COMMUNITY HEALTH NURSING II- MODULE 1

Part 1

Health- a state of complete physical, mental, and Public health-Nursing:

social well being and not merely the absence of Community-oriented nursing
disease or infirmity (WHO,1994). - A philosophy of nursing service delivery
that involves the generalist or specialist
Community public health and community health nurse.
Requisites for health (OTTAWA 1986): - The nurse provides health care through
● Peace community diagnosis and investigation of
● Shelter major health and environmental problems,
● Education health surveillance, and monitoring and
● Food evaluation of community and population
● Income health status for the purpose of disease
● Stable ecosystem and disability and promoting, protecting,
● Sustainable resources and maintaining health to create
● Social justice conditions in which people can be healthy.
● Equity
Community-based nursing
Healthy Community - Setting specific practice whereby care is
- continually creates and improves the provided for clients and families where
environment and expands resources such that they live, work, and attend school.
the prerequisites for health are provided and all - The emphasis of community-based
citizens move toward the broad definition of nursing practice is acute and chronic care
health. and the provision of comprehensive,
coordinated, and continuous practice.
Public health practice: - Nurses who deliver community-based
- “What we, as a society, do collectively to assure care are generalists or specialists in
the conditions in which people can be healthy (IM, maternal/infant, pediatric, adult, or
1988). psychiatric/mental health nursing.
- “An organized activity of society to promote,
protect, improve, and when necessary restore Public Health Foundation Pillars:
health (Scutchfield & Keck, 2009). ● Assessment
● Policy Development
Era’s: ● Assurance
1st Epidemiologic Era- infectious disease Service Delivery Concentration:
2nd Epidemiologic Era- cellular aberrations ● Health promotion
3rd Epidemiologic Era- mental, physical, ● Health protection
emotional alterations ● Disease prevention

Branches of Public Health: Public Health Intervention Wheel:

Nursing ● Advocacy
Medicine ● Social Marketing
Engineering ● Policy Development
● Surveillance
● Etc. (+11 interventions)
Community-Oriented Nursing Practice Model
(Stanhope & Lancaster, 2012)
Assumptions: Assessment
● The model shown is a flying balloon,
representing community-oriented nursing First: Understand the Systems within the
and is filled with knowledge, skills, and Community
abilities needed in this practice to carry
the world. >Place
● The public health foundation pillars of Measures: geopolitical boundaries, local or folk
assurance, assessment and policy name of area, size (in acre, sq. miles, blocks),
development hold up to the world of transport avenues (such as rivers, highways,
communities, where people love, work, railroads, and sidewalks), history, physical
play, go to school, and worship. environment (such as land use patterns, housing
● The ribbons flying from the balloon conditions).
indicate the interventions used by nurses.
This serves to provide lift and direction, > People and Person
tying the services together for the clients Measures: population (no. and density),
that are served. demographic structure of population (age, race,
“Fulfilling society‟s interest in assuring conditions socioeconomic status, racial distribution, rural and
in which people can be healthy (IM, 1988).” urban character).
Informal groups: block clubs, service
Public Health foundation Pillars: clubs, friendship networks
- The public health foundation pillars of Formal groups: schools, churches,
assurance, assessment, and policy businesses, industries, gov‟t bodies,
development hold up the world of unions, health & welfare agencies.
communities, where people love, work,
play, go to school, and worship. > Function
Measures: production, distribution and
FIRST PILLAR: Assessment consumption of goods and services.
 Regularly and systematically collect, - Socialization of new members,
assemble, analyze, and make available maintenance of social control, adapting to
information on the health of the ongoing and expected change.
community. It includes statistics on health
status, community health needs, and Examples of data sources:
epidemiologic and other studies of the
population (Scutchfield & Keck, 2009).
Maps Local News Paper
 Refers to systematically collecting data on
the population, monitoring the population‟s City gov‟t Library Archives
health status, and making information
available about the health status of the Census data Local Housing
community (Stanhope & Lancaster, Offices
20120).
Examples of data sources:

Census data Tourist Bureau

Churches Tel. Directory

Senior Center State Officials

Civic groups State Departments

 >Structure
Examples of data sources:
Measures:
Health facilities such as: hospitals, nsg. homes,
State Dept. Police Station
industrial and school health services, health
Business & Labor Welfare Agencies departments, voluntary health associations.
Health manpower such as: physicians, dentists,
Local Library Churches nurses, environmental sanitarians, social workers.
Health resources use pattern such as:
Social and Local
Res. Reports Bed occupancy days, client/provider visits.

