CHAPTER 3
EXPANDING FIELDS OF
COMMUNITY & PUBLIC
HEALTH NURSING
PRACTICE
LEARNING OBJECTIVES
❑ Describe Public Health as a field of practice
❑ Enumerate the standards of Public Health practice
❑ Discuss the nature & scope of Occupational Health Nursing
❑ Explain the value of School Health Nursing for both students and
personnel
❑ Identify emerging fields of community & public health nursing
KEY TERMS
❑ Public Health nursing
❑ Occupational safety and health (OSH)
❑ Occupational health nursing
❑ School health nursing
❑ Faith community nursing
❑ Correctional nursing
❑ Independent practice
❑ Entrepreneurship in nursing
❑ Levels of prevention
Public Health Nursing
❖ Public health nursing may be defined as a field of professional practice in
nursing and in public health in which technical nursing, interpersonal, analytical,
and organizational skills are applied to health problems as they affect the
community. (Freeman, 1963)
❖ Traditionally, “public health nursing” was seen as a subspecialty nursing practice
generally delivered within “official” or governmental agencies. In contrast,
“community health nursing” was considered a broader and more general
specialty area that encompassed many additional subspecialties (e.g., school
nursing, occupational health nursing, forensic nursing, homehealth).
Public Health Nursing
❖ In 1980, the American Nurses Association (ANA) defined community
health nursing as “the synthesis of nursing practice and public health
practice applied to promoting and preserving the health of populations”.
❖ Thus, the American Public Health Association (APHA) defined public
health nursing as “the practice of promoting and protecting the health of
populations using knowledge from nursing, social, and public health
sciences”.
Occupational Health Nursing
❖ Occupational Safety and Health “the promotion and maintenance of the highest
degree of physical, mental, and social well-being of workers in all occupations.”
❖ Occupational Health Nursing is defined by the AAOHN as “the specialty practice
that focuses on the promotion, prevention, and restoration of health within the
context of a safe and healthy environment. It includes the prevention
of adverse health effects from occupational and environmental hazards. It
provides for and delivers occupational and environmental health and safety
programs and services to clients.”
Occupational Health Nursing
Occupational Health Nursing derives its theoretical, conceptual, and factual
framework from a multidisciplinary base. Elements of this multidisciplinary base
include the following:
❖Nursing Sciences- to provide the context for health care delivery and recognize the
needs of individuals, groups, and populations within the framework of prevention, health
promotion, and illness and injury care management, including risk assessment, risk
management, and risk communication.
❖Medical Science- specific to treatment and management of occupational health illness
and injury, integrated with nursing health surveillance activities.
❖Occupational health sciences
Occupational Health Nursing
Occupational Health Nursing derives its theoretical, conceptual, and factual
framework from a multidisciplinary base. Elements of this multidisciplinary base
include the following:
❖Nursing Sciences- to provide the context for health care delivery and recognize the
needs of individuals, groups, and populations within the framework of prevention, health
promotion, and illness and injury care management, including risk assessment, risk
management, and risk communication.
❖Medical Science- specific to treatment and management of occupational health illness
and injury, integrated with nursing health surveillance activities.
❖Occupational health sciences
Occupational Health Nursing
❖ Epidemiology- to study health and illness trends and characteristics of the worker
population, investigate work-related illness and injury episodes, and apply
epidemiological methods to analyze and interpret risk data to determine causal
relationships and participate in epidemiological research.
❖ Business and economic theories, concepts, and principles- for strategic and operational
planning for valuing quality and cost-effective services, and for management of
occupational health and safety programs.
❖ Social and behavioral sciences- to explore influences of various environments (e.g.,
work and home), relationships, and lifestyle factors in worker’s health and determine
the interactions affecting worker health.
Occupational Health Nursing
❖ Environmental Health- to systematically examine the interrelationship between the
worker and the extended environment as a basis for the development of prevention and
control strategies.
❖ Legal and ethical issues- to ensure compliance with regulatory mandates and contend
with ethical concerns that may arise in competitive environments.
Evolution of Occupational Health Nursing in the
Philippines
November 11, 1950 ❖ Mrs. Magdalena Valenzuela of DOH, instituted the Industrial
Nursing Unit (INU) of the Philippine Nurses Association.
❖ Ms. Peria Gorres of the Philippine Manufacturing Company(PMC)
served as the first chairperson.
August 19, 1964 ❖ Ms. Anita Santos of Jardine Davies was elected as first president.
