College of Nursing

NCM 104 – COMMUNITY HEALTH NURSING 1 Module 1

I. Title

INTRODUCTORY CONCEPTS OF COMMUNITY HEALTHNURSING

II. Overview

In this session, learners will learn about the concepts of community and public health nursing. They
will be ushered back to the history of community and public health nursing. This part of the module
will also introduce the learners to the levels of clientele and roles and functions of a public health
nurse.

III. Learning Outcomes

Given a group of learners, they will be able to:

a) Integrate the concepts of public health, public health nursing, and community health nursing as
applied to an individual in a given health and nursing situation.
b) Relate the different concepts of community health nursing tracing back the history of community
health nursing, the levels of clientele, and the roles and functions of a public health nurse in the
delivery of health care to the clients.
IV. Content

A. Concepts of Public Health, Public Health Nursing, and Community Health Nursing

Public Health-a science and art of preventing disease, prolonging life, promoting health and
efficiency through organized community effort for the sanitation of the environment, control of
communicable diseases, the education of individuals in personal hygiene, the organization of medical
and nursing services for the early diagnosis and preventive treatment of disease, and the development
of the social machinery to insure everyone a standard of living adequate for the maintenance of
health, so organizing these benefits as to enable every citizen to realize his birthright of health and
longevity. (Dr. Charles Edward Winslow)

Public health is dedicated to the common attainment of the highest level of physical, mental and
social well-being and longevity consistent with available knowledge and resources at a given time
and place. (Hanlon)
 Public health is the art of applying science in the context of politics so as to reduce inequalities in
health while ensuring the best health for the greatest number. It points to the fact that public health
is a core element of the government’s attempts to improve and promote the health and welfare of
their citizens. (WHO)

Public Health Nursing

The practice of nursing in national and local government health department, and public schools.

It is community health nursing practiced in the public sector. (Standard of Public Health Nursing
in the Philippines, 2005)

Public health nursing is a 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 programme for
the promotion of health, the improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability.(WHO Expert Committee of Nursing)

Community health nursing is a unique blend of nursing and public health practice woven into a
human service that when properly developed and applied has a tremendous impact on human well-
being. Its responsibilities extend to the care and supervision of individuals and families in their
homes, in places of work, in schools and clinics. It is one of the basic services of the health
departments.

Community Health Nursing is the utilization of the nursing process in the different levels of
clientele concerned with the promotion of health, prevention of disease and disability and
rehabilitation. (Maglaya, Araceli)

Broader sense-

Includes CHN in both public and private sectors

Community health nursing is 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 through teaching and delivery of care. (Jacobson)

B. History of Community Health Nursing

The history of Public Health Nursing is embedded in the history of the Department of Health which
was first established as the Department Public Works, Education and hygiene in 1898.

❖ 1912. The Fajardo act (Act NO. 2156) created the sanitary divisions
-PGH sent 4 nurses to Cebu to take care of mothers and their babies.
❖ 1914. School nursing was rendered by a nurse employed by the Bureau of Public Health in
Tacloban, Leyte.
❖ Two nurses, Mrs. Casilang Eustaquio and Mrs. Matilde Azurin were employed for MCH and
sanitation
❖ 1916-1918-Ms. Perlita Clark took charge of the Public Health Nursing work.
❖ 1917-Four graduate nurses paid by the city of Manila were employed to work in the city
division.
❖ 1918-The office of Miss Clark was abolished due to lack of funds.
❖ 1919-Ms. Carmen del Rosario, the first Filipino nurse supervisor was appointed under the
Bureau of Health.
❖ 1923-Two government schools of nursing were established
➢ Zamboanga General Hospital School of Nursing
➢ Baguio General Hospital
❖ July 1, 1926- Ms. Carmen resigned and Ms. Genara Manongdo, ranking supervisor of American
Red Cross replaced her.

❖ 1927- The office of District Nursing under the Office of General Inspection of Health Service was
abolished and replaced by the Section of Public Health Nursing with Mrs. Genara de Guzman as
consultant to the Director of Health.

❖ 1928- First convention of nurses was held until the advent of World War II.

