CENTRAL LUZON DOCTORS’ HOSPITAL

EDUCATIONAL INSTITUTION, INC

Romulo Highway, San Pablo, Tarlac City
Tel No. (045) 982-5019/ 982-5052/ 982-0264 Fax No. (045) 982-0780/982-2757

DEPARTMENT OF NURSING

NCM 104 CHN1 (RLE) MODULE ONE

Overview
In the same manner that the Department of Health and the public health system have
evolved into what it is now response to the challenges of the times, so has Public Health
Nursing practice been influenced by the challenging global and local health trends. These
global and country health imperatives brought public health nursing into new frontiers and
have positioned nurses to emerge as leaders in health promotion and advocacy.
This perception has been validated by a WHO report acknowledging the significant
contribution of the nursing workforce to the achievement of health outcomes.
Public Health Nursing in the Philippines evolved alongside the institutional development of
the Department of Health, the government agency mandated to protect and promote
people’s health and the biggest employer of health workers including public health nurses.
Historical accounts show that as far back as the 1900s, nurses working in the communities
were already given the title Public Health Nurses.
In the light of the changing national and global health and the acknowledgement that
nursing is a significant contributor to health, the Public Health Nurse is strategically
positioned to make a difference in the health outcomes of individuals, families and
communities cared for.

Objectives
1. Define health and community.
2. Discuss the focus of public health.
3. Explain the differences among community health nursing, public health nursing, and
community-based nursing.
4. Cite the distinguishing features of community health nursing.
5. Discuss public health nursing practice in terms of public health’s core functions and
essential public health functions.
6. Compare the different fields of community health practice.
7. Apply the competency standards of nursing practice in the Philippines in community
health nursing practice.
8. Outline the historical development of public health nursing in the Philippines.

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 Table of Contents

A. Global and National Health Situations ----------------------------------------------------------------------3

B. Definition and Focus ---------------------------------------------------------------------------------------------4

1. Public Health -----------------------------------------------------------------------------------------------------4

2. Community Health ----------------------------------------------------------------------------------------------4

3. Public Health Nursing ------------------------------------------------------------------------------------------8

4. Community Health Nursing -----------------------------------------------------------------------------------9

5. Standards of Public Health Nursing in the Philippines -----------------------------------------------10

6. Evolution of Public Health Nursing in the Philippines ------------------------------------------------11

7. Roles and Responsibilities of a Community Health Nurse -------------------------------------------16

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A. Global and National Health Situations
The National Health Situation
Population
1. Population in the 1990s was about 60 million
2. Population as of 2010 is 94 million, growing at an annual rate of 1.75% -
2.32%
3. 65% of the population will be living in urban areas by 2020
4. Life expectancy is 66.9 years for males and 72.2 years for females, with a
mean of 69.6 years.

Health Indices
✔ Every minute, 1 child dies of measles
✔ Every hour, 6 Filipinos die of heart disease while 4 Filipinos die of cancer
✔ Everyday, 28 babies die of tetanus, 1,277 children die of pneumonia, and 217
children die of diarrhea
✔ Everyday, 55 die of tuberculosis, 15 die of renal disease, and 300 Filipinos die
develop malaria
✔ 12 million are at risk of malaria
✔ 2.5 million children are malnourished
✔ More than 50% of pregnant and lactating women suffer from anemia
✔ Some 194 babies are born every hour with less than 50% of couples using
reliable methods if family planning
✔ 23.4 million Filipinos still don’t have access to toilets
✔ More than 2 million Filipinos are suffering from diabetes which is the 10 th
leading cause of death.

Leading cause of Morbidity

1. Diarrheal diseases
2. Acute bronchitis
3. Pneumonias
4. Influenza
5. Chickenpox, hypertension, dengue fever, typhoid and paratyphoid fever
6. Tuberculosis (all forms)
7. Malaria
8. Accidents
9. Malignant neoplasms
10. Diseases of the heart

Leading cause of Mortality

1. Diseases of the heart
2. Diseases of the vascular system

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 3. Pneumonias
4. Other diseases of the respiratory system
5. Chronic obstructive pulmonary disease (COPD)
6. Tuberculosis (all forms)
7. Accidents and diarrheal diseases
8. Diabetes Mellitus
9. Malignant neoplasms (cancer)
10. Nephritis, nephritic syndrome, and nephrosis

B. Definition and Focus

1. Public Health
Public health
Public health is defined as the science and art of preventing disease,
prolonging life, promoting health and efficiency through the following
(Winslow, 1982)
1. Organized community effort for environmental sanitation;
2. Control of communicable diseases,
3. The education of individuals in personal hygiene
4. The organization of medical and nursing services for the early
diagnosis and treatment of disease; and
5. The development of social machinery to insure everyone a standard
of living adequate for the maintenance of health for everyone.

