Typology of Nursing Problems in Family Nursing Practice

First Level Assessment

I. 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 client’s performance, current competencies, or performance,
clinical data or explicit expression of desire to achieve a higher level of state or function in a specific area on
health promotion and maintenance. Examples of this are the following:

A. Potential for Enhanced Capability for:

1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity

2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being- process of client’s developing/unfolding of mystery through harmonious
interconnectedness that comes from inner strength/sacred source/God (NANDA 2001)
6. Others. Specify.

B. Readiness for Enhanced Capability for:

1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others. Specify.

II. Presence of Health Threats - conditions that are conducive to disease and accident, or may result to failure to
maintain wellness or realize health potential. Examples of this are the following:

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards specify.
1. Broken chairs
2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
5. Others specify.

E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices. Specify.

1. Inadequate food intake both in quality and quantity

2. Excessive intake of certain nutrients
3. Faulty eating habits
4. Ineffective breastfeeding
5. Faulty feeding techniques
F. Stress Provoking Factors. Specify.

1. Strained marital relationship

2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members
4. Care-giving burden

G. Poor Home/Environmental Condition/Sanitation. Specify.

1. Inadequate living space

2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sights of vectors of diseases
5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lightning and ventilation
9. Noise pollution
10. Air pollution

H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.

1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10. Lack of /inadequate exercise/physical activity
11. Lack of/relaxation activities
12. Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis endemic areas).

J. Inherent Personal Characteristics-e.g. poor impulse control

K. Health History, which may Participate/Induce the Occurrence of Health Deficit, e.g. previous history of
difficult labor.
L. Inappropriate Role Assumption - e.g. child assuming mother’s role, father not assuming his role.
M. Lack of Immunization/Inadequate Immunization Status Specially of Children
N. Family Disunity-e.g.
1. Self-oriented behavior of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement
O. Others. Specify._________
III. Presence of health deficits-instances of failure in health maintenance.
Examples include:

A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner.

B. Failure to thrive/develop according to normal rate
C. Disability-whether congenital or arising from illness; transient/temporary (e.g. aphasia or temporary
paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness from measles,
lameness from polio)

IV. Presence of stress points/foreseeable crisis situations-anticipated periods of unusual demand on

the individual or family in terms of adjustment/family resources. Examples of this include:

A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________

Second-Level Assessment
I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge

B. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem,
specifically:
1. Social-stigma, loss of respect of peer/significant others
2. Economic/cost implications
3. Physical consequences
4. Emotional/psychological issues/concerns
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
D. Others. Specify _________

II. Inability to make decisions with respect to taking appropriate health action due to:

A. Failure to comprehend the nature/magnitude of the problem/condition

B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought about by perceive magnitude/severity of
the situation or problem, i.e. failure to breakdown problems into manageable units of attack.
D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them
E. Inability to decide which action to take from among a list of alternatives
F. Conflicting opinions among family members/significant others regarding action to take.
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
 Social consequences
 Economic consequences
 Physical consequences
 Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative attitude is meant one that
interferes with rational decision-making.
J. In accessibility of appropriate resources for care, specifically:
1. Physical Inaccessibility
2. Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of action
M. Others specify._________

III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of
the family due to:

A. Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications,
prognosis and management)
B. Lack of/inadequate knowledge about child development and care
C. Lack of/inadequate knowledge of the nature or extent of nursing care needed
D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or
treatment/procedure of care (i.e. complex therapeutic regimen or healthy lifestyle program).
F. Inadequate family resources of care specifically:

1. Absence of responsible member

2. Financial constraints
3. Limitation of luck/lack of physical resources

G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection)
which his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk
member
I. Member’s preoccupation with on concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity of family members.
K. Altered role performance, specify.

1. Role denials or ambivalence

2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
L. Others. Specify.________

IV. Inability to provide a home environment conducive to health maintenance and personal development due to:
A. Inadequate family resources specifically:
1. Financial constraints/limited financial resources
2. Limited physical resources-e.i. lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of investments in home environment improvement
C. Lack of/inadequate knowledge of importance of hygiene and sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication pattern within the family
G. Lack of supportive relationship among family members
H. Negative attitudes/philosophy in life, which is not conducive to health maintenance and personal
development
I. Lack of/inadequate competencies in relating to each other for mutual growth and maturation (e.g.
reduced ability to meet the physical and psychological needs of other members as a result of family’s
preoccupation with the current problem or condition.
J. Others specify._________

V. Failure to utilize community resources for health care due to:

A. Lack of/inadequate knowledge of community resources for health care

B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically:
1. Physical/psychological consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1. Cost constrains
2. Physical inaccessibility
H. Lack of /inadequate family resources, specifically
1. Manpower resources, e.g. baby sitter
2. Financial resources, cost of medicines prescribe
I. Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness, AIDS, etc.
J. Negative attitude/ philosophy in life which hinders effective/maximum utilization of community
resources for health care
K. Others, specify __________

Breastfeeding or Lactation Management Education Training

Introduction:
Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the
following laws support the full implementation of this program:

 Executive Order 51
 Republic Act 7600
 The Rooming-In and Breastfeeding Act of 1992

Program Objectives and Goals

 Protection and promotion of breastfeeding and lactation management education training
activities and strategies
1. Full Implementation of Laws Supporting the Program

a. EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and adequate
nutrition of infants through regulation of marketing of infant foods and related products. (e.g. breast milk
substitutes, infant formulas, feeding bottles, teats etc. )
b. RA 7600 THE ROOMING –IN and BREASTFEEDING ACT of 1992
 An act providing incentives to government and private health institutions promoting and practicing
rooming-in and breast-feeding.
 Provision for human milk bank.
 Information, education and re-education drive
 Sanction and Regulation
2. Conduct Orientation/Advocacy Meetings to Hospital/ Community
Advantages of Breastfeeding:
Mother
 Oxytocin help the uterus contracts
 Uterine involution
 Reduce incidence of Breast Cancer
 Promote Maternal-Infant Bonding
 Form of Family planning Method (Lactational Amenorrhea)
Baby
 Provides Antibodies
 Contains Lactoferin (binds with Iron)
 Leukocytes
 Contains Bifidus factor promotes growth of the Lactobacillus inhibits the growth of pathogenic bacilli
Positions in Breastfeeding of the baby:
1. Cradle Hold = head and neck are supported
2. Football Hold
3. Side Lying Position

BEST FOR BABIES

REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL
ANTIBODIES PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW)
TEMPERATURE ALWAYS IDEAL
FRESH MILK NEVER GOES OFF
EMOTIONALLY BONDING
EASY ONCE ESTABLISHED
DIGESTED EASILY
IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED
 Communicable Disease (Vector Borne)
Leptospirosis (Weil’s disease)
 An infectious disease that affects humans and animals, is considered the most common zoonosis in the
world
Causative Agent:
Leptospira interrogans

Sign/Symptoms:

 High fever
 Chills
 Vomiting
 Red eyes
 Diarrhea
 Severe headache
 muscle aches
 may include jaundice (yellow skin and eyes)
 abdominal pain
Treatment:
PET – > Penicillins, Erythromycin, Tetracycline

Malaria
 Malaria (from Medieval Italian: mala aria – “bad air”; formerly called ague or marsh fever) is an infectious
disease that is widespread in many tropical and subtropical regions.
Causative Agent:
Anopheles female mosquito

Signs & Symptoms:

 Chills to convulsion
 Hepatomegaly
 Anemia
 Sweats profusely
 Elevated temperature
Treatment:
 Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before entering the
endemic area.
 Anti-malarial drugs – sulfadoxine, quinine sulfate, tetracycline, quinidine
 Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable preventive
and vector control meas
Preventive Measures: (CLEAN)
 Chemically treated mosquito nets
 Larvae eating fish
 Environmental clean up
 Anti mosquito soap/lotion
 Neem trees/eucalyptus tree
Filariasis

 name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and
their larvae
 larvae transmit the disease to humans through a mosquito bite
 can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis
Sign/Symptoms:
Asymptomatic Stage
 Characterized by the presence of microfilariae in the peripheral blood
 No clinical signs and symptoms of the disease
 Some remain asymptomatic for years and in some instances for life
Acute Stage
 Lymphadenitis (inflammation of lymph nodes)
 Lymphangitis (inflammation of lymph vessels)
 In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum)
Chronic Stage
 Hydrocoele (swelling of the scrotum)
 Lyphedema (temporary swelling of the upper and lower extremities
 Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum,
breast)
Management:
 Diethylcarbamazine citrate (DEC) or Hetrazan
 Ivermectin,
 Albendazolethe
 No treatment can reverse elephantiasis

Schistosomiasis

 parasitic disease caused by a larvae

Causative Agent:
Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni

Signs & Symptoms: (BALLIPS)

 Bulging abdomen
 Abdominal pain
 Loose bowel movement
 Low grade fever
 Inflammation of liver & spleen
 Pallor
 Seizure
Preventive measures
 health education regarding mode of transmission and methods of protection; proper disposal of feces and
urine; improvement of irrigation and agriculture practices
 Control of patient, contacts and the immediate environment
Treatment:
 Diethylcarbamazepine citrate (DEC) or Praziquantel (drug of choice)
Dengue

 DENGUE is a mosquito-borne infection which in recent years has become a major international public
health concern..
 It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban
areas.
Sign/Symptoms: (VLINOSPARD)
 Vomiting
 Low platelet
 Nausea
 Onset of fever
 Severe headache
 Pain of the muscle and joint
 Abdominal pain
 Rashes
 Diarrhea
Treatment:
 The mainstay of treatment is supportive therapy.
 Intravenous fluids
 A platelet transfusion

Communicable Diseases (Chronic)

Tuberculosis
 TB is a highly infectious chronic disease that usually affects the lungs.
Causative Agent:
Mycobacterium Tuberculosis

