NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*MIDWIFERY*MEDTECH

LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM

NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

HANDOUTS
Community Health Nursing
Prepared by: Prof. Ronald Tomines
REFERENCES:
1) Jimenez, C. (2010) Community Health Development. Manila: C&E Publication. ISBN: 978-971-
584-755-1.
2) Department of Health. (n.d.) Programs of the DOH. Retrieved from www.doh.gov.ph
3) NLPGN. (n.d.) 2007 Public Health Nursing in the Philippines.
4) Maglaya, A. (2015). Nursing Practice in the Community. Marikina: Argonauta Corp. ISBN: 971-
91924-3-7.
5) World Health Organization (n.d.) Care for mothers and newborns: Highlights from the World
Health Organization 2013 Guidelines. Retrieved from www.mcsprograms.org.
NOTE: This is a combination of different sources that the lecturer ASSOC. PROF. RONALD C.
TOMINES research thoroughly for the accuracy and consistency of the facts. The arrangement of the
lectures is set by the one who made this lecture notes. No repetition of the same kind in terms of
organization and how it is being presented without prior arrangement or without asking permission
unless the research conducted of the same kind was made prior the lecturer made this and shared.
This lecture handout is only made for this purpose ONLY. Not publishable without the consent of the
professor who made these notes. DATE: MARCH 08, 2021

Community
(Blackwell, 1994) – Group of people living in a same place with a same government.
(WHO, n.d.) – Social structure that exhibits and creates norms and values that establishes social
institution.

Health
(WHO, n.d.) – State of complete physical, mental, social wellbeing not merely the absence of disease
or infirmity (1978).
(WHO, n.d.)
- New Concept in Determinants of Health – Optimum Level of Functioning (OLOF)
- Factor that affects OLOF – ECOSYSTEM 
Factors affecting OLOF
1. Behavioral
2. Political
3. Environmental
4. Hereditary
5. Socio-economi
6. Health Care Delivery System 

Nursing
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Any activities performed by the nurse in accordance with the restoration and maintenance of health
of an individual, family or community as a whole.

I. Philosophy of Community Health Nursing (Dr. Magaret Shetland)

▪ Based on the worth and dignity of a man.

II. Ultimate Goal of Community Health Nursing

a. Increase the level of health of the citizenry (old)
b. Increase the level of wellness of the people 

III. Primary Goal of Community Health Nursing

▪ Enhance people’s Capabilities

IV. Principles of Community Health Nursing

1. CHN is for ALL
2. Presence of existing active groups
3. Presence of indigenous resources
4. Implementation and evaluation of health programs/services
5. Conducting health education

V. Focus of Community Health Nursing

1. Health Promotion
2. Disease Prevention

VI. Client in Community Health Nursing

1. Individual – “Point of entry”
2. Family – “Center in delivery of Care” 
3. Group – “Point of SPECIFIC care
4. Community – “Point of Entire Care”

VII. Places in Community Health Nursing

1. Public Health Nursing
▪ (WHO, n,d,) Special field in nursing, combination of skills in nursing, some phases of
social assistance, and function of all public health programs.
a. Function of PHW in the City/Municipal Health Office
▪ PHN II – Frontline Health Workers
▪ PHN III – Nurse In-Charge
▪ PHN V – Nurse Supervisor
▪ PHN VI – Nurse Program Supervisor
b. LAWS:
▪ RA 7305 – Magna Carta for Public Health Workers
▪ RA 7160 – Local Government Code of the Philippines “Devolution Code” 
▪ RA 6758 – Standardized Salary Among Government Employees
▪ RA 6713 – Code of Ethics for PHW
▪ RA 1082 – Rural Health Act of the Philippines

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2. School Health Nursing

a. Law in SHN – RA 124 – Every School should have a School Clinic
b. 3 Determinants of SHN
1. Characteristics of the client
2. Programs of the DOH
3. Policy of the DepEd
c. Primary Role of a School Nurse – Ensure that educational potential is not hampered due
to unmet health needs. 

