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COMMUNITY HEALTH NURSING Mrs. Laarne Estenzo-Pontillas BSN , R.N.

, MSN (Mark 10:45) Discipleship is a lifestyle Not just a biblical truth Nor a Christian ideal but a way of life For the Son of Man also came not to be served But to serve and to give His life as a ransom for many. COVERAGE FOR LOCAL BOARD EXAM : CHN Safe and Quality Care, Health Education, and Communication, Collaboration and Teamwork a. Principles and Standard of CHN b. Levels of care c. Types of Clientele d. Health Care Delivery System e. PHC as a Strategy f. Family-based Nursing Services(Family Health Nursing Process) g. Population Group-based Nursing Services h. Community-based Nursing Services/Community Health Nursing Process i. Community Organizing j. Public Health Programs Research and Quality Improvement Research in the Community National Health Situation Vital Statistics Epidemiology Demography Management of Resources & Environment and Records Management Field Health Services And Information System Target-setting Environmental Sanitation Ethico-Moral-Legal Responsibility Socio-cultural values, beliefs, and practices of individuals, families, groups and communities Code of Ethics for Government Workers WHO, DOH, LGU policies on health Local Government Code Issues Personal And Professional Development Self-assessment of CHN competencies, importance, methods and tools Strategies and methods of updating ones self, enhancing competence in community health nursing and related areas. HISTORY OF CHN Date Event 1901 - Act # 157 ( Board of Health of the Philippines) ; Act # 309 ( Provincial

and Municipal Boards of Health) were created. 1905 - Board of Health was abolished; functions were transferred to the Bureau of Health. 1912 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of present MHOs; male nurses performs the functions of doctors 1919 Act # 2808 (Nurses Law was created)
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Carmen del Rosario , 1 Fil. Nurse supervisor under Bureau of Health Oct. 22, 1922 Filipino Nurses Organization (Philippine Nurses Organization) was organized. 1923 Zamboanga General Hospital School of Nursing & Baguio General Hospital were established; other government schools of nursing were organized several years after. 1928- 1 Nursing convention was held 1940 Manila Health Department was created. 1941 Dr. Mariano Icasiano became the first city health officer; Office of Nursing was created through the effort of Vicenta Ponce (chief nurse) and Rosario Ordiz (assistant chief nurse) Dec. 8, 1941 Victims of World War II were treated by the nurses of Manila. July 1942 Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31 Filipino nurses in Bilibid Prison as prisoners of war by the Japanese. Feb. 1946 Number of nurses decreased from 556 308. 1948 First training center of the Bureau of Health was organized by the Pasay City Health Department. Trinidad Gomez, Marcela Gabatin, Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and Zenaida Nisce composed the training staff. 1950 Rural Health Demonstration and Training Center was created. 1953 The first 81 rural health units were organized. 1957 RA 1891 amended some sections of RA 1082 and created the eight categories of rural health unit causing an increase in the demand for the community health personnel.
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1958-1965 Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288) 1961 Annie Sand organized the National League of Nurses of DOH. 1967 Zenaida Nisce became the nursing program supervisor and consultant on the six special diseases (TB, leprosy, V.D., cancer, filariasis, and mental health illness). 1975 Scope of responsibility of nurses and midwives became wider due to restructuring of the health care delivery system. 1976-1986 The need for Rural Health Practice Program was implemented. 1990- 1992- Local Government Code of 1991 (RA 7160) 1993-1998 Office of Nursing did not materialize in spite of persistent recommendation of the officers, board members, and advisers of the National League of Nurses Inc. Jan. 1999 Nelia Hizon was positioned as the nursing adviser at the Office of Public Health Services through Department Order # 29. May 24, 1999 EO # 102, which redirects the functions and operations of DOH, was signed by former President Joseph Estrada. LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSING R.A. 7160 - or the Local Government Code. This involves the devolution of powers, functions and responsibilities to the local government both rural & urban.The Code aims to transform local government units into self-reliant communities and active partners in the attainment of national goals thru a more responsive and accountable local government structure instituted thru a system of decentralization. Hence, each province, city and municipality has a LOCAL HEALTH BOARD ( LHB ) which is mandated to propose annual budgetary allocations for the operation and maintenance of their own health facilities. Composition of LHB Provincial Level 1.Governor- chair 2. Provincial Health Officer vice chair 3. Chair , Committee on Health of Sangguniang Panlalawigan

4. DOH rep. 5. NGO rep. Composition of LHB City and Municipal Level Mayor chair 2. MHO vice chair 3. Chair, Committee on Health of Sangguniang Bayan 4. DOH rep 5. NGO rep EFFECTIVE LHS DEPENDS ON: 1. the LGUs financial capability 2. a dynamic and responsive political leadership 3. community empowerment R.A. 2382 Philippine Medical Act. This act defines the practice of medicine in the country.
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R.A. 1082 Rural Health Act. It created the 1 81 Rural Health Units. -amended by RA 1891 ; more physicians, dentists, nurses, midwives and sanitary inspectors will live in the rural areas where they are assigned in order to raise the health conditions of barrio people ,hence help decrease the high incidence of preventable diseases R.A. 6425 Dangerous Drugs Act. It stipulates that the sale, administration, delivery, distribution and transportation of prohibited drugs is punishable by law. R.A. 9165 the new Dangerous Drug Act of 2002 P.D. No. 651 requires that all health workers shall identify and encourage the registration of all births within 30 days following delivery. P.D. No. 996 requires the compulsory immunization of all children below 8 yrs. of age against the 6 childhood immunizable diseases. P.D. No. 825 provides penalty for improper disposal of garbage. R.A. 8749 Clean Air Act of 2000 P.D. No. 856 Code on Sanitation. It provides for the control of all factors in mans environment that affect health including the quality of water, food, milk, insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, pollution and control of nuisance. R.A. 6758 standardizes the salary of government employees including the nursing personnel. R.A. 6675 Generics Act of 1988 which promotes, requires and ensures the production of an adequate supply, distribution, use and

acceptance of drugs and medicines identified by their generic name. R.A. 6713 Code of Conduct and Ethical Standards of Public Officials and Employees. It is the policy of the state to promote high standards of ethics in public office. Public officials and employees shall at all times be accountable to the people and shall discharges their duties with utmost responsibility, integrity, competence and loyalty, act with patriotism and justice, lead modest lives uphold public interest over personal interest. R.A. 7305 Magna Carta for Public Health Workers. This act aims: to promote and improve the social and economic well-being of health workers, their living and working conditions and terms of employment; to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs; and to encourage those with proper qualifications and excellent abilities to join and remain in government service. R.A. 8423 created the Philippine Institute of Traditional and Alternative Health Care. P.D. No. 965 requires applicants for marriage license to receive instructions on family planning and responsible parenthood. P.D. NO. 79 defines , objectives, duties and functions of POPCOM RA 4073 advocates home treatment for leprosy Letter of Instruction No. 949 legal basis of PHC dated OCT. 19, 1979 - promotes development of health programs on the community level RA 3573 requires reporting of all cases of communicable diseases and administration of prophylaxis Ministry Circular No. 2 of 1986 includes AIDS as notifiable disease R.A. 7875 National Health Insurance Act R.A. 7432 Senior Citizens Act R. A. 7719 - National Blood Services Act R.A. 8172 Salt Iodization Act ( ASIN LAW) R.A. 7277- Magna Carta for PWDs, provides their rehabilitation, self-development and selfreliance and integration into the mainstream of society O. No. 2005-0014- National Policies on Infant and Young Child Feeding:

1.All newborns be breastfeed within 1 hr after birth 2. Infants be exclusively breastfeed for 6 mos. 3. Infants be given timely, adequate and safe complementary foods 4. Breastfeeding be continued up to 2 years and beyond EO 51- Phil. Code of Marketing of Breastmilk Substitutes R.A.- 7600 Rooming In and Breastfeeding Act of 1992 R.A. 8976- Food Fortification Law R.A. 8980- prolmulgates a comprehensive policy and a national system for ECCD A..O. No. 2006- 0015- defines the Implementing guidelines on Hepatitis B Immunization for Infants R.A. 7846- mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs old R.A. 2029- madates Liver Cancer and Hepatitis B Awareness Month Act ( February) A.O. No. 2006-0012- specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk Code, Relevant International Agreements, Penalizing Violations thereof and for other purposes Public Health - science and art of preventing diasease, prolonging life, promoting health and efficiency thru 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 diseases and the development of 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 off birth and longevity ( DR. C.E. Winslow) Community Health Nursing - special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability ( WHO Expert Committee of Nursing ) CHN - a learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the clients optimum level of

functioning thru teaching and delivery of care ( Jacobson ) - a service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools , workplace for the promtion of health, preventionof illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman) Concepts 1. The primary focus of community health nursing is health promotion. 2. Community health nurses provide care necessary to meet the requirements of an individual all throughout the life cycle. 3. Knowledge on different fields (biological and social sciences, clinical nursing, and community health organizations) is used. 4. Nursing process in community health nursing changes based on the needs of the community. Goal To elevate the level health of the multitude. Worth and dignity of man. 1.The need of the community is the basis of community health nursing. 2.The community health nurse must understand fully the objectives and policies of the agency she represents. 3. The family is the unit of service. 4. CHN must be available to all regardless of race,creed and socioeconomic status 5. The CHN works as a member of the health team 6. There must be provision for periodic evaluation of community health nursing services 7. Opportunities for continuing staff education programs for nurses must be provided by the community health nursing agency and the CHN as well 8. The CHN makes use of available community health resources 9. The CHN taps the already existing active organized groups in the community 10. There must be provision for educative supervision in community health nursing 11. There should be accurate recording and reporting in community health nursing 12. Health teaching is the primary responsibility of the community health nurse

Standards III. Diagnosis Analyzes collected data to determine the needs/ health problems of IFC IV. Planning At each level of prevention, develops plans that specify nursing actions unique to needs of clients Standards V. Intervention Guided by the plan, intervenes to promote, maintain or restore health, prevent illness and institute rehabilitation VI. Evaluation Evaluates responses of clients to interventions to note progress toward goal achievement, revise data base, diagnoses and plan Standards VII. Quality Assurance and Professional Development Participates in peer review and other means of evaluation to assure quality of nursing practice Assumes professional development Contributes to development of others Standards VIII. Interdisciplinary Collaboration Collaborates with other members of the health team, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health Standards

Research Indulges in research to contribute to theory and practice in community health nursing

LEVELS OF CARE/ PREVENTION


1. PRIMARY 2. SECONDARY 3. TERTIARY

Types of Clientele
1. INDIVIDUALS 2. FAMILIES 3. COMMUNITIES 4. POPULATION GROUPS - Aggregate of people who share common characteristics, developmental stage or common exposure to particular environmental factors thus resulting in common health problems ( Clark, 1995:5) e.g. children . elderly, women, workers etc.

Standards in CHN
I. Theory Applies theoretical concepts as basis for decisions in practice II. Data Collection Gathers comprehensive , accurate data systematically

Phil.Health Care Delivery System


1.PRIMARY LEVEL FACILITIES 2. SECONDARY LEVEL FACILITIES 3. TERTIARY LEVEL FACILITIES Classify as to what level the ff. belong 1. Teaching and Training Hospitals 2. City Health Services 3. Emergency and District Hospitals 4. Private Practitioners 5. Heart Institutes 6. Puericulture Centers 7. RHU THE DEPARTMENT OF HEALTH VISION: Health for all Filipinos MISSION: Ensure accessibility & quality of health care to improve the quality of life of all Filipinos, especially the poor. NATIONAL OBJECTIVES Improve the general health status of the population (reduce infant mortality rate, reduce child morality rate, reduce maternal mortality rate, reduce total fertility rate, increase life expectancy & the quality of life years). Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases, Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders, Protein Energy Malnutrition, Iron Deficiency Anemia & Obesity. 3.Eliminate the ff. diseases as public health problems: Schistosomiasis Malaria Filariasis Leprosy Rabies Measles Tetanus Diphtheria & Pertussis Vitamin A Deficiency & Iodine Deficiency Disorders 4. Eradicate Poliomyelitis 5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness, personal hygiene, mental health & less stressful life & prevent violent & risk-taking behaviors. 6. Promote the health & nutrition of families & special populations through child, adolescent & youth, adult health, womens health, health of older persons, health of indigenous people, health of migrant workers and health of different disabled persons and of the rural & urban poor.

7. Promote environmental health and sustainable development through the promotion and maintenance of healthy homes, schools, workplaces, establishments and communities towns and cities.

Basic Principles to Achieve Improvement in Health


Universal access to basic health services must be ensured. The health and nutrition of vulnerable groups must be prioritized. The epidemiological shift from infection to degenerative diseases must be managed. The performance of the health sector must be enhanced. Primary Strategies to Achieve Goals Increasing investment for Primary Health Care. Development of national standards and objectives for health. Assurance of health care. Support to the local system development. Support for frontline health workers. PHC as a Strategy PRIMARY HEALTH CARE (PHC) May 1977 -30 World Health Assembly decided that the main health target of the government and WHO is the attainment of a level of health that would permit them to lead a socially and economically productive life by the year 2000. September 6-12, 1978 - First International Conference on PHC in Alma Ata, Russia (USSR) The Alma Ata Declaration stated that PHC was the key to attain the health for all goal October 19, 1979 - Letter of Instruction (LOI) 949), the legal basis of PHC was signed by Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and implementation of programs focusing on health development at community level. Magnitude of Health Problems Inadequate and unequal distribution of health resources Increasing cost of medical care Isolation of health care activities from other development activities DEFINITION OF PRIMARY HEALTH CARE essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at cost that the community can afford at every stage of development.
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a practical approach to making health benefits within the reach of all people. an approach to health development, which is carried out through a set of activities and whose ultimate aim is the continuous improvement and maintenance of health status of the community. GOAL OF PRIMARY HEALTH CARE: HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the year 2020. An improved state of health and quality of life for all people attained through SELF-RELIANCE. KEY STRATEGY TO ACHIEVE THE GOAL: Partnership with and Empowerment of the people - permeate as the core strategy in the effective provision of essential health services that are community based, accessible, acceptable, and sustainable, at a cost, which the community and the government can afford. OBJECTIVES OF PRIMARY HEALTH CARE Improvement in the level of health care of the community Favorable population growth structure Reduction in the prevalence of preventable, communicable and other disease. Reduction in morbidity and mortality rates especially among infants and children. Extension of essential health services with priority given to the underserved sectors. Improvement in Basic Sanitation Development of the capability of the community aimed at self-reliance. Maximizing the contribution of the other sectors for the social and economic development of the community. MISSION: To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. TWO LEVELS OF PRIMARY HEALTH CARE WORKERS Barangay Health Workers - trained community health workers or health auxiliary volunteers or traditional birth attendants or healers. Intermediate level health workers include the Public Health Nurse, Rural Sanitary Inspector and midwives. PRINCIPLES OF PRIMARY HEALTH CARE 1. 4 A's = Accessibility, Availability, Affordability & Acceptability, Appropriateness of health services. The

health services should be present where the supposed recipients are. They should make use of the available resources within the community, wherein the focus would be more on health promotion and prevention of illness. 2. COMMUNITY PARTICIPATION =heart and soul of PHC 3. People are the center, object and subject of development. Thus, the success of any undertaking that aims at serving the people is dependent on peoples participation at all levels of decision-making; planning, implementing, monitoring and evaluating. Any undertaking must also be based on the peoples needs and problems (PCF, 1990) Part of the peoples participation is the partnership between the community and the agencies found in the community; social mobilization and decentralization. In general, health work should start from where the people are and building on what they have. Example: Scheduling of Barangay Health Workers in the health center