Public health is dedicated to the common attainment of the highest level

of physical, mental and social well-being longevity consistent with
available knowledge and resources at a given time and place (Hanlon,
1984)
2. Community Health
Definition of Health and Community
Health
The definition of health is evolving. The early, classic definition of health by
the World Health Organization (WHO) set a trend toward describing health in
social terms, rather than in medical terms. WHO defined health as “a state of
well-being and not merely the absence of disease or infirmity”.
Social means “of or relating to living together on organized groups or similar
close aggregates” (American Heritage Collage Dictionary, 1997,p.1291) and is
used in the context of unites of people in communities who interact with each
other. “Social Health” connotes community vitality and is a result of positive
interaction among groups within the community with an emphasis on health
promotion and illness prevention.

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 Saylor (2004) pointed out that the WHO definition considers several
dimensions of health. These include physical (structure/function), social, role,
mental (emotional/intellectual), and general perception of health status. It also
conceptualizes health from a macro perceptive, as a resource to be used rather
than a goal in and of itself.
Nursing literature contain many varied definitions of health. For example,
health has been defined as “a state of well-being, in which the person is able to
use purposeful, adaptive responses, and processes physically, mentally,
emotionally, spiritually, and socially” (Murray et. Al., 2009 p. 53); “actualization
of inherent and acquired human potential through goal directed behavior,
competent self-care and satisfying relationship with others” (Pender et. Al., 2006
p. 22); and “a state of a person that is characterized by soundness or wholeness
of developed human structures and of bodily mental functioning” (Orem 2001).
Commonalities involve description of “goal-directed” or “purposeful” actions,
processes, responses, or behavior processing “soundness”, “wholeness”, and/or
“well-being”.
For many years, community and public health nurses have favored Dunn’s
(1961) classic concept of wellness, in which family, community, society, and
environment are interrelated and have an impact on health. From his viewpoint,
illness, health, and peak wellness are on continuum; health is fluid and changing.
Consequently, within a social environment, the state of health depends on the
goal, potentials, and performance of individuals, families, communities, and
societies.
Health
Health is considered as the goal of public health in general and of community
health nursing in particular. Health has been defined as a state of complete
physical, mental, and social well-being and not merely the absence of a disease
or infirmity (WHO, 1995).
Optimum level of Functioning
The modern concept of health refers it to the “optimum level of functioning”
(OLOF) of individuals, families, and communities which is affected by several
factors in the ecosystem, as follows:
1. Political factors – politics have power and authority to regulate the
environment or social climate. For example, laws or legislative acts are
often related to promoting safety and people empowerment.
2. Behavioral factors – a person’s level of functioning as affected by certain
habits while their lifestyle, health care, and child-rearing practices are
determined by their culture and ethnic heritage. For example, culture,
habits, mores, and ethnic customs influence a person’s health behavior.

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 3. Hereditary factors – understand of genetically-influenced diseases and
genetic risks. For example, familial, ethnic, or racial defects, strengths,
and/or risks may be passed on through the genes of both parents.
4. Health care delivery system – primary health care is a partnership
approach to the effective provision of essential health services that are
community-based, accessible, acceptable, sustainable, and affordable.
For example, promotive, preventive, curative, and rehabilitative aspects
are done in the community.
5. Environmental influences – the menace of pollution, communicable
diseases due to poor sanitation, poor garbage collection, smoking,
utilization of pesticide. For example, air pollution, contaminated food,
water waste, health hazards, and health risks, which are inherent in
urban/rural milieu, noise, and radiation pollution
6. Socio-economic influences – families in lower income group are the ones
mostly served. For example, unemployment or underemployment, lack of
education and lack of decent housing may all have some effect on the
optimum level of functioning.