Sign/Symptoms:
 cough
 afternoon fever
 weight loss
 night sweat
 blood stain sputum
Prevalence/Incidence:
 ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines
 Sixth leading cause of mortality (with 28,507 cases) in the Philippines.
Nursing and Medical Management
 Ventilation systems
 Ultraviolet lighting
 Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine
 drug therapy
Preventing Tuberculosis
 BCG vaccination
 Adequate rest
 Balanced diet
 Fresh air
 Adequate exercise
 Good personal Hygiene
National Tuberculosis Control Program – Key policies
 Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics who are negative
after 2 or more sputum exams
 Treatment – shall be given free and on an ambulatory basis, except those with acute complications and
emergencies
 Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB patients.
DOTS (Direct Observed Treatment Short Course)
 Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-
negative PTB with extensive parenchymal involvement (moderately- or far advanced) and extra-pulmonary
TB (meningitis, pleurisy, etc.)
 Intensive Phase (given daily for the first 2 months) – Rifampicin + Isioniazid + pyrazinamide +
ethambutol.
 If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum is still
positive in 2 months, all drugs are discontinued from 2-3 days and a sputum specimen is examined for
culture and drug sensitivity. The patient resumes taking the 4 drugs for another month and then
another smear exam is done at the end of the 3rd month.
 Maintenance Phase (after 3rd month, regardless of the result of the sputum exam)-INH + rifampicin
daily
 Category 2-previously-treated patients with relapses or failures.
 Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+ pyrazinamide+
ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol
on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more
month and then another sputum exam is done. If still positive after 4 months, intensive phase is
continued for the next 5 months.
 Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+ rifampicin+ ethambutol
 Category 3 – new TB patients whose sputum is smear negative for 3 times and chest x-ray result of PTB
minimal
 Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide
 Maintenance Phase (daily for the next 2 months) – Isioniazid + rifampicin

Leprosy

 Sometimes known as Hansen’s disease

 is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
 Gerhard Armauer Hansen
 Historically, leprosy was an incurable and disfiguring disease
 Today, leprosy is easily curable by multi-drug antibiotic therapy

Signs & Symptoms

Early stage (CLUMP) Late Stage (GMISC)
Change in skin color Gynocomastia
Loss in sensation Madarosis(loss of eyebrows)
Ulcers that do not heal Inability to close eyelids (Lagopthalmos)
Muscle weakness Sinking nosebridge
Painful nerves Clawing/contractures of fingers & nose

Prevalence Rate
 Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand population.
Management:
 Dapsone, Lamprene
 clofazimine and rifampin
 Multi-Drug-Therapy (MDT)
 Six month course of tablets for the milder form of leprosy and two years for the more severe form

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:
 Prevention – health education, healthful living through proper nutrition, adequate rest, sleep and good
personal hygiene;
 Casefinding
 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
 Rehabilitation-makes patients’ capable, active and self-respecting member of society.

Community Assessment
Community Assessment
 Status
 Structure
 Process

Types of Community Assessment

Community Diagnosis
 A process by which the nurse collects data about the community in order to identify factors which may
influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis and
develop and implement community health nursing interventions and strategies.
2 Types:
Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis

 aims to obtain general information about the  type of assessment responds to a particular
community need

Steps:
 Preparatory Phase
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data collection
6. finalize sampling design and methods
7. make a timetable
Implementation Phase

1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. prioritization of health problems
7. development of a health plan
8. validation and feedback
Evaluation Phase

Biostatistics
 DEMOGRAPHY – study of population size, composition and spatial distribution as affected by births,
deaths and migration.
 Sources: Census – complete enumeration of the population

2 Ways of Assigning People

1. De Jure – People were assigned to the place they usually live regardless of where they are at the time of
census.
2. De Facto – People were assigned to the place where they are physically present at are at the time of census
regardless, of their usual place of residence.
Components
1. Population size
2. Population composition
 Age Distribution
 Sex Ratio
 Population Pyramid
 Median age – age below which 50% of the population falls and above which 50% of the population
falls. The lower the median age, the younger the population (high fertility, high death rates).
 Age – Dependency Ratio – used as an index of age-induced economic drain on human resources
 Other characteristics:
 occupational groups
 economic groups
 educational attainment
 ethnic group
3. Population Distribution
 Urban-Rural – shows the proportion of people living in urban compared to the rural areas
 Crowding Index – indicates the ease by which a communicable disease can be transmitted from 1 host
to another susceptible host.
 Population Density – determines congestion of the place
 §
Vital Statistics
 The application of statistical measures to vital events (births, deaths and common illnesses) that is utilized
to gauge the levels of health, illness and health services of a community.
Types of Vital Statistics

Fertility Rate
1. Crude Birth Rate
Total # of livebirths in a given calendar year X 1000
Estimated population as of July 1 of the same given year
2. General Fertility Rate

Total # of livebirths in a given calendar year X 1000

Total number of reproductive age

Mortality Rate
1. Crude Death Rate
_Total # of death in a given calendar year_ X 1000
Estimated population as of July 1 of the same calendar year
2. Infant Mortality Rate
Total # of death below 1 yr in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year
3. Maternal Mortality Rate

Total # of death among all maternal cases in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year
Morbidity Rate
1. Prevalence Rate

Total # of new & old cases in a given calendar year X 100

Estimated population as of July 1 of the same calendar year
2. Incidence Rate
Total # of new cases in a given calendar year_ X 100
Estimated population as of July 1 of the same calendar year
3. Attack Rate
Total # of person who are exposed to the disease X 100
Estimated population as of July 1 of the same calendar year

Epidemiology

 the study of distribution of disease or physiologic condition among human population s and the factors
affecting such distribution
 the study of the occurrence and distribution of health conditions such as disease, death, deformities or
disabilities on human populations

1. Patterns of disease occurrence

Epidemic
 A situation when there is a high incidence of new cases of a specific disease in excess of the expected.
 when the proportion of the susceptible are high compared to the proportion of the immunes
Epidemic potential
 an area becomes vulnerable to a disease upsurge due to causal factors such as climatic changes, ecologic
changes, or socio-economic changes
Endemic
 habitual presence of a disease in a given geographic location accounting for the low number of both
immunes and susceptibles. E.g. Malaria is a disease endemic at Palawan.
 The causative factor of the disease is constantly available or present to the area.
Sporadic
 disease occurs every now and then affecting only a small number of people relative to the total population
 intermittent
Pandemic
 global occurrence of a disease
Steps in Epidemiological Investigation:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained
2. Role of the Nurse
 Case Finding
 Health Teaching
 Counseling
 Follow up visit

Community Health Nurse Roles and Functions

Qualifications
1. Bachelor of Science in Nursing
2. Registered Nurse of the Philippines

Planner/Programmer
1. Identifies needs, priorities, and problems of individuals, families, and communities
2. Formulates municipal health plan in the absence of a medical doctor
3. Interprets and implements nursing plan, program policies, memoranda, and circular for the
concerned staff personnel
4. Provides technical assistance to rural health midwives in health matters

Provider of Nursing Care

1. Provides direct nursing care to sick or disabled in the home, clinic, school, or workplace
2. Develops the family’s capability to take care of the sick, disabled, or dependent member

Community Organizer
1. Motivates and enhances community participation in terms of planning, organizing,
implementing, and evaluating health services
2. Initiates and participates in community development activities
Coordinator of Services
1. Coordinates with individuals, families, and groups for health related services provided by
various members of the health team
2. Coordinates nursing program with other health programs like environmental sanitation, health
education, dental health, and mental health
Trainer/Health Educator
1. Identifies and interprets training needs of the RHMs, Barangay Health Workers (BHW), and
hilots
2. Conducts training for RHMs and hilots on promotion and disease prevention
3. Conducts pre and post-consultation conferences for clinic clients; acts as a resource speaker on
health and health related services
4. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health education
purposes
5. 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
1. Prepares and submits required reports and records
2. Maintain adequate, accurate, and complete recording and reporting
3. Reviews, validates, consolidates, analyzes, and interprets all records and reports
4. Prepares statistical data/chart and other data presentation
Researcher

1. Participates in the conduct of survey studies and researches on nursing and health-related
subjects
2. Coordinates with government and non-government organization in the implementation of
studies/research

Community Health Nursing: An Overview

Community
 a group of people with common characteristics or interests living together within a territory or
geographical boundary
 place where people under usual conditions are found
 Derived from a latin word “comunicas” which means a group of people.
Health
 OLOF (Optimum Level of Functioning)
 Health-illness continuum
 High-level wellness
 Agent-host-environment
 Health belief
 Evolutionary-based
 Health promotion
 WHO definition

Community Health
 Part of paramedical and medical intervention/approach which is concerned on the health of the
whole population
Aims:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health

Nursing
 Both profession & a vocation. Assisting sick individuals to become healthy and healthy
individuals achieve optimum wellness

Community Health Nursing

 “The utilization of the nursing process in the different levels of clientele-individuals, families,
population groups and communities, concerned with the promotion of health, prevention of
disease and disability and rehabilitation.” ( Maglaya, et al)
 Goal: “To raise the level of citizenry by helping communities and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential for high-
level wellness” ( Nisce, et al)
 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)
 A learned practice discipline with the ultimate goal of contributing as individuals and in
collaboration with others to the promotion of the client’s 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 promotion of health, prevention of illness, care of the sick at home
and rehabilitation (DR. Ruth B. Freeman)

Public Health
 “Public Health is directed towards assisting every citizen to realize his birth rights and
longevity.” “The science and art of preventing disease, prolonging life and efficiency through
organized community effort for:
1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for the early diagnosis and preventive
treatment of disease
5. The development of a social machinery to ensure every one a standard of living, adequate for
maintenance of health to enable every citizen to realize his birth right of health and longevity
(Dr. C.E Winslow)
Mission of CHN
 Health Promotion
 Health Protection
 Health Balance
 Disease prevention
 Social Justice

Philosophy of CHN
 “The philosophy of CHN is based on the worth and dignity on the worth and dignity of
man.”(Dr. M. Shetland)
Basic Principles of CHN
1. The community is the patient in CHN, the family is the unit of care and there are four levels of
clientele: individual, family, population group (those who share common characteristics,
developmental stages and common exposure to health problems – e.g. children, elderly), and
the community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in
society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.

Roles of the PUBLIC HEALTH NURSE

 Clinician - who is a health care provider, taking care of the sick people at home or in the RHU
 Health Educator - who aims towards health promotion and illness prevention through
dissemination of correct information; educating people
 Facilitator - who establishes multi-sectoral linkages by referral system
 Supervisor - who monitors and supervises the performance of midwives
 Health Advocator - who speaks on behalf of the client
 Advocator - who act on behalf of the client
 Collaborator - who working with other health team member
*In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions or
is not available, the Public Health Nurse will take charge of the MHO’s responsibilities.
Other Specific Responsibilities of a Nurse, spelled by the implementing rules and
Regulations of RA 7164 (Philippine Nursing Act of 1991) includes:
 Supervision and care of women during pregnancy, labor and puerperium
 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of a physician
 Provision of first aid measures and emergency care
 Recommending herbal and symptomatic meds…etc.