BARRIERS OF COMMUNITY INVOLVEMENT


Lack of motivation Attitude Resistance to change Dependence on the part of community people Lack of managerial skills

4.SELF-RELIANCE 5.Partnership between the community and the health agencies in the provision of quality of life. Providing linkages between the government and the non-government organization and peoples organization. 6. Recognition of interrelationship between the health and development HEALTH is not merely the absence of disease. Neither it is only a state of physical and mental well-being. Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. Good Health therefore, is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents (PCF, DEVELOPMENT is the quest for an improved quality of life for all. Development is multi-dimensional. It has a political, social, cultural, institutional and environmental dimensions(Gonzales 1994). Therefore, it is measured by the ability of people to satisfy their basic needs. 7. SOCIAL MOBILIZATION

It enhances people participation or governance, support system provided by the Government, networking and developing secondary leaders. MAJOR STRATEGIES OF PRIMARY HEALTH CARE A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORTS. Attaining Health for all Filipino will require expanding participation in health and health related programs whether as service provider or beneficiary. Empowerment to parents, families and communities to make decisions of their health is really the desired outcome. Advocacy must be directed to National and Local policy making to elicit support and commitment to major health concerns through legislations, budgetary and logistical considerations. B. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CARE The health in the hands of the people brings the government closest to the people. It necessitates a process of capacity building of communities and organization to plan, implement and evaluate health programs at their levels. C. INCREASING EFFICIENCIES IN THE HEALTH SECTOR Using appropriate technology will make services and resources required for their delivery, effective, affordable, accessible and culturally acceptable. The development of human resources must correspond to the actual needs of the nation and the policies it upholds such as PHC. The DOH will continue to support and assist both public and private institutions particularly in faculty development, enhancement of relevant curricula and development of standard teaching materials. D. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCH Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral, multidisciplinary and scientific approach to health programming and delivery. FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE 1. Active Community Participation 2. Intra and Inter-sectoral Linkages 3. Use of Appropriate Technology 4. Support mechanism made available ELEMENTS OF PRIMARY HEALTH CARE: Is one of the potent methodologies for information dissemination. It promotes the partnership

of both the family members and health workers in the promotion of health as well as prevention of illness. The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Example Malaria Control and Schistosomiasis Control Expanded Program on Immunization This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus, diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. The goal of Family Planning includes spacing of children and responsible parenthood. Environmental Sanitation and Promotion of Safe Water Supply Environmental Sanitation is defined as the study of all factors in the mans environment, which exercise or may exercise deleterious effect on his wellbeing and survival. Water is a basic need for life and one factor in mans environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health. One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country. Treatment of Communicable Diseases and Common Illness The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death. Most communicable diseases are also preventable. The Government focuses on the prevention, control and treatment of these illnesses.

This focuses on the information campaign on the utilization and acquisition of drugs. In response to this campaign, the GENERIC ACT of the Philippines is enacted . It includes the following drugs: Cotrimoxazole, Paracetamol,

Amoxycillin, Oresol, Nifedipine, Rifampicin, INH(isoniazid) and Pyrazinamide,Ethambutol, Streptomycin,Albendazole,Quinine


FAMILY HEALTH NURSING - that level of CHN practice directed to the FAMILY as the unit of care with HEALTH as the goal and NURSING as the medium, channel or provider of care Family Case Load - the no. and kind of families a nurse handles at any given time - variable for cases are added or dropped based on the need for nursing care and supervision

Family Nursing Problem Arises when the family cannot effectively perform its health tasks Nurses Roles in Family Health Nursing 1. HEALTH MONITOR 2. PROVIDER OF CARE TO A SICK FAMILY MEMBER 3. COORDINATOR OF FAMILY SERVICES 4. FACILITATOR 5. TEACHER 6. COUNSELOR INITIAL DATA BASE FOR FAMILY NURSING PRACTICE Family structure, Characteristics, and Dynamics Members of the household and relationship to the head of the family Demographic data age, sex, civil status, position in the family Place of residence of each member whether living with the family or elsewhere . Type of family structure e.g. matriarchal or patriarchal, nuclear or extended Dominant family members in terms of decisionmaking, especially in matters of health care General family relationship/dynamics presence of any readily observable conflict between members; characteristics communication patterns among members Socio-economic and Cultural Characteristics Income and Expenses Occupation, place of work and income of each working members Adequacy to meet basic necessities Who makes decisions about money and how it is spent Educational attainment of each other Ethnic background and religious affiliation Significant Others role(s) they play in familys life Relationship of the family to larger community Nature and extent of participation of the family in community activities Home and Environment Housing Adequacy of living peace Sleeping arrangement Presence of breeding or resting sites of vectors of diseases

Types of Families
1. Nuclear 2. Extended 3. Three generational 4. Dyad 5. Single- Parent 6. Step- Parent 7. Blended or reconstituted

Types of Families
1. Single adult living alone 2. Cohabiting/ Living in 3. . No- kin 4. Compound 5. . Gay 6. Commune

Stages of Family Life Cycle


1. Newly married couple 2. Childbearing 3. Preschool age 4. Schoolage 5. Teenage 6. Launching 7. Middle-aged ( empty nest retirement) 8. Period from retirement to Death of both spouses HEALTH TASKS OF THE FAMILY( Freeman, 1981) 1. recognizing interruptions of health or development 2. seeking health care 3. managing health and non-health crises 4. providing nursing care to the sick, disabled and dependent member of the family 5. maintaining a home environment conducive to good health and personal development 6. maintaining a reciprocal relationship with the community and health institutions

Presence of accidents hazards Food storage and cooking facilities Water supply source, ownership, portability Toilet facility type, ownership, sanitary condition Drainage system type, sanitary condition Kind of neighborhood, e.g. congested, slum, etc. Social and health facilities available Communication and transportation facilities available Health Status of each Family Member Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health illness Nutritional assessment Anthropometric data: Measures of nutritional status of children, weight, height, mid-upper arm circumference: Risk assessment measures of obesity: body mass index, waist circumference, waist hip ratio Dietary history specifying quality and quantity of food/nutrient intake per day Eating/ feeding habits/ practices 3. Developmental assessments of infants, toddlers, and preschoolers e.g., Metro Manila 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse 5. Physical assessment indicating presence of illness state/s 6. Results of laboratory/ diagnostic and other screening procedures supportive of assessment findings Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. Examples include: Immunization status of family members Healthy lifestyle practices. Specify. Adequacy of: rest and sleep exercise use of protective measures- e.g. adequate footwear in parasite-infested areas; relaxation and other stress management activities Use of promotive-preventive health services A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST-LEVEL ASSESSMENT Presence of Wellness Condition stated as Potential or Readiness- a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on clients performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on clients current competencies or performance, clinical data explicit expression of desire to achieve a higher level of state or function in specific area on health promotion and maintenance. Examples of these are the following: Potential for Enhanced Capability for: Healthy lifestyle e.g. nutrition/diet, exercise/ activity Health Maintenance Parenting Breastfeeding Spiritual Well-being process of a clients unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/GOD (NANDA 2001) Others, Readiness for Enhanced Capability for: Healthy Lifestyle Health Maintenance Parenting Breastfeeding Spiritual Well-being Others, Presence of Health Threats conditions that are conducive to disease, accident or failure top realize ones health potential. Examples of these are the following: Family history of hereditary condition, e.g. diabetes Threat of cross infection from a communicable disease case Family size beyond what family resources can adequately provide Accidental hazards Broken stairs Sharp objects, poison, and medicines improperly kept Fire hazards

