“Navigating Healthcare Frontiers: An In-Depth Examination of Challenges Faced by Public Health Nurses in Implementing Universal Health Services in San Carlos City, Pangasinan”

This study explored the lived experiences of public health nurses in implementing universal health services in San Carlos City, Pangasinan. Specifically, it sought to describe the challenges encountered by public health nurses in delivering community-based health services, the effects of these challenges on service delivery and professional practice, and the strategies they used to manage difficult situations. A qualitative descriptive phenomenological research design was employed, guided by Giorgi’s phenomenological method. Seven public health nurses who had direct experience in implementing universal health services were purposively selected based on the established inclusion criteria. Data were gathered through individual, in-depth, semi-structured interviews conducted in English, Filipino, Pangasinan, and/or Ilocano. Interviews were audio-recorded with consent, transcribed, translated when necessary, and analyzed through the identification, transformation, and synthesis of meaning units until a general structure of the phenomenon was developed.
The findings revealed five major themes: (1) Demanding and Expanding Nature of Public Health Nursing, (2) Health-System and Resource Constraints Affecting Care Delivery, (3) Patient Engagement, Communication, and Cultural Determinants of Care, (4) Consequences of Interacting Health-System Challenges, and (5) Adaptation, Collaboration, and Professional Resilience. The findings showed that public health nurses managed multiple and competing responsibilities, including direct patient care, health programs, documentation, home visits, and community activities, which at times extended beyond regular working hours. Medication and supply shortages, limited facility capacity, and unavailable diagnostic services further constrained their ability to provide timely and complete care. Communication difficulties, health beliefs, traditional practices, and challenging patient interactions also influenced health education, treatment adherence, and patient engagement. These challenges interacted with one another, contributing to delayed or incomplete care, emotional and professional strain, and work-life spillover. Despite these difficulties, nurses demonstrated resourcefulness, strategic problem-solving, time management, collaboration, continuing professional development, patience, and resilience to sustain service delivery.
The study concludes that the implementation of universal health services is influenced not only by the commitment and competence of public health nurses but also by the organizational and health-system conditions in which they work. Individual resilience and adaptability help nurses manage challenges but cannot replace adequate staffing, reliable resources, sufficient facility capacity, accessible services, and supportive working environments. The study recommends strengthening workforce planning, improving the availability and management of medicines and supplies, enhancing facility and referral capacity, streamlining administrative requirements, promoting culturally responsive communication, and strengthening organizational support and continuing professional development for public health nurses. These measures may contribute to more accessible, timely, equitable, and sustainable universal health services in community settings.

public health nurses, universal health services, lived experiences, phenomenology, rural health units, health service delivery, professional resilience

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