Community
Community comes from the Old French word “communite” which is derived
from the Latin “communitas” (cum, “with/together” + munus, “gift”), a broad
term for the fellowship or organized society.
Baldwin et. al. (1998) outlined the evolution of the definition of the
community by examining definitions that appeared in community health nursing
texts. They determined that, before 1996, definitions of community focused on
geographical boundaries, combined with social attributes of people. Later part of
the decade, the authors observed that geographical location became a secondary
characteristic in the discussion of what defines a community.
In recent nursing literature, community has been defined as “a collection of
people who interact with one another and whose common interest are
characteristics from the basis of a sense of unity or belonging” (Allender et.al.,
2009, p. 6); “a group of people who share something in common and interact
with one another, who may exhibit a commitment with one another and may
share a geographic boundary” (Lundi and James, 2009, p. 16).
Maurer and Smith (2009) further addressed the concept of community and
identified for defining attributes (1.) People, (2.) Place, (3.) Interaction, and (4.)
Common characteristics, interests, or goals. He also noted that there are two
main types of communities: Geopolitical communities, and phenomenological
communities. Geopolitical communities are most traditionally recognized or
imagined when considering term community. It is also defined or formed by both
natural and man-made boundaries, and include barangays, municipalities, cities,
provinces, regions, and nations. These may also called territorial communities.

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 Phenomenological communities refer to the relational, interactive groups, in
which the place or setting is more abstract, and people share a group perspective
or identify based on culture, values, history, interests, and goals. Examples are
schools, colleges, and universities; churches, and mosques; and various group or
organizations.
Since the advent of the Internet, the concept of community no longer has
geographical limitations, as people can now virtually gather in an online
community and share common interests regardless of physical location.
General characteristics of a community
1. A community is defined by the geographic boundaries within certain
identifiable characteristics:
a. It is made up of institutions organized into a social system with the
institutions and organizations linked in a complex network having
formal and informal power structure and communication system;
b. It has common or shared interests that bind the members together;
c. It has an areas with fluid boundaries within which a problem can be
identified and solved; and
d. It has population aggregate concept.
2. A community is regarded as an “organism” which has its own stages of
development (matures fast or slow) and responses to problems maybe
adequate, inadequate, inappropriate or delayed.

Classifications of a community
There is a big difference between urban and rural communities such as
physical environment, population size and density, economy, culture, political
dynamics, availability and adequacy of social services, and availability and
accessibility to health resources.
1. Rural communities – also known as open lands, often agricultural in nature
which is more spacious and less densely populated (i.e., Sto. Tomas, La
Union).
2. Urban communities – often known as city or cities which are non-agricultural
by nature, are densely populated, and marked by industrial products and
technology; Central Business Districts (CBDs) are found here (i.e., Makati
City).
3. Suburban or urban or the capitals – usually the administrative capital of a
province characterized by a unique mix of agriculture and industry (i.e., San
Fernando, La Union).

Characteristics of a Health Community

1. Awareness what “we are a community”
2. Conservation of natural products

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 3. Recognition of and respect for the existence of subgroups
4. Participation of subgroups in community affairs
5. Preparation to meet crises
6. Ability to solve problems
7. Communication through open channels
8. Resources available to all
9. Settling of disputes through legitimate mechanisms
10. Participation by citizens in decision-making
11. Wellness of a high degree among its members

3. Public Health Nursing

Definitions of Public Health Nursing According to:
WHO – a special field of nursing, public health and some phases of social
assistance and functions as part of the total public health programme for the
promotion of health, the improvement of the condition in the social and physical
environment, rehabilitation of illness and disability.
Ruth B. Freeman – a service rendered by a professional nurse with communities,
groups, families, individuals at home, in health centers, in clinics, in schools, in
places of work for the promotion of health, prevention of illness, care of the sick
at home and rehabilitation.
Jacobson – it encompasses “nursing practice in a wide variety of community
services and consumer advocate areas, and in a variety of roles, at times
including independent practice… community nursing is certainly not confined to
public health nursing agencies.”
Lillian Wald – a director of the Henry Street Settlement in New York City to
denote a service that was available to all people. The term, public health nursing
became associated with “public” or government agencies and in turn with the
care of the poor people.
The National League of Philippine Government came up with Standards of Public
Health Nursing in the Philippines 2005. The Standards differentiated public
health nursing and community health nursing only in one area: setting of work as
dictated by funding.
Public Health Nurses – refer to the nurses in the local/national health
departments or public schools whether their official position title is Public Health
Nurse or Nurse or school nurse. Public Health Nursing – refers to the practice of
nursing in national and local government health departments (which includes
health centers and rural health units), and public schools. It is community health
nursing practiced in the public sector
The Public health nurse (PHN)

