Chapter 2

Foundation of community and public health nursing practice

Learning Objectives:

1. Define the key concepts of community and public health nursing

2. Enumerate the different levels of clientele in community and public health nursing

3. Explain the various principles underpinning the practice of community health nursing

4. Identif
Identify
y myriad roles and function
functions
s of the nurse
nurse in communit
community
y and public health
health

nursing

5. Discuss the various public health interventions applied in practice

Key concepts of community and public health nursing

 To better understand the complex nature of community and public health nursing, we

have three basic concepts: (l) the community as a client, (2) health as a goal, and (3)

nursing as the vehicle or means to achieve its aims.

Deali
Dealing
ng wi
with
th th
the
e commu
communi
nity
ty as a client
client enta
entails
ils a collec
collectiv
tive
e appr
approac
oach.
h. Indiv
Individu
iduals
als,,

families, and population groups are included. Women, children, elderly, adults form part

of our clientele. Community and Public Health work requires an understanding and

respe
respect
ct for cultu
culture
re in the hope
hope of intro
introduc
ducing
ing meanin
meaningfu
gfull healt
health
h inform
informati
ation
on and
and

influencing people to embrace a culture of health.

Nursing is traditionally defined as the art and science of caring. Its body of knowledge is

grounded on the works of nursing theorists or philosophers, foremost of whom is the

Mother of Modern Nursing herself, Florence Nightingale. She defined nursing as means
 

of ensuring that people are placed in an optimum condition where nature can contribute

to healing and wellness.

Definitions of community and public health nursing (CPHN)

Community Health Nursing is defined as a specialized field of nursing practice that

renders care to individuals, families, and communities; focusing on health promotion

and disease prevention through people empowerment. Health promotion and disease

prevention are the core of community health nursing practice. Efforts to help people

reduce their risks from developing disease and maintain their optimum functioning is a

priority in this field. Preventive measures like vaccination and screening activities for 

certain diseases for early detection and prompt treatment are packaged into health

programs for communities.

Janet Heinrich and Ruth Freeman (1981) define Community Health Nursing as -an area

of human services directed toward developing and enhancing the health capabilities of 

people
people - either
either singly,
singly, as individu
individuals,
als, or collect
collectivel
ively,
y, as groups
groups and communities
communities."
."

Enabling people in communities provide them the opportunity to do things on their own

to maximize wellness. This requires the utilization of health education to equip patients
with the information critical to self-care.

Characteristics and features of community and public health nursing (CPHN)

Nursing practice has changed in response, and today a growing proportion of nurses

are working outside of hospitals.

hospitals. Public and community health nursing practice includes

populat
population
ion-foc
-focuse
used
d interve
interventio
ntions
ns that seek
seek to improve
improve the health
health and well-be
well-being
ing of 

groups, aggregates, and communities.

 

CPHN is developmental. People are imbued with human rights and this includes right to

health however, with rights it has responsibilities.

CPHN is multidisciplinary. Health needs of our clientele are varied. It ranges from

sanitat
sanitation,
ion, food safety,
safety, control
control of non-comm
non-communic
unicabl
able
e disease
diseases,
s, and infectio
infection.
n. All of 

these result from the interaction of the core determinants of health. Community and

Public Health nurses do not work in a silo and operates not on claiming that solutions

ar
are
e in th
thei
eirr hand
hands
s alon
alone.
e. Rath
Rather
er the
the nurs
nurse
e fost
foster
ers
s coll
collab
abor
orat
atio
ion
n wi
with
th diff
differ
eren
entt

professionals and sectors from society.

CPHN is ecology oriented. The largest portion of the healthcare delivery system is

community based and that care is provided in the natural environment of people.

CPHN promotes social justice. Health is a human right and all people should enjoy

access to healthcare. This puts the community/public health nurse in a pivotal position

to ensure
ensure that
that peopl
people
e regar
regardle
dless
ss of age,
age, sex,
sex, cree
creed,
d, or relig
religion
ion enjoy
enjoy health
healthca
care
re

services in their communities.

CPHN
CPHN values
values consume
consumerr involvem
involvement
ent.. Patient
Patients
s in communit
community/pu
y/public
blic health
health are not

merely consumers or end-users of healthcare service. They are considered

considered as partners
partners
in health.

CPHN uses prepayment mechanism. Services provided by public health system are not

given for free. It is funded by taxes of the people. Hence, healthcare is a basic social

service that should be provided by the state to all people.