In the care of the families:

 Provision of primary health care services
 Developmental/Utilization of family nursing care plan in the provision of care

In the care of the communities:

 Community organizing mobilization, community development and people empowerment
 Case finding and epidemiological investigation
 Program planning, implementation and evaluation
 Influencing executive and legislative individuals or bodies concerning health and development

Responsibilities of CHN
 be a part in developing an overall health plan, its implementation and evaluation for
communities
 provide quality nursing services to the three levels of clientele
 maintain coordination/linkages with other health team members, NGO/government agencies in
the provision of public health services
 conduct researches relevant to CHN services to improve provision of health care
 provide opportunities for professional growth and continuing education for staff development

Standards in CHN
1. Theory
 Applies theoretical concepts as basis for decisions in practice
2. Data Collection
 Gathers comprehensive, accurate data systematically
3. Diagnosis
 Analyzes collected data to determine the needs/ health problems of IFC
4. Planning
 At each level of prevention, develops plans that specify nursing actions unique to needs of
clients
5. Intervention
 Guided by the plan, intervenes to promote, maintain or restore health, prevent illness and
institute rehabilitation
6. Evaluation
 Evaluates responses of clients to interventions to note progress toward goal achievement,
revise data base, diagnoses and plan
7. 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
8. Interdisciplinary Collaboration
 Collaborates with other members of the health team, professionals and community
representatives in assessing, planning, implementing and evaluating programs for
community health
9. Research
 Indulges in research to contribute to theory and practice in community health nursing

Community Organizing Participatory Action

Research (COPAR)
Definitions of COPAR
 A social development approach that aims to transform the apathetic, individualistic and
voiceless poor into dynamic, participatory and politically responsive community
 A collective, participatory, transformative, liberative, sustained and systematic process of
building people’s organizations by mobilizing and enhancing the capabilities and resources of
the people for the resolution of their issues and concerns towards effecting change in their
existing oppressive and exploitative conditions (1994 National Rural Conference)
 A process by which a community identifies its needs and objectives, develops confidence to
take action in respect to them and in doing so, extends and develops cooperative and
collaborative attitudes and practices in the community (Ross 1967)
 A continuous and sustained process of educating the people to understand and develop their
critical awareness of their existing condition, working with the people collectively and
efficiently on their immediate and long-term problems, and mobilizing the people to develop
their capability and readiness to respond and take action on their immediate needs towards
solving their long-term problems (CO: A manual of experience, PCPD)

Importance of COPAR

1. COPAR is an important tool for community development and people empowerment as this
helps the community workers to generate community participation in development activities.
2. COPAR prepares people/clients to eventually take over the management of a development
programs in the future.
3. COPAR maximizes community participation and involvement; community resources are
mobilized for community services.
Principles of COPAR

1. People, especially the most oppressed, exploited and deprived sectors are open to change, have
the capacity to change and are able to bring about change.
2. COPAR should be based on the interest of the poorest sectors of society
3. COPAR should lead to a self-reliant community and society.

COPAR Process
 A progressive cycle of action-reflection action, which begins with small, local and concrete
issues identified by the people and the evaluation and the reflection of and on the action taken
by them.
 Consciousness through experimental learning central to the COPAR process because it places
emphasis on learning that emerges from concrete action and which enriches succeeding action.
 COPAR is participatory and mass-based because it is primarily directed towards and biased in
favor of the poor, the powerless and oppressed.
 COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are
tested through action rather than appointed or selected by some external force or entity.

COPAR Phases of Process

1. Pre-entry Phase
 Is the initial phase of the organizing process where the community/organizer looks for
communities to serve/help
 It is considered the simplest phase in terms of actual outputs, activities and strategies and time
spent for it
Activities include:
 Designing a plan for community development including all its activities and strategies for
care development.
 Designing criteria for the selection of site
 Actually selecting the site for community care
2. Entry Phase
 Sometimes called the social preparation phase as to the activities done here includes the
sensitization of the people on the critical events in their life, innovating them to share their
dreams and ideas on how to manage their concerns and eventually mobilizing them to take
collective action on these.
 This phase signals the actual entry of the community worker/organizer into the community.
She must be guided by the following guidelines however.
 Recognizes the role of local authorities by paying them visits to inform them of their
presence and activities.
 The appearance, speech, behavior and lifestyle should be in keeping with those of the
community residents without disregard of there being role models.
 Avoid raising the consciousness of the community residents; adopt a low-key profile.

3. Organization Building Phase
 Entails the formation of more formal structures and the inclusion of more formal procedures of
planning, implementation, and evaluating community-wide activities. It is at this phase where
the organized leaders or groups are being given trainings (formal, informal, OJT) to develop
their skills and in managing their own concerns/programs.
4. Sustenance and Strengthening Phase
 Occurs when the community organization has already been established and the community
members are already actively participating in community-wide undertakings. At this point, the
different communities setup in the organization building phase are already expected to be
functioning by way of planning, implementing and evaluating their own programs with the
overall guidance from the community-wide organization.
Strategies used may include:
 Education and training
 Networking and linkaging
 Conduct of mobilization on health and development concerns
 Implementing of livelihood projects
 Developing secondary leaders

Control of Acute Respiratory Infections (CARI)

Classification
A. No Pneumonia: Cough or Cold

1. No chest in drawing
2. No fast breathing (<2 mos. – <60/min, 2-12 mos. – less than 50 per minute; 12 mos. – 5 years –
less than 40 per minute)
Treatment:
1. If coughing more than 30 days, refer for assessment
2. Assess and treat ear problems/sore throat if present
3. Advise mother to give home care
4. Treat fever/wheezing if present
Home Care:
1. Feed the Child
 Feed the child during illness
 Increase feeding after illness
 Clear the nose if it interferes with feeding
2. Increase Fluids
 Offer the child extra to drink
 Increase breastfeeding
3. Soothe the throat and relieve the cough with a safe remedy
4. Watch for the following signs and symptoms and return quickly if they occur
 Breathing becomes difficult
 Breathing becomes fast
 Child is not able to drink
 Child becomes sicker
B. Pneumonia

1. No chest in drawing
2. Fast breathing (less than 2 mos- 60/min or more; 2-12 mos. – 50/min or more; 12 mos. – 5
years – 40/min or more)
Treatment
1. Advise mother to give home care
2. Give an antibiotic
3. Treat fever/wheezing if present
4. If the child’s condition gets worst, refer urgently to hospital; if improving, finish 5 days of
antibiotic.
Antibiotics Recommended by WHO
 Co-trimoxazole,
 Amoxycillin, Ampicillin, (p.o)
 or Procaine penicillin (I.M.)
C. Severe Pneumonia

1. Chest indrawing
2. Nasal flaring
3. Grunting (short sounds made with the voice)
4. Cyanosis
Treatment
 Refer urgently to hospital
 Treat fever ( paracetamol), wheezing ( salbutamol)
D. Very Severe Disease

1. Not able to drink

2. Convulsions
3. Abnormally sleepy or difficult to wake
4. Stridor in calm child
5. Severe undernutrition
Treatment
 Refer urgently to hospital
Assessment of Respiratory Infection
Ask the Mother

1. How old is the child?

2. Is the child coughing? For how long?
3. Age less than 2 months: Has the young infant stopped feeding well?
4. Age 2 months up to 5 years: Is the child able to drink?
5. Has the child had fever? For how long?
6. Has the child had convulsions?
Look, Listen
1. Count the breaths in one minute.

Age Fast Breathing

Less than 2 months 60/minute or more

2 months- 12 months 50/minute or more

12 months – 5 years 40/minute or more

2. Look for chest in drawing.
3. Look and listen for stridor. Stridor occurs when there is a narrowing of the larynx, trachea or
epiglottis, which interferes with air entering the lungs.
4. Look and listen for wheeze. Wheeze is a soft musical noise, which shows signs that breathing out
(exhale) is difficult.
5. See if the child is abnormally sleepy or difficult to wake. (Suspect for meningitis)
6. Feel for fever or low body temperature.
7. Check for severe under nutrition

Control of Diarrheal Diseases (CDD)

Management of the Patient with Diarrhea
A. No Dehydration
 Condition – well, alert
 Mouth and Tongue – moist
 Eyes – normal
 Thirst – drinks normally, not thirsty
 Tears – present
 Skin pinch – goes back quickly
 TREATMENT PLAN A- HOME Treatment.
Three Rules for Home Treatment
1. Give the child more fluids than usual
 Use home fluid such as cereal gruel
 Give ORESOL, plain water
2. Give the child plenty of food to prevent under nutrition
 Continue to breastfeed frequently
 If child is not breastfeed, give usual milk
 If child is less than 6 months and not yet taking solid food, dilute milk for 2 days
 If child is 6 months or older and already taking solid food, give cereal or other starchy food
mixed with vegetables, meat or fish; give fresh fruit juice or mashed banana to provide
potassium; feed child at least 6 times a day. After diarrhea stops, give an extra meal each
day for two weeks.
3. Take the child to the health worker if the child does not get better in 3 days or develops any of
the following:
 Many watery stools
 Repeated vomiting
 Marked thirst
 Eating or drinking poorly
 Fever
 Blood in the stool
Oresol Treatment

Amount of ORS to give after each loose Amount of ORS to provide for use at
Age stool home

< 24
months 50-100 ml 500 ml/day

2-10 years 100- 200 ml 1000 ml/day

10 years up As much as wanted 2000 ml/day

B. Some Dehydration
 Condition – restless, irritable
 Mouth and Tongue – dry
 Eyes – sunken
 Thirst – thirsty, drinks eagerly
 Tears – absent
 Skin pinch – goes back slowly
 WEIGH PT, TTT. PLAN B

Approximate amount of ORS to give in 1st 4 hours

Age Weight (kg) ORS (ml)

4 months 5 200- 400

4- 11 months 5- 7.9 400- 600

12-23 months 8- 10.9 600- 800

2-4 yrs. 11- 15.9 800- 1200

5-14 yrs. 16- 29.9 1200- 2200

15 yrs. up 30 up 2200- 4000

1. If the child wants more ORS than shown, give more
2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed, give 100-200 ml clean water during the
period
4. For a child less than 2 years give a teaspoonful every 1-2 min.
5. If the child vomits, wait for 10 min, then continue giving ORS, 1 tbsp/2-3 min
6. If the child’s eyelids become puffy, stop ORS, give plain water or breast milk, Resume ORS
when puffiness is gone
7. If (-) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
 Antibiotics should only be used for dysentery and suspected cholera
 Antiparasitic drugs should only be used for amoebiasis and giardiasis
C. Severe Dehydration
 Condition – lethargic or unconscious; floppy
 Eyes – very sunken and dry
 Tears – absent
 Mouth and tongue – very dry
 Thirst- drinks poorly or not able to drink
 Skin pinch – goes back very slowly
 Treatment PLAN C- treat quickly
1. Bring pt. to hospital
2. IVF – Lactated Ringers Solution or Normal Saline
3. Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink

Role of Breastfeeding in the Control of Diarrheal Diseases Program

Two problems in CDD
1. High child mortality due to diarrhea
2. High diarrhea incidence among under fives
 Highest incidence in age 6 – 23 months
 Highest mortality in the first 2 years of life
 Main causes of death in diarrhea:
 Dehydration
 To prevent dehydration, give home fluids “AM” as soon as diarrhea starts and if
dehydration is present, rehydrate early, correctly and effectively by giving ORS
 Malnutrition
 For under nutrition, continue feeding during diarrhea especially breastfeeding.
Interventions to prevent diarrhea
1. Breastfeeding
2. Improved weaning practices
3. Use of plenty of clean water
4. Hand washing
5. Use of latrines
6. Proper disposal of stools of small children
7. Measles immunization
Breastfeeding
1. Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants.
2. Advantages of breastfeeding in relation to CDDa. Breast milk is sterile
b. Presence of antibodies protection against diarrhea
c. Intestinal Flora in BF infants prevents growth of diarrhea causing bacteria.
3. Breastfeeding decreases incidence rate by 8-20% and mortality by 24- 27% in infants under 6
months of age.
4. When to wean?
 4-6 months – soft mashed foods 2x a day
 6 months – variety of foods 4x a day

Summary of WHO-CDD recommended strategies to prevent diarrhea

1. Improved Nutrition
 Exclusive breastfeeding for the first 4-6 months of life and partially for at least one year.
 Improved weaning practices
2. Use of safe water
 Collecting plenty of water from the cleanest source
 Protecting water from contamination at the source and in the home
3. Good personal and domestic hygiene
 Hand washing
 Use of latrines
 Proper disposal of stools of young children
4. Measles immunization

Department of Health (DOH) Philippines

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
1. 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).
2. 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, and Iron Deficiency Anemia & Obesity.
3. Eliminate the ff. diseases as public health problems:
1. Schistosomiasis
2. Malaria
3. Filariasis
4. Leprosy
5. Rabies
6. Measles
7. Tetanus
8. Diphtheria & Pertussis
9. 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, women’s 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

1. Universal access to basic health services must be ensured.
2. The health and nutrition of vulnerable groups must be prioritized.
3. The epidemiological shift from infection to degenerative diseases must be managed.
4. The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals

1. Increasing investment for Primary Health Care.
2. Development of national standards and objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.

Expanded Program for Immunization (EPI)

Principles of EPI
1. Epidemiological situation
2. Mass approach
3. Basic Health Service

The 7 immunizable diseases

1. Tuberculosis
2. Diptheria
3. Pertussis
4. Measles
5. Poliomyelitis
6. Tetanus
7. Hepatitis B

Target Setting
 Infants 0-12 months
 Pregnant and Post Partum Women
 School Entrants/ Grade 1 / 7 years old

Objectives of EPI
 To reduce morbidity and mortality rates among infants and children from six childhood
immunizable disease

Elements of EPI
 Target Setting
 Cold chain Logistic Management- Vaccine distribution through cold chain is designed to
ensure that the vaccines were maintained under proper environmental condition until the time
of administration.
 Information, Education and Communication (IEC)
 Assessment and evaluation of Over-all performance of the program
 Surveillance and research studies

Administration of vaccines
# of
Vaccine Content Form & Dosage Doses Route

Freeze dried
BCG (Bacillus Calmette Live attenuated Infant- 0.05ml
Guerin) bacteria Preschool-0.1ml 1 ID

DT- weakened toxin

DPT (Diphtheria Pertussis P-killed bacteria
Tetanus) liquid-0.5ml 3 IM

OPV (Oral Polio Vaccine) weakened virus liquid-2drops 3 Oral

Hepatitis B Plasma derivative Liquid-0.5ml 3 IM

Freeze dried-
Measles Weakened virus 0.5ml 1 Subcutaneous
 Schedule of Vaccines
Age at 1st Interval between
Vaccine dose dose Protection

BCG is given at the earliest possible age protects against

the possibility of TB infection from the other family
BCG At birth members

An early start with DPT reduces the chance of severe

DPT 6 weeks 4 weeks pertussis

The extent of protection against polio is increased the

OPV 6weeks 4weeks earlier OPV is given.

At birth, 6th An early start of Hepatitis B reduces the chance of being

Hepa B at birth week, 14th week infected and becoming a carrier.

9m0s.- At least 85% of measles can be prevented by

Measles 11m0s. immunization at this age.
 6 months - earliest dose of measles given in case of outbreak
 9months -11months- regular schedule of measles vaccine
 15 months- latest dose of measles given
 4-5 years old- catch up dose
 Fully Immunized Child (FIC)– less than 12 months old child with complete immunizations of
DPT, OPV, BCG, Anti Hepatitis, Anti measles.

Tetanus Toxiod Immunization

Schedule for Women
Vaccine Minimum age interval % protected Duration of Protection

TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 years

TT3 6 months later 95% 5 years

TT4 1year later/during next pregnancy 99% 10 years

TT5 1 year later/third pregnancy 99% Lifetime

 There is no contraindication to immunization except when the child is immunosuppressed or is
very, very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT
or measles vaccine, report such to the doctor immediately.
 Malnutrition is not a contraindication for immunizing children rather; it is an indication for
immunization since common childhood diseases are often severe to malnourished children.
Cold Chain under EPI

 Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the
time it is given to child or pregnant woman.
 The allowable timeframes for the storage of vaccines at different levels are:
 6months- Regional Level
 3months- Provincial Level/District Level
 1month-main health centers-with ref.
 Not more than 5days- Health centers using transport boxes.
 Most sensitive to heat: Freezer (-15 to -25 degrees C)
 OPV
 Measles
 Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
 BCG
 DPT
 Hepa B
 TT
 Use those that will expire first, mark “X”/ exposure, 3rd- discard,
 Transport- use cold bags let it stand in room temperature for a while before storing DPT.
 Half-life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
 FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines are utilized
before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date
are done to identify those near to expire vaccines.

Family Care Plan

Definition

 It is the blue print of the care that the nurse designs to systematically minimize or eliminate the
identified health and nursing problem through explicitly formulated outcomes of care (goals
and objectives) and deliberately chosen set of interventions, resources and evaluation criteria,
standards, methods and tools.

Characteristics, which are based on the Concept of Planning as a Process:

1. The nursing care plan focuses on actions, which are designed to solve or minimize existing
problem.
 The cores of the plan are the approaches, strategies, activities, methods and materials,
which the nurse hopes, will improve the problem.
2. The nursing care plan is a product of the liberate systematic process.
3. The nursing care plan as with all other plans relate to the future.
 It utilizes events in the past and what is happening in the present to determine patterns. It
also projects the future scenario if the situation is not corrected.
4. The nursing care plan is based upon identified health and nursing problems.
5. The nursing care plan is a means to an end, not an end in itself.
 The goal in planning is to deliver the most appropriate care to the client by eliminating
barriers to the family health development.
6. The nursing care plan is a continuous process not a one shot deal.
 The results of evaluation of the plan’s effectiveness trigger another cycle of the planning
process until the health and nursing problems are eliminated.

Desirable Qualities of a Nursing Care Plan

1. It should be based on clear, explicit definition of the problem(s).
2. A good plan is realistic.
3. The nursing care plan is prepared jointly with the family.
4. The nursing care plan is most useful in written form.
Importance of Planning Care
1. They individualize care to clients.
2. The nursing care plan helps in setting priorities by providing information about the client as
well as the nature of his problem.
3. The nursing care plan promotes systematic communication among those involve in the health
care effort.
4. Continuity of care is facilitated through the use of nursing care plans.
 Gaps and duplications in the services provided are minimized, if not totally eliminated.
5. Nursing care plans facilitate the coordination of care by making known to other members of the
health team what the nurse is doing.
Steps in Developing Care Plan
1. The prioritized conditions of the problem
2. Goals and objectives of the nursing care
3. The plan of interventions
4. The plan for evaluating care
Prioritizing Health Problems
Four Criteria for Determining Priorities:
1. Nature of the condition or problem – categorized into wellness state/potential, health threat,
health deficit of foreseeable crisis.
2. Modifiability of the condition or problem-refers to the probability of success in enhancing the
wellness state improving the condition minimizing, alleviating or totally eradicating the
problem through intervention.
3. Preventive potential-refers to the nature and magnitude of future problem that can be
minimized or totally prevented if interventions are done on the condition or problem under
consideration.
4. Salience-refers to the family’s perception and evaluation of the condition or problem in terms
of seriousness and urgency of attention needed or family readiness.
Factors Affecting Priority Setting
Nature of the problem
 The biggest weight is given to the wellness state or potential because of the premium on
client’s effort or desire to sustain/maintain high level of wellness.
 The same weight is given to health deficit because of its sense of clinical urgency, which may
require immediate intervention.
 Foreseeable crisis is given the least weight because culture linked variables/factors usually
provide our families with adequate support to cope with developmental or situational crisis.
Modifiability if the problem
 Current knowledge, technology and interventions to enhance the wellness state or manage the
problem.
 Resources of the family
 Resources of the nurse
 Resources of the community
Preventive potential
 Gravity or severity of the problem-refers to the progress of the disease/problem indicating
extent of damage on the patient/family; also indicates prognosis, reversibility or modifiability
of the problem. In general, the more severe the problem is, the lower is the preventive potential
of the problem.
 Duration of the problem-refers to the length of time the problem has existed. Generally
speaking, duration of the problem has a direct relationship to gravity; the nature of the problem
is variable that may, however, alter this relationship. Because of this relationship to gravity of
the problem, duration has also a direct relationship to preventive potential.
 Current management-refers to the presence and appropriateness of intervention measures
instituted to enhance the wellness state or remedy the problem. The institution of appropriate
intervention increases condition’s preventive potential.
 Exposure of any vulnerable or high risk group-increases the preventive potential of condition
or problem
Formulation of Goals and Objectives
 GOAL-is a general statement of condition or state to be brought about by specific courses of
action.
 OBJECTIVE-refers to a more specific statement of the desired results or outcomes of care.
They specify the criteria by which the degree of effectiveness of care is to be measured.
*A cardinal principle in goal setting states that goal must be set jointly with the family. This
ensures family commitment to realization.