❖ 1930- Conversion of Section of Public Health Nursing into Section of Nursing

❖ 1933-Reorganization Act 4007 transferred the Division of Maternal and Child Health of the Office
of Public Welfare Commission to the Bureau of Health.
❖ 1941- Transferring of activities and personnel of the Metropolitan Division and Bureau of Health
transferred to a new department with Dr. Mariano Icasiano as City Health Officer of Manila; also
and Office of Nursing was established with Mrs. Vicenta C. Ponce as Chief Nurse and Mrs. Rosario
A. Ordiz as her assistant.
❖ December 8, 1941- Health nurses in Manila were assigned to devastated areas to attend to the sick
and wounded during World War II.
❖ 1942- A group of health nurses, doctors and administrators from the Manila Health Department
went to the internment camp in Capas, Tarlac to receive sick prisoners of war by the Japanese
army. They were confined at San Lazaro Hospital and sixty-eight National Public Health Nurses
took care of them.
❖ July 1942- Thirty-one nurses taken prisoners of war by the Japanese army and jailed in Bilibid
Prison in Manila were released to the Director of the Bureau of Health, Dr. Eusebio Aguilar, their
guarantor. Public Health Nurses joined guerillas during the World War II.
❖ February 1946- Comparison of war records of the Bureau of Health: a. 308 public nurses and 38
supervisors (post war), b. 556 nurses and 38 supervisors (pre-war). Mrs. Genara M. de Guzman,
technical assistant in Nursing of the Department of Health recommended the creation of a Nursing
Office of the DOH.
❖ October 7, 1947- Executive Order (EO) NO. 94 reorganized government offices and created the
Division of Nursing under the Office of the Secretary of Health implemented on December 16,
1947. Mrs. Genara de Guzman was appointed as Chief of the Division with three assistants: Ms.
Annie Sand (Nursing Ed.), Mrs. Magdalena C. Valenzuela (Public Health Nursing) and Mr.
Patrocinio Montellano for Staff Education.
❖ The Nursing Division was placed directly under the Secretary of Health for bureaus and units to
help carry out health programs. At the Bureau of Health, the Section of Nursing Supervision took
over the former function of the Section of Nursing. Mrs. Soledad Buenafe was appointed Chief
 with Ms. Marcela Gabatin as assistant Chief. The newly created Section of Puericulture Center of
the Bureau of Hospitals had Mrs. Teresa Malgapo as Chief.
❖ 1948- The first training Center of the Bureau of Health was organized in cooperation with Pasay
Cit Health Department housed at the Tabon Health Center which was later renamed as Doña Marta
Health Center. The staff consisted of Dr. Trinidad A. Gomez, Center Physician; Ms. Marcela
Gabatin, Nurse Supervisor; Ms. Constancia Tuazon, Mrs. Bugarin and Ms. Ramos as Nurse
Instructors, later on joined by Ms. Zenaida Panlilio, National Public Health Nurse of the Bureau
of Health.
❖ 1950- The Rural Health Demonstration and Training Center (RHDTC) was established by the
Dept. of Health through Dr. Hilario Lara, Dean of the Institute of Hygiene, now College of Public
Health, University of the Philippines. Dr. Amansia Mangay (Mrs. Andres Angara), a Doctor of
Public Health graduate of Harvard was chosen to be Chief of the RHDTC. Dr. Antonio N. Acosta,
former Physician of the Manila Health Dept. was Medical Training Officer. The first Supervising
Training Nurse was Ms. Marta Obaña with Ms. Jean Bactat, Mrs. Mary Velono and Mrs. Natividad
B. Asuque as Nurse Instructor.
❖ 1953- The office of the Health Ed. and Personnel Training was established with Dr. Trinidad
Gomez as Chief. Four nurse instructors were recruited, two from the Manila Health Dept, Mrs.
Venancia Cabanos and Mrs. Damasa Torrejon and two from the BOH, Ms. ZenaidaY. Panlilio and
Ms. Leonora Liwanag (first graduates of the University of the Philippines, College of Nursing to
join the BOH).
❖ Republic Act No. 1082 or the Rural Health Law created the first 81 Rural Health Units. Among
the first public health nurses assigned to the Rural units were two graduates of class 1952 of the
Philippine General Hospital School of Nursing, Miss Florida B. Ramos (Mrs. Martinez) and Ms.
Lydia Amurao (Mrs Cabigao).
❖ 1957- Republic Act 1891 was approved amending Sections II, III, IV, VII and VIII of the R.A.
1082. This second Rural Health Act created 8 categories of rural health units based on population.
❖ 1958- 1965- R.A. 977 passed by the Congress in 1954 abolished the Division of Nursing, creating
nursing positions at different levels. Ms. Annie Sand was appointed Nursing Consultant under the
Office of the Secretary of Health.
❖ Two nurses of the former Bureau of Hospitals worked with the Nursing consultant: Ms. Rosita
Furia for Hospital Nursing Service, and Ms. Eva Obsequio for Nursing Education. Mrs. Rosita
Villanueva and Mrs. Juanita Hospitals vice Ms. Furia and Ms. Obsequio when they retired.
❖ The Department of Health National Leagues of Nurses, Inc was founded by Ms. Annie Sand in
1969 and became its President and Adviser. The Reorganization Act embodied in EO 288, Series
of 1959 de-centralized and integrated health services creating 8 Regional Health offices in the
country.
❖ At the Regional level two supervising positions for nurses were created: Regional Nurse
Supervisor and Regional Public Health Nurse.
❖ The Supervising Public Health Nurses (SPHN) at the Provincial Health supervised the public