November 12, 1996 ❖ Ms. Santos’ education programs and constitutions and by-laws
governing the association were approved.
June 5-6, 1970 The first annual convention was held
Occupational health strategies: assessment and
control hazards in the workplace
❖ Health Hazards- are the elements in the work environment that can cause work-related
disease to the worker.
❖ Safety Hazards- these are the unsafe conditions or unsafe acts that significantly increase
the risk of workers being injured.
✔ The occupational health team may categorize identified health hazards in the
workplace as follows:
❖ Administrative control
- refers to the development and implementation of policies, standards, training, job design,
and the like.
Occupational health strategies: assessment and
control hazards in the workplace
❖ Engineering- refers to the adaptation of physical, chemical, or technological
improvements to limit the exposure of workers to hazards of the workplace.
❖ Material Provision- refers to providing the workers with supplies or supplements that
can decrease their exposure or susceptibility to occupational hazards.
❖ Supplementation- to decrease the exposure and increase the resistance to infections.
Occupational health strategies: assessment and
control hazards in the workplace
Framework and Scope of Occupational Health
Nursing Practice
✔ In the Philippines, Rule 1965.04 of the Amended OSHS published by DOLE
(1996) stipulated the expected duties and functions to be performed by
occupational health nurses, as follows:
1. Organizing and administering a health service program integrating occupational safety
in the absence of a physician; otherwise these activities of the nurse shall be under the
physician.
2. Providing nursing care to injured or ill workers.
3. Participating in health maintenance examination. If a physician is not available, to perform
work activities that are within the scope allowed by the nursing profession, and if more
extensive examinations are needed, referring the same to a physician.
Framework and Scope of Occupational Health
Nursing Practice
4. Participating in the health maintenance of occupational health and safety by giving
suggestions for the improvement of the working environment affecting the health and
well-being of the workers.
4. Maintaining a reporting and records system and, if a physician is not available,
preparing and submitting an annual medical report, using the prescribed form to the
employee as required by this standard
Levels of Prevention in Occupational Health Nursing
Primary Prevention
In the area of primary prevention, the occupational health nurse is involved in both
health promotion and disease prevention.
O’Donnell (2009) describes health promotion as:
“The art and science of helping people discover the synergies between their passions
and optimal health to give them more motivation and support to change their lifestyle. It
is about achieving the necessary balance between physical, emotional, social, spiritual,
and intellectual health. Lifestyle change can be facilitated through a combination of
learning experiences that enhance awareness, increase motivation, and build skills,
most importantly, through the creation of opportunities that open access to
environments that make positive health practices the easiest choice”.
Levels of Prevention in Occupational Health Nursing
Primary Prevention
⮚ The occupational health nurse plans and implements programs.
⮚ Performing “walkthrough” surveys.
⮚ The occupational health nurse may be in an advocacy role to negotiate with the
employer for changes in the work environment that will reduce or eliminate existing
or potential occupational exposure to risk factors.
Levels of Prevention in Occupational Health Nursing
Secondary Prevention
✔ aimed at early diagnosis, early treatment interventions, and attempts to limit
disability. The focus on this level of prevention is on identification of health
needs, health problems, and employees at risk.
⮚ As with primary prevention, the occupational health nurse uses a number of
different secondary prevention strategies (Rogers,2003).
⮚ The occupational health nurse can offer health screenings which are designed
for early detection of disease, at the worksite with relative ease and at
minimal cost.
Levels of Prevention in Occupational Health Nursing
Tertiary Prevention
On a tertiary level, the occupational health nurse plays a key role in the
rehabilitation and restoration of the worker to an optimal level of functioning
based on the limitations imposed by the disability or illness.
⮚ Although the occupational health nurse is often independent, and most of the
time is the only healthcare provider in an organization he or she usually
works with other occupational health and safety specialists who may or may
not be employed by the company
Levels of Prevention in Occupational Health Nursing
❖ Toxicologist- studies and identifies the toxic properties of agents used in work
to which the workers might be exposed.
❖ Industrial hygienist- prevents occupational injuries and evaluates safety
practices and protocols in the workplace.
❖ Ergonomist- design specialist who helps promote a healthy interface of
humans and their tools.
❖ Epidemiologist- conducts research studies on the patterns of disease and
injuries in the workforce
SKILLS AND COMPETENCIES FOR OCCUPATIONAL
HEALTH NURSING
Although clinical and emergency care remains an important tenet of occupational
health nursing, the current and future practice must focus on a proactive approach to
prevent illness and injury and promote health.
