C.A.

COMMUNITY HEALTH NURSING FAMILY HEALTH NURSING Malnutrition in the Philippines Based on the 2010 Millennium Development Goals (MDG) Progress Report, . Only four out of every ten Filipino households have per capita energy intake that meets the recommended intake . From 2005 to 2008, there was a significant increase in the proportion of underweight children aged 0-5 from 24.6 percent to 26.2 percent . Iron and iodine deficiency remain as public health problem among infants, children and pregnant woman . Causes of hunger and malnutrition: -poverty -rising food prices -poor dietary diversity -lack of access to potable drinking water and sanitation -poor health status Facts from the 2001 nationwide nutrition survey by the Food and Nutrition Research Institute of the DOST UNDERWEIGHT . lowest portion is seen among infants . Prevalence rises up to three times reaching 35.6% when the child turns 1 year and 35.2% at age two, then slightly decreasing ... UNDER HEIGHT . prevalence significantly increased from 7.9% among infants to more than 29% among children aging 1-2years old . This continues to rise as age increases up to 40% at age five years THINNESS most affected are the 1 year old children at 14.3 % prevalence CAUSES OF MALNUTRITION R/T FEEDING PRACTICES 1. Non-breast feeding and early weaning

2.Dependence on artificial feeding 3. Absence of inadequate complementary feeding 4. Lack or inadequate skill of managing diarrhea at home The Philippine DOH Nutrition Program Goal: to improve quality of life of Filipinos through better nutrition, improved health and increased productivity Objectives: 1. Reduction in the proportion of Filipino households with intake below 100% of the dietary energy requirement from 53.2 % to 44%. 2. Reduction in: -underweight among pre-school children -stunting among per-school children -chronic energy deficiency among pregnant women -iron deficiency among children 6 months to 5 years old, pregnant, and lactating mothers - prevalence of overnight, obesity and noncommunicable diseases - reduction in the prevalence of iron deficiency disorder among lactating mothers -elimination of moderate and sever IDD among per-school children and pregnant women STRATEGIES 1. Food-based interventions for sustained improvements in nutritional status 2. Life-cycle approach with strategic attention to 0-3 years old children, adolescent females and pregnant/lactating mothers 3. Effective implementation of nutrition interventions with other services 4. Geographical focus to needier areas. PROGRAMS AND PROJECTS 1. Micronutrient Supplementation The twice-a-year distribution (or every 6 months) of vit. A capsules through the " Araw ng Sangkap Pinoy" (ASAP), known as the . . . . 2. Food Fortification The Food Fortification Act of 2000 provides the mandatory fortification of staples, namely: flour with iron and vit. A, cooking oil and refined sugar with vit. A, and rice with iron , and

voluntary fortification of processed foods through the "Sangkap Pinoy" seal. 3. Essential Maternal and Child Health Service Package This ensures the right of the child to survival, development, protection and participation. It includes the delivery of essential maternal and child health and nutrition package of services that will ensure the right of survival, development, protection and participation as follows: 1. Breast feeding 2. Complementary feeding 3. Micronutrient Supplementation 4. Nutrition Information, Communication, and Education These includes the promotion for nutritional guidelines for Filipinos and other nutrition key messages and training of health workers. 5. Home, School, and Community Food Production It includes establishment of kitchens, gardens in homes, schools and in communities in urban and rural areas to serve as source of additional food for the home and establishment of demonstration centers and nurseries and distribution of planting materials. September 6, 2012 Roche Cagara 6. Food assistance includes center based complementary feeding for wasted or stunted children and pregnant women delivering neonates with low birth weight. These may be done in schools through the effort of local government units. Food discounts were provided through tindahan natin program 7.livelihood assistance is done by provision of credit and livelihood opportunities to poor households, especially worse with malnourished children through linkage with lending and financial institutions. Functional literacy helps in this endeavour. Examples: 4 ps and ALS