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 - Are found in various health settings and occupying various positions in the
hierarchy.
- Are assigned in rural health units, city health centers, provincial health
offices, regional health offices, and evening the national office of the
Department of Health.
- Are also assigned in public schools and in the offices of government agencies
providing health care services.
- Occupy a range of positions from Public Health Nurse I to Nurse Program
Supervisors to Chief Nurse in public health settings.
- Uses various tools and procedures necessary for her to properly practice her
profession and deliver basic health service.
- Uses nursing process in her practice and is adept in documenting and
reporting accomplishments through records and reports.
- Technically competent in various nursing procedures conducted in settings
where she is assigned

4. Community Health Nursing

The Community Health Nurse
The priority of Community Health Nursing (CHN) is to promote and maintain
health and prevent the occurrence of disease or illness. The community health
nurse, thus, conducts a continuing and comprehensive practice that is
preventive, promotive, curative, and rehabilitative using the nursing process as
its primary tool. Nursing services are delivered in community settings like home,
rural health centers, clinics, schools, factories, and other industrial sites and
offices.
The community health nurse is not restricted to the care of a particular age
or diagnostic group. Participation of all consumers of health care is encouraged in
the development of community activities that contribute to the promotion of,
education about, and maintenance of good health requiring comprehensive
health programs which focus on social and ecologic influences and specific
populations at risk.
Management functions of the Community health nurse
1. Planning – entails establishing the mission, vision, philosophy and goals of
the organization. The mission of community health nursing is to provide
and promote healthy lifestyle choices through education, public
awareness, and community activities. The main objectives of community
health nursing are the attainment and maintenance of optimum
individual and community health.
2. Organizing – putting order and system to be able to implement the goals
and achieve the objectives of the planning. There are three components
of community health organizing. These are as follows:
a. Man or people, in this case, the health care workers;
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 b. Work, which involves machine and equipment use; and
c. Interpersonal relationships focusing on holistic and team concept
approach, leadership and management functions, intersectoral
collaboration and linkaging.
3. Directing – involves communicating or conveying to the health workers
what have transpired during the planning and organizing stages. It gives
direction for leadership, motivation and communication.
4. Coordinating – involves bringing together people in the health team and
“getting their acts together” so that they will be “singing the same tune”
resulting in harmony, achievement of objectives, and the development of
framework.
5. Controlling – a process which measures and corrects the activities or
functions of the people so that objectives are met. It clearly sets the
standards or parameters of the desired performance or output(s) based
on the set objectives; measures performance criteria; and correct
deviations from normal or below average performance.
6. Evaluating – assessing or appraising performance by comparing it with
performance standards and performing needed modifications or
revisions.

Recipients of care by Community Health Nurses

The Individual - is a specific person or client in various stages of health
or illness who is given the appropriate nursing intervention by the
community health nurse and other members of the health team as
the condition warrants.
The Family – is a group of people affiliated by consanguinity, affinity,
or co-residence. In many societies including the Philippines, the family
is the principal institution for the socialization of children and is often
called the “basic unit of the society”.

5. Standards of Public Health Nursing in the Philippines

Qualifications and Functions
The standards of Public Health Nursing in the Philippines developed by the
National League of Philippine government Nurses in 2005 described the
qualification and functions of a Public Health Nurse.
Public health nurse
- must be professionally qualified and licensed to practice in the area of
public health nursing.
- Must possess personal qualities and “people skills” that would allow
her practice to make a difference in the lives of these people.

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 - Functions in accordance with the dominant values of public health
nurses, within the ethico-legal framework of the nursing profession, and in
accordance with the needs of the clients and available resources for health
care.
- Functions of PHN are consistent with the Nursing Law 2002 and
program policies formulated by the DOH and local government health
agencies. They are related to management, supervision, provision of
nursing care, collaboration and coordination, health promotion and
education training and research.
● Management function
● Supervisory function
● Nursing function
● Collaborating and coordinating function
● Health Promotion and Education function
● Training function
● Research function

6. Evolution of Public Health Nursing in the Philippines

Historical Background
1898
- Department of Health was first established as Department of Public
Works, Education and Hygiene.
1912
- The Fajardo Act (Act No. 2156) created Sanitary Divisions.
- The President of Sanitary Division took charge of two or three
municipalities. Where there are no physicians available, male nurses
were assigned to perform the duties of the President, Sanitary
Division.
- Philippine General Hospital (PGH), then under the Bureau of Health
sent four nurses to Cebu to take of mothers and their babies.
- St. Paul’s Hospital School of Nursing in Intramuros, also assigned two
nurses to do home visiting in Manila and gave nursing care to mothers
and newborn babies from the outpatient obstetrical service of the
PGH.
1914
- School nursing was rendered by a nurse employed by the Bureau of
Health in Tacloban, Leyte.
- Reorganization Act No. 2462 created the Office of General Inspection.
- Dr. Rosario Pastor a lady physician was headed the Office of District
Nursing.