>Process
Second: Understand the Dimensions Measures: commitment to community health,
within the Community awareness of self and others and clarity of
situational definitions, effective communication,
> Status conflict containment, management of
Three areas of concern: relationships with society.
a. Biological part- focuses on health
indicators (Mortality & Morbidity rates, life
expectancy rates, case fatality Examples of data sources:
ratio/rate,etc).
b. Emotional part- measured through Health Dept. NGO‟s
satisfaction rates and mental health
Support Groups
indices.
c. Social part- measured through the social Census Date
functional level of the members of society
(e.g crime rates, worker absentism).
Examples of data sources:
> Structure
Measures of community health services and Local News Paper Health Insurance
resources: Databases
a. Service use patterns
Local Gov‟t.
b. Provider-to-client ratio (data will provide
number of available hospital beds or the Professional
number of necessary facilities within a Licensing boards
care facility).
Hospital Reports
> Process
- Community health when viewed in terms
Examples of data sources:
of process deals with the process of
effective community functioning or
problem solving. In its sense, it will direct State Dep‟t. Community Meeting
notices
the study of community health for
community action. Local History Windshield survey:
Observation of
>Status interactions
Measures: vital statistics (live births, neonatal
Neighborhood Help
deaths, infants deaths, maternal deaths), Org.
incidence and prevalence of leading causes of
mortality and morbidity, health risk profiles of
selected aggregates, functional ability levels.
Third: Understand the Community The practitioner will be able to:
Behavioral Health Needs 1. Facilitate collation and analysis of data
2. Identification, clustering, and prioritization
- We need to understand the theory in the of problems/needs
community because theories comprise 3. Planning of health programs and
principles devised to explain a group of intervention
facts or phenomenon. 4. Implementation of plans/ programs
- Thus, health behavior theories are meant 5. Monitoring and evaluation
to provide broader understanding of that
behavior and its links to the general COMMUNITY NURSING PROCESS (ADPIE)
human condition. As these are vital and
influential to the social determinants of ONPRIME MODEL
health in the community.  ONPRIME integrates many of the public
- health core competencies within a single
Common Theories: phase, recursive model.
● Communication  ONPRIME components will contribute
● Economics toward the development skills in:
● Psychology  Leadership and systems thinking
● Philosophy (broad) (comm. organizing)
 Analysis and assessment (esp. needs
Common Theories utilized in Practice: assessment and evaluation)
● Communication Theories:  Policy dev‟t and program planning
(Prochaska & DiClemente, 1998) (priority setting)
 Communication Persuasion Model  Community dimensions of practice
(1989) (needs and resource assessment)
 Transtheoretical Approach  Communication (interventions)
● Behavioral Change Theories  Management (monitoring and eval)
- Provide strategies for tailoring  and Cultural competency as well as
interventions to individual
 Public Health
participants.
- Behavioral Analysis Theory
Organization
(Skinner, 1953; Holland & Skinner,
- refers to whether the program entails working
1961; Baer et.al.,1968;
within existing organizations, working through
Miller,1980)
various community gatekeepers, program
- Social Learning Cognitive Theory
planners, grassroot workers to develop a
sponsoring structure where no apparent
candidate exists.
Things to Note when Facilitating Assessment
- Therefore, establishing organizations
as a Pillar:
within the community provides links and
relationships to facilitate entry,
assessment and delivery of programs.