A man treads ether world over in search of what he needs, and returns home to find it. - george moore Definitions of family - is a unit of interacting persons related by ties of marriage, birth or adoption, whose central purpose is to create Nd maintain a common culture which promotes the physical, mental, emotional and social development of each of its members (duval and miller, 1985) - is emotionally involved with each other and they live in close geographical proximity (friedman, 1981) - cooperates economically in the upbringing of children, most of whom share a common dwelling (gough, 1986) - is the basic unit of society and the social institution that has the songs marked effect on its members ( Friedman, 1986) - the family engage in interrelated social positions, roles, and tasks; and share a sense of affection and belonging (murray & zetner, 1997; friedman, 1998) - has a boundary which means other people can recognize its members. Changes in. The Filipino family may have affected...on how they perform the health tasks and it's capacity to remain as the primary source of support to its members. ( fr. Malaya) - a family is an open and developing system of interacting personalities with a structure and processes...regulated by resources and stressors, and existing within the larger community. Why choose a family perspective? 1. Prevents, generates, tolerates and corrects health problems among its members 2. Has a powerful influence on values, beliefs and practices on health and illness 3. A locus of decision making in the use of manpower and economic support especially during illness and crisis

4. A dysfunction in one member may lead to added stress and depletion of resources for the family. Universal characteristics - every family is 1. A small social system 2. Has it's own cultural values and rules 3. Hs structure 4. Has certain basic functions: 4.1. Providing affection 4.2. Providing security and acceptance 4.3. Instilling identity and satisfaction 4.4. Promoting affiliation and companionship 4.5. Providing socialization 4.6. Establishing controls 5. Moves through stages in its life cycle (newly married coupe, childbearing, preschool-age, school age, teenage, launching center, middle age, aging) duval And miller 1985 What are the steps in the community health nursing process? 1. Establish I a good working relationship 2. Assessment of nursing diagnosis 3. Planning 4. Implementation (monitoring) 5. Evaluation Family nursing assessment - data collection - data analysis - problem definition or nursing diagnosis Two major types of nursing assessment (maglaya) - first level assessment - process whereby existing and potential health conditions or problems of the family are determined A. Wellness states B. health threats C. ......................... How would you classify the following nursing problems 1. Malnutrition 2. Adequate 3. Blindness 4. Family disunity 5. Loss of job of bread earner 6. Regular exercise 7. Poor impulse control

8. Spiritual well being 9. Fare cost of the eldest child to canada Second level assessing - defines the nature of the or type of nursing problems that the mainly encounters in the performance of the health tasks it's respect to a given health condition or problems Characteristics of a healthy family - the ability to perform the health tasks expected of a family 1. Recognize the presence of wellness state or health condition or problem 2. Make decisions about taking an appropriate health action to maintain wellness o manage the adapts problem 3. Provide nursing care to the sick, disabled, dependent, or at risk member 4. Maintain a home environment conducive to health maintenance and personal development 5. Utilize community resources for health care Data collection 1. Family structure, characteristics and dynamic 2. Socio-economic and cultural characteristics 3. Home and environment 4. Health status of each member 5. Values and practices on health promotion or maintenance and disease prevention Tool: initial data base (IDB) Data gathering methods 1. Observation 2. Physical examination 3. Interview 4. Record review 5. Laboratory or diagnostic tests Data analysis 1. Sorting the data for board categories such as those related to those related to Health with the health status or practices of family members of data about home environment 2. Clustering of related cues to determine relationships between and among data 3. Distinguishing relevant from irrelevant data fr .............................................. 4. Identifying patterns such as physiologic function, developmental, nutritional or dietary,