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 - Two graduate Filipino nurses, Mrs. Casilang Eustaquia and Mrs.
Matilde Azurin were employed for Maternal and Child Health and
Sanitation in Manila under an American nurse, Mrs. G.D. Schudder.
1919
- The first Filipino nurse Supervisor under the Bureau of Health, Miss
Carmen del Rosario was appointed. She succeeded Miss Mabel Dabbs.
1923
- Two government Schools of Nursing were established: Zamboanga
General Hospital School of Nursing in Mindanao and Baguio General
Hospital in Northern Luzon. These schools were primarily intended to
train non-Christian women and prepare them to render service
among their people.
- Four more government School of Nursing were establish: one in
Southern Luzon (Quezon Province) and three in the Visayan Islands of
Cebu, Bohol and Leyte.
1927
- The Office of District Nursing under the Office of General Inspection,
Philippine Health Service was abolished and supplanted by the Section
of Public Health Nursing. Mrs. Genara de Guzman acted as consultant
to the Director of Health on nursing matters.
1928
- First convention of nurses was held followed by yearly conventions
until the advent of World War II. Pre-service training was initiated as a
pre-requisite for appointment.
1930
- The Section of Public Health Nursing was converted into Section of
Nursing. The Section of Nursing was transferred from the Office of
General Services to the Division of Administration. This Office covered
the supervision and guidance of nurses in the provincial hospitals and
the government schools of nursing.
1933
- Reorganization Act No. 4007 transferred the Division of Maternal and
Child Health of the Office of Public Welfare Commission to the Bureau
of Health.
- Mrs. Soledad A. Buenafe, former Assistant Superintendent of Nurses
of the Public Welfare Commission was appointed as Assistant Shief
Nurse of the Section of Nursing, Bureau of Health
1941

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 - Bureau of Health were transferred to the new department.
- Dr. Mariano Icasiano became the first City Health Officer of Manila.
- An office of Nursing was organized with Mrs. Vicenta C. Pnce. As Chief
Nurse and Mrs. Rosario A. Ordiz as Assistant Chief Nurse.
Dec 8. 1941
- World War II broke out, public health nurses in Manila were assigned
to devastated areas to attend to the sick and the wounded.
1942
- A group of public health nurses, physicians and administrators from
the Manila Health Department went to the internet camp in Capas,
Tarlac to receive sick prisoners of war repleased by the Japanese
Army.
- They were confined at San Lazaro Hospital and 68 Public Health
Nurses were assigned to help the hospital staff take care of them.
July 1942
- 31 nurses who were taken prisoners of war by the Japanese army and
confined at the Bilibid Prison in Manila were released to the Director
of the Bureau of Health, Dr. Eusebio Aguilar who acted as their
guarantor.
- Many public health nurses joined the guerillas or went to hide in the
mountains during World War II.
February 1946
- Post war records of the Bureau of Health showed that there were 308
public health nurses and 38 supervisors compared to pre-war when
there were 556 public health nurses and 38 supervisors.
- Mrs. Genera M. de Guzman, Technical Assistant in Nursing of the
Department of Health and concurrent President of the Filipino Nurses
Association recommended the creation of a Nursing Office in the
Department of Health.
Oct. 7, 1947
- Executive Order No. 94 organized government offices and created the
Division of Nursing under the Office of the Secretary of Health. This
was implemented on December 16, 1947.
- Mrs. Genara de Guzman was appointed as Chief of the Division, with
three Assistant: Miss Annie Sand for Nursing Education; Mrs.
Magdalena C. Valenzuela for Public Health Nursing and Mrs.
Patrocinio J. Montellano for Staff Education.
- At the Bureau of Health, the Section of Nursing Supervision took over
the functions of the former Section of Nursing.

