St.

Paul University Iloilo

St. Paul University System

MODULE in COMMUNITY HEALTH NURSING I

Block 2 SY 2022-2023

Subject/Course Code: NCM 104A

Class Schedule:
Instructor/Professor: Marilyn D. Junsay
Email/Contact Number: [email protected]

Course Description: This course deals with the concepts, principles, theories, techniques in
the provision of basic care on terms of health promotion, disease
prevention, restoration, maintenance and rehabilitation at the individual
and family level. It include the study of the Philippine Health Care Delivery
System, national health situation and the global context pf public health.
The learners are expected to provide safe appropriate and holistic nursing
to individual and family as clients in the community setting utilizing the
nursing process

Learner, please be mindful of the Paulinian Essential Elements that you are supposed to develop:

LIFE PERFORMANCE OUTCOMES (LPOs) ESSENTIAL PERFORMANCE ELEMENTS (EPEs)

LPO1. ETHICAL, PAULINIAN LEADERS & EPE1.1 Consistently adhere to acknowledged moral standards of decision making and
PROFESSIONALS behaviour in their personal, professional and organizational affairs;
EPE1.2. Declare and affirm the values and principles of honesty, transparency and fairness
AFFIRMATION in their professional lives and endeavours;
EPE1.3 Launch and sustain initiatives that openly advocate and tangibly uphold the rights
“As a Christ-centered Paulinian, I am a mindful, self and dignity of those seeking redress for injustices committed against them;
directed learner and role model, consciously expressing EPE1.4 Articulate, advocate and exemplify Paulinian ideals and values in their private and
my Faith”. professional lives nurtured by prayer and a deep relationship with God;
EPE1.5 Speak out to expose and redress violations of social and professional norms and
principles whatever the consequences may be.
LPO2. CUTTING-EDGE, RESILIENT VISIONARIES EPE2.1 Anticipate potential social and technological changes and proactively pursue fruitful
AND INNOVATORS ways of responding to them;
who EPE2.2 Gather information on emerging trends in their field and propose novel ways they
could incorporate them into their work;
AFFIRMATION: EPE2.3 Develop ideas for innovations in their field, testing meticulously their feasibility and
“As a Christ- centered Paulinian, I am a courageous, utility
resourceful explorer and problem solver, demonstrating EPE2.4 Look beyond conventional approaches to challenges in their field and identify
my creativity and charism”. creative ways these could be addressed;
EPE2.5 Explain significant setbacks they have experienced in life and the inner resources
and ‘out of the box’ actions taken to address and overcome them.

LPO3. ENGAGING, TRUSTWORTHY TEAM EPE3.1 Invite open, non-judgemental communication

BUILDERS AND MENTORS EPE3.2 Clarify at the outset the substance and intent of all agreements and commitments
who made, making every effort to fulfil them and supporting others to do the same;
EPE3.3 Publicly explain the purpose and potential benefits of all group endeavours, enlisting
AFFIRMATION: explicit agreement and support for them from participants before proceedings

“As a Christ-centered Paulinian, I am credible, EPE3.4 Initiate and develop jointly beneficial projects with colleagues in which plans and
responsive and communicator and team player, building responsibilities are equitably shared, reliably carried out and honestly evaluated by all;
community through active collaboration”. EPE3.5. Openly share relevant insights, observations and expertise with less experienced
colleagues, offering guidance and support when requested.
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St. Paul University System

EPE4.1 Continuously set and diligently pursue high performance standards and
LPO4 RELIABLE, PRODUCTIVE EXPERTS & improvement goals for themselves and for their organization;
IMPLEMENTERS EPE4.2 Accurately describe the knowledge and skills that adept career professionals in their
field consistently demonstrate, and evaluate whether theirs compare favourably;
Who EPE4.3 Devote significant time and effort to upgrading their competencies, the quality of
their work, and its tangible benefits to their colleagues and clients;
AFFIRMATION: EPE4.4 Accomplish projects and related work that meet or exceed quality standards within
agreed-upon timelines and resource limits
“As a Christ-centered Paulinian, I am conscientious, EPE5.5 Develop and regularly update a performance portfolio of their advancements in
adept performer and achiever, competently knowledge, techniques, and tangible accomplishments.
implementing my mission in life”.

EPE 5.1 Promote and actively participate in initiatives that benefit and directly support the
LPO.5 DEDICATED, TRANSFORMATIVE right of all creatures to exist and flourish;
SUPPORTERS & STEWARDS OF ALL CREATION EPE5.2 Devise programs and strategies that shift the momentum of society toward
consciously preserving and improving the viability of our planet’s eco-and social support
Who systems;
AFFIRMATION: EPE5.3 Devote their time, talents and resources to improving and maintaining the well-being
and health of peoples, especially the less privileged and underserved;
“As a Christ-centered Paulinian, I am a caring, EPE5.4 Mobilize others in advocating and implementing public policies and programs that
committed advocate for peace and universal well-being, foster peace, justice, solidarity and respect for life and cultures;
impelled by compassion and charity for all”. EPE5.5 Act decisively to inform others of ways they can tangibly reduce environmental
pollution and improve the quality of life in their local and larger communities.

