Nursing Concepts IV CONCEPTS of PUBLIC HEALTH
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GRADUATE SCHOOL MASTER IN NURSING NRS 211 Nursing Concepts IV Advanced Community Health Nursing CONCEPTS OF PUBLIC HEALTH Submitted by: Arnold L. De Guzman Jr. RN MN Student Submitted to: Mr. Dean Michael D. Songco, RN, MAN Professor June 2014 DEFINITIONS & CONCEPTS HEALTH The World Health Organization defines health as a “state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.” PUBLIC HEALTH The classic definition of public health comes from Dr. C. E. Winslow. He defines public health as the “science and art of preventing diseases, prolonging life, promoting health and efficiency through organized community effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.” On the other hand, WHO defined public health as the “art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number”. It points to the fact that public health is a core element of government attempts to improve and promote the health and welfare of their citizens”. HISTORY OF PUBLIC HEALTH FROM ITS EARLY BEGINNINGS TO PRESENT The history of public health nursing in the Philippines is embedded in the history of the Department of Health which was first established as the Department of Public Works, Education, and Hygiene in 1898. Since then, various laws were enacted to organize and establish the various structures and activities of the health agency covering the entire country. The following milestones marked the events when the nurses and nursing were particularly mentioned in the historical accounts. The Fajardo Act (Act No. 2156) created Sanitary Divisions. The President of Sanitary Division took charge of two or three municipalities. Where 1912 there were no physicians available, male nurses were assigned to perform the duties of the President, Sanitary Division. School nursing was rendered by a nurse employed by the Bureau of Health in Tacloban, Leyte. In the same year, Reorganization Act No. 2462 created the Office of General Inspection. The Office of District Nursing 1914 was organized under this office. It was headed by a lady physician, Dr. Rosario Pastor who was also a nurse. This Office was created due to increasing demands for nurses to work outside the hospital, and the need for direction, supervision and guidance of public health nurse. Ms. Perlita Clark took charge of the public health nursing work. Her staff was composed of one American nurse supervisor, one American dietitian, 1916-1918 36 Filipino nurses working in the provinces and one nurse and one dietitian assigned in two Sanitary Divisions. Four graduate nurses paid by the City of Manila were employed to work in 1917 the City Schools. Provinces that could afford to carry out school health services were encouraged to employ a district nurse. 1918 The office of Ms. Clark was abolished due to lack of funds. The first Filipino nurse supervisor under the Bureau of Health, Miss 1919 Carmen del Rosario was appointed. She succeeded Ms. Mabel Dabbs. She had a staff of 84 public health nurses assigned in five health stations. Two government Schools of Nursing were established: Zamboanga General Hospital School of Nursing in Mindanao and Baguio General 1923 Hospital in Northern Luzon. In later years, four more government Schools of Nursing were established. The first convention of nurses was held followed by yearly conventions 1928 until the advent of World War II. The Section of Public Health Nursing was converted into Section of 1930 Nursing due to pressing need for guidance not only in public nursing service but also in hospital nursing and nursing education. When World War II broke out, public health nurses in Manila were 1941 assigned to devastated areas to attend to the sick and the wounded. October 7, Executive Order No. 94 reorganized government offices and created the 1947 Division of Nursing under the Office of the Secretary of Health. The first training center of the Bureau of Health was organized in cooperation with the Pasay City Health Department. Physicians and 1948 nurses undergoing pre-service and in-service training in public health/ public health nursing as well as nursing students 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. It was used as a laboratory for the field experience of graduate and basic students in medicine, nursing, health education, nutrition and social work. Philippine Congress approved Republic Act No. 1082 or the Rural Health 1953 Law. It created the first 81 Rural Health units. Each unit had a physician, a public health nurse, midwife, a sanitary inspector and a clerk driver. Republic Act 1891 was approved amending Sections 2, 3, 4, 7, & 8 of R.A. 1082 “ Strengthening Health and Dental Service in the rural Areas 1957 and Providing Funds thereto”. This resulted in additional number of positions fro health workers including public health nurses and midwives. 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. The Reorganization Act with implementing details embodied in Executive Order 288, series 1959 de-cetralized and integrated health services. It 1958 – 1965 created 8 Regional Health Offices in the country, which were later increased to 11 and eventually 17. The reorganization of 1959 also merged two Bureaus in the Department if Health. The Bureau of Health was merged with the Bureaus of Hospitals to form the Bureau of Health and Medical Services. In the bureau of Disease Control, Mrs. Zenaida Panlilio – Nisce was appointed as Nursing Program Supervisor and served as consultant on 1967 the nursing aspects of the 5 special diseases: TB, Leprosy, Venereal Disease, Cancer, Filiariasis; and, Mental Health. She was involved in program planning, monitoring, evaluation and research. As a result of the restructuring of the health care delivery system based on findings of the Operations Research (WHO assisted) conducted in the province of Rizal in the early 70’s, the functions of the health team 1975 members were redefined. The roles of the public health nurse and the midwife were expanded. Two thousand midwives were recruited and trained to serve in the rural areas. The Nursing Consultant and Nursing Program Supervisor of the Office of the Secretary of Health were involved in the Rural Health Practice Program which required medical and nursing graduates to serve for two months in the rural areas of the country before their licenses could be issued by the Professional Regulation Commission. When the number of 1976 – 1986 nursing graduates reached over 12,000 per year, the program was stopped. By then, the objectives of the program that health services be made available in the rural areas of the country and that the young medical and nursing graduates develop a liking for working in these remote underserved areas were partially attained. Executive Order No. 119 reorganized the Department of Health and 1987 – 1989 created several offices and services within the Department of Health. 1990-1992 Aside from the usual services for mothers and children, involvement of nurses in the following programs has emerged: Expanded Program on Immunization, Control of Diarrheal Diseases and control of Acute Respiratory Infections. Department Order No. 29 designated Mrs. Nelia F. Hizon, Nurse IV, then President of the National League of Philippine Government Nurses, as January 1999 Nursing Adviser. She was detailed at the Office of Public Health Service. As Nursing Adviser, matters affecting nurses and nursing are referred to her Executive Order No. 102 was signed by President Joseph Ejercito Estrada, redirecting the functions and operations of the Department of May 24, 1999 Health. Based on this Executive Order, most of the nursing positions at the Central Office were either transferred or devolved to other offices and services The development of the Rationalization Plan to streamline bureaucracy 2005 – 2006 further was stated and is in the last stages of finalization. CORE BUSINESS OF PUBLIC HEALTH 1. Disease Control 2. Injury Prevention 3. Health Protection 4. Healthy public policy including those in relation to environmental hazards such as in the workplace, housing, food, water, etc. 5. Promotion of health and equitable health gain. The core business of public health cannot be achieved without the proper delivery Of essential public health functions which Yach described as “ a set of fundamental activities that address the determinants of health, protect a population’s health and treat disease. These public health functions represent public goods, and in this respect governments would need to ensure the provision of these essential functions, but would not necessarily have to implement and finance them. They prevent and manage the major contributors to the burden of disease by using effective technical, legislative, administrative and behavior-modifying interventions or deterrents, and thereby provide an approach for intersectoral action for health. This approach stresses the importance of numerous different public health partners. Moreover, the need for flexible, competent state institutions to oversee these cost-effective initiatives suggests that the institutional capacity of states must be reinforced. The following are the essential public health functions: 1. Health situation monitoring and analysis 2. Epidemiological surveillance/disease prevention and control 3. Development of policies and planning in public health 4. Strategic management of health systems and services for population health gain 5.