✔ The Occupational Health Nurse must the possess competencies necessary to
recognize and evaluate potential and existing health hazards in the workplace.
SKILLS AND COMPETENCIES FOR OCCUPATIONAL
HEALTH NURSING
Examples of some of the numerous skills and competencies, according to the
nine (9) defined areas of competence:
1. Clinical and Primary Care
2. Case Management
3. Workforce, Workplace, and Environmental Issues
4. Legal and Ethical Responsibilities
5. Management and Administration
6. Health Promotion and Disease Prevention
7. Occupational and Environmental Health and Safety Education
8. Research
9. Professionalism
LEGISLATION and OCCUPATIONAL HEALTH
Being a staunch advocate for the promotion of occupational health and safety, DOLE has
consistently implemented and enforced policies and practices to meet its goals. It possesses
legislative and rule-making powers concerning the following laws and standards.
❖ Presidential Decree (PD) 442- Philippine Labor Code
❖ The Administrative Code on Enforcement of Safety and Health Standards
❖ The Occupational Safety and Health Standards (OSHS)
❖ Executive Order 307- Creating the Occupational Safety and Health Center (OSHC) under the
Employees Compensation Commission
❖ PD 626-Employees Compensation and State Insurance Fund
❖ Hazard- specific laws regarding antisexual harassment
❖ RA 9165-Comprehensive Drugs Act of 2002
❖ RA 6969- Toxic Substance Act
❖ RA 9231- Special Abuse, Exploitation and Discrimination Act
❖ R.A. No. 11058- Strengthening Compliance with Occupational Safety and Health personnel in
workplaces
LEGISLATION and
OCCUPATIONAL
HEALTH
SCHOOL HEALTH NURSING
School-aged children and adolescents face increasingly difficult challenges related to health.
Education and Health are interrelated. As early as 1950, the World Organization (WHO)
Expert Committee on School Health Services noted that, “
to learn effectively, children need good health”.
There are more teachers than health professionals in the country (Philippines). Generally,
the school nurse visits four to six schools per month, with each visit lasting for 3 days or
more, depending on the type of school, location, and population. For the rest of the month,
teachers, who also serve as school health guardians, provide primary care as necessary, such
as the detection of obvious health problems and administration of first aid. Thus, the
School Nurse is responsible for planning and conducting programs for teachers on health
and nutrition
HISTORICAL DEVELOPMENT OF SCHOOL HEALTH
SERVICES
The definition of school health and how a school health program should behave evolved
markedly in the past 50 years. Traditionally, School health programs were defined as
covering:
1. School health services
2. School health education
3. A healthy school environment includes both physical and psychosocial aspects of the
environment(WHO, 1997)
In the Philippines, the first school health program required by law consisted mostly of school
health services with the passage of Republic Act 124 in 1947. Entitled “An Act to Provide for
Medical Inspection of Children Enrolled in Private Schools, Colleges and Universities in the
Philippines”.
HISTORICAL DEVELOPMENT OF SCHOOL HEALTH
SERVICES
With the changing roles and responsibilities of schools came a redefinition of school health
programs in the 1980s. The evolving roles of the school nurse the school children and the
other members of the school community resulted in the expansion of the school health
program to eight components. In addition to the first three components, there are five more
components have been included, namely (WHO,1997):
1. Health promotion for school personnel
2. School-community project and outreach
3. Nutrition and food safety
4. Physical education and recreation
5. Mental health, counseling, and social supports
HISTORICAL DEVELOPMENT OF SCHOOL HEALTH
SERVICES
School nursing covers the entire scope of the eight components of school health programs.
The National Association of School Nurses (in the United States) defines it as advancing the well-
being, academic success, and life-long achievement of students.
In the Philippines, a holistic approach to strengthening health and nutrition among schoolchil
dren is the concept embodied by the Redesigned Approach in School Health Nursing (RASHN),
officially adopted through the Department of Education, Culture and Sports (DECS) Memorandum
No.37, series 1991.
The Department of Education (DepEd) Order No.43, s. 2011 on the subject Strengthen the
School Health and Nutrition Programs for the achievement of the Education for All (EFA) and
Millennium Development Goals (MDGs) seeks to strengthen the School Health and Nutrition
Program(SHNP) through a seamless alignment of SHNP activities with other key school programs,
thus the title Integrated School Health and Nutrition Program (ISHNP).