As a Paulinian nursing student, you are also expected to exhibit the BSN Program Outcomes

Particularly to provide safe, evidence based appropriate and holistic care to individuals, families,
population groups and community utilizing nursing process in the delivery of care to clients and in
accordance with existing laws, legal, ethical and moral principles for safe nursing practice
(Please find the 14 Nursing Program Outcomes ( PO) in the course outline/syllabus)

Block 2 Sept 28, 2022

Topic: Epidemiology
Hours: 3 hours
Learning By the end of the lesson, learners are able to:
Outcom
es: 1. Explain epidemiology, how diseases developed and analyze how biological, social,
economic, environmental, cultural factors impact on man’ s health
2. Analyze the multiple factors in disease causation
3. Innovate ways and means of preventing and controlling the occurrence of selected
common diseases in the community

4. a. Adhere to ethico –legal considerations when providing safe quality and professional
nursing care in the care of individual / family in community setting.
b. Apply ethical reasoning and decision making process to address situations of ethical
distress and moral dilemma.
c. Adhere to established norms of conduct based on the Philippines Nursing Law and
other legal, regulatory and institutional requirements relevant to safe nursing practice in
the community.
- Cite the different mandates , Presidential decrees, Letter of Instructions and
 St. Paul University Iloilo
St. Paul University System

RAs for health promotion and disease prevention

(15
minutes) Given the following scenario, and with your prior knowledge in Community CHN I identify
the factors / lifeways that you think can contribute to disease causation

What are the factors and lifeways that you see in the image that can contribute to cause a disease
and match with the possible disease/s that the individual, population or community will be
affected of.

1.

2.

3.

4.

(15 Having knowledge of modes of transmission, since we cannot allow other people to have
minutes) close interaction with you ( due to COVID 19 issues) this activity will allow you to
understand how some disease can be transferred by airborne / droplet .

Requirements: Prepare the following: Soap and water to make soap suds, container for
soap suds, mask, tissue papers

Explore You are familiar with this exercise when you were young. ( Nice to throwback)
1. You are tasked to create a bubble using soap suds.
2. Blow the soap suds on air and make observation.
3. What happened? Where did it landed?
4. This time take a mask and tissue. Put on mask, cover your exposed parts of the body: part
of face, neck, hands with a tissue.
5. Blow the soap suds again and see what happened.
6. How can the bubbles simulated as droplet can become airborne?
7. Draw conclusion from this exercise taking into consideration the mode of transmission of
direct contact through airborne and droplet.

1.5
hours
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Concepts of Epidemiology

Description
⮚ It is the discipline that provide the structure for systematically studying health,
diseases and conditions related to health status.
Explain ⮚ It is used to understand and explain how and why health and illness occur as they do
in human population
⮚ It is the study of all factors in man’s environment that influence the occurrence,
distribution and causes of diseases
⮚ Frequency of occurrence of the state of health and illness
⮚ It is the backbone of disease prevention

Uses of epidemiology
❑ To measure the distribution and dimension of illness in terms of incidence, prevalence,
disability and mortality
❑ To diagnose the health of the community and the conditions of the people
❑ To understand the causes of diseases
❑ To explain local disease pattern
❑ To describe the natural history of the disease

Natural history of a disease

Refers to the events that occurs before its development, during the course and during its
conclusions
Stages:
1. Pre-pathogenesis
⮚ Before the detectability of the disease
⮚ Two stages:
o Stage of susceptibility: the disease is not yet present and the individual has
not been exposed.
However, host and environmental factors could very likely influence
people’s susceptibility to a causative agent and lead to the development of
disease
o Stage of Adaptation
- If exposure to an agent occurs at this time, a response will take place.
- Initial responses reflects the normal adaptation response of the cell or
functional system ( immune system).
- If this adaptation responses are successful, then no disease occurs and
the process is arrested in the second stage of pre-pathogenesis ,
adaptation.
2. Pathogenesis
⮚ Exposure stage: Occurs when the individual has been exposed to a disease but are
asymptomatic
⮚ Incubation period – the exposure to the organism to the appearance of the first signs
and symptoms. The organism multiplies to a sufficient numbers to produce a host
reaction and clinical symptoms
⮚ Induction or latency – some condition may have 5 years or more from exposure to
detection of signs and symptoms
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⮚ Early clinical stage or early discernible lesion stage – evidence of the disease or
condition is present and diagnosis occurs
⮚ Clinical disease stage – the health condition causes sufficient anatomic or functional
changes to produce recognizable signs and symptoms
⮚ Advanced disease stage – the disease may conclude with a return to health, a
residual or chronic form of the disease with some disabling limitations or death.