Faulty nutritional habits or feeding practices. Inadequate food intake both in quality & quantity Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding practices Stress-provoking factors Strained marital relationship Strained parent-sibling relationship Interpersonal conflicts between family members Care-giving burden Inadequate living space Lack of food storage facilities Polluted water supply Presence of breeding sites of vectors of disease Improper garbage Unsanitary food handling and preparation Unhealthful lifestyles and personal habits Alcohol drinking Cigarette smoking Inadequate footwear Eating raw meat Poor personal hygiene Self-medication Sexual promiscuity Engaging in dangerous sports Inadequate rest Lack of inadequate exercise Lack of relaxation activities Non-use of self protection measures Inherent personal characteristics e.g. poor impulse control Health history which induce the occurrence of a health deficit, e.g. previous history of difficult labor Inappropriate role assumption e.g. child assuming mother's role, father not assuming his role Lack of immunization/ inadequate immunization status specially of children Family disunity Self-oriented behavior of member(s) Unresolved conflicts of member(s) Intolerable disagreement Other Other

Presence of Health Deficits instances of failure in health maintenance. Examples include: Illness states, regardless of whether it is diagnosed or by medical practitioner Failure to thrive/ develop according to normal rate Disability whether congenital or arising from illness; temporary Presence of stress Points/ Foreseeable Crisis Situations anticipated periods of unusual demand of the individual or family in terms of family resources. Examples of these include: Marriage 9. Menopause Pregnancy 10. Loss of job Parenthood 11. Hospitalization of a Additional member family member Abortion 12. Death of a manner Entrance at school 13. Resettlement in a Adolescence new community Divorce 14. illegitimacy Second Level Assessment Focus on determining familys capacity to perform the health tasks Statements on family health nursing problem: Inability to recognize the presence of the condition or problem Inability to make decisions with respect to taking appropriate health action Inability to provide adequate nursing care to the sick, disabled , dependent or vulnerable member of the family Inability to provide a home environment conducive to health maintenance or personal development Failure to utilize community resources for health care Scale for Ranking Health Conditions and Problems according to priorities Criteria: a. Nature of the condition or problem presented ( wellness state, health deficit, health threat, forseeable crisis)

b. Modifiability of the condition or problem ( easily, partially, not modifiable) c. Preventive Potential (high, moderate , low) d. Salience ( needs immediate attention, not immediate, not perceived as a problem)

4. discarding properly all nasal and throat discharges of any member sick with communicable disease 5. burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering INTRAVENOUS THERAPY insertion of a needle or catheter into a vein to provide medication and fluids based on physicians written prescription - can be done only by nurses accredited by ANSAP PRINCIPLES OF HEALTH EDUCATION It considers the health status of the people, which is determined by the economic and social conscience of the country. It is a process whereby people learn to improve their personal habits and attitudes, to work responsibly for the improvement of health conditions of the family, community, and nation. It involves motivation, experience, and change in conduct and thinking, while stimulating active interest. It develops and provides experience for change in peoples attitudes, customs, and habits in relation to health and everyday living. It should be recognized as the basic function of all health workers. It takes place in the home, in the school, and in the community. It is a cooperative effort requiring all categories of health personnel to work together in close teamwork with families, groups, and the community. It meets the needs, interests, and problems of the people affected. It finds means and ways of carrying out plans by encouraging individual and community participation. It is a slow, continuous process that involves constant changes and revisions until objectives are achieved. Makes use of supplementary aids and devices to help with the verbal instructions. It utilizes community resources by careful evaluation of the different services and resources found in the community. It is a creative process requiring methods and techniques with various characteristics, not following a rigid and flexible pattern. It aims to help people make use of their own efforts and education to improve their conditions of living,

COMMUNITY HEALTH CARE PROCESS


Assessment Purpose : To identify the health needs of the people Planning of nursing actions Purpose : To act on the determined needs of the community people Implementation Purpose : To achieve the optimum level of health of the community people Evaluation Purpose : To determine the effectiveness of health care programs NURSING PROCEDURES CLINIC VISIT - process of checking the clients health condition in a medical clinic HOME VISIT - a professional face to face contact made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency BAG TECHNIQUE -a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort with the end in view of rendering effective nursing care THERMOMETER TECHNIQUE -to assess the clients health condition through body temperature reading NURSING CARE IN THE HOME - giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in dignity ISOLATION TECHNIQUE IN THE HOME -done by : 1. separating the articles used by a client with communicable disease to prevent the spread of infection: 2. frequent washing and airing of beddings and other articles and disinfections of room 3. wearing a protective gown , to be used only within the room of the sick member

It makes careful evaluation of the planning, organization, and implementation of all health education programs and activities.

THE COMMUNITY HEALTH NURSE


Qualifications Bachelor of Science in Nursing Registered Nurse of the Philippines Planner/Programmer Identifies needs, priorities, and problems of individuals, families, and communities Formulates municipal health plan in the absence of a medical doctor Interprets and implements nursing plan, program policies, memoranda, and circular for the concerned staff personnel Provides technical assistance to rural health midwives in health matters Provider of Nursing Care Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace Develops the familys capability to take care of the sick, disabled, or dependent member Manager/Supervisor Formulates individual, family, group, and communitycentered plan Interprets and implements programs, policies, memoranda, and circulars Organizes work force, resources, equipments, and supplies at local level Provides technical and administrative support to Rural Health Midwives (RHM) Conducts regular supervisory visits and meetings to different RHMs and gives feedback on accomplishments Community Organizer Motivates and enhances community participation in terms of planning, organizing, implementing, and evaluating health services Initiates and participates in community development activities Coordinator of Services Coordinates with individuals, families, and groups for health related services provided by various members of the health team Coordinates nursing program with other health programs like environmental sanitation, health education, dental health, and mental health Trainer/Health Educator Identifies and interprets training needs of the RHMs, Barangay Health Workers (BHW), and hilots Conducts training for RHMs and hilots on promotion and disease prevention

Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on health and health-related services Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education purposes Conducts pre-marital counseling Health Monitor Detects deviation from health of individuals, families, groups, and communities through contacts/visits with them Role Model Provides good example of healthful living to the members of the community Change Agent Motivates changes in health behavior in individuals, families, groups, and communities that also include lifestyle in order to promote and maintain health Recorder/Reporter/Statistician Prepares and submits required reports and records Maintain adequate, accurate, and complete recording and reporting Reviews, validates, consolidates, analyzes, and interprets all records and reports Prepares statistical data/chart and other data presentation Researcher Participates in the conduct of survey studies and researches on nursing and health-related subjects Coordinates with government and non-government organization in the implementation of studies/research

Community Organizing
Approaches to community devt.: Welfare approach Technological approach Transformatory approah Community Organizing Principles of CO: 1. People esp. the oppressed, exploited and deprived sectors are most open to change, have the capacity to change and are able to bring about change. Hence , CO is based on the ff: A. Power must reside in the people B. Devt. is from the people to the people C. People participation Principles of CO 2.-must be based on the poorest sectors of society. The solutions of problems commonly shared by these sectors must be focused on collective organizations, planning and action 3. should lead to self-reliant communities THE HRDP-COPAR PROCESS 1. PRE-ENTRY PHASE