Needs & resource assessment

- this phase may include key informant reviews,
archival research, surveys, examinations of
existing health and related env‟t needs, economic
and social problems. The program planner may
- Understanding of the community and also be directed through activities that have been
practice and population and the indices conducted in the past and how community
that influence and work within = resources have been, or could be used to
ASSESSMENT address the problem.
 - Therefore, a successful health program Evaluation
looks at the community as one that has - determine whether a program was effective or
many strengths, abilities, and potential which of its elements were most effective.
resources that can be employed to - Therefore, evaluation information may be
address a problem. used to determine whether to extend a
program and promote its generalization to
Priority setting other communities, or conversely, whether
- occurs after data are collected by health to terminate or revise the effort.
officials, community advisory boards,
representative individuals within the community. ASSESSMENT AS CORE FUNCTION
Health data and information is examined to help (Activities and Sub-Activities)
establish health-and-disease-related priorities.
- Therefore, communities that have been 1. Monitor health status to identify
successful in selecting their own community health problems
interventions or targeted health priorities  Participate in community assessment-
will likely embrace a program over a proofing, comm. Survey, etc.
longer period of time.  Identify subpopulation at risk for
disease or disability- high risk infants
Research under the age of 1 year, unmarried
- in this process, research does not focus on pregnant adolescents.
epidemiology (as a separate context for research  Collect information on interventions to
in public health) or survey research to identify the special population.
health problems. Instead, focus on the formative  Define and evaluate effective
and other qualitative/ quantitative research strategies and programs- by
needed to develop health behavior change. evaluation, assessment of strategies
- Therefore, qualitative and quantitative and programs will help determine the
research is conducted specifically to baseline efficacy of such to the
develop new techniques or refine old population.
ones.  Identify potential environmental
hazards.
Intervention Activities
- done after the aforementioned (ONPR) phases 2. Diagnose and investigate health
have been completed. The program planner/ problems and hazards in the
manager develops a set of intervention activities community
through the most techniques available.  Understand and identify determinants
Techniques: (personal and social) of health and
 Individual level behavioral change disease-
 Communication activities Personal: health seeking behavior,
 Changes in physical and environment practices;
 Skills building Social: health systems, environment,
 Policy change socially learned behaviors, etc.
 Apply knowledge about environmental
Monitoring influences of health.
- comprises both the monitoring of the  Recognize multiple causes or factors
implementation process of health and illness.
(e.g “were televisions shows aired on their  Participate in case identification and
supposed time slot?”) as well as responses to treatment with persons with
interventions (e.g “after a grocery store promotion communicable diseases.
was undertaken, what sales changes occured?”)
SECOND PILLAR: Policy Development 1. State and National Legislation
 Serve the public interest in the  Statutes- the state and national
development of comprehensive public legislation create the law through the
health policies by promoting use of enactment of statutes that are often
scientific knowledge (Scutchfield & Keck, broadly worded yet provide a
2009). framework and objectives as guidance
 Refers to the need to provide leadership in for addressing a specific issue.
developing policies that support the health  Regulations- agencies are often
of the population, including the use of delegated the task of implementing a
scientific knowledge-based in making particular statute by issuing
decisions about policy (Stanhope & regulations that may entail defining
Lancaster, 20120). core terms, adopting standard for the
industry, interpreting ambiguous or
Public Policy broadly worded phrases of terms, and
- Is described as all gov‟t activities, direct or outlining attendant costs and benefits.
indirect, that influences the lives of all
citizens. Policy Development (The Process)
Policy - Process of turning health problems into
- Is a settled course of action to be followed workable action solutions.
by a specified gov‟t or institution to obtain  Cost- how will this impact the economy
a desired end = SPECIFIC. of the country, state, and
organization?
Policy Development  Access- with the bill, will there be
- The law affects public health by setting access and would the targeted
boundaries of authority among decision population benefit?
makers and to the extent possible,  Quality- how is quality assured in
ensuring transparency and accountability terms of law enforcement, outcomes
in the process. delivery and the processes involved?
- Public health law may be defined as that
branch of jurisprudence which treats the Policy Development (Key Elements)
relation and application of the common  A- statement of health care problem
statutory law to the principles, and  D- Statement of policy options to
procedures of hygiene, sanitary science, address the health problem
and public health administration (Tobey,  P- adoption of a particular policy
1947 in Bhattacharya, 2013). option
- Public health law is the study of legal  I- implementation of the policy product
powers and duties of the state, in
 E- evaluation of the policy‟s intended
collaboration with its partners (e.g health
and unintended consequences in
care, business, the community, the
solving the original health problem
emedia, and the academe), to ensure the
- Thus, the policy process is very similar to
conditions for the people to be healthy,
the nursing process, but the focus is on
and of the limitations on the power of the
the level of the larger society and the
state to constrain for the common good
adoption strategies require political (the
the autonomy, privacy, liberty, propriety,
art of influencing others to accept a
and other legally protected interests of
specific course of action) action.
individuals (Gostin, 2008 in Bhattacharya,
2013).
Policy Development (Evaluation Process) POLICY DEV’T AS CORE FUNCTION
 Engage Stakeholders- this includes (Activities and Sub-Activities)
those who are involved in planning,
funding, and implementing the program, 3. Inform, educate, and empower people about
those who are affected by the policy, and health issues
the intended users of its services.  Develop health and educational plans for
individuals and families in multiple
 Describe the Program- the program settings.
description should address the need for  Develop and implement community-based
the program and should include the health education.
mission and goals. This set the standard  Provide regular reports on health status of
for the judging results of the evaluation. special populations within clinic settings,
community settings, and groups.
 Focus the Evaluation Design- describe  Advocate for and with underserved and
the purpose for the evaluation, the users disadvantaged populations.
who will receive the report, how it will be
used, the questions and methods to be 4. Mobilize community partnership to identify
used, and any necessary agreement. and solve health problems
o Gather Credible Evidence-  Interact regularly with many providers and
specify the indicators that will be services within each community.
used, source of data, quality of  Convene groups and providers who share
data, quantity of information to be common concerns and interests in special
gathered, and the logistics of the populations.
data gathering phase. Data  Provide leadership to prioritize community
gathered should provide credible problems and dev‟t. of interventions.
evidence and should convey a  Explain the significance of health issues to
well-rounded view of the program. the public and participate in developing
plans of action.
○ Justify Conclusions- the 5. Develop policies and plans that support
conclusions of the evaluation individuals and community health efforts
should be validated by linking them  Participate in community and family
to the evidence gathered and then decision-making processes.
appraising them against the values  Provide information and advocacy for
or standard set by the consideration of the interests of special
stakeholders. Approaches for groups in program dev‟t.
analyzing, synthesizing, and
 Develop programs and services to meet
interpreting the evidence should be
the needs of high-risk populations as well
agreed on before data collection
as broader community members.
begins to ensure that all needed
 Participate in disaster planning and
information will be available.
mobilization of community resources in
emergencies.
○ Ensure Use and Share of
 Advocate for appropriate funding for
Lessons Learned- use and
services.
dissemination of findings require
deliberate effort so that the lessons
learned can be used in making
decisions about the program.
THIRD PILLAR: Assurance Assurance (Role of Devolution in Service
- Ensuring that essential community- Delivery)
oriented services are available
- Making sure that a competent public
health and personal health care workforce
is available
- Public health in the assurance should be
involved in developing and monitoring the
quality of services provided (Stanhope &
Lancaster, 20120).
We focus on:
 Healthcare Workforce and Services
 Social Structures and Systems
 Population as Clienteles
 Assuring the constituents that services
necessary to achieve agreed upon goals
are provided, either by encouraging
actions by other entities (public/private
sector), by requiring such acts through
regulation or by providing services directly
(IM, 1988).
ASSURANCE IN SERVICE DELIVERY
Partnership (Public/Private Partnership):
 Politics Key Areas:
 Advocacy 1. Healthcare Workforce and Services
2. Social Structure and Systems
 Lobbying
3. Population as Clienteles
Policy and Law Enforcement:
Healthcare Workforce and Services
 Health Education
● Entry Level Competence
 Social Marketing
- Bachelor‟s Degree Holder in Nursing
 Community Organizing Activities
- An Active Philippine Nursing License

Assurance (Law Enforcement)