Levels of Prevention

Primary - Health promotion and Specific Protection

Secondary – early diagnosis and prompt treatment
Tertiary - rehabilitation

Identify what are the categories that belong in each levels. This will be included in the CS
assessment
For in depth discussion visit this site and take down notes:

Epidemiology and Prevention

https://www.ump.edu.pl/files/8_483_epidemiology_and_prevention.pdf Retrieved
September 3, 2021

Go to this site to have a deeper understanding of the concepts of epidemiology.

Introduction to epidemiology
https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section8.html#:~:text=The%20triad%20co
nsists%20of%20an,a%20source%20to%20that%20host.

Multiple factors in disease transmission. Agent, Host and the environment

Triad of disease causation:
Agent –
❖ An element, substance, or force, animate or inanimate , the presence or absence of
which may perpetuate a disease process
❖ Presence or absence of biologic, physical, chemical, nutritive, genetic, psychologic
factors that have the ability to affect health and disease in a person
-Biologic: Microorganisms/infectious agents bacteria, virus fungi, metazoa , etc.
-Chemical: Poison, drugs, gas, dust, fumes, vapors, pesticides, allergens
❖ Physical: heat, light, radiation, excessive sun exposure, intense sounds, vibration,
extreme heat/cold, light
❖ Mechanical: forces resulting in cutting, tearing, crushing.
❖ Nutritive elements: Avitaminosis, Vitamin/protein deficiencies

Host
A person, animal capable of being infected by an agent.
Factors:
⮚ Demographic characteristics ( age, gender, ethnic background, race, marital status,
religion, education, economic status)
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⮚ Levels of health and history of prior disease (genetic risk factors, physiologic states,
anatomical factors, response to stress, previous disease, nutrition, fitness
⮚ Genetic predisposition ( hereditary diseases)
⮚ States of immunity ( susceptibility vs. active or passive immunity)
⮚ Body defenses ( autoimmune system
⮚ Diet, exercise hygiene, occupation
Environment
⮚ Anything external to the person or agent, including the presence of other persons or
animals that potentially affect health and diseases.
⮚ Factors outside of the host that are associated with the development of disease,
disorder or injury.
- Geographic factors like climate, altitude, geography, pollution
- Physical properties: water, air climate, season, weather, geology, Biologic entities:
animals, plants, insects, food, drugs and food source
- Social and economic consideration: family, community, political organization, public
policy, regulations, institutions, workplace, occupation, economic status, technology,
mobility, housing population density, attitudes, customs, culture, health practices,
health services

This website will provide understanding of the interaction of agent, host and
environmental factors. This source will give you understanding how diseases is spread.
https://www.rivier.edu/academics/blog-posts/what-is-the-epidemiologic-triangle/
Retrieved September 3, 2021

Reservoir of Infection:
o Person, animal, arthropod, plant, soil, or substance, or a combination of these, in
which an infectious agent normally lives and multiplies, on which it depends primarily
for survival, and where it reproduces itself in such a manner that it can be transmitted
to a susceptible host.
o It is the natural habitat of the infectious agent.
o These are living bodies that harbor, sustain and maintain the growth and
multiplication of infectious agents

Human reservoir - infected persons from whom the infectious agents are transmitted
to other persons

Animal reservoir – animals that are infected with certain microorganism that would
prove to be pathogenic to man.

Types of Human reservoir

1. Frank or typical case –The persons are obviously ill with the disease. Frankly manifest
typical signs and symptoms of the disease
2. Subclinical Infectious case – symptoms are mild and the person can still perform her daily
routines and activities
3. Carrier- a person that does not manifest any signs and symptoms
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Animal Reservoir
- Dogs –reservoir for rabies
- Rats – bubonic plague, leptospirosis
- Birds – Bird Flu or Avian Flu

Mode of transmission of Diseases:

A. Direct - transfer of infectious agent without intermediary host as in kissing, touching,
biting, sexual contact, droplet spread when coughing and sneezing

Droplet spread – direct transfer of infectious agent by droplet as in coughing, sneezing

Organism that travels through the air very short distances that is, less than three feet from
the source to the host

B. Indirect contact – when the organisms are transmitted from a source (either animate or
inanimate) to a susceptible host by means of an inanimate objects

The infectious agent is transferred indirectly through intermediary agents of transmission