health nurses at the Rural Health Units as well as the Chief Nurses in Hospitals.
❖ The reorganization of 1959 also merged two Bureaus in the Dept. of Health: The Bureau of Health
(in charge of preventive programs) merged with Bureau of Hospitals (curative programs and
regulatory/licensing functions) to form the Bureau of Health and Medical Services.
❖ In the merged Bureau of Health and Medical Services, Nursing program supervisors were
appointed for the different programs. In the Maternal and Child Health Division, Ms. Saturnina
Latorre, Mrs. Fe Bacaloso and later Mrs. Rosario Zaraspe, Mrs. Isabel Pascua and Mrs. Emilia
Briones. In the occupational Health Division, Mrs. Felisa V. Chanco was nurse in charge of
Occupational Health Nursing.
❖ 1967 – In the Bureau of Disease Control, Mrs. Zenaida Panlilio-Nisce was appointed as Nursing
Program Supervisor and served as consultant on 5 diseases: TB. Leprosy, Venereal Diseases,
Cancer and Filariasis; and Mental Health.
❖ At the Office of Health Education and Personnel Training, the nurses were Mrs. Josefina A.
Mendoza, Supervising Nurse Instructor, Ms. Carmen Panganiban, Ms. Virginia Orais and later
Mrs. Constancia Asinas.
❖ November 1971 – Mrs. Josefina A. Mendoza, Supervising Nurse Instructor, Office of the Health
Education and Personnel Training succeeded Ms. Annie Sand as Nursing Consultant. Later, Mrs.
Nelida K. Castillo, former Nurse Instructor at San Lazaro Hospital and counterpart to Ms. Helen
Filmore, WHO consultant of Pediatric Nursing was appointed Nursing Program Supervisor, Office
of the Secretary of Health
❖ 1974- The Project Management Staff was organized as part of Population Loan II of the Philippine
Government with Dr. Francisco as Project Manager. Experts on different fields were recruited and
Mrs. Nelida Castillo joined the PMS staff. Her position as Nursing Program Supervisor, Office of
the Secretary of Health was taken over by Mrs. Zenaida Nisce, Nursing Program supervisor Bureau
of Disease Control. Ms. Julita Yabes, faculty member of the Institute of Hygiene (now College of
Public Health) University of the Philippines served as consultant on nursing matters in the Project
Manage Staff.
❖ 1975 – As a result of the restructuring of the health care delivery system based on the findings of
the Operations Research (WHO assisted) conducted in the province of Rizal the functions of the
health team were redefined.
❖ 1976-1986 – The Nursing Consultant and Nursing Program Supervisor of the Office of the
Secretary of Health were involved in the Rural Health Practice Program which required medical
and nursing graduates to serve for two months in rural areas before the licenses could be issued by
the Professional Regulatory Commission.
❖ 1986 – The reorganization of the Department of Health during this period placed the position of
Nursing Consultant at the Bureau of Health and Medical Services later abolished when Mrs.
Mendoza retired. Mrs. Zenaida Nisce remained as Nursing Program Supervisor of the Office of
the Secretary of Health.
❖ The other nursing positions at the Central Office were at the National Family Planning Service.
Among these nurses were Miss Leonora Liwanag, Ms. Virginia Orais, Mrs. Vilma Paner, Mrs.
Sarah Austria and Mrs. Leticia Daga, Mrs. Nelia Hizon joined the NFPS when Miss Liwanag
retired.
❖ 1987-1989 – Executive Order No. 119 reorganized the Department of Health and created several
offices and services within the Department of Health.
❖ 1990-1992 – The number of positions of Nursing Program Supervisors (Nurse VI) was increased
as there were three or more appointed in each service. In the Maternal and Child Health Services
Mrs. Emilia Briones and Mrs. Nilda Silvera and Mrs. Vicenta Borja. Mrs. Asucena Alcantara and
Mrs. Lucila Agripa later joined them.
 ❖ In the non-communicable Disease Control Service (NCDCS), the first two Nursing Program
Supervisors were Mrs. Gloria Temelo and Miss Gilda Estipona who were with the cardiovascular
and cancer control programs respectively. In 1989, Mrs. Carmen Buencamino joined the
Occupational Health Division. When these three nurses retired one after another, their positions
were taken over by Miss Ma. Thelma Bermudez, Ms. Frances Prescilla Cuevas and Mrs. Ma.
Theresa Mendoza.
❖ The three nurses at the Communicable Disease Control Service, Mrs. Zenaida P. Nisce, Mrs.
Carolina A. Ruzol and Mrs. Zenaida Recidoro participated in the planning, training, monitoring,
supervision and evaluation of diseases. At the Community Health Service, the Nursing Program
Supervisor was Mrs. Patrocinio Ferrera. At the Department of Health Administrative Service there
were four Public Health Nurses and one Senior Public Health Nurse assigned at the Medical
Examination Division and Infirmary (MEDI) formerly called the Physical Examination Division.
❖ January 1999 – Department Order No. 29 designated Mrs. Nelia F. Hizon, Nurse VI, then the
President of the National League of Philippine Government Nurses as Nursing Adviser
❖ May 24, 1999 – Executive Order No. 102 was signed by the President Joseph Ejercito Estrada
redirecting the functions and operations of the DOH.
❖ 2005-2006 – The development of the rationalization plan to streamline (simplify) the bureaucracy
(official procedure) was started and is in the last stages of finalization.