CPHN focuses on preventive service. Nurses on the field provide healthcare to a wide

range of clientele afflicted by both acute and chronic conditions. Services required at the
 

point of contact does not limit his/her application of science but extends to reducing

risks of the current patient being attended to and groups who may similarly end up with

the same condition.

CPHN offers comprehensive care. The old adage that nursing is caring from womb to

tomb is a reality in community and public health.

Philosophical and ethical underpinnings

Respect for people's inherent value regardless of their background and beliefs are

edifi
edified
ed in th
the
e unive
univers
rsal
al bioet
bioethic
hical
al princ
princip
iples
les.. The
The role
role of nurse
nurses
s when
when enga
engagin
ging
g

communities is to foster awareness that will lead people to manage their own health.

Individual and to do this requires awareness that health truly lies in his/her own hands.

One hallmark of a profession is having its own code of ethics. This serves as a guide

among its members in dealing with clients and society. Community and Public Health

Nurses engage population groups imbued with human rights. This may open doors to

issues specifically in delivering healthcare enforced by the state.

Roles of the community and public health nurse

Professional nurses to be able to perform three roles; that of health care provider,

manager-leader, and researcher.

Healthcare Provider. Caring is the essence of nursing and has been widely accepted in

all settings. The use of the nursing process applied in the natural environment of the

client pertains to this role.

 

Health Educator.
Educator. Communicating
Communicating information to help patients make an informed choice

regarding their health is a key activity in public health work. It is hoped that awareness

will impact people's behavior to achieve health in their own hands.

Program Implementer.
Implementer. Nurses working under local government units deliver healthcare
healthcare

to the grassroots.
grassroots. This also requires that programs initiated by the national
national government
government

thru the Philippine Department of Health (DOH) are executed at all levels.

Commu
Communit
nity
y Orga
Organiz
nizer
er.. Worki
Working
ng wi
with
th peop
people
le in commu
communit
nities
ies and
and prov
providi
iding
ng them
them

ownersh
ownership
ip of their
their healthc
healthcare
are needs and to act collectivel
collectively
y on their
their issues
issues is best

captured by this role of the nurse in public health.

Manager/
Manager/Lea
Leader.
der. Communit
Community
y and public
public health
health work
work deals
deals with
with competi
competing
ng claims
claims

specifically on utilization of limited resources.

Rese
Researc
arche
her/E
r/Epi
pidem
demio
ioIog
Iogist
ist.. The
The nurse
nurse is regar
regarde
ded
d as the
the healt
health
h monito
monitorr of the
the

commu
communi
nity.
ty. Toge
Togethe
therr with
with the
the rural
rural healt
health
h midwi
midwife,
fe, they
they keep
keep track
track of illnes
illnesse
ses
s

encountered in their areas of jurisdiction and submits reports to health authorities as

required by law.

Cl
Clien
ientt Advo
Advoca
cate.
te. The
The commu
communit
nity/p
y/publ
ublic
ic healt
health
h nurs
nurse
e takes
takes a proac
proactiv
tive
e stance
stance in

ensuring that the right to health of the population

 Analytic assessment
assessment skills- Identifies
Identifies sources of public health data and Information,
Information,

collects, Interprets, and documents data in understandable terms

Policy
Policy develop
development
ment program
program plannin
planning-
g- Describ
Describes
es the structu
structure
re of the public
public health
health

sy
syst
stem
em;; id
iden
enti
tifi
fies
es publ
public
ic heal
health
th laws
laws and
and regu
regula
lati
tion
ons
s rele
releva
vant
nt to prac
practi
tice
ce and
and

participates as a team member to implement programs and policies

 

Communication skills - Communicates effectively in writing, orally, and electronically;

communicates in a culturally responsive and relevant manner 

Cultural competency- Adapts PHN care on the basis of cultural needs and differences

and demonstrates culturally appropriate public health nursing practice

Community dimensions of practice skills- Partners effectively with key stakeholders and

group
groups
s in care
care deliv
delivery
ery,, colla
collabor
borate
ates
s wi
with
th commu
communit
nity
y partne
partners
rs to promo
promote
te healt
health.
h.

Participates
Participates effectively in activities
activities that facilitate community
community involvement.
involvement. Describes the

role
role of govern
governmen
mentt and the
the priva
private
te and
and nonpro
nonprofit
fit sect
sectors
ors in the
the deliv
delivery
ery of healt
health
h

services. Utilizes community assets and resources to promote health and deliver care.

