITY IMMERSION – Supervises the students in the Community
(Community Coordinator)

5. HEALTH SERVICES COORDINATOR – Provides health care services; Clinical Instructor

6. TRAINING COORDINATOR – Prepare training design; Trains student on PAR

7. FINANCIAL OFFICER – Set up financial system (Treasurer)

8. BOOKKEEPER – Record fund releases and expenditures, prep cash flow

9. SECRETARY – Maintains project records and reports, Documents process and proceedings

RECORDING AND REPORTING

1. FHSIS Field Health Services Information System
2. NESSS

AIMS to Provide:
• Raw , Standardized, Evidenced based data and Facility Based
• Official Reporting and Recording System
• EO 352 – Official Recording and Reporting System of the DOH

RECORDING TOOLS
• Treatment Record (ITR) → Primary Building Block of FHSIS
• Target Client List → Secondary Building Block
• Summary Table (ST) → Form with 12 months columns
→Accomplishment and Trends Mortality and Morbidity
• Monthly Consolidation Table (MCT) → Source of the Quarterly Forms

REPORTING FORMS
• Monthly Form
- Program Report (M1)
- Morbidity Report (M2)- Midwife
• Quarterly Report
- Program Report (Q1)
- Morbidity Report (Q2) - Nurse
• Annual Form
- Annual Form 1 – Data and Indicators needed on a yearly basis
- Annual Form 2 – Enlisting all the diseases occurred
- Annual Form 3 – Deaths over the year

The National Epidemic Sentinel Surveillance System (NESSS)

It is a hospital-based information system that monitors the occurrence of infectious diseases with outbreak or
epidemic potential. Serves as a supplemental information system of the DOH

Objectives: • To provide early warning on occurrence of outbreaks.

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• To provide program managers, policy makers, and public administrators, rapid, accurate and timely information so
that inventive and control measures can be instituted.

The NESSS Data shows: "TIDE-C"

• T: Trends of cases across time
• I: Demographic characteristics of cases
• D: Estimates of case fatality ratio
• E: Clustering of cases in a geographical area
• C: Information to formulate hypotheses for disease causation

The National Epidemic Sentinel Surveillance System (NESSS) in the Philippines is now called the "Philippine
Integrated Disease Surveillance and Response (PIDSR)

The Philippine Integrated Disease Surveillance and Response (PIDSR) is a comprehensive and systematic public
health surveillance system implemented by the Department of Health (DOH) in the Philippines. It aims to monitor,
detect, and respond to infectious diseases and other health events that may pose a threat to public health. The PIDSR
system ensures that health data is collected, analyzed, and shared to facilitate timely responses to disease outbreaks
and prevent the spread of infectious diseases.

Goals and Objectives:

• Early detection of outbreaks and health events.
• Timely response to public health threats.
• Reduction of disease burden and prevention of disease outbreaks.
• Strengthening public health systems at the local, regional, and national levels.
• Improved collaboration between different sectors and stakeholders in managing health crises.

Legal and Policy Framework:

• The PIDSR operates under several legal frameworks, including Republic Act No. 11332 (The Mandatory
Reporting of Notifiable Diseases and Health Events of Public Health Concern Act), which mandates the
reporting of certain diseases and health events, as well as the Philippine Disaster Risk Reduction and
Management Act and the WHO International Health Regulations (IHR 2005).

Key Features of PIDSR:

1. Surveillance of Notifiable Diseases:
o PIDSR focuses on diseases that are considered notifiable by law, meaning healthcare providers are
required to report them to local or national health authorities. These diseases include a wide range of
communicable diseases such as dengue, measles, tuberculosis, cholera, and HIV/AIDS, among
others.
2. Health Events of Public Health Concern:
o In addition to specific notifiable diseases, PIDSR also monitors health events that may require public
health intervention, such as epidemics, disease outbreaks, and environmental health hazards (e.g.,
waterborne diseases, food safety issues).
3. Data Collection and Analysis:
o PIDSR collects data from various sources, including hospitals, clinics, and local government units.
This data is analyzed to identify trends, potential outbreaks, and public health risks. The system uses
a sentinel surveillance system, where specific health facilities or regions report data regularly to
the DOH.
4. Timely Reporting and Communication:
o Healthcare providers, local government units (LGUs), and other stakeholders are required to report
health data regularly and promptly to the DOH. This ensures that health authorities can assess and
respond to emerging health threats in a timely manner.
5. Early Detection of Outbreaks:
o PIDSR is designed to identify outbreaks as early as possible. Early detection is critical in limiting the
spread of diseases, particularly those that can become epidemics, such as dengue fever and
influenza.
6. Response and Control:
o When an outbreak is detected or a health event of public concern is identified, PIDSR triggers an
emergency response to control the spread of disease. This may involve interventions like
vaccination campaigns, mass treatment programs, public awareness campaigns, and coordination
with local health authorities.
7. Coordination Across Levels:
o PIDSR promotes coordination between the national, regional, and local levels of government, as
well as with healthcare facilities, to ensure efficient surveillance, response, and management of
diseases.
8. Preparedness and Capacity Building:

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 o The system enhances the country's ability to prepare for and respond to public health emergencies,
including epidemics and pandemics. This includes the continuous training of health personnel,
updating surveillance tools, and improving response protocols.

FIELDS OF NURSING COMMUNITY HEALTH NURSING PRACTICE

1. School Health Nursing
2. Occupational Health Nursing

School Health Nursing

LEGAL MANDATE
RA 124 – An Act to provide for the medical inspection of children enrolled in private schools, colleges and universities
in the Philippines
PD 603 – The Child and Youth Welfare Code

Focus: School Populace

Primary Role: Support the student in learning and ensure that educational potential is not hampered by unmet
health needs

FUNCTION OF A SCHOOL HEALTH NURSE

1. School Health and Nutrition Survey (Annual)
2. Student Health and Nutrition Assessment (Annual)
3. Referral of Cases – MHO / Private / Social Services
4. School Plant Inspection → Environmental Sanitation
5. Attendance to Emergency Cases
6. School – Community Health Council
7. Establish Data Bank on School Activities
8. Health and Nutrition Education Activities
9. Rapid Classroom Inspection
10. Home Visitation

Current Health Programs of the Department of Education:

a. School-Based Feeding Program;
b. National Drug Education Program;
c. Adolescent Reproductive Health Program;
d. Water Sanitation, and Hygiene in Schools Program;
e. Medical, Dental and Nursing Services, including the School Dental Health Care Program; and
f. School Mental Health Program.

Procedures of Annual Physical Examination

▪ Classroom Lecture
▪ 3 -5 Children in Waiting Area
▪ Handwashing
▪ Assessed 1 by 1 / Cephalocaudal

Clinic Teacher
1. At least 1 Clinic Teacher in every School
2. Trained by the School Nurse
3. Duties are:

Steps in the conduct of health assessment

a. Arms, hands, and finger nails: Children should be told to roll their sleeves, extend their arms, show their hands one
side first, then the other, and spread their fingers.
b. Eyes: The child should pull down his lower lids using his index finger placed under them, and then tell him to look
up.
c. Nose: The child should place his second finger on the tip of the nose and pull up his nose and extend his head
backward.
d. Teeth: The child should be told to open his mouth and say "ah" to show his throat.
e. Ears: The child should be requested to push back his hair behind his ear and pull the outer ear up, slightly backward
and then forward.
f. Neck and Chest: The neck should be examined. Chest and back should be auscultated.
g. Hair: The pupil should be asked to run his fingers through his hair several times. He may show the back of the neck
by pushing the hair up.
h. Feet and legs: The girls should pull up her dress and the boy, his trousers to their knees. Observations may also be
done while the children are marching in and out of the room. Child

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Duties of a Clinic Teacher
Remedies administered are simple like 1st Aid
Records keeping
Responsible for the clinic maintenance
Reports to the principal
Recommends improvement of services