● Advanced Practice, Supervisory Roles
> Executive Branch- suggests, administers, and
(Health Program Manager, Nurse
regulates policies.
Supervisor), Specialty Practice (Nurse
 President
Epidemiologist, Researcher, Nurse
 Vice- President Genetic Counselor)
 Cabinet 1. Professional experience in Public
Health
> Legislative Branch- identifies problems and to 2. Program Trainings
propose, debate, pass, and modify laws to 3. Post Graduate Education
address problems. Masters:
 Congress - Master in Public Health
 Senate - Master in Science in Nursing major in
 House of Representatives Community or Public Health
Doctorate:
>Judicial Branch- interprets laws and their - Doctor in Public Health
meaning, as in its ongoing interpretation of rights - Doctor in Philosophy, Nursing, Nursing
to define access of health services to the state. Science
 Supreme Court - Doctor in Nursing Science
 Other courts 4. Certified in Public Health License
(optional)
Ethics in Public Health Utilitarianism
- “A branch of philosophy that includes both HOW TO: Apply the Utilitarianism Ethics
a body of knowledge about the moral life 1. Determine the moral rules that are
and a process of reflection of determining important to society and that are derived
what persons ought to do or be, regarding from the principle of utility.
life” 2. Identify the communities or populations
Bioethics that are affected or most affected by the
- “A branch of Ethics that applies the moral rules.
knowledge and process of ethics to the 3. Analyze viable alternatives for each
examination of ethical problems in health proposed action based on the moral rules.
care” 4. Determine the consequences or outcomes
Ethical Theories of each viable alternative on the
- Consequentialism communities or populations most affected
- Deontology by the decision.
- Utilitarianism 5. Select actions on the basis of the rules
that produce the greatest amount of good
GUIDING THEORIES OF ETHICS or the least amount of harm for the
- GOAL: “To choose that action or state of communities or populations that are
affairs that is good or right in the affected by the actions.
circumstance”
Deontology
Consequentialism - “Deontology is an ethical theory that uses
- “Holds that the consequences of one‟s rules to distinguish right and wrong”
conduct are the ultimate bias for any - Ex. “Don‟t lie, Don‟t steal, Don‟t cheat, etc)
judgment about rightness or wrongness of = Universal Moral Laws
that conduct”
Putting Into Perspective
Putting Into Perspective 1. It requires that people follow the rules and
1. The Nurse may diagnose a situation on do their duty. This approach fits well
the basis of the best available information without natural intuition about what is or
then choose the course of action that what isn‟t ethical.
seems to provide the best ethical 2. Unlike consequentialism, (which judges
resolution to the issue. action by their results) deontology doesn‟t
2. Most of the people agree that lying is require weighing the costs and benefits.
wrong but, if telling a lie would help save a This avoids subjectivity and uncertainty
person‟s life, consequentialism says it‟s because you only have to follow set rules
the right thing to do.
Things to Keep in Mind
Things To Keep In Mind - “People SHOULD follow the rules and DO
- Consequentialism is sometimes criticized their duty”
because it can be difficult, or even - For example, suppose you‟re a software
impossible, to know what the result of an engineer and learn that a nuclear missile
action will be ahead of time. is about to launch that might start a war.
- Indeed, no one can know the future with You can hack the network and cancel the
certainty. launch but it‟s against your professional
code of ethics to break into any software
system without permission and it‟s form of
lying and cheating.
- Deontology advises not to break or violate
these rules. However, in letting the missile
launch, thousands of people will die.
- So following the rules makes deontology
easy to apply. But it also means
 disregarding the possible consequences - “The fallacy with dissemination is that
of our actions when determining what is there is no built-in accountability that what
right and wrong. is disseminated will be read or
understood, harm could come to groups
ETHICS AND THE CORE FUNCTIONS OF and populations regarding their health
PUBLIC HEALTH status.
(Population-Centered NUrsing Pactice)
Policy Development
Assessment - We remember that: “Refers to the need in
- We remember that: “Assessment refers to developing policies that support the health
the systematic collection of population of the population, including the use of
data, monitoring the population's health scientific knowledge base in making
status and making information available decisions about policy.”
about the health of the community”
First Ethical Tenet: “An important goal of both
First Ethical Tenet: “Relates to the competency policy and ethics is to achieve the public good
related to knowledge development, analysis, and (Silva, 2002)”
dissemination” - “The concept of the „public good‟ is rooted
- “Are the persons assigned to develop in citizenship (Denhardt & Dendhart, 2000;
community knowledge adequately Rogers, 2006; Ruger, 2008)
prepared to collect data on groups and - “Democratic Citizenship”, as a stance in
population?” which citizens play a more substantial role
- This question is important because the in policy development. For this to occur,
research, measurement, analysis citizens must be willing NOT ONLY to be
techniques used to gather information informed about policy, but also to DO what
about the population usually differ from is in the interest of the community.
techniques to assess individuals.
- “Wrong research technique can lead to Second Ethical Tenet: “Service to others over self
wrong assessments, which in turn, may is a necessary condition of what is “good” or
hurt rather that help the intended “right” policy”
population” - Perspective of the 2nd Tenet accdg. to
Denhardt & Denhardt (2000):
Second Ethical Tenet: “Relates to virtue ethics or 1. “Serve rather than steer, is to help citizens
one‟s moral character” accumulate and meet their shared interest
- “Is the person selected to develop, rather than to attempt to control or steer
assess, and disseminate community society in a new direction”
knowledge process integrity?” - “Attuning oneself with the felt needs of the
- The importance of this virtue is self community to develop their potential
evident: without integrity, the core function (Gaviola, 2019)”
of assessment is endangered. Persons 2. “Serve citizens not customer, thus public
with compromise integrity are easy prey servants do not merely respond to the
for scientific misconduct. demands of customers but focus on
- “An example: Nurses would be bias in building relationship of trust and
collecting or reporting based on racism or collaboration with and among the citizens”
homophobic grounds.” 3. “Value citizenship and public service
above entrepreneurship, where there
Third Ethical Tenet: “Relates to do no harm” should be commitment to making
- “Is disseminating appropriate information meaningful contributions to society rather
about groups and populations morally than acting as if public money is solely
necessary and sufficient?” owned.
- The answer to “morally necessary” is yes,
but to “morally sufficient”, it‟s no.
Third Ethical Tenet: “States that what is ethical is ● Public health should seek the information
also good policy” needed to implement effective policies
- “What is ethical should be singular and programs that protect and promote
foundational pillar upon which nursing is health.
based” ● Public health institutions should provide
communities with the information they
Assurance have that is needed for decisions on
- We remember that: “Refers to the role of policies or programs and should obtain the
public health in ensuring that essential community‟s consent for their
community services are available, which implementation.
may include providing personal health ● Public health institutions should act in a
service.” timely manner on the information they
- “Assurance also refers to making sure have, within the resources and the
that competent public health and personal mandate given to them by the public.
healthcare workforce is available” ● Public health programs and policies
should incorporate a variety of
First Ethical Tenet: “All persons should receive approaches that anticipate and respect
essential personal health services or, put in terms diverse values, beliefs, and cultures in the
of justice, “to each person a fair share”, or community.
reworded, “to all groups and populations fair ● Public health programs and policies
share.” should be implemented in a manner that
- This perspective does not mean that all most enhances the physical and social
persons in society should share all of environment.
society‟s benefits equally, but that they ● Public health institutions should protect
should share at least those benefits that the confidentiality of information that can
are essential” bring harm to an individual or community if
made public. Exceptions must be justified
Second Ethical Tenet: “Providers of public health on the basis of high likelihood of
service are competent and available.” significant harm to the individuals or
- This doesn‟t speak directly to workforce others.
availability but, it does speak directly to ● Public health institutions should ensure
ensuring professional competence of the professional competencies of their
public health employees. employees.
● Public health institutions and their
ETHICS IN THE PRACTICE PUBLIC HEALTH employees should engage in
(Population-Centered Nursing Practice) collaborations and affiliations in ways that
● Public health should address principally build the public‟s trust and the institution‟s
the fundamental causes of disease and effectiveness.
requirements for health, aiming to prevent
adverse health outcomes ASSURANCE IN THE PUBLIC HEALTH
● Public health should achieve community 1. The Healthcare Workforce and Services
health in a way that respects the rights of
individuals in the community. ● Professional Development and
● Public health policies, programs, and Competence
priorities should be developed and - Entry Level Competence (Bachelor's
evaluated through processes that ensure Degree in Nursing and Active Professional
an opportunity for input from community Board Licenses)
members. - Advanced Practice (Post Graduate
● Public health should advocate and work Education, e.g Masters/Doctorate, Post
for the empowerment of disenfranchised Graduate Certifications/Licenses
community members, aiming to ensure
that the basic resources and conditions
necessary for health are accessible to all.
 ● Theories of Ethics Let‟s Take into Account…
- Utilitarianism
- Deontolgy
- Consequentialism
● Ethics in Public Health
- 12 Ethical principles in Public Health
Practice