Public health sciences - incorporates public health and nursing science in the delivery of 

care

Financi
Financial
al planning
planning and manageme
management
nt skills
skills - Describ
Describes
es the interre
interrelati
lationsh
onships
ips among
among

loca
locall and
and nati
nation
onal
al heal
health
thca
care
re sy
syst
stem
ems.
s. Desc
Descri
ribe
bes
s the
the stru
struct
ctur
ure,
e, func
functi
tion
on,, and
and

 jurisdictional
 jurisdictional authority
authority of organizational
organizational units within national
national and local public health

agencies.

Leadership and systems thinking - skills Incorporates ethical standards of practice as

the basis of all interactions Applies systems theory to PHN practice

Levels of clientele in community and public health nursing (CPHN)

Philippine Nursing Law of 2002 (RA 9173) states that a person shall be deemed to be

practicing nursing within the meaning of this Act when he/she singly or in collaboration

with
with anot
another
her,, ini
initia
tiate
tes
s and
and perf
perform
orms
s nurs
nursing
ing serv
service
ices
s to indivi
individu
duals
als,, famili
families
es and
and

communities in any health care setting. It includes, but not limited to, nursing care
 

during conception, labor, delivery, infancy, childhood, toddler, preschool, school age,

adolescence, adulthood and old age. As independent practitioners, nurses are primarily

responsible for the promotion of health and prevention of illness. As members of the

health team, nurses shall collaborate with other health care providers for the curative,

prevent
preventive,
ive, and rehabili
rehabilitati
tative
ve aspects
aspects of care,
care, restorat
restoration
ion of health,
health, alleviat
alleviation
ion of 

suffering, and when recovery is not possible, towards a peaceful death. Community

healt
health
h nurse
nurses
s deal
deal with
with four
four level
levels
s of clien
cliente
tele
le in his/he
his/herr prac
practic
tice.
e. Thes
These
e inclu
include
de

individuals, families, groups, and communities. Community and Public Health nurses

can influence health practices and policies that will positively affect the future health of 

individuals, families, groups, and communities.

Public health

Public Health is the science and the art of preventing disease. prolonging life, and

promoting physical health and efficiency through organized community efforts for the

sanitation of the environment the control of community infections, the education of the

individual in principles of personal hygiene the organization of medical and nursing

se
serv
rvic
ice
e fo
forr th
the
e earl
early
y diag
diagno
nosi
sis
s and
and prev
preven
enti
tive
ve trea
treatm
tmen
entt of dise
diseas
ase,
e, and
and the
the
deve
develop
lopme
ment
nt of the socia
sociall machi
machine
nery
ry which
which wi
willll ensu
ensure
re to ev
every
ery indivi
individu
dual
al in the

community a standard of living adequate for the maintenance of health; organizing

these benefits in such fashion as to enable every citizen to realize his birthright of health

and longevity. (Winslow, 1920 as cited in Kemper 2015). Public health as a science is

concerned with the knowledge and skills required of a nurse to be able to institute

interventions for the welfare of the public.

 

Local-level structures provide direct services to communities through two avenues:

• Community health services, which protect the public from hazards such as polluted

water and air, tainted food, and unsafe housing.

• Personal health care services, such as immunization and family planning services,

well-infant care, and sexually transmitted disease (SFD) treatment.

The purpose of public health is to improve the health of the public by promoting
promoting healthy

lifestyles, preventing disease and injury, and protecting the health of communities.

Core Public Health Functions

 Assessment:
 Assessment: Regular collection,
collection, analysis,
analysis, and information
information sharing about health

conditions. risks, and resources in a community.

Policy development:
development: Use of information gathered
gathered during ass
assessment
essment to deve
develop
lop local

and state health policies and to direct resources toward those policies.

 Assurance:
 Assurance: Focuses on the availability
availability of necessary
necessary health services throughout
throughout the

co
comm
mmun
unit
ity
y It Incl
Includ
udes
es main
mainta
tain
inin
ing
g the
the abil
abilit
ity
y of both
both publ
public
ic heal
health
th

agencies and private providers to manage day-to-day operations and the

capacity to respond to critical situations and emergencies.

