LESSON 2: DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING

There are other fields of nursing where public health nurses are working. they are in schools and work
settings.
In schools, public health nurses take care of the health needs of the students. In communities where there
are workers and laborers, the public health nurse in the health centers is expected to provide occupational health
nursing activities to those who need them.

A. SCHOOL NURSING
● a type of public health nursing that focuses on the promotion of health and wellness of the
pupils/students, teaching and non-teaching personnel of the school.
● School nurses also assist young people in making choices for a healthy lifestyle, reduce risk taking
behavior and focus on issues such as prevention of drug and substance abuse, teenage pregnancy,
sexually transmitted infection, malnutrition, and communicable and non-communicable diseases.

Objectives of School Nursing

General: To promote and maintain the health of the school populace by providing comprehensive and
quality nursing care.

Specific:
1. Provide quality nursing service to the school population.
2. Create awareness among school children, personnel and administrators on the importance of the
promotive and preventive aspects of health through health education.
3. Encourage the provision of standard functional facilities.
4. Provide nursing personnel with opportunities for continuing education and training.
5. Conduct and participate in researches related to nursing care.
6. Establish/strengthen linkages with government and non-government organization/agencies for
school community health work.

Duties and Responsibilities

1. Health advocacy
2. Health and nutrition assessment including other screening procedures such as vision and hearing.
3. Supervision of the health and safety of the school plan.
4. Treatment of common ailments and attending to emergency cases.
5. Referrals and follow-up of pupils and personnel.
6. Home visits
7. Community outreach like attending community assemblies and organizing school community health
councils.
8. Recording and reporting of accomplishments.
9. Monitoring and evaluation of programs and projects.

Skills needed by and provided to the school nurses to enable them to deliver effective health care to the
school populace:
● Assessment and Screening Skills
● Health Counseling Skills
● Social Mobilization Skills
● Good Oral and Written Communication Skills
● Basic Management Skills
● Life Skills
LESSON 2: DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING

Functions of the School Nurse

1. School Health and Nutrition Survey
 to provide data for evaluation and for planning purposes.
 the survey shall include among others the current health and nutritional status of school children
 Situation on health facilities as well as actual status of health education activities undertaken by the
teachers and health personnel. A survey form is available for this purpose.
 Actual survey should be done during the first visit of the nurse to the school and every years
thereafter.

2. Putting up a Functional School clinic

R.A. 124 mandates that all schools are to provide school clinics for the treatment of minor ailments and
attendance to emergency cases. The school nurse encourages the provision of this facility.

3. Health Assessment
 aims to discover the signs of illness and physical defects in order to correct them
 check on the health habits of pupils and prevent the progress of those which cannot be corrected.
 In order to attain the purpose, the examination must be thorough. It cannot be considered complete
unless the necessary advice for the improvement or correction of the defects found has been given to
the person concerned.

Health Assessment should include:

● Interviewing for information gathering
● Nutritional assessment – height and weight measurements
● Vision acuity test/hearing test
● Four methods of physical examination
● Taking of vital signs
● Appraisal of the general physical and mental condition
● Recording of findings

Preparation: The following should be ready for use

● A well-lighted, ventilated, screened room or a corner of the classroom
● Two or three chairs according to need
● Wastebasket
● Hand washing facilities
● Tongue depressor, penlight
● Stethoscope and sphygmomanometer
● Forms/records

Frequency
● Every school child should be examined once a year and as the need arises like during epidemics.

Procedure of Health Assessment

1. Before the health assessment, the nurse should conduct a classroom health lecture and inform the children
on what they are to do during the assessment.
2. Three to five children at a time should be in waiting for the assessment.
3. She should wash her hands with soap and water before the start of the assessment.
4. Children are to be assessed one by one.
5. Complete inspection should be made from head to foot for cleanliness, skin diseases and signs of abnormal
condition.
6. Stethoscope must be used for the heart and lung assessment.
7. Findings should be recorded during the assessment.
LESSON 2: DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING

Important Reminders in the Conduct of Health Assessment

1. If the health personnel is the opposite sex, it must be done in the presence of other school personnel
preferably of the same sex.
2. Discuss with the teacher and the pupil concerned the results of the findings and what should be done after
the assessment if finished.
3. Treat cases needing treatment during the special treatment periods and nit during the inspection except in
case of emergency.
4. Refer cases which cannot be handled by the nurses promptly.
5. Parents must be informed of the findings.