* Basic to the establishment of mutually acceptable goals is the family’s recognition and
acceptance of existing health needs and problems.

Barriers to Joint Goal Setting Between the Nurse and the Family:
1. Failure on the part of the family to perceive the existence of the problem.
2. The family may realize the existence of the health condition or problem but is too busy at the
moment.
3. Sometimes the family perceives the existence of the problem but does not see it as serious
enough to warrant attention.
4. The family may perceive the presence of the problem and the need to take action. It may
however refuse to face and do something about the situation.
 Reasons to this kind of behavior:
a. Fear of consequences of taking actions.
b. Respect for tradition.
c. Failure to perceive the benefits of action.
d. Failure to relate the proposed action to the family’s goals.
5. A big barrier to collaborative goal setting between the nurse and the family is the working
relationship.
Focus on Interventions to Help The Family Performs Health Tasks:
1. Help the family recognize the problem
 Increasing the family’s knowledge on the nature, magnitude and cause of the problem.
 Helping the family see the implications of the situation or the consequences of the
condition.
 Relating the health needs to the goals of the family.
 Encouraging positive or wholesome emotional attitude toward the problem by affirming
the family’s capabilities/qualities/resources and providing information on
available actions.
2. Guide the family on how to decide on appropriate health actions to take.
 Identifying or exploring with the family courses of action available and the resources
needed for each.
 Discussing the consequences of action available.
 Analyzing with the family of the consequences of inaction.
3. Develop the family’s ability and commitment to provide nursing care to each member.
 Contracting-is a creative intervention that can maximize the opportunities to develop the
ability and commitment of the family to provide nursing care to its members.
4. Enhance the capability of the family to provide home environment conducive to health
maintenance and personal development.
 The family can be taught specific competencies to ensure such home environment through
environmental manipulation or management to minimize or eliminate health threats or
risks or to install facilities of nursing care.
5. Facilitate the family’s capability to utilize community resources for health care.
 Involves maximum use of available resources through the coordination, collaboration and
teamwork provided by effective referral system.
Criteria for Selecting the Type of Nurse Family Contact
1. Effectivity
2. Efficiency
3. Appropriateness
Types of Nurse Family Contact
Home Visit
 While it is expensive in terms of time, effort and logistics for the nurse, it is an effective and
appropriate type of family nurse contact if the objectives and outcomes of care require accurate
appraisal of family relationship, home and environment and family competencies. i.e. The best
opportunity to serve the actual care given by family members.
Clinic or Office Conference
 It is less expensive for the nurse and provides the opportunity to use equipment that can’t be
taken to the home. In some cases, the other team members in the clinic may be consulted or
called in to provide additional service.
Telephone Conference
 May be effective, efficient, and appropriate if the objectives and outcomes of care require
immediate access to data given problems on distance or travel time. Such data include
monitoring of health status or progress during the acute phase of an illness state, change in
schedule of visit or family decision, and updates on outcomes or responses to care and
treatment.
Written Communication
 It is another less time consuming option for the nurse in instances when there are large number
of families needing follow-up on top of problems of distance or travel time.
School Visit or Conference
 It is done to work with family and school authorities on how to appraise the degree of
vulnerability of and worked out interventions to help children and adolescence on specific
health risks, hazards or adjustment problems.
Industrial or Job Site Visit
 It is done when the nurse and family need to make an accurate assessment of health risks or
hazards and work with employer or supervisor on what can be done to improve on provisions
for health and safety of workers.
Implementing the Nursing Care Plan
 During this phase, the nurse encounters the realities in family nursing practice that motivates
her to try out creative innovations or overwhelm her to frustration or inaction. A dynamic
attitude on personal and professional development is, therefore, necessary if she has to face up
challenges of nursing practice.
Implementation Phase: A Phenomenological Experience
 Meeting the challenges of this phase is the essence of family nursing practice. During this
phase, the nurse experiences with the family a lived meaningful world of mutual, dynamic
interchange of meanings, concerns, perceptions, biases, emotions and skills. Just as the self
aims to achieve body-mind integration to achieve wholeness in the experience of “being” and
“becoming” in expert caring. Unless there is such a dynamic and active involvement between
the nurse and the family in understanding and making choices in this meaningful world of
coping, aspirations, emotions and skills the nurse can’t hope to achieve expert caring.
Expert Caring: Methods and Possibilities
 Expert caring in the implementation phase is demonstrated phase is demonstrated when the
nurse carries out interventions based on the family’s understanding of the lived experience of
coping and being in the world. Expert caring is developing the capability of the family for
“engage care” through the nurses skilled practice, the family learns to choose and carry out the
 best possibilities of caring given the meanings, concerns, emotions and resources(skills &
equipments) as experienced in the situation. While the challenge for expert caring is a reality,
the nurse is enriched as a result of such an experience (Benner & Wrubel 1989).
 …By being experts in caring, nurses must takeover and transform the notions of expertise.
Expert caring has nothing to do with possessing privileged information that increases one’s
control and domination of another. Rather, expert caring unleashes the possibilities inherent in
the self and the situation. Expert caring liberates and facilitates in such a way that the one
caring is enriched in the process.
 While expert caring does not happen overnight to the novice nurse, there are methods and
possibilities that can enhance learning towards expert caring. Such methods and possibilities
need to be carried out and experienced in real contexts and real relationships to achieve
skillfully comportment and excellence in the current situation.
Two such major methods and possibilities:
1. Performance-focus learning through competency-based teaching
2. Maximizing caring possibilities for personal and professional development
Competency-Based Teaching
 A substantive part of the implementation phase is directed towards developing the family’s
competencies to perform the health tasks. Competencies include the cognitive (knowledge),
psychomotor (skills) and attitudinal or affective(emotions, feelings, values). The following are
examples of these family health competencies using the corresponding health task in our case
illustration:
 Health Task: The family recognizes the possibility of cross-infection of scabies to other family
members.
Cognitive Competency:
1. The family explains the cause of scabies
2. The family enumerates ways by which cross-infection of scabies can occur among the family
members.
3. Health Task: The family provides a home environment conducive to health maintenance and
personal development of its members.
Psychomotor Competency:
 The family carries out the agreed-upon measures to improve home sanitation and personal
hygiene of family members.
 Health Task: The family decides to take appropriate health action.
Attitudinal or Affective Competencies:
1. Family members express feelings or emotions that act as barriers to decision-making
2. Family members acknowledge the existence of these feelings or emotions.
 In order to systematically work towards development of the family’s competencies, such
competencies need to be explicitly defined. Cognitive and psychomotor competencies are
reflected explicitly as objectives in the family nursing care plan. The attitudinal or affective
competencies may also be translated into objective of care as feelings, emotions or
philosophy in life that enhance the family’s desire or commitment to behavior change and
sustain the needed action.
Learning Principles and Teaching- Learning Methods and Techniques that the Nurse
Can Use in Competency-Based Teaching:
1. Learning is both intellectual and emotional process.
2. Learning is facilitated when experience has meaning.
3. Learning is individual matter.
Learning is Both Intellectual and Emotional Process
Six General Methods and Techniques:
1. Provide information to shape attitude
2. Provide experiential learning activities to shape attitudes
3. Provide examples or models to shape attitudes
4. Providing opportunities for small group discussion
5. Role playing exercises
6. Explore the benefits of power of silence
Learning is Facilitated When Experience Has Meaning
1. Analyze and process family members all teaching-learning based on their grasp on the live
experience of the situation in terms of the meaning for the self.
2. Involve the family actively in determining areas for teaching-learning based on the health tasks
that members made to perform.
3. Used examples or illustrations that the family is familiar with.
Learning is Individual Matter: Ensure Mastery of Competencies for Sustained
Actions:
Some Techniques to Develop Mastery:
1. Make the learning active by providing opportunities for the family to do specific activities,
answer questions or apply learning in solving problems.
2. Ensure clarity. Use words, examples, visual materials and handouts that the family can
understand.
3. Ensure adequate evaluation, feedback, monitoring and support for sustained action by:
 Explaining well how the family is doing
 Giving the necessary affirmations or reassurances
 Explaining how the skill can be improved
 Exploring with the family how modifications can be carried out to maximize situated
possibilities or best options.

Family Coping Index

Purpose:
 To provide a basis for estimating the nursing needs of a particular family.
Health Care Need
A family health care need is present when:
1. The family has a health problem with which they are unable to cope.
2. There is a reasonable likelihood that nursing will make a difference in the in the family’s
ability to cope.
Relation to Coping Nursing Need:
 COPING may be defined as dealing with problems associated with health care with reasonable
success.
 When the family is unable to cope with one or another aspect of health care, it may be said to
have a “coping deficit”
Direction for Scaling
 Two parts of the Coping index:
1. A point on the scale
2. A justification statement
 The scale enables you to place the family in relation to their ability to cope with the nine areas
of family nursing at the time observed and as you would expect it to be in 3 months or at the
time of discharge if nursing care were provided. Coping capacity is rated from 1 (totally unable
to manage this aspect of family care) to 5 (able to handle this aspect of care without help from
community sources). Check “no problem” if the particular category is not relevant to the
situation.
 The justification consists of brief statement or phrases that explain why you have rated the
family as you have.
General Considerations

1. It is the coping capacity and not the underlying problem that is being rated.
2. It is the family and not the individual that is being rated.
3. Rating should be done after 2-3 home visits when the nurse is more acquainted with the family.
4. The scale is as follows:
 0-2 or no competence
 3-5 coping in some fashion but poorly
 6-8 moderately competent
 9 fairly competent
5. Justification- a brief statement that explains why you have rated the family as you have. These
statements should be expressed in terms of behavior of observable facts. Example: “Family
nutrition includes basic 4 rather than good diet.
6. Terminal rating is done at the end of the given period of time. This enables the nurse to see
progress the family has made in their competence; whether the prognosis was reasonable; and
whether the family needs further nursing service and where emphasis should be placed.
Scaling Cues

 The following descriptive statements are “cues” to help you as you rate family coping. They
are limited to three points – 1 or no competence, 3 for moderate competence and 5 for
complete competence.
Areas to Be Assessed