Historical Development of Community Health Nursing in the Philippines

❖ Before (1898) – Traditional health care practices especially the use of herbs and rituals for healing
were practiced. In 1876, Medicos Titulares, equivalent to provincial health officers were already
existing. In 1888, a Superior Board of Health and Charity was created by the Spaniards which
established a hospital system and a board of vaccination.
❖ June 23, 1898 – Shortly after the proclamation of the Philippine independence from Spain. The
Department of Public Works, Education and hygiene was created by a decree signed by Pres.
Emilio Aguinaldo. However, this was short live because of the American invasion.
❖ September 29, 1898 – With the primary objective of protecting the health of the American soldiers,
General Orders No. 15 established the Board of Health for the City of Manila.
❖ July 1, 1901- because it was realized that it was impossible to protect the American soldiers without
protecting the natives, a board of Health for the Philippine Islands was created through Act No.
157. It became an Insular Board of Health when Act Nos. 307, 308 dated December 2, 1901
established the Provincial and Municipal boards respectively. The Insular Board of Health proved
to be inefficient operationally so it was abolished and replaced with the Bureau of Health under
the Department of Boards of Health.
❖ 1912- Act No. 2156 also known as the Fajardo act, consolidated municipalities into sanitary
divisions and established the Health Fund for travel and salaries.
❖ 1915- Act No. 2468 transformed the Bureau of Health into a commissioned service called the
Philippine Health Service.
❖ August 2, 1916- The passage of the Jones Law also known as the Philippine Autonomy Act
provided the highlight in the struggle of the Filipinos for independence from the American Rule.
The establishment of an elective Philippine Senate completed an all Filipino Philippine Assembly
which majored in reorganization, culminating the Administrative Code of 1917 (Act 2711), which
included the Public Health Law of 1917.
 ❖ 1932- Because of the need to coordinate public health, Act No. 4007 known as the Reorganization
Act of 1932 reverted back the Philippine Service into Bureau of Health, and combined the Bureau
of Public Welfare under the Office of the Commissioner of Health and Public Welfare.
The Philippine Commonwealth and the Japanese Occupati0on (1935- 1945)