3. Occupational Health Nursing

a. Mission of OHN – To ensure that every working person are safe and healthy.
b. Primary role of the PHN
Observe personal protective equipment
Health hazards control measure and sanitation
Never neglect to perform physical assessment

VIII. Activities in Community Health Nursing

1. Clinic Visit
a. Two Programs
1. Program based – The nurse manages the case.
2. Non-program based – Medical intervention is needed.
b. Standard procedure in conducting Clinic Visit
1. Registration/Admission
2. Waiting Time
3. Triaging
4. Medical assessment
5. Laboratory
6. Referral
7. Prescription
8. Health Education

2. Home Visit
a. Principles of Home Visit
1. Involve the family/individual
2. Prioritize essential needs
3. Plan of the home visit should be flexible
4. Use available information
5. There should be a purpose and objectives
b. Factors affecting the frequency of Home Visit
1. Delivered/rendered previous health services
2. Acceptance of the family
3. Manpower (RN)
4. Policy of a given agency (school)
5. Other agency (School, institution etc.) involved
6. The needs of the Family/individual
c. Resources in conducting Home Visit
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▪ PH bag – Essential and indispensable equipment of the PHN in rendering nursing care
in the community.
▪ Bag Technique - Is a tool being used in rendering effective and efficient nursing care
with ease and deftness.
▪ Principles in Bag Technique – 1) Minimize the spread of infection/disease ; 2) It
saves time and effort; 3) Show effectiveness of total care; 4) Can be preformed in
variety of ways.
IX. Research in Community Health Nursing
▪ Epidemiology – study of occurrence and distribution of a disease and factors affecting
the disease occurrence and distribution. 
1. Phases of Epidemiologic Approach
a. Descriptive – Frequency and distribution of a disease
b. Analytical – Causes and determinants of a disease
c. Experimental – Ne approach in dealing with a disease
d. Evaluative – Effectiveness of the program/services/s
2. Patterns of Occurrence and distribution
a. Sporadic – on and off in occurrence; cases are few and scattered
b. Epidemic – Sudden increase in occurrence or outbreak
c. Endemic – continuous in occurrence; cases are constant in a period of time
d. Pandemic – Simultaneous epidemic of the same disease in several countries
3. Disease Surveillance and Registration
a. NESSS (National Epidemic Sentinel Surveillance System)  Monitoring of all
infectious disease with outbreak potential.
b. FHSIS (Field Health Services and Information System – Reporting and recording
system of all cases in the health sector.
c. LAW:
• RA 3573 – Reporting of Communicable Disease
• RA 11332 – Mandatory Reporting of Notifiable Diseases and Health events of
Public Health Concerns
• PD 651 – Registration Law of the Philippines
d. Vital Statistics – Study of vital events and indices of health status of the
community
1. Crude Birth Rate
Total Number of Registered Live Births in a given Calendar Year / Estimated
Population of the same calendar X 1000

2. Crude Death Rate

Total Number of Registered Deaths in a given Calendar Year / Estimated
Population of the same calendar X 1000

3. Maternal Mortality Rate

Total Number of Maternal Related Deaths in a given Calendar Year/ Total
Number of Registered Live Births of the Same Calendar Year X 1000

4. Infant Mortality Rate

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Total Number of death under 1st year of life in a given Calendar Year/ Total
Number of Registered Live Births of the Same Calendar Year X 1000

5. Neonatal Mortality Rate

Total Number of under 28 days of life in a given Calendar Year/ Total Number of
Registered Live Births of the Same Calendar Year X 1000

6. Fetal death Rate

Total Number of under 28 days of life in a given Calendar Year/ Total Number of
Registered Live Births of the Same Calendar Year X 1000
▪ COPAR Community Organizing Participatory Action Research
• CO – Community Organizing – Process and structure wherein the people
become more organized in participation in health care and development
activities.
• PAR – Participatory Action Research – community-directed activity of
colleting, organizing , and analyzing of data for change.