4. Standard Vision Testing for School Children

This procedure aims to;
● Screen students with poor visual acuity and identify other ocular problems.
● Refer students with eye diseases and errors of refraction for further examination and
management.
 Ear Examination
 Height and Weight Measurement and Nutritional Status Determination
 Medical Referrals
 Attendance to Emergency Cases
 Student Health Counseling
 Health and Nutrition Health Activities
 Organization of School-Community Health and Nutrition Councils
 Communicable Disease Control
 Establishment of Data Bank on School Health and Nutrition Activities

Accurate and up-to-date health records are essential in helping monitor the health of students while they
are in schools. Findings are recorded in the health examination card and reviewed and updated annually.

Data bank shall include the following:

● Treatments in the school clinic
● Records of the school visit (RHU and school health personnel)
● Health Assessment Report of the School Health personnel
● Health and Nutritional Status of pupils/students
● Form 86 (Examination Card) of teaching and non-teaching personnel
● Teacher’s Health Profile
● Records of emergency cases attended to
● Records of referrals made
● Inventory of clinic equipment and supplies
● Health and nutrition activities in school
● Records of accomplishments of school health services
● Records of officers/officials of the School-Community Health Council and the accomplishments
● Action Plan
● Performance Contract

5. School Plant Inspection for Healthy Environment

6. Rapid Classroom Inspection
This aims to:
● Detect cases of communicable diseases
● Note corrections that have been made
● Note if eyeglasses are correctly adjusted
● Note the general cleanliness of pupils
● Note new ailments
LESSON 2: DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING

7. Home Visitation
The following are some cases needing home visitation:
● Pupils whose parents are afraid of some medical procedures.
● Pupils who get re-infected because of home conditions.
● Pupils suffering from communicable diseases.
● Pupils who are absent frequently because of sickness.
● Pupils who are malnourished.

Note: For Legal Bases of School Health Program open your Public Health Nursing book, pages 99 –
101
B. OCCUPATIONAL HEALTH NURSING
● Occupational health nursing is a specialty nursing practice that provides for and delivers health
and safety programs and services to workers, worker populations, and community groups.

Functions of Public Health nurses as an Occupational Health Nurse

(Referenced from PD 856, Chapter VII-Industrial Hygiene of the Sanitation Code of the Philippines)
1. Work with the occupational Health team to lead the sanitary and industrial hygiene of all industrial
establishments including hospitals to determine their compliance with the sanitation code and its
implementing rules and regulations.
2. Recommends to Local Health Authority the issuance of license/business permits and suspensions or
revocation of the same for any violation of the condition upon which said licenses or permits had been
issued, pursuant to existing rules and regulations.
3. Coordinates with other government agencies relative to the implementation of the implementing rules and
regulations.
4. Attends to complaints of all establishments in the area of assignment related to industrial hygiene and
recommends appropriate measures for immediate compliance.
5. Participates to provide, install and maintains in good condition all control facilities and protective barriers
for potential and actual hazards.
6. Informs all affected workers regarding the nature of hazards and the reasons for the control measures and
protective equipment.
7. Makes periodic testing for physical examination of the workers and other health examinations related to
worker’s exposure to potential or actual hazards in the workplace.
8. Provides control measures to reduce noise, dust, health and other hazards.
9. Ensure strict compliance on the regular use and proper maintenance of Personal Protective Equipment
(PPE).
10. Provide employees/workers an occupational health services and facilities.
11. Refers or elevates to higher authority all unsolved issues in relation to occupational and environmental
health problems.
12. Prepares and submit yearly reports to the Local and National Government.