SCHOOL HEALTH SERVICES
DepEd Order No.43, s.2011 directs the
integration of the School Health Nursing
Program (SHNP) with the annual and
medium-term development plans of
regions/divisions and with school
improvement plans, ensuring administrative
and financial support.
EIGHT COMPONENTS OF SCHOOL HEALTH PROGRAMS
1. Comprehensive School Health Education (GRADES K-12 )
⮚ This is a planned, sequential, K-12 curriculum that addresses the physical, mental, emotional, and
social dimensions of health.
2. Physical Education and Activity
⮚ This is a planned, sequential K-12 curriculum that provides cognitive content and learning
experiences in a variety of activity areas such as basic movement skills.
3. Nutritional Services
⮚ These provide access to a variety of nutritious and appealing meals that accommodate the health and
nutrition needs of all students.
4. School Health Services
⮚ These are services provided for students to appraise, protect and promote health
EIGHT COMPONENTS OF SCHOOL HEALTH PROGRAMS
5. School Counseling, Psychological, and Social Services
⮚ These services are provided to improve student’s mental, emotional, and social health.
6. Health and Safe Environment
⮚ This refers to the physical and aesthetic surroundings and the psychosocial climate and culture of
the school.
7. Student, Family and Community Involvement in School
⮚ This pertains to an integrated school, parent, and community approach for enhancing the health and
well-being of students.
8. Health Promotion for School Staff -
⮚ This provides opportunities for school staff to improve their health status through activities such as
health assessment, health education health-related fitness activities
SCHOOL HEALTH NURSING PRACTICE
School Nursing is a specialty area in healthcare practice. School nurses need education in
specific areas, such as growth and development, public health, mental health nursing, case
management, program management, family theory, leadership, and cultural sensitivity to effectively
perform their roles.
For entry into school nursing, it is recommended that nurses hold a minimum of a bachelor’s
degree. School nurses must be able to identify and access professional development to maintain
competency in the care of children and adolescents.
School Nurses function in many roles including care provider, student advocate, educator,
community liaison, and case manager. Additional skills needed by school nurses include
independently and to delegate care.
SCHOOL HEALTH NURSING PRACTICE
STANDARD OF SCHOOL HEALTH NURSING PRACTICE
EMERGING FIELDS OF COMMUNITY AND PUBLIC
HEALTH NURSING IN THE PHILIPPINES
Public health, Occupational health, and School health are established and recognized fields of practice
of community health nursing in diseases, such as diseases of the heart and the vascular system, cancer,
diabetes, and pulmonary and renal conditions, which inflict a heavy burden on the client and health
care system. Nurses engaged in the following care:
❖ Home Health Care
This practice involves providing nursing care to individuals and families in their places of residence
mainly to minimize the effects of illness and disability.
❖ Hospice Home Care
This is home care specifically rendered to the terminally ill
EMERGING FIELDS OF COMMUNITY AND PUBLIC
HEALTH NURSING IN THE PHILIPPINES
EntrepreNurse was launched in 2013 to help mainstream the concept of Entrepreneurship in
Nursing among nurses, this is a project initiated by the Department of Labor and Employment
(DOLE), in collaboration with the Professional Regulatory Board of Nursing of the Philippines,
Philippines Nurses Association and other stakeholders to promote nurses’ entrepreneurship
by introducing home health care industry in the Philippines. It aims to:
1. Reduce the cost of health care for the country’s indigent population by bringing primary
healthcare services to poor rural communities.
2. Maximize employment opportunities for the country’s unemployed nurses
3. Utilize the country’s Millennium Development Goals on the maternal and Child Health
(DOLE,2013)
EMERGING FIELDS OF COMMUNITY AND PUBLIC
HEALTH NURSING IN THE PHILIPPINES
❖ Faith Community Nursing or Parish Nursing
It is of the art and science of nursing combined with spiritual care.
❖ Correctional nursing is a specialized subset of forensic nursing.
❖ Entrepreneurship in nursing is recently gaining momentum in the field of healthcare
practice among nurses
EMERGING FIELDS OF COMMUNITY AND PUBLIC
HEALTH NURSING IN THE PHILIPPINES
❖ Faith Community Nursing or Parish Nursing
It is of the art and science of nursing combined with spiritual care.
❖ Correctional nursing is a specialized subset of forensic nursing.
❖ Entrepreneurship in nursing is recently gaining momentum in the field of healthcare
practice among nurses
