THE PUBLIC HEALTH NURSE

The Standards of Public Health Nursing in the Philippines developed by the National
League of Philippine Government Nurses in 2005 described the qualification and
functions of a Public Health Nurse. As a Public Health Nurse, you must possess personal
qualities and “people skills” that would enable you to make a difference in the lives of
people.
The functions of the PHN are consistent with the Nursing Law 2002 and program policies
formulated by the Department of Health and local government health agencies.

Management functions
The management function of the PHN is inherent in practice. The nurse, in
whatever setting and role has been trained to lead and to manage. Objectives set for work
being done can only be achieved through the execution of five management functions of
planning, organizing, staffing, directing and controlling. This function is performed when
organizing the “nursing service” of the local agency. In addition, the PHN functions as a
program manager wherein she is responsible for the delivery of the package of services
provided by the program to the target clientele.

Supervisory function
Generally, the PHN is the supervisor of the midwives and other auxiliary health
workers in the catchment area. As a supervisor she formulates a supervisory plan and
conducts supervisory visits using a supervisory checklist to implement the plan. The
Sentrong Sigla Program has developed a Supervisory package complete with supervisory
checklists for various programs.

Nursing care function

The PHN uses her knowledge and skill in the nursing process. She does
assessment, plans and implements care, and evaluates outcomes. She establishes
rapport with client, may it be individual, family or community. Home visits are must
activities of the PHN – it is a visible manifestation of her caring function. The nurse also
facilitates referral of patients to appropriate levels of care.

Collaborating and coordinating function

PHN are the care coordinators for communities and their members. They are
actively involved both socially and politically to empower individuals, families, and
communities as an entity to initiate and maintain health promoting environments. She
establishes linkages and collaborative relationships with other health professionals,
government agencies, the private sector, non-government organizations, people’s
organizations to address health problems. Also, she identifies persons, groups,
organizations, other agencies and communities whose resources are available within and
outside the community which can be tapped in the implementation of care.

Health promotion and education function

The PHN uses her skills in advocacy for the creation of a supportive environment
through policies and reengineering of the physical environment for healthier actions. As
an educator, the nurse provides clients with information that allows them to make
healthier choices and practices. Health education activities is a major component of any
public health program. PHN in the community are expected to teach daily as part of their
practice.

Training function
The PHN initiates the formulation of staff development and training programs for
midwives and other auxiliary workers. She does training needs assessment for these
health workers, designs the training program and conducts them in collaboration with
other resource persons as well as evaluation of training outcomes. The PHN also
participates in the training of nursing and midwifery affiliates in coordination with the
faculty of colleges of nursing and midwifery.
Health promotion calls for the active participation of the community. As such one
of the activities performed by the nurse is to mobilize communities for health actions.
Community organizing is a means of mobilizing people to solve their own problems.

Research function
The PHN participates in the conduct of research and utilizes research findings in
her practice.
One of the areas where a PHN functions is disease surveillance. It is a continuous
collectin and analysis of data of cases and deaths. The purposes of disease surveillance
are: (a) to measure the magnitude of the problem and (b) to measure the effect of the
control program.

The Public Health Nurse II works in a health center where she is the frontline health
worker and prime mover for all health programs and activities.

She is the first contact of the patient in the health center, where she screens cases
according to established program protocol. She only refers cases to physicians when its
not within her responsibilities to manage. Se assists the physician during consultation and
examination and gives treatment to patients. She provides health education to the public
by giving pre and post clinic lectures, reaching out to the community by conducting
mother’s classes and organizing community assemblies for health promotion as well
disease prevention and control. She performs home visits or follow cases that requires
nursing care and teaches the family members to care to the sick. Apart from the
mentioned functions of the PHN, she has prepare and submit the necessary reports
required of her, which are done weekly, monthly, quarterly or annually.

The PHN III performs the same functions but differs from the PHN II in the sense that
when they are assigned in the same health center, the PHN III acts as the nurse-in-
charge. She supervises. guides, coordinates and evaluates the work of her nurses. She
likewise interprets policies and participates in planning health programs or activities that
involves nursing service.

The Nurse V otherwise known as the "Supervising Public Health Nurse", is assigned in a
health center with a lying-in clinic, and takes charge of the unit, with several staff
members, assuming a bigger responsibility than the rest. She supervises and coordinates
the work of nurses, midwives and other health personnel and guides them in carrying out
health related activities ensuring that they use correct procedures and techniques. She
participates in program planning, provides training and guidance to in-service trainees
and student affiliates. She attends meetings, conferences or seminars for her own career
growth and for the improvement of health services. Still part of her task is to evaluate the
performance of her staff and analyze records and reports.