2. ENNTRY PHASE 3. COMMUNITY STUDY/DIAGNOSIS PHASE/RESEARCH PHASE 4.COMMUNITY ORGANIZATION AND CAPABILITYBUILDING PHASE 5. COMMUNITY ACTION PHASE 6. SUSTENANCE AND STRENGTHENING PHASE Classify the ff. CO activities as to phase of COPAR each belong: 1.Conducts community meetings to draw up guidelines for the organization of CHO 2. Trains BHWs 3. Sets up of linkages/network and referral systems 4. PIME of health services and or community devt. Projects 5. Provides continuing education to leaders or residents 6. Trains secondary leaders 7. Selects site for adoption 8. Identifies key leaders Continued. 9. Develops criteria for site selection 10. Forms the core group 11.Conducts SALT 12.Selects members of the research team 13. Assists the research team in presenting results during the general assembly 14. Helps the people identifying the community needs and health problems 15. Facilitates for the formulation and ratification of the constitution and by-laws of the organization FAMILY PLANNING The Philippine Family Planning Program is a national program that systematically provides information and services needed by women of reproductive age to plan their families according to their own beliefs and circumstances. GOALS AND OBJECTIVES: Universal access to family planning information, education and services. MISSION: To provide the means and opportunities by which married couples of reproductive age desirous of spacing and limiting their pregnancies can realize their reproductive goals. TYPES OF METHODS: A. NATURAL METHODS 1. Calendar or Rhythm Method 2. Basal Body Temperature Method 3. Cervical Mucus Method 4. Sympto-Thermal Method 5. Lactational Amennorhea

B. ARTIFICIAL METHODS I. CHEMICAL METHODS 1.Ovulation suppressant such as PILLS 2. Depo-Provera 3. Spermicidals 4. Implant II. MECHANICAL METHODS 1. Male and Female Condom 2. Intrauterine Device 3. Cervical Cap/Diaphragm III. SURGICAL METHODS 1. Vasectomy 2. Tubal Ligation WARNING SIGNS Pills Abdominal pain ( severe) Chest pain ( severe) Headache ( severe) Eye problems ( blurred vision, flashing lights, blindness) Severe leg pain ( calf or thigh ) Others: depression, jaundice, brest lumps WARNING SIGNS IUD *Period late, no symptoms of pregnancy, abnormal bleeding or spotting *Abdominal pain during intercourse *Infection or abnormal vaginal discharge *Not feeling well, has fever or chills *String is missing or has become shorter or longer WARNING SIGNS INJECTABLES Dizziness Severe headache Heavy bleeding WARNING SIGNS BTL Fever Weakness Rapid pulse Persistent abdominal pain Vomiting Dizziness Pus or tenderness at incision site Amenorrhea WARNING SIGNS Vasectomy Fever Scrotal blood clots or excessive swelling Nutrition

Goal To improve the nutritional status, productivity and quality of life of the population thru adoption of desirable dietary practices and healthy lifestyle Objectives Increase food and dietary energy intake of the average Filipino Prevent nutritional deficiency diseases and nutrition-related chronic degenerative diseases Promote a healthy well-balanced diet Promote food safety Nutrition is a state of well-being achieved by eating the right food in every meal and the proper utilization of the nutrients by the body. Proper nutrition is important because: it helps in the development of the brain, especially during the first years of the childs life. It speeds up the growth and development of the body including the formation of teeth and bones It helps fight infection and diseases It speeds up the recovery of a sick person It makes people happy and productive Proper nutrition is eating a balanced diet in every meal Balanced diet is made up of a combination of the 3 basic groups eaten in correct amounts. The grouping serves as a guide in selecting and planning everyday meals for the family. THE THREE (3) BASIC FOOD GROUPS ARE: 1. Body building food which are rich in protein and needed by the body for: < normal growth and repair of worn-out body tissues < supplying additional energy < fighting infections < Examples of protein-rich food are: fish; pork; chicken; beef; cheese; butter; kidney beans; mongo; peanuts; bean curd; shrimp; clams 2. Energy-giving food which are rich in carbohydrates and fats and needed by the body for: < providing enough energy to make the body strong < Examples of energy-giving food are: rice; corn; bread; cassava; sweet potato; banana; sugar cane; honey; lard; cooking oil; coconut milk; margarine; butter 3. Body-regulating food which are rich in Vitamins and minerals and needed by the body for: < normal development of the eyes, skin, hair, bones, and teeth < increased protection against diseases

< Examples of body-regulating food are: tisa; ripe papaya; mango; guava; yellow corn; banana; orange; squash; carrot Low Fat Tips Eat at least 3 meals/day Eat more fruits, vegetables, grain and cereals e.g. rice, noodles and potato If you use butter or margarine, pat it on thinly Choose low fat substitute i.e. replace whole milk with skimmed milk, low fat cheese Become a label reader. Look for foods that have less than 5 g /100 g of product Eat less high fat snacks and take away potato chips, sausage rolls or breaded meats Cut all visible fat from meat, remove skin from chicken fat drippings and cream sauces Aim for thin palm-size serving of lean meat, poultry and fish/ meal Grill, bake, steam, stew, stir fry and microwave, try not to fry Drink lots of water all day- its a food quencher Ambulate Start by walking for 10 min. Build up to 30-40 min/day Go for 3-4 times / week of any exercise you enjoy Filipino Food Pyramid Drink a lot- water, clear broth Eat most rice, root crops, corn, noodles, bread and cereals Eat more vegetables, green salads, fruits or juices Eat some fish, poultry, dry beans, nuts, eggs, lean meats, low fat dairy Eat a little fats, oils, sugar, salt IMPORTANT VITAMINS AND MINERALS MALNUTRITION MALNUTRITION An abnormal condition of the body resulting from the lack or excess of one or more nutrients like protein, carbohydrates, fats, vitamins and minerals. PRIMARY CAUSE: POVERTY Lack of money to buy food Majority of the victims of malnutrition comes from families of farmers, fisherfolk, and laborers who cannot afford to buy nutritious foods. Lack of food supply Lack of information on proper nutrition and food values

SECONDARY CAUSES Early weaning of child and improper introduction of supplementary food Incomplete immunization of babies and children Bad eating habits Poor hygiene and environmental sanitation: o lack of potable water o lack of sanitary toilet o poor waste disposal FORMS OF MALNUTRTION Protein-Energy Malnutrition (PEM) is a nutritional problem resulting from a prolonged inadequate intake of body-building and/or energy-giving food in the diet. Kinds: a.)MARASMUS b.) KWASHIORKOR MARASMUS This child does not get the right amount and kind of energy food. She/He: < is always hungry < has the face of an old man < is very thin < easily gets sick < looks weak THIS CHILD IS JUST SKIN AND BONES! KWASHIORKOR This child does not get enough bodybuilding food, although she/he may be getting enough energy. She/He: < has swollen face, hands, and feet < easily gets sick < has dry, thin, pale hair < has sores on the skin < has thin upper arms < looks sad < has dry skin < is underweight THIS CHILD IS SKIN, BONES, AND WATER! 2. VITAMIN A DEFICIENCY (VAD) a condition in which the level of Vitamin A in the body is low. Causes: not eating enough foods rich in vitamin A e.g. yellow vegetables and yellow fruits lack of fat or oil in the diet which help the body absorb Vitamin A. poor absorption or rapid utilization of Vitamin A during illness Eye Signs