EXAMPLES OF PREVENTION AND THE ROLE OF THE NURSE IN THE SCHOOL SETTING
PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION
Nutrition Education Screening Referral of Students for substance
Immunization Case Finding abuse or behavior problems
Safety Treatment Prevention of complications and
Health Education adverse effects
Faculty and Staff monitoring

Occupational Health Nursing

Article 23 of the United Nations

“Everyone has the right to work, to free choice of employment, to just and favorable conditions of work.”
DOLE is the lead agency for Occupational Safety and Health (OSH)
Target: Workers in all occupations

LEGAL MANDATES
▪ RA 11058 – Strengthening Compliance with Occupational Safety and Health Standard act of 2017
▪ PD 626 Employees Compensation and state insurance fund
▪ RA 6969 – Toxic Substances and Hazardous and Nuclear Waste Control Act
▪ EO 307 – Creating the occupational safety and Health Center (OSHC) under the employees Compensation
Commission
▪ PD 442 Philippines Labor Code Repealed RA 1054 of 1954
→ The Occupational Safety and Health Standards (OSHS)
Article 83 → 8hours/day for 5days a week = 40hours
(Demand of work: 6 days/week; should be given 30% additional compensation must be given)
Article 85 – regular meal periods of no less than 60minutes
Article 86 – night shift (10pm – 6am) – not less than after 10% of regular wage every hour of work
Article 87 – Overtime – at least 25% additional per hour after 8 hours of shift
Article 91 – Rest Dat, must not be less than 24 hours after 6 consecutive working days
Article 93 – work on schedules rest days or holidays – additional 30% compensation from regular wage;
Holiday + Rest Day work – additional 50% (at least)
Article 156 – must have first aid medicines and equipments in the workplace
Article 157 – Emergency medical and dental services

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 Duties and Functions of OHN as per DOLE

“O H N A P”
1. Organizing Health Programs
2. Health maintenance examination
3. Nursing Care to Injured and Ill
4. Administering PPE and Supplementation
5. Policy making

▪ Nov 11, 1950 → Creation of Industrial Nursing Unit (INU) Magdalena Valenzuela
→ First Chairman : Peria Gorres
▪ August 19, 1964 → Anita Santos elected on, Modified of the name to (OHNAP)
▪ Nov. 12, 1966 → Independence of OHNAP
▪ Mercedes L. Castillo, RN, MPSPA National President (2023-2024)
▪ OHNAP conduct BOSH or Basic Occupational Safety & Health

Health Hazards
- Elements in the work environment that can cause work related disease to worker
Safety Hazards
- Unsafe conditions or unsafe acts that significantly increase the risk of worker to be injured

CATEGORY EXPOSURE HEALTH EFFECTS

BIOLOGICAL Blood or Body Fluids Infections
CHEMICAL Solvents Central Nervous System Disturbance
Lead Asbestos Lung Dse
Asbestos Burns
Acids
ENVIROMECHANICAL Slippery Floors Injury
Poorly matched Furnitures Strained Muscles
Shift to Work Sleep Disorder
Repetitive / Forceful Exertions Musculoskeletal Disorder
Static/ Non-Natural Postures Back Injuries
PHYSICAL Electricity Electrocution
Noise Hearing Loss
Radiation Reproductive Effects and Cancer
Lighting Headache, eye strains, slips and falls
Vibration Raynauds Disease
Heat Heat Stroke/ Exhaustion
PSYCHOSOCIAL Stress Fatigue, Burnout
Work-home Imbalance Anxiety and variety of physical
symptoms

REFERENCES:
DAVID, E.S. (2007) COMMUNITY HEALTH NURSING: AN APPROACH TO FAMILIES AND POPULATION
GROUPS, MANILA, MERRIAM WEBSTER BOOKSTORE
MAGLAYA, A.S. (2009) NURSING PRACTICE IN THE COMMUNITY (5th Ed) MARIKINA CITY, ARGONAUTA
CORP.
SUMILE, E.F. (2019) COMMUNITY AND PUBLIC HEALTH NURSING (2ND Ed) ELSEVIER

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