The Primary Focus of Occupational Health Nursing

● The mission of occupational health and safety is to ensure so far as possible every working man and woman
in the country is safe and in healthful working conditions.
a. Occupational health and safety should be considered an integral part of all health services.
b. The occupational environment is complex and multi-dimentional; the recognition of occupational
hazards requires an appreciation of the social, cultural, political, and economic context of work:
Examples of factors that affect the work environment are as follows:
▪ Social: the meaning of work, the social milieu of the worker, and the structure of work.
▪ Cultural: beliefs, attitudes, and values related to work.
▪ Political: the prevalent ideology in a society, the distribution of power, and government
support for health safety of workers.
▪ Economic: level of unemployment, competition, wage regulation, and nature of local
economy.
c. Occupational health and safety affect not only the worker but also the worker’s family and
significant others, the worker’s community, and the larger society.
d. Occupational health as a specialty within public health is a population-based practice.
e. Occupational health sciences are in an early stage of development; much remains to be known about
the effect of the work environment on the health and safety of worker populations.
LESSON 2: DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING

Professional Goals of Occupational Health Nursing

Professionals from multiple disciplines work cooperatively to achieve the goals of occupational
health and safety:
a. Occupational health nurses’ central mission is to promote and maintain the health and safety of workers
through a systematic process of assessment, planning, intervention, and evaluation.
b. Occupational physicians focus on the prevention, detection, and treatment of work-related diseases and
injuries.
c. Industrial hygienists recognize, evaluate, and control toxic exposures and hazards in the work environment.
d. Safety engineers and other safety professionals focus on the prevention of occupational injuries and the
maintenance or creation of safe workplaces and safe worker practices.
e. Other professionals include:
▪ Epidemiologists, who study and describe the natural history of occupational diseases and injuries in
population groups.
▪ Toxicologists, who study and describe the toxic properties of agents used in work applications to
which workers may be exposed.
▪ Industrial engineers, who design the tools, equipment, and machines used in manufacturing and
other work applications.
▪ Ergonomists, who study design, and promote the healthy interface of humans, their tools, and their
work.
▪ Health educators, who promote workers’ healthy lifestyles and work practices.
▪ Environmental engineers, who concentrate on environmental controls to limit environmental
pollution and achieve a healthy environment.

The Practice
Occupational health nursing is the specialty practice that provides for and delivers health care
services to workers and worker populations.
● Occupational health nurses focus on the promotion, protection, and restoration of workers’ health within the
context of a safe and healthy work environment.
● Autonomy and independent nursing judgments characterize the practice of occupational health nursing.
● With a research-based foundation, occupational health nursing’s theoretical conceptual, and factual
framework is multidisciplinary.
● Occupational health nurses are advocates for worker’s and encourage and enable individuals to make
informed decisions about health care concerns.
● Through collaborative practice with other occupational health and safety professionals, occupational health
nurses are key to the coordination of a holistic approach to the delivery of quality, comprehensive
occupational health services.
● Occupational health nurses are professionally accountable to workers (their primary responsibility),
employers, their own profession, and themselves.
● The essential elements of occupational health and safety services are defined by the standards of
Occupational Health Nursing in the Philippines.

Special Components of Community Health Nursing includes”

1. Health promotion and prevention principles: incorporation of primary, secondary and tertiary strategies to
optimize the health and safety of the worker population.
● Health promotion and health education are vital parts of occupational health practice today and for
the future,
● The basic principles of health education provide tools that can be applied to health education and to
health promotion in the workplace.
● By helping individuals assess their health needs and by developing strategies to meet organizational
needs, the occupational health nurse can create an environment that values and support healthy
workers.
LESSON 2: DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING

2. Worker or workplace health hazard assessment and surveillance; identification of health problems and
health hazards and implementation of monitoring and surveillance strategies to mitigate health risk
exposure, improve worker’s health, and ensure safe working conditions.
● The chief discipline that guides the occupational health nurse in this aspects are nursing science,
environmental health, epidemiology, toxicology, industrial hygiene, ergonomics, injury prevention
in terms of physical and environmental hazards and social behavioral sciences that includes lifestyle
and psychosocial and emotional hazard.

3. Injury and illness investigation, analysis and prevention; examination of trends and work-related illnesses
and injuries to develop preventive strategies.
● The prevention of occupational injury and illness requires an in-depth knowledge of the work
environment as well as the appropriate skills to recognize and identify actual and potential hazards.
● It is the responsibility of occupational health nurses to determine the particular needs of their
organization and to tailor those programs to their setting.