night blindness (early stage); total blindness (later stage) bitots spot (foamy soapsuds-like spots on white part of the eye) dry, hazy and rough appearing cornea crater-like defect on cornea softened cornea; sometimes bulging Other Manifestations increased cases of childhood sickness, and death and decreased resistance to infection susceptibility to childhood malnutrition and infection (measles, diarrhea and pneumonia) Prevention eating foods rich in Vitamin A, such as liver, eggs, milk, crab meat, cheese, dilis, malunggay, gabi leaves, kamote tops, kangkong, alugbati, saluyot, carrots, squash, ripe mango, including fats and oils breastfeeding the child immunizing the child taking correct dose of Vitamin A capsules as prescribed VAD is most common in children suffering from PEM and other infectious diseases. Bottle-fed infants are also at risk of VAD especially if the milk formula used is not fortified with Vitamin A. Common among preschoolers and infants ( FNRI) SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO INFANTS PRESCHOOLERS AND MOTHERS SCHEDULE FOR TREATMENT OF VITAMIN A DEFICIENCY 3. ANEMIA - a condition characterized by the lack of iron in the body resulting in paleness. S/S: paleness of the eyelids, inner cheeks, palms and nailbeds; frequent dizziness and easy fatigability Common cause: inadequate intake of food rich in iron ; can also be caused by blood loss during menstruation, pregnancy and parasitic infections. Prevention: Eating iron-rich food such as liver and other internal organs; green leafy vegetables; and foods rich in Vitamin C Prevention of Iron Deficiency Treatment of Iron Deficiency 4.GOITER - enlargement of thyroid gland due to lack of iodine in the body.

-common in areas where the iodine content in the soil, water and food are deficient. - Effect of Iodine deficiency to fetus: may be born mentally and physically retarded. - Goiter can be prevented by: < daily intake of food rich in iodine < use of iodized salt Iodine Supplementation CHECKING THE NUTRITIONAL STATUS WEIGHT 1.1 Weight is a very important indicator of a persons nutritional status. It is measured in relation to either AGE or HEIGHT. Normally, a well-nourished child gains weight as she/he grows older. 1.2 On the other hand, a malnourished child either decreases in weight or maintains his/her previous weight. 1.3 The nutritional status of a person can also be checked by looking for specific signs and symptoms of the different forms of nutritional deficiencies. IMPORTANT: 1.1Weigh the child in minimal clothing, with no shoes, clogs or slippers on; and hands and pockets free of objects. 1.2The same type of scale should be used for subsequent weighing. 1.3Observe the proper maintenance of the weighing scale. 1.4Do not use a bathroom scale to avoid inaccurate readings of weight. < BRING THE MALNOURISHED CHILD TOGETHER WITH THE PARENTS TO THE HEALTH CENTER FOR PROPER NUTRITIONAL ADVICE AND TREATMENT. < VISIT THE MALNOURISHED CHILD REGULARLY AND MONITOR HIS/HER WEIGHT. < ADVISE PARENTS AND THE WHOLE COMMUNITY ABOUT BETTER NUTRITION AND PROPER FEEDING ESPECIALLY OF INFANTS, CHILDREN AND SICK PERSONS. NUTRITIONAL GUIDELINES Eat a variety of food everyday. Breastfeed infants exclusively from birth to 4-6 months, and then, give appropriate foods while continuing breastfeeding. Maintain childrens normal growth through proper diet and monitor their growth regularly. Consume fish, lean meat, poultry or dried beans. Eat more vegetables, fruits, and root crops. Eat foods cooked in edible/cooking oil daily. Consume milk, milk products or other calcium-rich foods such as small fish and dark green leafy vegetables everyday. Use iodized salt, but avoid excessive intake of salty foods.

Use iodized salt, avoid excessive intake of salty foods 9. Eat clean and safe food. 10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke, avoid drinking alcoholic beverages.

AIMS AND RATIONALE OF EACH OF THE GUIDELINES


Guideline No. 1 is intended to give the message that no single food provides all the nutrients the body needs. Choosing different kinds of foods from all food groups is the first step to obtain a well-balanced diet. This will help correct the common practice of confining of choice to a few kinds of foods, resulting in an unbalanced diet. Guidelines No.2 is entitled to promote exclusive breastfeeding from birth to 4-6 months and to encourage the continuance of breastfeeding for as long as two years or longer. This is to ensure a complete and safe food for the newborn and the growing infant besides imparting the other benefits of breastfeeding. The guideline also strongly advocates the giving of appropriate complementary food in addition to breast milk once the infant is ready for solid foods at 6 months. Malnutrition most commonly occurs between the age of 6 months to 2 years, therefore there is a need to pay close attention to feeding the child properly during this very critical period. Guideline No. 3 gives advise on proper feeding of children. In addition, the guideline promotes regular weighing to monitor the growth of children, as it is a simple way to assess nutritional status. Guidelines No. 4,5,6 and 7 are intended to correct the deficiencies in the current dietary pattern of Filipinos. Including fish, lean meat, poultry and dried beans, which will provide good quality protein and dietary energy, as well as iron and zinc, key nutrients lacking in the diet of Filipinos as a whole. Eating more vegetables, fruits and root crops will supply the much needed vitamins, minerals and dietary fiber that are deficient in our diet. In addition, they provide defense against chronic degenerative diseases. Including foods cooked in edible oils will provide additional dietary energy as a partial remedy to calorie deficiency of the average Filipino. Including milk and other calcium-rich foods in the diet will serve to supply not only calcium for healthy bones but to

provide high quality protein and other nutrients for growth. Guideline No. 8 promotes the use of iodized salt to prevent iodine deficiency, which is a major cause of mental and physical underdevelopment in the country. At the same time, the guideline warns against excessive intake of salty foods as a hedge against hypertension, particularly among high-risk individuals. Guideline No.9 is intended to prevent foodborne diseases. It explains the various sources of contamination of our food and simple ways to prevent it from occurring. Finally, Guideline No. 10 promotes a healthy lifestyle through regular exercise, abstinence from smoking and avoiding consumption. If alcohol is consumed, it must be done in moderation. All these lifestyle practices are directly or indirectly related to good nutrition. NUTRIENTS IN FOOD Nutrients are chemical substances present in the foods that keep the body healthy, supply materials for growth and repair of tissues, and provide energy for work and physical activities. The major nutrients include the macronutrients, namely; proteins, carbohydrates and fats; the micronutrients, namely vitamins such as A, D, E and K, the B complex vitamins and C and minerals such as calcium, iron, iodine, zinc, fluoride and water. Reproductive Health - a state of complete physical, mental and social well-being and not merely the absence of disease/ infirmity in all matters relating to the reproductive system and to its functions and processes. Basic RH Rights Right to RH information and health care services for safe pregnancy and childbirth Right to know different means of regulating fertility to preserve health and where to obtain them Freedom to decide the number and timing of birth of children

Right to exercise satisfying sex life Factors/ determinants of RH Socioeconomic conditions education, employment, poverty, nutrition, living condition/ environment, family environment Status of women equal right in education and in making decisions about her own RH; right to be free from torture and ill treatment and to participate in politics Social and Gender Issues Biological (individual knowledge of reproductive organs and their functions), cultural (countrys norms, RH practices) and psychosocial factors Elements Maternal and Child Health Nutrition Family Planning Prevention and Management of Abortion Complications Prevention and Treatment of Reproductive Tract Infections, including STDs, HIV and AIDS Education and Counseling on Sexuality and Sexual Health Elements Breast and Reproductive Tract Cancers and other Gynecological Conditions Mens Reproductive Health Adolescent Reproductive Health Violence Against Women Prevention and Treatment of Infertility and Sexual Disorders Selected Concepts RH is the exercise of reproductive right with responsibility It means safe pregnancy and delivery, the right of access to appropriate health information and services It includes protection from unwanted pregnancy by having access to safe and acceptable methods of family planning of their choice It includes protection from harmful reproductive practices and violence It ensure sexual health for the purpose of enhancement of life and personal relations and assures access to information on sexuality to achieve sexual enjoyment Goal To achieve healthy sexual development and maturation To achieve their reproductive intention To avoid diseases, injuries and disabilities related to sexuality and reproduction