As the PHN moves up to a higher level, she then becomes a "Nurse Program Supervisor"
or Nurse VI who manages and oversees the performance of a group of nurses assigned
in a number of health centers covered by a particular district or area. Her functions include
performing consultations and objective assessment and evaluation of nursing programs,
problems and services. She consolidates / evaluates and analyzes the necessary weekly,
monthly, quarterly, and annual reports of the health center. She studies and evaluates
the performance ratings of nurses. She initiates meetings, discussions and conferences
to provide joint planning to stimulate activities among nurses and other health personnel.
She conducts program orientation to and in-service nurse trainees and students and
coordinates with other health disciplines in the implementation of programs. She likewise
acts as an consultant on technical matters.
 STANDARDS OF PUBLIC HEALTH NURSING PRACTICE
I.Standards of Care
A. Assessment
B. Population DIagnosis and Priorities
C. Outcomes Identification
D. Implementation
1. Coordination
2. Health Education and Promotion
3. Consultation
4. Regulatory Activities
E. Evaluation
II.Standards of Professional Performance
. Quality of Practice
A. Education
B. Professional Practice Evaluation
C. Collegiality and Professional Relationships
D. Collaboration
E. Ethics
F. Research
G. Resource Utilization Population
H. Leadership

Like all types of Nurses, a Public Health Nurse has standards to maintain and live
up to. A public Health nurse’s roles and responsibilities revolves mainly around three main
proponents. Health Promotion, Disease Prevention, and Health Protection. The following
standards were generated by the American Nurses Association (2007). The Public Health
nurse must be capable of the following.

(1) Assessment of the population. The public health nurse must be able to collect
data with regards to the health status of the population the nurse serves.

(2) Population Diagnosis and Priorities. The public health nurse should be
knowledgeable on the manner with which they could use the data collected to be able to
determine a diagnosis and organize priorities.

(3) Outcomes Identification is where the nurse would plan their desired outcomes
for the priority objective.

(4) In Planning, the nurse must be able to develop a plan that would utilize the
strategies appropriate to attain expected outcomes.

(5) In Implementation, the nurse should be able to partner with others to obtain
their objective while maximizing resources within the community. The nurse should have
good coordination skills where the programs and activities should coincide with the
objectives to attain the desired objectives. The nurse should also be able to utilize multiple
strategies to promote health, prevent disease, and ensure a safe environment for the
population. The nurse should also be able to consult officials and community groups to
facilitate the cooperation and the implementation of the plan. Along with these, the nurse
should also be knowledgeable and be able to identify, interpret and implement public
health laws, regulations, and policies.

(6) Lastly, the public health nurse must be able to evaluate the health status of the
population after implementation.

Standards for the professional performance of public health nurses are as follows:

(7) The nurse must be able to systematically enhance the quality and effectiveness
of nursing practice.

(8) The nurse must attain knowledge and competency reflecting current nursing
trends and practice.

(9) The nurse must be able to evaluate their own practice to those of the
professional practice guidelines and standards relevant to rules and regulations.

(10) The nurse must be able to form collegial partnerships while interacting with
representative of the population and contributes to the professional development of peers,
students and colleagues.

(11) The nurse must collaborate with the representative of the population,
organizations, and services for the providing for and promoting of health of the population.

(12) The nurse must be able to integrate ethical aspects within all areas of their
practice.

(13) The nurse must be able to integrate research findings into their practice.

(14) The nurse must be able to consider the factors related to the safety,
effectiveness, and cost and their impact on practice in the planning and delivery of nursing
and public health programs.

(15) Lastly, the nurse must be a leader that could lead for the health of the public.

Non-communicable Diseases

Noncommunicable diseases (NCDs) are a major public health concern worldwide. The rapidly
escalating burden of these diseases is affecting the poor and the disadvantaged populations
disproportionately. The prevalence of NCD continues to rise in the Philippines and promoting
healthy lifestyle should be deemed as a priority especially with the current statistics. The
department of health said that “Diseases of the heart and vascular system made up almost one-
third (30.2%) of all deaths (Philippine Health Statistics, 2003)”. The other leading NCDs include
Cancer, COPDs, and Diabetes Mellitus. In 2008, the National Statistics Office reported that these
four diseases were also responsible for 54% of all deaths in the Philippines with 30 to 50 percent
of deaths attributed to NCDs occurring prematurely or before 60 years of age. The World Health
Organization themselves have said that NCDs have replaced infectious diseases particularly
pneumonia and tuberculosis as top-most common causes of deaths.