4. Primary Care: health care delivery provided to workers at the worksites or in the community, including
treatment, follow-up, referral for medical care, health monitoring and emergency care.

● Primary Care is an array of integrated and coordinated health services delivered by the occupational health
nurse with the following characteristics:
o Services are accessible and acceptable to the client.
o Frontline service and comprehensive in scope.
o Services are coordinated and continuous overtime.
o Service providers are accountable for the quality and potential health effects of the services.
o Primary care services are person-centered and holistic, which means they involved all levels of
prevention, that are not limited to an organ or a system or to a specific disease process.
● Primary health care will serve as the nucleus of the country’s health care system and of the overall social
and economic development of the community.
4. Case management: A process of coordinating an individual client’s health care services to achieve optimal,
quality care delivered in cost-effective manner.
● The case manager coordinates service with appropriate health care professionals.
● The case manager monitors the economic aspects of treatment.
● Assessment, planning, and implementation of the worker’s care and the progress toward returning to
work is part of the process.
● The case manager provides evaluation and follow-up of the worker’s progress.
5. Counseling: interventions and appropriate referral aimed at helping workers clarify problems, deal with
crises, and make informed decision and choices.
● Social and behavioral sciences can augment an understanding of factors that threaten the health of
the workers. A key area that would benefit from focus on psychosocial hazards is health promotion
that focuses on lifestyle and stress reduction.
6. Management and administration: the overall setting of goals and planning for the organization,
implementation, and evaluation of the work of the occupational health service.
● Occupational health nurses must have leadership, management and administration skills to give the
direction, provide services, manage the resources, and document the outcomes related to employee
health in the organizations.
7. Legal/ethical monitoring: Process of assuring that the provision of occupational health nursing service is
within the legal scope of nursing practice, that occupational health nurses are knowledgeable of the laws and
regulations governing occupational health and safety, and the decision making is based on an ethical
framework.
● Legal and ethical issues frequently arise in the occupational setting. It is essential that occupational
health nurses be familiar with the implementing rule and regulations (IRR) that affects employees in
their work settings and that nurses clearly understand their professional responsibility with regards to
those IRR.
LESSON 2: DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING

8. Research: the development, dissemination, and utilization of knowledge to support practice.

● Research is essential in supporting and expanding the knowledge base for occupational health
nursing practice. It contributes to the improvement in workers’ health and safety, and thereby to the
quality of their lives and work.
9. Community orientation: articulation with and utilization of appropriate community resources to provide
service more efficiently and effectively to employees and the company.
● Workers and workplaces are affected by changes and trends that occur in the larger
society/community. It is essential that occupational health nurses be knowledgeable about
the potential effects that these changes have on the workplace.

Issues in Occupational Health Nursing

1. Physical hazards: factors or conditions within the environment that can harm your health
2. Chemical hazards: is a type of occupational hazard caused by exposure to chemicals in the workplace
3. Biological hazards: biohazard, is a biological substance that poses a threat to the health of living
organisms, primarily humans. Sources of biological hazards may include bacteria, viruses, insects,
plants, birds, animals, and humans.
4. Mechanical hazards: are created as a result of either powered or manual (human) use of tools, equipment
or machinery and plant.
5. Psychosocial hazards: or work stressor is any occupational hazard related to the way work is designed,
organized and managed, as well as the economic and social contexts of work.

C. COMMUNITY MENTAL HEALTH NURSING

Community Mental Health Nurses are specialized Nurses who provide wholistic nursing services for
people with mental health issues, in a community setting.
It is the application of specialized knowledge to population communities to: a. Promote and maintain
mental health, and b. Rehabilitate population at risk.

Goals of Community Mental Health Nursing

1. Provide prevention activities to population for the purpose of promoting mental health.
2. Provide prompt interventions
3. Provide corrective learning experiences
4. Help individuals develop a sense of self-worth and independence.
5. Anticipate emotional problems
6. Identify and change social and psychological factors that influence human interactions.
7. Develop innovative approach to primary preventive activities
8. Provide mental health education and how to assess the mental health
LESSON 2: DIFFERENT FIELDS OF COMMUNITY HEALTH NURSING