✔ Airborne-
o Infectious organism present in the air and is inhaled by susceptible host during
respiration. Infections of the mouth and throat
o Refers to infection spread by droplet nuclei or dust.
o Droplet nuclei are the residue from the evaporation of fluids from droplets, are light
enough to be transmitted more than 3 feet from the source and may remain airborne
for prolonged period
o To be truly airborne, the particles should travel more than 3 feet through the air
from the source to the host

✔ Vehicle borne transmission:

- Contaminated materials or inanimate objects that may be contaminated and served
as intermediary means by which the infectious agent is transported from reservoir
and introduce into susceptible host
- water – contaminated by sewage as in cholera, dysentery
- Food. – improper handling, poor preparation. Like food poisoning, typhoid fever
- Milk- contaminated udder of animals during milking
- Air – air pollution
- Soil – parasitic infections
- Fomites- personal articles or objects used by infected persons ( Towels,
handkerchiefs,
linens, spoons and other personal articles

✔ vectors / insects borne transmission

- Vectors - arthropods or invertebrates which transmit infections by
inoculations into the skin or mucous membrane as in biting or depositing
infective materials in the skin, foods and other objects.

Patterns of occurrences and distribution of diseases

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1. Epidemic
⮚ The occurrence of unusually large number of cases in a relatively short period of time
⮚ Involves the occurrence of great number of cases of a disease far beyond what would
ordinarily be expected in a population
⮚ Short time fluctuation – changes in disease frequency in a very short time

2. Endemic
⮚ The continuous occurrence of cases throughout a period of time of the usual number
of cases in a given locality.
⮚ Diseases that are constantly present to certain locality to a greater or lesser degree
in a year round ( Schistosomiasis in Samar / Leyte; Malaria in Palawan and
Mindanao)
3.Sporadic
The occurrence of few isolated cases of a disease ( rabies, polio, )

4. Pandemic
⮚ World-wide occurrence of diseases ( SARS, Meningococcemia, COVID 19)
Epidemic Curve:
1. Common source epidemic
Exposure of group of people to common vehicle
( water, milk, foods)
The onset is rapid

2. Propagated epidemic
✔ Direct or indirect transmission of an infectious agents from an infected individual to
susceptible person
✔ The onset is gradual until all number of susceptible are exhausted
✔ person to person ( measles, mumps)
✔ arthropods/ vectors ( H fever, malaria)
Legal Mandates:
There are laws and decrees that will help protect our people from the menace caused by
humans to the community, to the world and the planet earth.

1. Presidential decree (PD) 825- pertains to the law on regulating the improper disposal of
garbage and other forms of human wastes.
2.PD 856 code on Sanitation
3. RA. 9275 Clean Water Act of 2004
4. RA 9003 Ecological Solid waste management
5. RA 8749 Clean Air Act of 1999
6. RA 3573 on Notifiable Disease. Amended by:

RA 11332 Mandatory Reporting of Notifiable Diseases and Health Events of Public Health
Concerns Act
( Amended RA 3573) Read the provision of this RA in this link.

RA. 11332 Center for Disease control and Prevention. Introduction to Epidemiology
https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section8.html#:~:text=The%20triad%20co
nsists%20of%20an,a%20source%20to%20that%20host.
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30 Moving
minutes

Elaborate

Given this image above:

1. Cite at least 5 health issues, health threats present in this community.
2. What possible epidemiological conditions will happen in this community if factors
that may cause diseases are not eradicated
( No need to submit output.)

The Story of Jaydan

The Story of cholera

Expanded
Learning
Opportuni
ties:
Assessme Quiz will be given to assess understanding
nt Tasks Quiz for class participation /class standing will be given face to face as announced

Resourc Department of Health( 2007) Public Health Nursing in the Philippines19th ed. 2007
es/ ( No updated edition )
Referen
ces: Maglaya , A. ; Earnshaw R.; Lao-Nario M.B. ; Maglaya, C. ; Dones, L. , Rabuco, L. et. Al (2009 )
Nursing in the Community. Argonauta Corp. Phil. 5th ed

Web-searched resources
Epidemiology and Prevention. https://www.ump.edu.pl/files/8_483_epidemiology_and_prevention.pdf
Retrieved August 30, , 2022

Center for Disease control and Prevention. Introduction to Epidemiology

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section8.html#:~:text=The%20triad%20consists%20of%20an,a%
20source%20to%20that%20host. Retrieved September 23, 2022

Revier University.What is Epidemiologic Triangle.

 St. Paul University Iloilo
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https://www.rivier.edu/academics/blog-posts/what-is-the-epidemiologic-triangle/
Retrieved September 23, 2022

RA. 11332 https://www.officialgazette.gov.ph/downloads/2019/04apr/20190426-RA-11332-

RRD.pdf Retrieved September 23, 2022

Prepared by:

MARILYN D. JUNSAY
CON FACULTY