10 Leading Causes of M O R T A L I T Y 10 Leading Causes of M O R B I D I T Y

1. Acute lower RTI and Pneumonia 1. Diseases of the Heart
2. Bronchitis/Bronchiolitis 2. Diseases of the Vascular System
3. Acute Watery Diarrhea 3. Malignant neoplasm
4. Influenza 4. Pneumonia
5. Hypertension 5. Accidents
6. TB Respiratory 6. Tuberculosis, all forms
7. Diseases of the Heart 7. Chronic Lower Respiratory Diseases
8. Malaria 8. Diabetes Mellitus
9. Chickenpox 9. Certain conditions originating
10. Dengue in the Perinatal Period
10. Nephritis, nephrotic
syndrome & Nephrosis
Source: National Epidemiology Center, Department of Health

a. WHO PEN
b. Diabetes Mellitus Prevention and Control Program
1. Early detection and Management
c. Occupational Health Program - “Healthy Filipino Workforce”
1. The program addresses the incidence of occupational diseases and work-related
diseases and injuries among workers through health promotion and protection in all
workplaces.
2. Main target for the program are: Agricultural Workers, Small-scale Miners, Transport
Group, Public Health Workers (PHW)
3. Includes:
1. Chemical safety Management
2. Poison Control and Information centers
3. Toxic/Biohazard waste management
d. Cardiovascular Disease Prevention and Control Program.
1. Adopted in the context of health promotion in order to decrease the chances of the
targeted population to adopt high risk behaviors and habits that may lead to the
development of cardiovascular disease.
2. Includes
1. Healthy lifestyle advocacy campaign.
2. Establishment of Philippine Coalition on the prevention and control of
NCD.
3. Healthy lifestyle advocacy campaign.
4. Training manual for Health workers: WHO/ DOH smoking cessation clinic:
Helping smokers quit.
5. Manual of operations on the prevention and control lifestyle related non-
communicable diseases in the Philippines.
3. Development of
1. Service package for cardiovascular diseases.
2. Clinical practice guideline for cardiovascular disease.
e. Smoking Cessation Program
1. Reduced prevalence of smoking and minimizing smoking-related health risks.
2. Goal: Promote and advocate smoking cessation in the Philippines
3. Methods:
1. All DOH health personnel, local government units (LGUs), selected
schools, industrial and other government health practitioners must be
trained on the policies and guidelines on smoking cessation.
2. Smoke-free environment (SFE) shall be maintained in DOH and
participating non-DOH facilities
3. World No Tobacco Day (WNTD) every 31st of May and the World No
Tobacco Month every June.
4. Smoking Cessation Services
1. Patient Assessment Tool
2. WHO Mental Health Checklist
3. Motivation and Confidence to quit
4. Smoking History and Current Smoking Status
5. Self-test for reason for smoking (Horn's Smoker's Selt-test)
6. Fagerstrom Nicotine Dependencetest
7. Self-test on Readiness to stop smoking
 8. Previous attempts to stop smoking
9. Quit Contract
f. Violence and Injury Prevention Program
1. Administrative Order No. 2007-0010 National Policy on Violence and Injury
Prevention
2. The program aims to reduce mortality, morbidity and disability due to the following
intentional and unintentional injuries:
1. road traffic injuries
2. interpersonal violence including bullying, torture and violence against
women and children
3. falls
4. occupational and work-related injuries
5. burns and fireworks-related injuries
6. drowning
7. poisoning and drug toxicity
8. animal bites and stings
9. self-harm / suicide
10. sports and recreational injuries
3. Strategies
1. Online National Electronic Injury Surveillance System (ONEISS)
2. Philippine Network for Injury Data Management System (PNIDMS)
3. Advocacy
4. Six (6) E’s. Strategies shall utilize the concept of the six E’s (Education,
Enactment / Enforcement, Empowerment, Engineering, Emergency
Medical Service, and Engagement in surveillance and research)
g. GO4HEALTH
1. GO Sustansya
2. GO Sigla
3. GO Smoke-free
4. GO Slow sa Tagay
h. Health Promotion Campaigns
1. No Smoking Month
2. • Ehersisyong Pangkalusugan para sa Lahat
3. • Cancer Awareness Month
4. • Heart Month
5. • Hypertension Day
6. • Burn Injury Awareness and Prevention Month
7. • Kontra Paputok
8. • Red Orchid Award (Anti-Tobacco Award)
9. • HL (Healthy Lifestyle) to the Max
10. • Poison Prevention Week
11. • Nutrition Month
12. • National Disability Prevention and Rehabilitation Week
13. • National Diabetes Awareness Week
14. • Obesity Prevention and Awareness Week
15. • Drug Abuse Prevention and Control Week