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 - Mrs. Soledad Buenafe was appointed Chief and Miss Marcela Gabatin,
Assistant Chief.
1948
- The first training Center of the Bureau of Health was organized in
cooperation with the Pasay City Health Department. This was housed
at the Tabon Health Center located in a marginalized part of the city.
It was later renamed as Doña Marta Health Center.
- Physicians and nurses undergoing pre-service and in-service training
in public health/public health nursing as well as nursing student on
affiliation were assigned to the above training center.
1950
- The Rural Health Demonstration and Training Center (RHDTC) was
established by the Department of Health through the initiative of Dr.
Hilario Lara, Dean, institute of Hygiene, now College of Public Health,
University of the Philippines.
- The WHO/UNICEF assisted project used health centers of the Quezon
City Health Department, which were located in the rural areas of the
city.
- Dr. Amansia S. Mangay (Mrs. Andres Angara), a Doctor of Public
Health Graduate form Harvard was chosen tobe the Chief of the
RHDTC.
- Dr. Antonio V. Acosta, former Physician of the Manila Health
Department was Medical Training Officer.
1953
- The Office of Health Education and Personnel Training was established
with Dr. Trinidad Gomez as Chief
- Philippine Congress approved Republic Act No. 1082 or the Rural
Health Law. It created the first 81 Rural Health Units.
1957
- Republic Act 1891 was approved amending Sections Two, Three, Four,
Seven and Eight of R.A. 1082 :Strengthening Health and Dental
Services in the Rural Areas and Providing Funds thereto.”
1958-1965
- Republic Act 977 passed by Congress in 1954 was implemented. This
abolished the Division of Nursing. However, it created nursing
positions at different levels in the health organization. Miss Annie
Sand was appointed Nursing Consultant under the Office of the
Secretary of Health.

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 - The Department of Health National League of Nurses, Inc. was
founded by Miss Annie Sand in 1961. She became its first President
and Adviser.
- The Reorganization Act with implementing details embodied in
Executive Order 288, series of 1959 de-centralized and integrated
health services.
- The reorganization of 1959 also merged two Bereaus in the
Department of Health. The Bureau of Health was merged with the
Bureau of Hospitals to form the Bureau of Health and Medical
Services.
1967
- In the Burea of Disease Control, Mrs. Zenaida Panlilio – Nisce was
appointed as Nursing Program Supervisor and served as consultant on
the nursing aspects of the 5 special diseases: TB, Leprosy, Venereal
Disease, Cancer, Filariasis, and Mental Health.
1974
- The Project Management Staff was organized as part of Population II
of the Philippine Government with Dr. Francisco Aguilar as Project
Manager.
1975
- The roles of the public health nurse and the midwife were expanded.
2000 midwives were recruited and trained to serve in the rural areas.
1987-1989
- Executive Order No. 119 reorganized the Department of Health and
created several offices and services within the Department of Health.
1990-1992
- Department Order No. 29 designated Mrs. Neila F. Hizon, Nurse VI,
then President of the National League of Philippine Government
Nurses, as Nursing Adviser. She was detailed at the Office Public
Health Services. As Nursing Adviser, matters affecting nurses and
nursing are referred to her.

May 24, 1999

- Executive Order No. 102 was signed by President Joseph Ejercito
Estrada, redirecting the functions and operations of the Department
of Health.
2005-2006
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 - The development of the Rationalization Plan to streamline the
bureaucracy further was started and is in the last stages of
finalization.

7. Roles and Responsibilities of a Community Health Nurse

Roles and functions of the Community Health Nurse (CHN)
1. Clinician – focus is on the health of the population or individuals on the
larger context of the community. Provides nursing care to the sick and
disabled in order to reduce disease, discomfort, disability, and premature
death, among others.
2. Advocate – speaks or acts for those who cannot speak/act for themselves.
Advocates for self-care and self-determination.
3. Collaborator – brings together strength and weaknesses of people
involved toward a common goal. She works with people in the
community toward a common goal and relies on joint or shared decision
making.
4. Consultant – catalyst to bring change, helping people understand
processes and actions, and assisting them in decision-making.
5. Counselor – listens and provides feedback and information, strengthens
and guides people’s own decision making skills, and explores feelings and
attitudes for people understand themselves and their decisions.
6. Educator – acts as a health educator which is one of her most important
roles as CHN. The CHN provides knowledge, skills, and attitudes needed
by the community members for self-efficacy in making decisions and
empowerment. Enables clients to make informed decisions, identifies
populations at risk, and explores learning strategies.
7. Researcher – utilizes data to predict future phenomenon and modify
interventions. Reliable research foundation allows nurses to anticipate
potential health problems and interventions. Identifies research
problems, works with data, and conducts research.
8. Case manager – coordinates care in a system that is made up of many
different programs which has different policies, services and missions in
order to avoid gaps in services and breakdown in the care system.

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