2. Social Structure and Systems

3. Population as Clienteles
- [Applicable for 2&3]
- Culture
- Culture Development
- The Philippine Public Health Culture of
Care
- Culture Competence and Development

Culture
- “A set of beliefs, values, adn assumptions Assumption 1: It takes time for culture to develop
about life that is widely held among a and is resistant to change
group of people and that are transmitted - Question1: Why is it necessary to
intergenerationally” examine the evolution of the Philippine
Culture?
ASSUMPTIONS:
- It takes time for culture to develop and is
resistant to change
- In response to the need of its members
and the environment, culture provides
tested solutions to life‟s problems and as a
result, guides our thinking, discussion and
actions.
- Individuals learn about their culture during
the process of learning language and
becoming socialized, usually as a child. Collective Unconscious
- Each culture has an organizational - “Refers to structures of the unconscious
structure that distinguishes it from other. mind which are shared among beings of
the same species
You May Come To Ask?
- How does this influence one‟s care? Culture Modification
- Who are we as Filipinos and how should - Data Banking capability of the collective
we approach caring for the Filipino unconscious to modify culture. (Gaviola,
population? 2019)

Assumption 3: Individuals learn about their culture

during the process of learning language and
becoming socialized, usually as a child.

Assumption 4: Each culture has an organizational

structure that distinguishes it from others.
DISCUSSION OF THE THEORETICAL MODEL Archetype
Archetypal constructs are abstract images that is
collectively shared (Jung, 1980)

THE ARCHETYPAL THEORY OF PHILIPPINE

PUBLIC HEALTH CARE
1. The collective unconscious is assumed as
affecting universally, shared by all, Propositions:
through the constant collection of social 1. Culture birth begins with a blank state or a
experiences. state of “Tabula Rasa” which continuously
2. The openness of the diagram collects the nourishes itself from historical and present
unconscious databanking capacity and the events
ability to cultural modification. 2. The collective unconscious functions to
3. The residue of pre-colonial and colonial society through its data banking capability
era of which are integrated and that molds culture.
continuously influence society at present. 3. The mind‟s evolutional residue, ticks for
4. This then provides a collectively recognition on the present time from
understood unconscious that; formed social archetypes.
a. From pre-colonial era, the 4. Caring in Philippine public health is
flourishing of culture of the influenced by the pre-colonial and colonial
Philippines and its health practices identity.
have been grounded in faith
healing, belief of the unknown, Assumptions
herbal medicine and tabooed 1. Social archetypes from ancestral history
practices. develops through time and by a series of
b. During the colonial era, Spanish social events, phenomenon, and
culture was forcedly introjected for occurrences.
three hundred years that entailed 2. Social archetypes of culture determines
oppression, caste segregation, the definition of care for each culture and
civilization, normative formation lastly,
and religion establishment to the 3. Caring is influenced by culture. Which, at
native Filipinos which conversely its diversity, differs based on caring-
influenced today‟s segregation of culture history and formed archetypes.
social conception and practices
especially in the area of public Question 2: How does culture affect the quality of
healthcare. care we render to the population?
Question 3: How are our clients based on this
cultural representation?
DEVELOPING CULTURAL COMPETENCE So how do we develop cultural competence?