coping or adaptation or communication patterns and lifestyle 5. Comparing patterns with norms and standards of health, functioning and assumption of health tasks 6. Interesting results of comparisons to determine signs, symptoms or cues of specific wellness states, health deficit, health threats of foreseeable crisis points in their underlying causes for associated factors 7. Making inferences or draining conclusions about the reasons for the existence of the health condition or problems After your home visit, you were able to gather the following data: - the two year old child also has a low weight for age. Both this child and the six year old child have s scabies - the two year old child ceased to breast feed at one year of age and has been given family food since then - lotto tickets were seen at one corner of the house which, according to the benita, his husband bets on daily .............................................................................. ... The following then the results of your second level assessment : 1. Malnutrition as a health deficit A. Inability to recognize the presence of malnutrition in dependent members due to lack of knowledge B. inability to decide a out taking appropriate actions due to failure go comprehend the nature, magnitude of the problem C. Inability to provide adequate nursing to a member suffering from malnutrition due to: - lack of knowledge about e health condition .............................................................................. 2. Scabies as health deficit A. Inability to provide adequate nursing to a member suffering from scabies due to - lack of knowledge about the health condition - lack of knowledge on the nature and extent of nursing care needed - inadequate resources for care

B. inability to decide about taking appropriate actions due to failure to comprehend the nature, magnitude of the problem 3. Threat of cross infection from communicable disease case 4. Inadequate family income as a health threat 5. Inadequate living space as a health threat 6. Improper garbage disposal as a health threat

30 item quiz next meeting and assignment on the health threats by CI group identify the second level assessment of the 4 g1 is no. 3 threat of ....... Put in short bond paper pass in next meeting.

September 13 The family care plan - blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care (goals and objectives) and deliberately chosen set of interventions, resources, and evaluation criteria, stands methods and tools. Imports of planning care - individualize care of clients - Sets priorities - promotes communication among those involved in the care - facilitates continuity of care - facilitates coordination of care Steps in developing the care plan 1. Prioritize condition according to: A. Nature of the problem B. modifiability of the condition C. Preventive potential (high moderate and highly preventive problems D. Salience (degree of recognition for the problem by the family) 2. Set goals and objectives of nursing care 3. Plan interventions 4. Plan for evaluating care

Health teaching on nutrition on children 2 years and older: 1. Give adequate amount of family food at three meals every day 2. Give nutritious snacks twice daily, between. S such as boiled yellow camote, boiled yellow corn, peanuts, bowled Saba, fresh. Banana, Taho, fruits - imci manual 2009 - monitor children's weight and improvement in eating habits - explore the family other ways to maximize the allocation of resources - Assist family identify health priorities - explore with the family alternative foods that equally provide proper nutrition Evaluation - the mean writ for age - setting of health priorities - coming up with a Neal plan that consist of alternative or food exchanges that cost less but adequate in quantity and quality Care of community of population groups Overview - community health nursing is one of the two major fields of nursing the country; the other is hospital nursing - often some people. Hear the terms community health horsing ad public health nursing interchangeably. In reality, the former is broader than the latter. - is it just the setting of professional proactive which is the distinguishing difference? Major concepts of community Heath nursing - community, is the client but the unit of care is the family - community health or public is the goal for ones care - nursing is the channel or the mechanism by which the community shall attain community health. Characteristics of community (maglaya, 2004) - defined by its geographical boundaries within identifiable characteristics

- made up of institutions organized into social systems, which are linked In a complex network. These networks have formal and informal power structures and a communication system - has shared interest which binds them together - they have an area with fluid imbalance - awareness that we are a community - conversation of natural resources - recognition of and respect for the existence of subgroups - participation of subgroups in community affairs - preparation to meet crises - ability to solve problems - communication is through open channels - settling of disputes through legitimate means - participation of citizens that are physically, psychologically and emotionally healthy What are the elements of a community? 1. Location 2. Population 3. Social systems Chronic Diseases or lifestyle related disease 1. Cardiovascular diseases 2. Cancer all-types 3. chronic obstructive pulmonary disorder 4. Diabetes mellitus - in 2005 - estimated to cause 35 million deaths contributing to 60% of deaths worldwide - aside from a high death toll, it also can cause disability - projected burden of disease is approximately 48% of the global burden - 2020- these diseases are expected to account for 73% of deaths and 60% of the disease burden - on the affected ones it can cause emotional problems and psychological burdens, so with the families Risk factors of NCD physical activity 60.5% Smoking 34.8% Hypertension 22.5% Hypercholesterolemia 8.5% Obesity 4.9% Diabetes 4.6% Actions taken