1. Physical independence: This category is concerned with the ability to move about to get out of
bed, to take care of daily grooming, walking and other things which involves the daily
activities.
2. Therapeutic Competence: This category includes all the procedures or treatment prescribed for
the care of ill, such as giving medication, dressings, exercise and relaxation, special diets.
3. Knowledge of Health Condition: This system is concerned with the particular health condition
that is the occasion of care
4. Application of the Principles of General Hygiene: This is concerned with the family action in
relation to maintaining family nutrition, securing adequate rest and relaxation for family
members, carrying out accepted preventive measures, such as immunization.
5. Health Attitudes: This category is concerned with the way the family feels about health care in
general, including preventive services, care of illness and public health measures.
6. Emotional Competence: This category has to do with the maturity and integrity with which the
members of the family are able to meet the usual stresses and problems of life, and to plan for
happy and fruitful living.
7. Family Living: This category is concerned largely with the interpersonal with the interpersonal
or group aspects of family life – how well the members of the family get along with one
another, the ways in which they take decisions affecting the family as a whole.
8. Physical Environment: This is concerned with the home, the community and the work
environment as it affects family health.
9. Use of Community Facilities: generally keeps appointments. Follows through referrals. Tells
others about Health Departments services

Family Health Nursing

Definition of Family
Family
 Basic unit in society, and is shaped by all forces surround it.
 Values, beliefs, and customs of society influence the role and function of the family
(invades every aspect of the life of the family)
 Is a unit of interacting persons bound by ties of blood, marriage or adoption.
 Constitute a single household, interacts with each other in their respective familial roles
and create and maintain a common culture.
 An open and developing system of interacting personalities with structure and process enacted
in relationships among the individual members regulated by resources and stressors and
existing within the larger community (Smith & Maurer, 1995)
 Two or more people who live in the same household (usually), share a common emotional
bond, and perform certain interrelated social tasks (Spradly & Allender, 1996)
 An organization or social institution with continuity (past, present, and future). In which there
are certain behaviors in common that affect each other.
The Filipino Family
 Based on the Philippine Constitution, Family Code with focus on religious, legal, and cultural
aspects of the definition of family.
Section 1
 The state recognizes the Filipino family as the foundation of the nation. Accordingly, it shall
strengthen its solidarity and actively promote its total development
Section 2
 Marriage, as an inviolable social institution, is the foundation of family and shall be protected
by the state.
Section 3
The state shall defend –

1. the right of spouses to found a family in accordance with their religious convictions and the
demands of responsible parenthood
2. the right of children to assistance including proper care and nutrition, and special protection
from all forms of neglect, abuse, cruelty, exploitation and other conditions prejudicial to their
development
3. the right of the family to a family living wage income
4. the right of families or family associations to participate in the planning and implementation of
policies and programs of that affect them
Section 4
 The family has the duty to care for its elderly members but the state may also do so through
just programs of social security
The Filipino Family and its Characteristics
The basic social units of Philippine society are the nuclear family
1. Although the basic unit is the nuclear family, the influence of kinship is felt in all segments of
social organizations
2. Extensions of relationships and descent patterns are bilateral
3. Kinship circles is considerably greater because effective range often includes the third cousin
4. Kin group is further enlarged by a finial, spiritual or ceremonial ties. Filipino marriage is not an
individual but a family affair
5. Obligation goes with this kingship system
6. Extended family has a profound effect on daily decisions
7. There is a great degree of equality between husband and wife
8. Children not only have to respect their parents and obey them, but also have to learn to repress
their repressive tendencies
9. The older siblings have something of authority of their parents.
Types of Family
 There are many types of family. They change overtime as a consequence of BIRTH, DEATH,
MIGRATION, SEPARATION and GROWTH OF FAMILY MEMBERS
A. Structure
 NUCLEAR- a father, a mother with child/children living together but apart from both sets of
parents and other relatives.
 EXTENDED- composed of two or more nuclear families economically and socially related to
each other. Multigenerational, including married brothers and sisters, and the families.
 SINGLE PARENT-divorced or separated, unmarried or widowed male or female with at least
one child.
 BLENDED/RECONSTITUTED-a combination of two families with children from both
families and sometimes children of the newly married couple. It is also a remarriage with
children from previous marriage.
 COMPOUND-one man/woman with several spouses
 COMMUNAL-more than one monogamous couple sharing resources
 COHABITING/LIVE-IN-unmarried couple living together
 DYAD—husband and wife or other couple living alone without children
 GAY/LESBIAN-homosexual couple living together with or without children
 NO-KIN- a group of at least two people sharing a relationship and exchange support who have
no legal or blood tie to each other
 FOSTER- substitute family for children whose parents are unable to care for them
FUNCTIONAL TYPE:

 FAMILY OF PROCREATION- refers to the family you yourself created.

 FAMILY OF ORIENTATION-refers to the family where you came from.
B. Decisions in the family (Authority)
 PATRIARCHAL – full authority on the father or any male member of the family e.g. eldest
son, grandfather
 MATRIARCHAL – full authority of the mother or any female member of the family, e.g.
eldest sister, grandmother
 EGALITARIAN- husband and wife exercise a more or less amount of authority, father and
mother decides
 DEMOCRATIC – everybody is involve in decision making
 AUTHOCRATIC-
 LAISSEZ-FAIRE- “full autonomy”
 MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father is
working overseas)
 PATRICENTIC- the father decides/ takes charge in absence of the mother
C. Decent (cultural norms, which affiliate a person with a particular group of kinsman
for certain social purposes)
 PATRILINEAL – Affiliates a person with a group of relatives who are related to him though
his father
 BILATERAL- both parents
 MATRILINEAL – related through mother
D. Residence
 PATRILOCAL – family resides / stays with / near domicile of the parents of the husband
 MATRILOCAL – live near the domicile of the parents of the wife
Ackerman States that the Function of Family are:
1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring man’s humanness
 Physical functions of the family are met through parents providing food, clothing and
shelter, protection against danger provision for bodily repairs after fatigue or illness, and
through reproduction
 Affect ional function – the family is the primary unit in which he child test his emotional
reactions
 Social functions – include providing social togetherness, fostering self esteem and a
personal identity tied to family identity, providing opportunity for observing and learning
social and sexual roles, accepting responsibility for behavior and supporting individual
creativity and initiative.
Universal Function of the Family by Doode
 REPRODUCTION – for replacement of members of society: to perpetuate the human species
 STATUS PLACEMENT of individual in society
 BIOLOGICAL and MAINTENANCE OF THE YOUNG and dependent members
 Socialization and care of the children;
 Social control
The Family as a Unit of Care
Rationale for Considering the Family as a Unit of Care:
 The family is considered the natural and fundamental unit of society
 The family as a group generates, prevents, tolerates and corrects health problems within its
membership
 The health problems of the family members are interlocking
 The family is the most frequent focus of health decisions and action in personal care
 The family is an effective and available channel for much of the effort of the health worker
The Family as the Client
Characteristics of a Family as a Client
 The family is a product of time and place-

 A family is different from other family who lives in another location in many ways.
 A family who lived in the past is different from another family who lives at present in
many ways.
 The family develops its own lifestyle

 Develop its own patterns of behavior and its own style in life.
 Develops their own power system which either be:
 Balance-the parents and children have their own areas of decisions and control.
 Strongly Bias-one member gains dominance over the others.
 The family operate as a group

  A family is a unit in which the action of any member may set of a whole series of reaction
within a group, and entity whose inner strength may be its greatest single supportive factor
when one of its members is stricken with illness or death.
 The family accommodates the needs of the individual members.

 An individual is unique human being who needs to assert his or herself in a way that
allows him to grow and develop.
 Sometimes, individual needs and group needs seem to find a natural balance;
1. The need for self-expression does not over shadow consideration for others.
2. Power is equitably distributed.
3. Independence is permitted to flourish.
 The family relates to the community

 Family develops a stance with respect to the community:
1. The relationship between the families is wholesome and reciprocal; the family utilizes
the community resources and in turn, contributes to the improvement of the
community.
2. There are families who feel a sense of isolation from the community.
 Families who maintain proud, “We keep to ourselves” attitude.
 Families who are entirely passive taking the benefits from the community without
either contributing to it or demanding changes to it.
 The family has a growth cycle

 Families pass through predictable development stages (Duvall & Miller, 1990)
 STAGES:
 Stage 1: MARRIAGE & THE FAMILY
 Involves merging of values brought into the relationship from the families of
orientation.
 Includes adjustments to each other’s routines (sleeping, eating, chores, etc.),
sexual and economic aspects.
 Members work to achieve 3 separate identifiable tasks:
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of orientation
3. If applicable, engage in reproductive life planning
 Stage 2: EARLY CHILDBEARING FAMILY
 Birth or adoption of a first child which requires economic and social role changes
 Oldest child: 2-1/2 years
 Stage 3: FAMILY WITH PRE-SCHOOL CHILDREN
 This is a busy family because children at this stage demand a great deal of time
related to growth and development needs and safety considerations.
 Oldest child: 2-1/2 to 6 years old
 Stage 4: FAMILY WITH SCHOOL AGE CHILDREN
 Parents at this stage have important responsibility of preparing their children to be
able to function in a complex world while at the same time maintaining their own
satisfying marriage relationship.
 Oldest child: 6-12 years old
  Stage 5: FAMILY WITH ADOLESCENT CHILDREN
 A family allows the adolescents more freedom and prepare them for their own life
as technology advances-gap between generations increases
 Oldest child: 12-20 years old
 Stage 6: THE LAUNCHING CENTER FAMILY
 Stage when children leave to set their own household-appears to represent the
breaking of the family
 Empty nests
 Stage 7: FAMILY OF MIDDLE YEARS
 Family returns to two partners nuclear unit
 Period from empty nest to retirement
 Stage 8: FAMILY IN RETIREMENT/OLDER AGE
 Stage 9: PERIOD FROM RETIREMENT TO DEATH OF BOTH SPOUSES
12 Behaviors Indicating a Well Family
 Able to provide for physical emotional and spiritual needs of family members
 Able to be sensitive to the needs of the family members
 Able to communicate thought and feelings effectively
 Able to provide support, security and encouragement
 Able to initiate and maintain growth producing relationship
 Maintain and create constructive and responsible community relationships
 Able to grow with and through children
 Ability to perform family roles flexibly
 Able to help oneself and to accept help when appropriate
 Demonstrate mutual respect for the individuality of family members
 Ability to use a crisis experience as a means of growth
 Demonstrate concern of family unity, loyalty and interfamily cooperation
Family Health Task
 Health task differ in degrees from family to family
 TASK- is a function, but with work or labor overtures assigned or demanded of the person
 Duvall & Niller identified 8 task essential for a family to function as a unit:
Eight Family Tasks (Duvall & Niller)
1. Physical maintenance- provides food shelter, clothing, and health care to its members being
certain that a family has ample resources to provide
2. Socialization of Family– involves preparation of children to live in the community and interact
with people outside the family.
3. Allocation of Resources- determines which family needs will be met and their order of priority.
4. Maintenance of Order– task includes opening an effective means of communication between
family members, integrating family values and enforcing common regulations for all family
members.
5. Division of Labor – who will fulfill certain roles e.g., family provider, home manager,
children’s caregiver
6. Reproduction, Recruitment, and Release of family member
 7. Placement of members into larger society –consists of selecting community activities such as
church, school, politics that correlate with the family beliefs and values
8. Maintenance of motivation and morale– created when members serve as support people to each
other
5 Family Health Tasks (Maglaya, A., 2004)
 Recognizing interruptions of health development
 Making decisions about seeking health care/ to take action
 Dealing effectively health and non-health situations
 Providing care to all members of the family
 Maintaining a home environment conducive to health maintenance
Family Roles
 Nurturing figure– primary caregiver to children or any dependent member.
 Provider – provides the family’s basic needs.
 Decision maker– makes decisions particularly in areas such as finance, resolution, of conflicts,
use of leisure time etc.
 Problem-solver– resolves family problems to maintain unity and solidarity.
 Health manager– monitors the health and ensures that members return to health appointments.
 Gate keeper-Determines what information will be released from the family or what new
information cam be introduced.
Theoretical Approaches to Family Health Care (family apgar)
Family Models
 the use of family model provides a perspective of focus for understanding the family
 have categorized according to their basic focus as developmental, interactional structural-
functional, and systems model
Developmental Models
Duvall’s and Stevenson’s Family development model
 Evelyn Duvall’ (1977) family developmental framework provides guide to examine and
analyze the basic changes and developmental tasks common to most families during their life
cycle. Although each family has unique characteristics normative patterns of sequential
development are common to all families
 These stages and developmental tasks illustrate common family behaviors that may be
expected at specific times in the family life cycle. The stages are marked by the age of the
oldest child however some overlapping occurs in families with several children.
STAGES OF DEVELOPMENT BASIC FAMILY TASK