1. Pre-Entry Phase
1. Formulation of programs – based on the VMG of the college/institution.
2. Conduct COPAR Staff Training
COPAR Staff:
a. Community Organizer
b. Training Coordinator
c. Health Services Coordinator
d. Student Immersion Coordinator
3. Conduct PSI (Preliminary Social Investigation) – gathering of information of
different barangays for potential adopted community
4. Meeting the Community Key Leaders – To know if the community will accept,
support, and participate in your programs, projects, activities in the community.
5. Sport Mapping – To know vulnerable groups, their health status, and health
resources

2. Entry
1. Community Integration
2. Conduct DSI – Deepening Social Investigation
3. Provide basic Health Care Services – PHC implementation
4. Conduct SALT (Self Awareness and Leadership Training)
5. Core Group Formation
• Roles and Functions of the Core Group
1. Prepare the Community Health Development
2. Organize research team
3. Set up Community health organizers
4. Organize and mobilize them during immediate community health needs

3. Community Study Phase

1. Training on data collection, organization, and analysis
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2. Plan when to conduct actual survey

3. Actual data gathering
4. Data organization
5. Data analysis and prioritization
6. Data presentation

4. Community Organizing and Capability building

1. Provide management process
2. Election of officers and members
3. Discuss their roles and functions
4. Conduct ARAS (Action Reflection Action Session)

5. Community Action Phase

1. Program implementation, monitoring and evaluation
2. Identify other resources
3. Set up Linkages and referrals
4. Organize and training Community Health Workers

6. Sustenance and Strengthening Phase

1. Develop Financial Management
2. Identify secondary leaders
3. Negotiate for the absorption of CHW to LGU
4. Develop medium- and long-term health plans
5. Formalize linkages and networks

DEPARTMENT OF HEALTH

VISION - Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040.
MISSION - To lead the country in the development of a productive, resilient, equitable and people-
centered health system
DOH SECRETARY – DR. FRANCISCO T. DUQUE III

PRIMARY HEALTH CARE

To provide accessible, available and affordable primary health care o people.

4 A’s - Accessible, Available, Affordable, and Acceptable

3 Core Concepts – Self Reliance, Empowerment, and Partnership
4 PILLARS/Cornerstone – Support mechanism made available, Active Community Participation,
Intra and Inter sectoral linkages, and Use of appropriate technologies.
ELEMENTS of PHC
Provide Medical Care and Surgical Treatment
Render Essential Drugs
Immunization
Maternal Health and Family Planning
Adequate Nutrition and Sanitation
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Render Health Education

Yes to control Communicable Diseases and Locally Endemic Diseases

GOAL – Health for All by Year 2000.

UNDERLYING THEME – Health for all and health in the hands of people by the year…
MDG’s until 2015
Promote gender equality and empower women
Achieve universal primary education
Reduce child mortality
Eradicate extreme poverty
Combat HIV and other diseases
Ensure environmental sustainability
Develop global partnership
Improve maternal health
SDGs by 2030
No poverty
Zero hunger
Good health and wellbeing
Quality education
Gender equality
Clean water and sanitation
Affordable and clean energy
Decent work and economic growth
Industry, innovation, and infrastructure
Reduced inequalities
Sustainable cities and communities
Responsible consumption and production
Climate action
Life below water
Life on land
Peace, justice, and strong institution
Partnerships for the Goals

PROGRAMS OF THE DOH

I. ENVIRONMENTAL HEALTH AND SANITATION

1. LAWS
▪ PD 856 – Sanitation Code of the Philippines
▪ PD 825 – Improper Garbage Disposal Law of the Philippines
▪ RA 9003 – Ecological Solid Waste Management Act of the Philippines
▪ RA 9275 – Clean Water Act of the Philippines
▪ RA 8749 – Clean Air Act of the Philippines
▪ RA 6969 – Toxic, Hazardous, Nuclear Waste Control Act of the Philippines
2. WATER SANITATION
▪ 3 Unapproved Water Source Facility
a. Open dug wells
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b. Unimproved spring
c. Wells that need priming/repair
▪ 3 Level of Approved Water Source Facility
a. Level I (Protected Spring) – 250 meters; 40 to 140 L/min; 15-25 household
b. Level II (Protected Wells) – 25 m; 40 to 80 L/Capita/Day; 100 household
c. Level III (Water Works System – Own connection
3. EXCRETA DISPOSAL
▪ 3 Level of Excreta Disposal
a. Level I – Negative
1. Reed Odorless Earth Closet
2. Pit Privy
3. Pit Latrine
4. Bucket Latrine
5. VIP
– Minimal
1. Pour Flush
b. Level II – Water sealed type of toilet, flush-type
c. Level III – Water sealed, water sewage, treatment facility