Cultural Competence 1. Cultural Awareness

- Combination of culturally congruent - Refers to the self-examination and in-
behaviors, practice attitudes, and policies depth exploration of one‟s own beliefs and
that allow nurses to use interpersonal values as they influence behavior
communication, relationship skills, and - Culturally aware nurses are conscious of
behavioral flexibility to work effectively in culture as an influencing factor on
cross-cultural situations. differences between themselves and
- Nurses who strive to become culturally others; and are receptive to learning about
competent respect individuals from the cultural dimensions of the client.
different cultures and value diversity - EXAMPLE: At a community outreach
- Culture competence reflects a higher level program, a nurse was teaching a racially
of knowledge than cultural sensitivity. mixed group, the screening protocol for
breast and cervical cancer detection. An
4 Principles in Culture Competent Practice African-American woman in the group
1. Care is designed for the specific client. refused to give the return demonstration
2. Care is based on the uniqueness of the for BSE. When encouraged, she said “My
client‟s culture and includes cultural norms breasts are much larger than those on the
and values. model. Besides, the models are not like
3. Care includes self-empowerment me. They are all white.”
strategies to facilitate client decision
making in health behavior. 2. Cultural Knowledge
4. Care is provided with sensitivity and is - Process of searching for and obtaining a
based on the cultural uniqueness of the sound educational understanding about
client. culturally diverse groups
- Emphasis is on learning about the client‟s
Key Elements in Developing Cultural world view from an emic (native)
Competence perspective
1. Experiences with clients from other - EXAMPLE: Middle Eastern women might
cultures not attend prenatal classes without
2. An awareness of these experiences encouragement and support from nurses.
3. Promotion of mutual respect for The nurse understands at middle eastern
differences culture, the mother‟s focus is at the
present and what is happening on an
Culturally Culturally Culturally immediate environment. The nurse may
Competen Sensitive Competent interject by forming strategies that would
t
facilitate understanding that prenatal
Cognitive Oblivious Aware Knowledgeable sessions are beneficial for the baby‟s
Dimension
future.
Affective Apathetic Sympathetic Committed to
Dimension change
3. Cultural Skill
Psychomotor Unskilled Lacking Highly Skilled - Ability of the nurse to effectively integrate
Dimension some skill
cultural awareness and cultural knowledge
Overall Effect Destructive Neutral Constructive when conducting cultural assessment and
to use the findings to meet needs of
Adapted: The Cultural Competence Framework; culturally diverse clients.
Stages of Competence Development, (Orlandi, - Culturally skillful nurse elicit from clients
1992) their perception of the health problems,
discuss treatment protocols, negotiate
acceptable options, select interventions
that incorporate alternative treatment
plans, and collaborate with all stakeholder.
 - EXAMPLE: Culturally competent nurses Indicators of Successful Encounter
use appropriate touch during conversation 1. The nurse feels successful about the
and modify the physical distance between relationship with the client.
and others while meeting mutually agreed- 2. The client feel that interactions are warm,
upon goals. cordial respectful, and cooperative
3. Tasks are done effectively
4. Cultural Encounter 4. Nurse and client experience little or no
- Refers to the process that permits nurses stress
to seek opportunities to engage in cross-
cultural interaction PUBLIC HEALTH CONCENTRATIONS
- 2 types of Cultural Encounter: Direct
(Face-to-Face) and Indirect 1. Health Promotion
- EXAMPLE 1 Direct Encounter: A direct - Health promotion enables people to
cultural encounter occurs when nurses increase control over their own health. It
learn directly from their Puerto Rican client covers a wide range of social and
about spicy foods that she will avoid environmental interventions that are
during periods of breastfeeding. designed to benefit and protect individual
- EXAMPLE 2 Indirect Encounter: An people‟s health and quality of life by
indirect cultural encounter occurs when addressing and preventing the root
nurses share these assessment findings causes of ill health, not just focusing on
with other nurses to help them develop treatment and cure.
their knowledge to effectively care for
other Puerto Rican clients who are 2. Health Protection
breastfeeding. - Health protection offers equality of
opportunity for people to enjoy the highest
5. Cultural Desire attainable level of health, and is achieved
- Refers to the nurses‟ intrinsic motivation to through the development and
want to engage in the previous four implementation of legislation, policies and
constructs necessary to provide culturally programmes in the areas of environmental
competent care. health protection and community care
- Nurses who have desire to become facilities. Health protection in the modern
culturally competent do so because they public health age focuses mainly on:
want to, rather than because they are - 1. Preventing and controlling of infectious
directed to do so. disease
- They demonstrate a sense of energy and - 2. Protecting against radiation, chemical
enthusiasm about the possibility of and environmental hazards.
providing culturally competent nursing
interventions. 3. Disease Prevention
- Unlike other constructs, cultural desire - Prevention in health calls for action in
cannot be directly taught in the classroom advance, based on knowledge of natural
or in other educational or work settings. history, in order to make it improbable that
- Nurses should be aware that having the disease will progress subsequently.
cultural competence is not the same as Preventive actions are defined ass
being an expert on the culture of a groups interventions directed to averting the
that is different from their own. emergence of specific diseases and
reducing their incidence and prevalence in
populations.
THE PUBLIC HEALTH INTERVENTION WHEEL RESEARCH IN PUBLIC HEALTH
● Logico Positivist Paradigm (Quantitative
Research)
● Naturalist Paradigm
(Qualitative Research)

EPIDEMIOLOGY
- Epidemiology is the basic science of
disease prevention and plays major roles
in developing and evaluating public
policies relating to health and to social
legal issues.

1. Epidemiologic Approach to Disease and

Intervention
Component 1: 2. Epidemiology to Identify the Causes of
- The Model is Population Based Disease
3. Epidemiology Application in Evaluation
Competent 2: and Policy
- The Model encompasses Three Levels of
Practice Epidemiology and Its Objectives
1. Community level practice = increase the 1. Identify the etiology or cause of a disease
knowledge and attitude and the relevant risk factors.
2. Systems Level Practice = change the 2. Determine the extent of disease found in
laws, policies the community
3. Individual/Family Level Practice = change 3. Study the natural history and prognosis of
the laws, policies disease
4. Evaluate both existing and newly
developed preventive and therapeutic
measures and modes of healthcare
delivery
5. Provide the information for developing
public policy relating to environmental
problems, genetic issues, and other
considerations regarding disease
prevention and health promotion
Competent 3:
- The Model identifies and Defines 17
Public Health Interventions
 NCM113 (THEORY) | 2M : SOCIO-CULTURAL DETERMINANTS OF HEALTH
THE EPIDEMIOLOGIC SHIFTS 1ST EPIDEMIOLOGIC SHIFT
- AGE OF PESTILENCE AND FAMINE
Epidemiology - came from the latin word “epi” which means upon and “demos” which (Infectious)
means population and logos which means study.
Pestilence - by the term itself pestilence or from pests
Epidemiology - is a study about what befalls or what happens/ what comes upon a
population. Back in history, if you could recall stories in the bible and actual famine stories brought
about by several diseases or droughts, severe climate changes -these actually
- it is also known as a study of dynamics between disease and the population. contributed to a high mortality rate.