❖ May 31, 1939- Commonwealth Act No. 430 created the Department of Public Health and Welfare
but the full implementation was only completed through Executive Order no. 317, January 7, 1941.
Dr Jose Fabella became the First Department Secretary of Health and Public Welfare Act in 1941.
❖ 1942- During the period of the Japanese occupation reorganizations and issuances for the health
and welfare of people were instituted.
❖ October 4, 1947- Executive Order No. 94 provided for the post war reorganization of the
Department of Health and Public Welfare which resulted in the split of the Department and transfer
of the Bureau of Public Welfare (became Social Welfare Administration) and the Philippine
General Hospital to the office of the President.
❖ January 1, 1951- The office of the President of the Sanitary District was converted into a Rural
Health Unit, carrying out seven basic Health services: maternal and child health, environmental
health, communicable disease control, vital statistics, medical care, health education and public
health nursing. The impact of the community was so strong that it resulted in the passage of the
Rural Health Act of 1954 (RA 1082). This Act created more health units and created posts for
municipal health.
❖ February 20, 1958- Executive Order No. 288 provided for what is described as the “most
sweeping” reorganization in the History of the Department. This came about as an effort to
decentralize governance of health services.
❖ 1970- The Restructured Health Care Delivery System was conceptualized. It classified health
services into primary, secondary and tertiary levels of care. Under this concept the ration of a nurse
to a population is 1: 20,000. The expanded role of the public health nurse was highlighted
❖ June 2, 1978- With the proclamation of martial law in the country, Presidential Decree 1397
renamed the Department of Health to the Ministry of Health with Sec. Gatmaitan as its first
Minister of Health.
❖ December 2, 1982- Executive Order No. 851 signed by President Ferdinand Marcos reorganizes
the Ministry of Health as an integrated health care delivery system through the creation of the
Integrated Provincial Health Officers.
❖ April 13, 1987- Executive Order No. 119, “Reorganizing the Ministry of Health” by President
Corazon C. Aquino saw a major change in the structure of the ministry. EO 119 clustered agencies
and programs under the Office for Public Health Regulations and Office of Management Services.
The Field Offices were composted of the Regional Health Offices and National Health Facilities.
The latter was composed of National Medical Centers, Special Research Centers and Hospitals.
❖ October 10, 1991- Republic Act 7160 also known as the Local Government Code provided for the
decentralization of the entire government. Under this law, all structures, personnel and budgetary
allocations from the provincial health level down to the barangays were devolved to the Local
Government Units to facilitate health service delivery.
❖ May 24, 1999- EO No. 102, “Redirecting the Functions and Operations of the Department of Health” by
President Joseph Estrada granted the DOH to proceed with its Rationalization and Streamlining Plan
which prescribed the current organizational, staffing and resource structure consisted with its new
 mandate. EO 102 mandates the Department of Health to provide assistance to local government units,
people’s organization, and other members of the civic society in implementing programs, projects and
services which promote the health and well-being of every Filipino.
❖ 1999-2004 – Development of the Health Sector Reform agenda which describes the major strategies,
organization and policy changes and public investments needed to improve the way health care is
delivered, regulated and financed.
❖ 2005- on-going!

Roles of a Community Health Nurse

a) Client-oriented roles
• Caregiver
• Educator
• Counselor
• Referral resource
• Role model
• Case manager
b) Delivery-oriented roles
• Coordinator
• Collaborator
• Liaison
c) Population-oriented roles
• Case finder
• Leader
• Change agent
• Community mobilizer
• Coalition builder
• Policy advocate
• Social marketer
• Researcher

Functions of a Public Health Nurse

Provision of health and nursing care

➢ Utilizes the nursing process in the care of client in the home setting through home visits and in
public health care facilities; conducts referral of patients to appropriate levels of care when
necessary.
Health Education
➢ Utilizes teaching skills to improve the health knowledge, skills and attitude of the individual,
family and the community and conducts health information campaigns to various groups for the
purpose of health promotion and disease prevention.
Coordination & Collaboration
 ➢ Establishes linkages and collaborative relationships with other health professionals, government
agencies, the private sector, non-government organizations and people’s organizations to address
health problems
Supervision
➢ Monitors and supervises the performance of midwives and other auxillary health workers; also
initiate the formulation of staff development and training programs for midwives and other
auxillary health workers as part of their training function as supervisor.
Leader and Change Agent
➢ Influences people to participate in the overall process of community development.
Management
➢ Organizes the nursing service component of the local health agency or local government unit;
and as program manager, the PHN is responsible for the delivery of the package of services
provided by the health program to the target clientele.
Researcher
➢ Participates in the conduct of research and utilizes research findings in practice.

Levels of clientele

a) Individual
Individual- sick or well individuals in the home and health center.

Considered as the entry point in working with the family.

b) Family
Family-two or more persons bound together by blood, marriage, or adoption.

c) Population group
Population Group-a group of people sharing the same characteristics, developmental stage,
or common exposure to particular environmental factors thus resulting in community
health problems.

d) Community
Community-group of people sharing common geographic boundaries and/or common
values and interests.

• No two communities are the same.

• Exerts a strong influence on health of individuals, families and communities.
V. Learning Activities
Read the contents
 Answer tasks
VI. Learning Materials/Resources:

Maglaya, A. (2009). Nursing Practice in the Community, 5th Edition

Cuevas, P (2007). Public Health Nursing in the Philippines, 10 th Edition

www.rnpedia.com › nursing-notes › history-community History of Community Health Nursing-

RNPedia

Community Public Health Nursing-Roles and Responsibilities, RNspeak.com

VII. Self-Check Test

Write a synopsis of the history of community and public health nursing.

Basing on the history, what are still practiced nowadays?

VIII. Assessment (Quiz/Post-test)