To receive appropriate counseling and care of RH problems Strategies Increase and improve the use of more effective or modern contraceptive methods Provision of care, treatment and rehabilitation for RH RH care provision should be focused on adolescents, men and unmarried and other displaced people with RH problems Strengthen outreach activities and referral system Prevent specific RH problems through information dissemination and counseling of clients

HEALTH AND SANITATION


Environmental Sanitation is still a health problem in the country. Diarrheal diseases ranked second in the leading causes of morbidity among the general population. Other sanitation related diseases : tuberculosis, intestinal parasitism, schistossomiasis, malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever DOH thru Environmental Health Services (EHS) unit is authorized to act on all issues and concerns in environment and health including the very comprehensive Sanitation Code of the Philippines (PD 856, 1978). WATER SUPPLY SANITATION PROGRAM EHS sets policies on: Approved types of water facilities Unapproved type of water facility Access to safe and potable drinking water Water quality and monitoring surveillance Waterworks/Water system and well construction Approved type of water facilities Level 1 (Point Source)- a protected well or a developed spring with an outlet but without a distribution system o indicated for rural areas; o serves 15-25 households; its outreach is not more than 250 m from the farthest user o yields 40-140 L/ min Level II ( Communal Faucet or Stand Posts) o With a source, reservoir, piped distribution network and communal faucets

Located at not more than 25 m from the farthest house o Delivers 40-80 L of water per capital per day to an average of 100 households o Fit for rural areas where houses are densely clustered Level III ( Individual House Connections or Waterworks System) o With a source, reservoir, piped distributor network and household taps o Fit for densely populated urban communities o Requires minimum treatment or disinfection ENVIRONMENTAL SANITATION - the study of all factors in mans physical environment, which may exercise a deleterious effect on his health, well-being and survival. Includes: Water sanitation Food sanitation Refuse and garbage disposal Excreta disposal Insect vector and rodent control Housing Air pollution Noise Radiological Protection Institutional sanitation Stream pollution

1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11

PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM EHS sets policies on: Approved types of toilet facilities : LEVEL II on site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal. LEVEL III water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant. FOOD SANITATION PROGRAM -sets policy and practical programs to prevent and control food-borne diseases to alleviate the living conditions of the population HOSPITAL WASTE MANAGEMENT PROGRAM Disposal of infectious, pathological and other wastes from hospital which combine them with the municipal or domestic wastes pose health hazards to the people.

Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of nosocomial diseases PROGRAM ON HEALTH RISK MINIMIZATION DUE TO ENVIRONMENTAL POLLUTION Foci: 1. Prevention of serious environmental hazards resulting from urban growth and industrialization 2. policies on health protection measures 3. researches on effects of GLOBAL WARMING to health (depletion of the stratosphere ozone layer which increases ultraviolet radiation, climate change and other conditions) NURSING RESPONSIBILITIES AND ACTIVITIES Health Education IEC by conducting community assemblies and bench conferences. The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart the need for an effective and efficient environmental sanitation in their places of work and in school. Actively participate in the training component of the service like in Food Handlers Class, and attend training/workshops related to environmental health. Assist in the deworming activities for the school children and targeted groups. Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies. Act as an advocate or facilitator to families in the community in matters of program/projects/activities on environmental health in coordination with other members of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors. Actively participate in environmental sanitation campaigns and projects in the community. Ex. Sanitary toilet campaign drive for proper garbage disposal, beautification of home garden, parks drainage and other projects. Be a role model for others in the community to emulate terms of cleanliness in the home and surrounding. Non-Communicable Diseases and Rehabilitation 1. Prevention and Control of Cardiovascular Diseases
st leading cause of death nd

Causes: envtl factors, maternal diseases or genetic aberrations Rheumatic Fever or Rheumatic Heart Disease: Systematic inflammatory disease that may develop as a delayed reaction to repeated and an inadequately treated infection of the upper respiratory tract by group A beta-hemolytic streptococci. Hypertension: Persistent elevation of the arterial blood pressure. ( primary or essential) ;frequent among females but severe,malignat form is more common among males Ischemic Heart Disease/ Atherosclerosis: Condition usually caused by the occlusion of the coronary arteries by thrombus or clot formation. higher among males than females for the latter are protected by estrogen before menopause PF: HPN, DM, Smoking Minor RF: stress, strong family history, obesity CVD CVD Primary Prevention: CVD Primary Prevention thru health education is the main focus of the program: 1. maintenance of ideal body wt. 2. diet - low fat 3. alcohol/smoking avoidance 4. exercise 5. regular BP check up 2. Cancer Prevention and Early Detection Any malignant tumor arising from the abnormal and uncontrolled division of cells causing the destruction in the surrounding tissues. Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer, skin cancer, prostate cancer. 3 leading cause of illness and death ( Phil.) Incidence can only be reduced thru prevention and early detection NINE WARNING SIGNS OF CANCER: Change in blood bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness Unexplained anemia Sudden unexplained weight loss Prevention & Early Detection PRINCIPLES OF TREATMENT OF MALIGNANT DISEASES One third of all cancers are curable if detected early and treated properly. Three major forms of treatment of cancer:
rd

- heart 1 ; bld vessels - 2 Congenital Heart Disease (CHD): Result of the abnormal development of the heart that exhibits septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in children

Surgery Radiation Therapy Chemotherapy 3. Natl Diabetes Prevention and Control Program Aim: Controlling and assimilating healthy lifestyle in the Filipino culture ( 2005-2010) thru IEC Main Concern: modifiable risk factors( diet, body wt., smoking, alcohol, stress, sedentary living, birth wt. ,migration 4. Prevention and Control of Kidney Disease Acute or Rapidly Progressive Renal Failure : A sudden decline in renal function resulting from the failure of the renal circulation or by glomerular or tubular damage causing the accumulation of substances that is normally eliminated in the urine in the body fluids leading to disruption in homeostatic, endocrine, and metabolic functions. Acute Nephritis: A severe inflammation of the kidney caused by infection, degenerative disease, or disease of the blood vessels. Chronic Renal Failure: A progressive deterioration of renal function that ends as uremia and its complications unless dialysis or kidney transplant is performed. Neprolithiasis: A disorder characterized by the presence of calculi in the kidney. Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into the urine because of increased permeability of the glomerular capillary membrane Urinary Tract Infection: A disease caused by the presence of pathogenic microorganisms in the urinary tract with or without signs and symptoms. Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials back into the blood and secretion, collection, and conduction of urine. Urinary Tract Obstruction: A condition wherein the urine flow is blocked or clogged. 5. Program on Mental Health and Mental Disorders 6. Program on Drug Dependence/ Substance Abuse 7.Community-Based Rehabilitation Program A creative application of the primary health care approach in rehabilitation services, which involves measures taken at the community level to use and build on the resources of the community with the community people, including impaired, disabled and handicapped persons as well.