Beginning FamiliesEarly Physical maintenance

childbearing
Families with preschoolers Allocation of resources

Families with school children Division of labor

Families with teen-agers Socialization of members.

Launching center families Reproduction, recruitment and release of Members

Middle-aged families Maintenance of order

Aging Families Placement of members in larger community Maintenance of motivation
and morale
 Duvall’s developmental model is an excellent guide for assessing, analyzing and planning
around basic family tasks developmental stage, however, this model does not include the
family structure or physiological aspects, which should be considered for a comprehensive
view of the family. This model is applicable for nuclear families with growing children and
families who are experiencing health-related problems.
Stevenson’s Family Developmental Model
 Joanne Stevenson (1977) describes the basic tasks and responsibilities of families in four
stages.
STAGES HEALTH TASKS

Emerging family (from marriage for 7 to Couple strives for independence from their parents and to
10 years) develop a sense of responsibility for family life.

Crystallizing family (with teenage To assume responsibility for growth and development of
children) individual members and outside organizations

Interacting family(children grown and Assumption of responsibility for “continued survival and
small grandchildren) enhancement of the nation.”

Actualizing family (aging couple alone Assume the responsibility for sharing the wisdom of age,
again) reviewing life and putting affairs in order
 She views family tasks as maintaining a common household rearing children and finding
satisfying work and leisure. It also includes sustaining appropriate health patterns and
providing mutual support and acculturation of family members.
 This model is useful for nuclear families because it examines psychosocial patterns to specific
stage of development, however, it also does not include family structure, nor it addresses health
promotion and health-related concerns that the family may face.
Structural- Functional Model
Friedman’s Structural- Functional Family Model
 Was developed from sociological frameworks and systems theory by Marilyn Friedman (1986)
 The family is the focus of this model as it interacts with supra-systems in the community and
with individual family members in the subsystem.
Friedman’s Family Model Components
STRUCTURAL COMPONENTS FUNCTIONAL COMPONENTS

Family composition Affective

Value systems Physical necessities and care

Communication patterns Economic

Role structure Reproductive

Socialization and social placement

Power structure Family coping
 Structural component examines the family unit, how it is organized and how members relate to
one another in terms of values, communication network, role system and power while
functional components refers to the interaction outcomes resulting from family organizational
structure.
 The structural-functional components and parts all intimately interrelate and interact; the others
affect each component and part.
 This model provides a broad framework for examining the interactions among family and
within the community. This incorporates physical, psychosocial and cultural aspects of the
family along with interacting relationships.
 This model is very applicable to any type of family and their health-related problems
Systems Model
Calgary’s Family Model (system’s model)
 Is an integrated conceptual framework of several theorists.
 Model is based on three major categories: family structure, function and development. Each is
further subdivided into parts that interacts with others and changes the whole family
configuration.
Calgary Family Model
Family Structure Family Development Family Functions
Internal developmental stage daily living activities
Family composition developmental tasks allocation of tasks
Rank order of member’s attachments
Subsystems in family
Boundaries of familyExternal Expressive
Culture Communication
Religion Problem-solving
Social class status Roles
And mobility Control
Environment Beliefs
Extended family Alliances/coalitions
 This model is comprehensive and incorporates three major areas, namely, the structure,
function and development of the family.
 It is complex, with too many sub concepts for the health worker to explore and focus.
 It can be applied to any type of family with any health-related problems.
Family Apgar Questionnaire (SMILKESTEIN, 1978)
ALWAYS SOMETIMES HARDLY
(2 PTS.) (1 pt.) EVER
 (0 PT.)

I am satisfied with the help I receive from my family

when something is troubling me.

I am satisfied with the way my family discovers items of

common interest and shares problem-solving with me.

I find that my family accepts my wishes to take on new

activities or make changes in my lifestyle.

I am satisfied with the way my family expresses

affection and responds to my feelings such as anger,
sorrow and love

I am satisfied with the way my family and I spend time

together.

Scoring:
Check one of the three choices:
Total Score:
 7-10 = suggests a highly functional family
 4-6 = moderately dysfunctional family
 0-3 = severely dysfunctional family
Health as a Goal of Family Health Care
 HEALTH DEFICIT- this refers to conditions of health breakdowns or advent of illness in the
family
 HEALTH THREAT- these are the conditions that make it more likely for accidents, disease or
failure to thrive or develop to occur.
 FORESEEABLE CRISIS- these are anticipated periods of unusual demand on the family in
terms of time or resources
 WELLNESS POTENTIAL- this refers to states of wellness and the likelihood for health
maintenance or improvement to occur depending on the desire of the family
Roles of Health Care Provider in Family Health Care
 HEALTH MONITOR
 PROVIDER OF CARE
 COORDINATOR
 FACILITATOR
 TEACHER
 COUNSELOR
Family Health Care Process
 DATA COLLECTION: METHODS AND TOOLS
 DATA ANALYSIS or INTERPRETATION
 PLANNING
 IMPLEMENTATION
 EVALUATION PHASE
ASSESSMENT PHASE
 first major phase of nursing process in family health nursing
 Involves a set of action by which the nurse measures the status of the family as a client. Its
ability to maintain wellness , prevent, control or resolve problems in order to achieve health
and wellness among its members
 Data about present condition or status of the family are compared against the norms and
standards of personal , social, and environmental health, system integrity and ability to resolve
social problems.
 The norms and standards are derived from values, beliefs, principles, rules or expectation.
TWO MAJOR TYPES
1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential health conditions or
problems of the family are determined (WS, HT, HD, SP or FC)
2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that family
encounters in performing health task with respect to given health condition or problem and
etiology or barriers to the family’s assumption of the task
DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD
 OBSERVATION

 done through use of sensory capacities
 The nurse gathers information about the family’s state of being and behavioral responses
 the family’s health status can be inferred from the s/sx of problem areas
 a. communication and interaction patterns expected ,used, and tolerated by family
members
 b. role perception / task assumption by each member including decision making
patterns
 c. conditions in the home and environment
** Data gathered though this method have the advantage of being subjected to validation and
reliability testing by other observers

 PHYSICAL EXAMINATION

 significant data about the health status of individual members can be obtained through
direct examination through IPPA, Measurement of specific body parts and reviewing the
body systems
 data gathered from P.A form substantive part of first level assessment which may indicate
presence of health deficits (illness state )
 INTERVIEW

 Productivity of interview process depends upon the use effective communication
techniques to elicit needed response PROBLEMS ENCOUNTERED:
 How to ascertain where the client is in terms of perception of health condition or
problems and the patterns of coping utilized to resolve them
  Tendency of community health worker to readily give out advice, health teachings or
solutions once they have identified the health condition or problems.
 Provisions of models for phrasing interview questions utilization of deliberately chosen
communication techniques for an adequate nursing assessment.
 confidence in the use of communication skills
 Being familiar with and being competent in the use of type of question that aim to explore,
validate, clarify, offer feedback, encourage verbalization of thought and feelings and offer
needed support or reassurance.
 TYPES:
1. completing health history of each family member
 Health history determines current health status based on significant PAST HEALTH
HISTOI\RY e.g. developmental accomplishment, known illnesses, allergies, restorative
treatment, residence in endemic areas for certain diseases or sources of communicable
diseases.
 FAMILY HISTORY e.g. genetic history in relation to health and illness.
 SOCIAL HISTORY e.g. intra-personal and inter-personal factors affecting the family
member social adjustment or vulnerability to stress and crisis
2. Collecting data by personally asking significant family members or relatives questions
regarding health, family life experiences and home environment to generate data on what
wellness condition and health problem exist in the family ( first level assessment) and the
corresponding nursing problems for each health condition or problem ( 2nd level assessment)
 RECORDS REVIEW

Gather information through reviewing existing records and reports pertinent to the client
 Individual clinical records of the family members, laboratory and diagnostic reports,
immunization records reports about home and environmental conditions
 LABORATORY/ DIAGNOSTIC TEST
ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS
1. CRITERIA FOR ANALYSIS:
2. PROCESS FOR ANALYSIS:
 SORTING OF DATA
 CLUSTERING OF RELATED CUES
 DISTINGUISHING RELEVANT FROM IRRELEVANT CUES
 IDENTIFYING PATTERNS
 COMPARING PATTERNS
 INTERPRETING RESULTS OF COMPARISON
 MAKING INFERENCES AND DRAWING CONCLUSIONS
Health Needs and Problems of the Family
 A situation which interferes with the promotion and / or maintenance of health
 It is a health problem when it stated as the family’s failure to perform adequately specific
health task to enhance the wellness state or manage a health problem

Family Nursing Care Plan (FNCP)