Back in 1971, there was a person called Mr. Abdel Omran ★ Main concept that you should remember in the first epidemiologic shift is that
- He coined the term epidemiological transition or epidemiological shift “It is marked by a high mortality rate and a high occurrence of infectious
- To denote the change in disease patterns and the cause of death within a diseases.”
population.
- Back then, people were not really aware about these diseases and the treatment for
This could be due to various demographic economic industrial and sociological factors them was very limited. The scientists still studied about all those diseases so the
treatment was not readily available.They did not have the advanced technology and the
March 2019, it was the start of the “novel coronavirus pandemic” equipment to make these certain cures for the diseases.

Many of those affected with or who contracted the virus have been affected negatively, The average life expectancy at birth is low and its variable ranges from 20 to 40 years
most severely those who died with the pandemic. These changes in the population like from the time a person is born.
for example in the coronavirus pandemic these changes in the population with the
death of those who were affected contributes to the increasing mortality rates. One example was the “Black Plague”
- This was an infection from rats.
Mortality is central to the epidemiological shifts. - Most violent form of epidemic that belongs to stage once in the age of
pestilence and famine

2ND EPIDEMIOLOGIC SHIFT

The 3 Main Epidemiologic Shifts
- AGE OF RECEDING PANDEMICS
(Non-communicable)
1st Epidemiologic Shift
- AGE OF PESTILENCE AND FAMINE
- term itself receding pandemics, it's not as vicious as it is
- marked by a decline in the mortality theory
2nd Epidemiologic Shift
- AGE OF RECEDING PANDEMICS
Population growth is sustained because there are also women giving birth so it’s trying
to balance out those who have died.
3rd Epidemiologic Shift
- AGE OF DEGENERATIVE AND MAN-MADE DISEASE
There is a shift of disease here in this stage from infectious to non-communicable
diseases. People were trying or slowly discovering these vaccines to treat disease
among these infectious diseases.

Non-communicable diseases started to become popular

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 NCM113 (THEORY) | 2M : SOCIO-CULTURAL DETERMINANTS OF HEALTH
Examples:
- Lifestyle diseases Income and social status
- Common examples are Diabetes, Hypertension, Cancer.
- Higher income is linked to better health because you can pay or have all the
Average life expectancy at this stage increased slightly higher from 30 to 50 years. money to be treated overseas, internationally, and the best doctors in the world.

There are still problems occurring because of the term itself receding pandemic. There - Social status is between the rich and the poor. If there is a really big gap between
are still these infectious diseases that are present but mostly in industrial cities where the rich and the poor it means there is a greater difference in health. More
people crowd together. detrimental effects if there is a bigger gap in the social standing of people.
3RD EPIDEMIOLOGIC SHIFT
- AGE OF DEGENERATIVE AND MAN-MADE DISEASE Education

- Stable low and decline in mortality rates and a shift in the primary cause of - Low education levels are linked to poor health. If a person isn’t educated and
death which is from non-communicable diseases doesn't know is very ignorant about such things.
- More like cardiovascular and degenerative diseases like cancer and diabetes - - Low education also more stress because you will be looking for jobs
still considered as non-communicable diseases but primarily myocardial
cardiac diseases. Physical Environment

The average life expectancy at birth rises gradually by more than 50 years. It has the - Safe water is the most basic one of the most basic necessities that people need
highest life expectancy. to be healthy
- Clean air
The last report or last study of the average life expectancy of a person is 77 year old. - Healthy workplace
*(77.1 or 0.2 background of 77 years old) - Safe houses
- Communities and roads
Major health issues with this shift or the third shift are mostly heart attacks and cancer
as I have stressed out cardiac diseases. There is also a decline in infectious diseases Now the physics that contributes to physical environment so if one of those are very
here because of the discovery of vaccines and the roll out of these vaccines to the problematic
majority of the people.
Now we need all those to have good health with the physical environment.
10 DETERMINANTS OF HEALTH AND DISEASE
Employment and Working Conditions
- Income and social status
- Education
- Employed people are healthier, especially those with control over their working
- Physical Environment
conditions.
- Employment and working conditions
- Social Support Networks
- Culture
Social Support Networks
- Genetics
- Personal Behavior and Coping Skills
- These could be families, our friends, communities.
- Health Services
- Gender
If we have these networks of people that support us, now it also links to better health
because we are not an island so we need other people to help us deal with stress,
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 NCM113 (THEORY) | 2M : SOCIO-CULTURAL DETERMINANTS OF HEALTH
problems which contribute to better health and a happier life. Social support is very
important so we try to ward off those negative people in our lives.
FOCUS ON PUBLIC HEALTH IN RELATION TO THE FILIPINO POPULATION
Culture GROUP

- Culture also affects health. The customs, traditions, and beliefs. 1. Preventing Disease
2. Prolonging Life
For example, in a place in the Philippines, very rural areas. They have a tradition there 3. Promoting Health and Efficiency
of treating cough with leaves. 4. Health Protection

Genetics

- Inheritance plays a role in determining the lifespan, longevity, healthiness 1. Preventing Disease
- Genetics plays a role in developing the likelihood of us developing certain
- Public health or community health really focuses on preventing disease,
illnesses which affects health. promoting “health promotion disease prevention”.