Essential Public Health Services

• Monitor health status to Identify and solve community health problems

Diagnose and Investigate health problems and health hazards in the community

Inform. educate, and empower people about health issues

 

• Mobilize community partnerships and actions to Identify and solve health problems

Develop policies and plans that support individual and

community health efforts

• Enforce laws and regulations that protect health and ensure safety

• Link people to needed personal health services and assure the provision of health

care when otherwise unavailable

• Assure a competent public health and personal health

care workforce

• Evaluate effectiveness, accessibility. and quality of personal and population-based

health services

• Research for new Insights and Innovative solutions to health problems

Public Health Interventions

Publ
Public
ic health
health nurs
nurses
es focus
focus on the
the care
care of indiv
individu
idual
als,
s, group
groups,
s, ag
aggre
grega
gates
tes,, and
and

populations in many settings, including homes, clinics, worksites, and schools.

The public health intervention wheel

The Public Health Intervention Model was initially proposed in the late 1990s by nurses

from the Minnesota Department of Health in the USA to describe the breadth and scope

of public health nursing practice (Keller et al., 1998).

 

Surveillance - Describes and monitors health events through ongoing and systematic

collect
collection,
ion, analyst
analysts,
s, and interpre
interpretati
tation
on of health
health data for the purpose
purpose of planning
planning,,

implementing. and evaluating public health interventions

 

Disease and other health event investigation - Systematically gathers and analyzes data

regarding
regarding threats to the health of populations, source of the threat, identifies
identifies cases and

others at risk, and determines control ascertains the measures.

Outr
Outreac
each
h - Loca
Locates
tes popu
populat
lation
ions
s of inter
interest
est or popula
populatio
tions
ns at risk
risk and
and provi
provide
des
s

information about the nature of the concern. what can be done about lt. and how

services can be obtained

Screening
Screening - Identifies individuals
individuals with unrecognized
unrecognized health risk factors or asymptomatic

disease

Conditions

Case finding - Locates individuals and families with identified risk factors and connects

them with resources

Referra
Referrall and follow-
follow-up
up - Assists
Assists individu
individuals,
als, families
families,, groups,
groups, organiza
organization
tions,
s, and/or 
and/or 

communities to identify and access necessary resources to prevent or resolve problems

or concerns

Case management
management - Optimizes
Optimizes self-care capabilities of individuals and families and the

capacity of systems and communities to coordinate and provide services

Delegated functions - Carnes out direct care tasks under the authority of a health care
practitioner as allowed by law

Healt
Health
h te
teac
achin
hing
g - Commu
Communic
nicate
ates
s facts
facts,, Idea
Ideas,
s, and
and skill
skills
s that
that chang
change
e know
knowled
ledge
ge..

attitud
attitudes.
es. values.
values. beliefs,
beliefs, behavio
behaviors.
rs. and practice
practices
s of individ
individuals
uals.. familie
families.
s. syst
systems,
ems,

and/or communities
 

Counseling - Establishes an interpersonal relationship with a community. a system. and

a family or individual. With the Intention of increasing or enhancing their capacity for 

self-care and

Consu
Consulta
ltatio
tion
n - Seeks
Seeks Inform
Informati
ation
on and
and gene
generat
rates
es optio
optional
nal solut
solution
ions
s to perce
perceive
ived
d

problems or issues through interactive problem solving with a community system and

family or individual

Collaboration - Commits two or more persons or organizations to achieve a common

goal by enhancing the capacity of one or more of the members to promote and protect

health

Coal
Coalit
itio
ion
n buil
buildi
ding
ng - Prom
Promot
otes
es and
and deve
develo
lops
ps alli
allian
ance
ces
s amon
among
g orga
organi
niza
zati
tion
ons
s or 

constituents for a common purpose

Communit
Community
y organizi
organizing
ng - Helps
Helps communit
community
y groups
groups to identif
identify
y common
common problems
problems or 

goals. mobilize resources.

resources. and develop and implement strategies for realizing the goals

they collectively have set

 Advocacy
 Advocacy - Pleads someone cause or acts on someone behalf. With a focus on

developing the community, system. and individual or family capacity to plead their own

cause or act on their own behalf 

Soci
Social
al marke
marketin
ting
g - Utili
Utilize
zes
s comme
commerc
rcial
ial marke
marketin
ting
g princ
principl
iples
es and
and techn
technolo
ologi
gies
es for 

programs designed to influence the knowledge, attitudes. values. beliefs, behaviors,

and practices of the population of interest

Policy development - Places health issues on decision makers' agendas, acquires a

plan of resolution. and enforcement determines needed resources. resulting in laws,

 

rules.
rules. regulati
regulations
ons.. ordinan
ordinances
ces,, and policies
policies.. Policy
Policy enforce
enforcement
ment compels
compels others
others to

comply with laws, rules, regulations, ordinances. and policies