Goal: To improve the quality of life and increase productivity of disabled, handicapped persons. Aim: To reduce the prevalence of disability through prevention, early detection and provision of rehabilitation services at the community level. 7. Program on the Elderly/Geriatric Nursing Services

7 humanitarian issues: family, health, income, security, employment and labor, social welfare, education, recreation, culltural activities and housing
Leading causes of illness:elderly Influenza, HPN, diarrhea, bronchitis, TB, diseases. of the heart, pneumonia, malaria, malignant neoplasm, chickenpox Leading causes of death:elderly Diseases of heart and vascular system Pneumonia, TB, CCOPD Malignant neoplasms Diabetes Nephritis Accidents 8. Programs on Blindness, Deafness and Osteoporosis Cataract- main causes of blindness VAD- main cause of childhood blindness; most serious eye problem of Fil. children below 6 yrs. old Osteoporosis special problem in women, highest bet. 5079 yrs. old, MENOPAUSE- main cause Prevention of NCD/Role of Nursing in Health Promotion And Advocacy Yosi Kadiri- anti smoking Edi Exercise/Hataw-regular physical activity Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, high fiber diet Mag HL exercise, no smoking, avoidance of alcohol, healthy diet, iwas stress, watch wt. Sentrong Sigla Movement ( SSM) -a certification recognition program which develops and promotes standards for health facilities Joint effort bet.: 1.DOH provides technical and financial assistance packages for health care

2. LGUs direct implementers of health programs & prime developers of health centers and hospitals making services accessible to every Filipino Pillars of SSM 1. Quality Assurance 2. Grant and Technical Assistance 3. Health Promotion 4. Awards Expected Outcome: SSM Empowered individuals adopting healthy lifestyle, improved health-seeking behavior and well-being & increased demand for quality health services Institutions will develop policies, provide quality services , institute system for surveillance/ merits and advocate for laws Programs: SSM EPI Disease Surveillance CARI CDD

Prevention health education, healthful living through proper nutrition, adequate rest, sleep and good personal hygiene; Casefinding A. Management and treatment prevention of secondary injuries, handling of utensils; special shoes w/ padded soles; importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time; mental & emotional support B. Rehabilitation-makes patients capable, active and self-respecting member of society. C. Control of Schistosomiasis a tropical disease caused by a blood fluke, Schistosoma Japonicum ; transmitted by a tiny snail Oncomelania quadrasi D. Preventive measures health education regarding mode of transmission and methods of protection; proper disposal of feces and urine; improvement of irrigation and agriculture practices E. Control of patient, contacts and the immediate environment F. Specific treatment- Praziquantel drug of choice Programs on Filariasis, Malaria and Dengue Hemorrhagic Fever Filariasis- a chronic prasitic infection caused by a nematode, Wuchereria bancrofti. Young and adult worms live in the lymphatic vessels and nodes, while the micro filariae are in the blood; transmitted through bites from an infected female mosquito, Aedes poecilius, that bites at night. Treatment: Diethylcarbamazine citrate or Hetrazan Elephantiasis and Hydrocoele are handled through surgery, prevention and supportive care Malaria infection caused by the bite of the female Anopheles mosquito, Chemoprophylaxis Chloroquine taken at weekly intervals, starting from 1-2 weeks before entering the endemic area. Anti-malarial drugs sulfadoxine, quiinine sulfate, tetracycline, quinidine Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable preventive and vector control meas Dengue H-fever 4 oclock habit

Nutrition/ Micronutrient Supplementation*Food Fortification : Rice iron; Oil and sugar Vit. A; Flour-Vit. A & iron; Salt- iodine Advocacy is a planned and continuous effort to inform people about issue and instigate change. Advocacy usually takes place over an extended period of time and includes a variety of strategies to communicate a specific message. TB is the number one infectious killer in the world. One TB suspect can infect another 10 healthy persons Leprosy Control Program WHO Classification basis of multi-drug therapy Paucibacillary/PB non-infectious types. 6-9 months of treatment. Multibacillary/MB infectious types. 24-30 months of treatment. Multi-drug therapy use of 2 or more drugs renders patients non-infectious a week after starting treatment Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of ROM regimen For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister packs taken monthly within a max. period of 9 mos. All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain. Responsibilities of the nurse

Programs on Measles. Chickenpox, Mumps, Diphtheria, Pertusis, Tetanus focused on health information campaigns and intensive immunization of children in barangays. Prevention and Control Program on Parasitic Infestations ( STH e.g. Ascaris, Trichuris, Hookworm) and Paragonimiasis in communities where eating of fresh or inadequately cooked crab is a practice Management: Deworming Health Education re: Good personal hygiene Use of footwear Washing fruits and vegetables well Use of sanitary toilets Sanitary disposal of garbage Boiling drinking water at least 2-3 min. from boiling point or chlorination Prevention and Control on Leptospirosis/ Weils Disease/ Mud fever/Flood fever/ Spirochetal Jaundice thru contact with the skin/ open wound with water or moist soil contaminated with urine of infected rat And Rabies Mgt. of Rabies Wash wound with soap and water, betadine or alcohol may be applied If dog is healthy observe for 14 days. If nothing happens- no need for ttt.If it dies or shows rabies, kill then bring head for lab. Exam & consult doctor. Active immunization body develops Ab against rabies up to 3 yrs. Passive I giving Ab to persons with head and neck bites, multiple single deep bites, contamination of mucous membranes or thin covering of the eyes, lips or mouth to provide immediate protection RPO immunization of pets at 3 mos. of age and yearly thereafter Prevention and Control on STIs Gonorrhea, Syphilis, HIV/AIDS, Trichomoniasis,Chlamydia, Hep B ( the most serious type cause of severe cx. Eg. Massive liver damage and hepatocarcinoma 4 Cs in the Syndromic Mgt 1. Compliance 2. Counseling/ Education 3. Contact tracing to treat partner 4. Condom use

Hep B vaccination Universal precautions Safe sex Other CHN Practice Settings I. Occupational Health - the application of public health, medical and engineering practice for the purpose of conserving, restoring the health and effectiveness of workers thru their places of employment A. Occupational Health Nursing - the application of nursing principles and procedures in providing health service to employees in their place of work by means of: 1. prompt and efficient nursing care of the ill and impaired 2. participation in teaching health and safety practices on the job 3. cooperation with plant department administrators 4.keeping the health clinic and staff ready to handle emergencies 5. advising workers in the utilization of community and welfare services Objectives of OHN To assist, maintain and promote positive health of laborers and employees thru early detection and prevention of occupational diseases and hazards of industrial processes and by coordinating and cooperating with activities of other community health and welfare services Nurses Role in OHN 1. Assists/participates in developing an adequate health program for workers and laborers including sound health education activities 2. Encourages periodic P.E. 3. Cooperates with occupational medical programs in the prevention of accidents as well as in the promotion of good working atmosphere and relationships in the place of work 4. Helps in teaching others in giving good nursing care to the sick or handicapped in their own homes II. School Health Nursing School Health Triad : o SERVICE o EDUCATION o ENVIRONMENT Mission of School Health Program: To maximize potential for learning and participation in the educational process by promoting optimum health of school-age children and adolescents School Health Team:

Psychologist/ Counselor Teacher Nutritionist Nurse Social Workers Maintenance Personnel Targets in SHN Family Students Teachers Supportive Personnel Community School Health Nurses Roles: a. EDUCATOR b. CONSULTANT /RESEARCHER c. STUDENT, FAMILY AND STAFF ADVOCATE/CHANGE AGENT d. HEALTH SCREENER e. HEALTH CARE PROVIDER Common Health Concerns of Schoolchildren: 1.Drug and Alcohol Abuse 2. STDs/STIs 3. Teenage Pregnancies 4. Mental Health 5. Dermatological Disorders- pimples/acne, fungal infections, allergies 6. Respiratory Conditions- asthma, URTI 7. Nutrition 8. Dental Health

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