Personal Behavior and Coping Skills 2. Prolonging Life

- These are very individual factors - We modify the different lifestyles such as the diet, the activities, the
exposure to these pollutants.
Changes that you do to your life or lifestyle such as having a balanced diet, being more 3. Promoting Health and Efficiency
active, engaging in sports, quitting smoking, quitting drinking. Whatever practices or
strategies that you have to deal with stress and positively impact our health. - By campaigning like the DOH in strengthening the public to get their
booster doses.
Health Services
4. Health Protection
- Access to health services is a very important priority talking about public
- Like a cluster of all these three with preventing disease with prolonging life
health because we are looking out for the best of the majority of the residents and promoting health and efficiency. We are protecting the health of the
in a certain community population.
- The access to health services is really very central

Gender CORE PUBLIC HEALTH FUNCTIONS

- There is a difference between men and women - Assessments

- There are diseases that men suffer more compared to women and there are - Policy Development
diseases also women suffer slightly more compared to men - Assurance
(Acronym: APA)
Different types of diseases across different ages:

● Men are more prone based on statistics to car developing cardiac diseases
● Women also have higher rates of developing breast cancer

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 NCM113 (THEORY) | 2M : SOCIO-CULTURAL DETERMINANTS OF HEALTH
Assessments HEALTH PROMOTION AND LEVELS OF PREVENTION

- Assessments involve the regular collection analysis and information sharing Primary
about health conditions.
- To address these, we try to measure the risks and the resources that are - Activities aimed to prevent problems before they occur.
available in the community - The main concept of primary is that before diseases occur or before a person
gets sick we try to alter their susceptibility to these certain diseases or reduce
their exposure to these pathogens and all especially to those susceptible
Policy Development individuals.

- Policy development in public health -it’s the use of information that we have ● GENERAL HEALTH PROMOTION
gathered during the assessment. In order to develop these local and national ○ Try to target the well population or those who aren’t sick but are healthy. We
policies, try to enhance their resiliency with different aspects in their life including
- we could suggest that to local boards or city counselors. If the problems are
lifestyle, healthy diet, the right exercise, keeping away from vices and all.
very common that really involves or really risks the health of a population and
to direct the resources for those policies because let’s say once policies are
there are being laid out or rolled out. There needs to be a resource so where * Adequate shelter, providing a safe and secure shelter -one that's durable for families
will the budget come from then is really a basic need.
- The budget is the supporting actor.
- These local and national policies there need to be a backup where you will get ● SPECIFIC PROTECTION
the resources. Who will be the people involved in doing these? So those are ○ This means we try to reduce or eliminate the risk factors of our clients. For
parts of the policy development
example, immunization because we try to protect the kids now with these
Assurance immunity against different illnesses. We also have water purification by
purification, distillation, filtration or the use of chemical agents to purify waters
- It focuses on the availability of necessary health services. There needs to be so that the public won’t catch any illness from waterborne diseases
an assurance that health services are readily available in the community.
Secondary

- Early detection and prompt interventions during the period of early disease
pathogenesis.
ESSENTIAL PUBLIC HEALTH FUNCTIONS - This could be implemented before the actual signs and symptoms appear
- The target population are those with high risk factors
- Health Situation Monitoring and Analysis rson needs to get a check
- Epidemiological Surveillance/Disease Prevention and Control Tertiary
- Development of Policies and Planning in Public Health
- Strategic Management of Health Systems and Services - Populations with disease or injury, focuses on limiting disability and
- Regulation and Enforcement rehabilitation.
- Human Resources and Development in Public Health - We target clients that already have an existing disease or injury focusing on
- Health Promotion, Social Participation and Empowerment limiting their disability and then rehabilitation as well.
- Ensuring Quality of Health Services - Our aim for this is to reduce the effects of the disease and to restore the
- Research, Development and Implementation of Innovative Public Health client’s optimum level of functioning.
Solutions
Example:
A client just had a stroke. He is being enrolled in rehabilitation therapies every Saturday.
That’s already included as a tertiary level of prevention so as to improve the client’s
level of functioning, every day and every session.
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 NCM113 (THEORY) | 2M : SOCIO-CULTURAL DETERMINANTS OF HEALTH
Another example is a diabetic client taking insulin so we try to teach the client how to
self-administer insulin at home. That’s also tertiary part of the rehabilitative process
since the client is for discharge already so as part of the tertiary level prevention we try
to teach the client.

* Health teaching is very central to these levels of prevention so that we can prevent
grave consequences or more serious consequences if the illness is not managed.

- Primary are for those well clients.

- Secondary are for those who will undergo screening such as laboratory diagnostics
before the appearance of signs and symptoms or trying to prevent a more serious
complication.

- Tertiary are those with already existing illnesses, Those were discharged and the
clients for rehabilitation

Family

- Those married couples without children are considered a family. Those who
have children such as nuclear families, extended families, cohabiting

Group or Aggregate

Example: Self-help groups, breastfeeding moms, a community of parents with

children with autism, alcoholics anonymous

Community and Population

- We’re talking about location, a locality of vicinity where people live in is

considered a social system
- Our clientele in the biggest scope in public and community health nursing

It also connects with the levels of prevention according to clientele.

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 NCM113 (THEORY) | 2M : SOCIO-CULTURAL DETERMINANTS OF HEALTH
For example:
1. Mothers Breastfeeding class - Group or Aggregate and Level of Prevention is
Primary
2. HIV Screening Programs for Communities - Community and Population Level
of Prevention is Secondary
3. Screening for Cervical Cancer - Individual and Level of Prevention is
Secondary
4. Exercise Therapy - Individual and Level of Prevention is Tertiary
5. Skincare for incontinent (bed ridden) clients - Family and Level of Prevention
is Tertiary

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EPIDEMIOLOGY
Vital statistics