II. REPRODUCTIVE HEALTH

1. LAW
▪ RA 10354 – Reproductive Health Act of the Philippines
2. 4 Main Objectives
a. Reduce maternal deaths
b. Reduce child mortality
c. Increase access to information and service
d. Halt the spread of HIV/STI
3. 4 Priority Elements
a. Family Planning
b. Adolescent Reproductive Health
c. Maternal and Child Health and Nutrition
d. Prevention of HIV/STI
4. Methods of Family Planning
a. Female Sterilization
b. Male Sterilization
c. Pills
d. Injectables
e. Billing’s Method
f. Basal Body Temperature
g. Sympto-Thermal Method
h. Two-day Method
i. Standard Days Method

III. MATERNAL HEALTH PROGRAMS

1. GOAL – Improve survival, health, and wellbeing among mothers and unborn.
2. Objectives – Reach out all pregnant women; To ensure a safe and healthy delivery.
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3. Risk Factors
a. Age – 17 years old and below; 36 years old and above
b. Height – 4’10” and below
c. Gravida – G5 and above
d. History
e. Present condition
4. Purpose of HBMR
a. To identify risk factors
b. To implement appropriate nursing care
5. Maternal Health Care Services
a. Benefits of Breastfeeding to mothers and infants
1. It will prevent unplanned pregnancy
2. It will prevent postpartum bleeding
3. It will prevent occurrence of cancer
4. It provides complete nutrition
5. It prevents infections
6. It increases IQ points

b. Micronutrients Supplementation

Vitamin A Iron supplements with Folic acid

- Pregnancy - 1st Trimester
- 10,000 IU - 60 mg EI/day for 6 months
- 4th – 9th month - 2nd/3rd trimester
- TWICE A WEEK - 120 mg EI/day until delivery
- Post-partum
- Post-Partum - 60mg EI/day for 3 months
- 100,000 IU
- Once within 4 weeks post-
partum

c. Tetanus Immunization

1st dose - ASAP during pregnancy

2nd dose - 1 month after the 1st dose
3rd dose - 6 months after the 2nd dose
4th dose - 1 year after the 3rd dose
5th dose - 1 year after the 4th dose

d. Complications: EMOC (Emergency Obstetric Care)

1. Basic Emergency Obstetric Care
o Travel time – within 30 minutes from the catchment area
o Population – 1:250,000
o Services – Manual delivery, IV antibiotics, IV fluids, D and C

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2. Comprehensive Emergency Obstetric Care

o Travel time – with 1 hour from BEmOC
o Population – 1:500,000
o Services – All BEmOC services, BT, and C/S

IV. CHILD HEALTH CARE

1. LAWS:
▪ RA 9288 – Newborn Screening Act
▪ RA 7600 – Breastfeeding and Rooming Act
▪ EO 51 – Milk Code of the Philippines
▪ PD 996 – Compulsory immunization of children below 8 years old
▪ RA 10152 – Mandatory Child and Infant Immunization Act of 2011
▪ RA 7846 – Hepa B Vaccination

2. VACCINES:

Vaccine Dose Schedule Dosage Route of

Administration
BCG 1 dose– Infancy 1 dose at birth At birth = .01 ml At birth – R arm
1 dose– Grade 1/ School 1 dose Grade 1 Grade 1 = .1 ml Grade 1 – L arm
entrants
Hep B 3 doses 1st dose – at .5 ml Upper outer portion
birth of the thigh
2nd dose – 6
weeks after the
1st dose
2rd dose – 8
weeks after the
2nd dose
DPT 3 doses 1st dose – 6 .5 ml Upper outer portion
weeks old of the thigh
2nd dose – 4
weeks interval
3rd dose – 4
weeks interval

OPV 3 doses 1st dose – 6 2 drops or it mouth

weeks old depends on the
2nd dose – 4 manufacturer
weeks interval
3rd dose – 4
weeks interval

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Measles 1 dose 9 months .5 ml arm/thigh

Penta 3 doses 1st dose – 6 .5 ml thigh
weeks old
2nd dose – 4
weeks interval
3rd dose – 4
weeks interval
MMR 1 dose 12 months .5 ml Arm/thigh

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