- controlling risk factors is e primary preventive action - intervention at the family and community level - promotion of healthy lifestyle (healthy diet and nutrition, regular and adequate physical activity and leisure, avoidance of substances that can be abused and adequate stress management and relaxation NCD program goal Reduce the toll or morbidity, disability and premature deaths due to chronic, noncommunicable lifestyle Objectives 1. Analyze the social, economic, political and behavioral determinants of NCD that will be as basis for A. Developing policy guidelines B. setting legislative and political directions C. Providing financial measures to support NCD prevention and control 2. Reduce exposure of individuals and population to major determinants of NCD while preventing emergence of preventable common risk factor - public policies that pro toe health lifestyle I. Workplace am school and communities - protection from activities of industry and commerce that promotes unhealthy products and lifestyle - communicating consequences of major risk factors of NCD especially to vulnerable groups 3. Strengthen health care for people with NCD through health sector reforms and cost effective interventions (strong community participation combined with institutions building and appropriate, cost effective health interventions) Approaches in the reduction of morbidity and mortality 1. Comprehensive approach focused on primary prevention 2. Community based approach 3. Integrated approach What do we know about type 2? - adult onset

- long term complications from high blood sugar can include increased risk of heart, attacks, strikes, amputation - one of the leading causes of disability I. Oraon over 45 years old - more than 50 percent of dm patients did of coronary heard disease - increases the risk of dying frm heart diseases Predisposing factors Family history of dm, overweight, sedge tray . .,.,,.,.,.,.,.,.,.., Goals of management in DM 1. Regulation of blood glucose 2. Prevention of acute and chronic complications When diabetes is successfully managed, clients avoid the complications ".,.,.,.,.,.,.,.,.,.,.,.,., What at the three factors on which diabetes management depends? 1. Physical exercise 2. Diet 3. Pharmacologic interventions Key areas or preventnion and control 1. Maintain body weight and prevent obesity through proper nutrition and physical activity o exercise 2. Encourage proper nutrition - take more dietary fiber, reduce salt and fat intake, avoid simple sugars like .,.,.,.,.,,..,.,.,.,.,.,., Types of community diagnosis 1. Comprehensive community diagnosis 2. Problem oriented diagnosis Steps in community diagnosis 1. Determining the objectives 2. Defining the study population 3. Determining the data to be collected 4. Collecting the data (deciding int he method) 5. Developing the instrument 6. Actual data gathering 7. Data collation 8. Data presentation 9. Data analysis 10. Identifying the community health nursing problems 11. Priority setting- basis for the plan

Identifying the CHN problem 1. Health status problem- ex. High incidence rate of 2. Health resource problem-diff resource, vaccinations, health man power( one midwife with 30 barangays) 3. Health-related problem- ex. Poverty as a course of malnutrition Priority setting 1. Nature of the condition or problem presented 2.Magnitude of the problem- number of population that is effected by th problem 3. Modifiability of the problem 4.Preventive potential 5. Social concern- refers to the communities to recognize the problem and urgency in intervention Tools in CNN 1. Demography (population size, composition and distribution) 2. Vital statistics (fertility rates, mortality rates, morbidity rates) 3. Epidemiology A. Multiple causation theory - the wheel, the web, ecological triad B. levels of prevention ( primary, secondary, tertiary) Planning for CHN programs 1. Where are we now? 2. Where do we want to go? 3. How do we get there? 4. He do we know we are there? Goal and objective setting Evaluation plan To determine whether the program is relevant, effective, efficient and adequate Steps: 1. Device on what to evaluate in terms of progress, effectively, impact .,..,.,.,.,.,.,., Implementation 1. Community organizing 2. Partnership and collaboration 3. Advocacy

4. Application of the principles of leadership and management

Evaluation ,.,..,..,.,.,.,.,.,, Types of evaluation 1. On going evaluation - measure expected output is met at certain stage of expectation 2. terminal evaluation after the project completion 3. Ex post evacuation Pale requirement.