Definition
 Is the 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
criteari, standards, methods and tools.
Features FNCP
1. The nursing care plan focuses on actions which are designed to solve or minimize existing
problem. The plan is a blueprint for action. The cores of the plan are the approaches, strategies,
activities, methods and materials which the nurse hopes will improve the problem situation.
2. The nursing care plan is a product of a deliberate systematic process. The planning process is
characterized by logical analyses of data that are put together to arrive at rational decisions.
The interventions the nurse decides to implement are chosen from among alternatives after
careful analysis and weighing of available options.
3. The nursing care plan, as with all plans, relates to the future. It utilizes events in the past and
what is happening in the present to determine patterns. It also projects the future scenario if the
current situation is not corrected.
4. The nursing care plan is based upon identified health and nursing problems. The problems are
the starting points for the plan, and the foci of the objectives of care and intervention measures.
5. The nursing care plan is a means to an end, not an end in itself. The goal in planning is to
deliver the most appropriate care to the client by eliminating barriers to family health
development.
6. Nursing care planning is a continuous process, not a one-shot-deal. The results of the
evaluation of the plan’s effectiveness trigger another cycle of the planning process until the
health and nursing problems are eliminated.
Steps in Making Family Nursing Care Plan
 The assessment phase of the nursing process generates the health and nursing problems which
become the bases for the development of nursing care plan. The planning phase takes off from
there.
Formulating a family care plan involves the following steps:
1.
1. The prioritized condition/s or problems
2. The goals and objectives of nursing care
3. the plan of interventions
4. The plan of evaluating care
 This is a schematic presentation of the nursing care plan process. It starts with a list of health
condition or problems prioritized according to the nature, modifiability, preventive potential
and salience. The prioritized health condition or problems and their corresponding nursing
problems become the basis for the next step which is the formulation of goals and objectives of
nursing care. The goals and objectives specify the expected health/clinical outcomes, family
response/s, behavior of competency outcomes.

Family Planning Program

Overview
 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
NATURAL METHODS
a. Calendar or Rhythm Method
b. Basal Body Temperature Method
c. Cervical Mucus Method
d. Sympto-Thermal Method
e. Lactational Amennorhea
ARTIFICIAL METHODS
a. Chemical Methods
i. Ovulation suppressant such as PILLS
ii. Depo-Provera
iii. Spermicidals
iv. Implant
b. Mechanical Methods
i. Male and Female Condom
ii. Intrauterine Device
iii. Cervical Cap/Diaphragm
c. Surgical Methods
i. Vasectomy
ii. 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, breast lumps
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
Injectables
 Dizziness
 Severe headache
 Heavy bleeding
BTL
 Fever
 Weakness
 Rapid pulse
 Persistent abdominal pain
 Vomiting
 Dizziness
 Pus or tenderness at incision site
 Amenorrhea
Vasectomy
 Fever
 Scrotal blood clots or excessive swelling

Functions of a Health Worker

Community Health Service Provider
 Carries out health services contributing to the promotion of health, prevention of illness, early
treatment of illness and rehabilitation.
 appraises health needs and hazards (existing or potential)
Facilitator
 helps plan a comprehensive health program with the people
 continuing guidance and supervisory assistance

Health Counselor
 provides health counseling including emotional support to individuals, family, group and
community
Co-researcher
 Provides the community with stimulation necessary for a wider or more complex study or
problems.
 Enforce community to do prompt and intelligent reporting of epidemiologic investigation of
disease.
 suggest areas hat need research (by creating dissatisfaction)
 participate in planning for the study in formulating procedures
 assist in the collection of data
 helps interpret findings collectively
 act on the result of the research
Member of a Team
 in operating within the team, one must be willing to listen as well as to contribute, to teach as
well as to learn, to lead as well as to follow, to share as well as to work under it
 helps make multiple services which the family receives in the course of health care,
coordinated, continuous and comprehensive as possible
 consults with and refers to appropriate personnel for any other community services
Health Educator
 Health education is an accepted activity at all levels of public works. A health educator is the
one who improves the health of the people by employing various methods of scientific
procedures to stimulate, arouse and guide people to healthful ways of living. She takes into
consideration these aspects of health education:
 information – provision of knowledge
 education – change in knowledge, attitude and skills
 communication – exchange of information

Garantisadong Pambata (GP)

Definition
 Garantisadong Pambata is a biannual week long delivery of a package of health services to
children between the ages of 0-59 months old with the purpose of reducing morbidity and
mortality among under fives through the promotion of positive Filipino values for proper child
growth and development.
Routine Health Services
Route of
Health Service Dosage Administration Target Population

12-59 months old,

200,000 IU or 1 nationwide9-12 months old
capsule100,000 IU or infants receiving AMV
Vitamin A capsule ½ cap or 3 drops Orally by drops nationwide

2-11 months old infants in

Ferrous Sulfate(25 mg.
Elemental Iron per ml; 30 ml.
Bottle as taken home
medicine with instructions)
0.3ml(2-6 mos) once Mindanao area, including
a day evacuation centers in armed
0.6ml(6- 11mos) once a Orally by drops conflict areas.
day

Routine Immunization- Intradermal on Nationwide0-11 mos

BCG* 0.05ml right deltoid 0-11 mos
-DPT* Intramuscularly on
0.5ml anterior thigh 0-11 mos
-OPV* Orally
2 drops 9-11 mos
-AMV* Subcutaneously on
0.5ml deltoid 0-11 mos
-Hepa B (if
0.5ml Intramuscularly
available)

Deworming drug(if available) 1 tablet as single dose Orally 36-59 mos, nationwide

Weighing 0-59 mos, nationwide

 The child should not have received megadose of Vit. A above the recommended dosage within
the past 4 weeks except if the child has measles or signs and symptoms of Vit A. deficiency.
 For any child between 12-23 months, who missed any of his routine immunization, the health
worker should give the child the necessary antigen to complete FIC and shall be recorded as
such.
Garantisadong Pambata
Sangkap Pinoy
 Vitamin A, Iron and Iodine
 Sources: green leafy and yellow vegetables, fruits, liver, seafoods, iodized salt, pan de bida and
other fortified foods.
 These micronutrients are not produced by the body, and must be taken in the food we eat;
essential in the normal process of growth and development:
1. Helps the body to regulate itself
2. Necessary in energy metabolism
3. Vital in brain cell formation and mental development
4. Necessary in the body immune system to protect the body from severe infection.
5. Eating Sangkap Pinoy-rich foods can prevent and control:

 Protein Energy Malnutrition
 Vitamin A Deficiency
 Iron Deficiency Anemia
 Iodine Deficiency Disorder

Breastfeeding
 Breast milk is best for babies up to 2 years old. Exclusive breastfeeding is recommended for
the first six months of life. At about six months, give carefully selected nutritious foods as
supplements.
 Breastfeeding provides physical and psychological benefits for children and mothers as well as
economic benefits for families and societies.
Benefits:

For infants
1. Provides a nutritional complete food for the young infant.
2. Strengthens the infant’s immune system, preventing many infections.
3. Safely rehydrates and provides essential nutrients to a sick child, especially to those suffering
from diarrheal diseases.
4. Reduces the infant’s exposure to infection.
For the Mother
1. Reduces a woman’s risk of excessive blood loss after birth
2. Provides a natural method of delaying pregnancies.
3. Reduces the risk of ovarian and breast cancers and osteoporosis.
For the Family and Community
1. Conserves funds that otherwise would be spent on breast milk substitute, supplies and fuel to
prepare them.
2. Saves medical costs to families and governments by preventing illnesses and by providing
immediate postpartum contraception.
Complimentary Feeding for Babies 6-11 Months Old
What are Complementary Foods?
1. foods introduced to the child at the age 6 months to supplement breastmilk
2. Given progressively until the child is used to three meals and in-between feedings at the age of
one year.
Why is there a Need to Give Complementary Foods?
1. breastmilk can be a single source of nourishment from birth up to six months of life.
2. The child’s demands for food increases as he grows older and breastmilk alone is not enough to
meet his increased nutritional needs for rapid growth and development
3. Breastmilk should be supplemented with other foods so that the child can get additional
nutrients
4. Introduction of complementary foods will accustom him to new foods that will also provide
additional nutrients to make him grow well
5. Breastfeeding, however, should continue for as long as the mother is able and has milk which
could be as long as two years
How to Give Complementary Foods for Babies 6-11 Months Old?
1. Prepare mixture of thick lugao/ cooked rice, soft cooked vegetables. Egg yolk, mashed beans,
flaked fish/chicken/ground meat and oil.
2. Give mixture by teaspoons 2-4 times daily, increasing the amount of teaspoons and number of
feeding until the full recommended amount is consumed
3. Give bite-sized fruit separately
4. Give egg alone or combine with above food mixture
 Health and Sanitation
Overview
 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
 indicated for rural areas
 serves 15-25 households; its outreach is not more than 250 m from the farthest user
 yields 40-140 L/ min
Level II (Communal Faucet or Stand Posts)
 With a source, reservoir, piped distribution network and communal faucets
 Located at not more than 25 m from the farthest house
 Delivers 40-80 L of water per capital per day to an average of 100 households
 Fit for rural areas where houses are densely clustered
Level III (Individual House Connections or Waterworks System)
 With a source, reservoir, piped distributor network and household taps
 Fit for densely populated urban communities
 Requires minimum treatment or disinfection
Environmental Sanitation
 The study of all factors in man’s 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
Proper Excreta and Sewage Disposal Program
EHS sets policies on approved types of toilet facilities:
Level I
 Non-water carriage toilet facility – no water necessary to wash the waste into receiving space
e.g. pit latrines, reed odorless earth closet.
 Toilet facilities requiring small amount of water to wash the waste into the receiving space e.g.
pour flush toilet & aqua privies
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
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 Handler’s 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.

Health Care Delivery System

Definition
 The totality of all policies, facilities, equipments, products, human resources and services
which address the health needs problems and concerns of the people. It is large, complex,
multi-level and multi-disciplinary.
Health Sectors
 Government Sectors
 Non Government Sectors
 Private Sectors
Department of Health
 Vision: Health for all by year 2000 ands Health in the Hands of the People by 2020
 Mission: In partnership with the people, provide equity, quality and access to health care esp.
the marginalized
5 Major Functions:
1.
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of labor and proper
coordination of operations among the government agency jurisdictions
3. Ensure a minimum level of implementation nationwide of services regarded as public
health goods
4. Plan and establish arrangements for the public health systems to achieve economies of
scale
5. Maintain a medium of regulations and standards to protect consumers and guide providers
Primary Strategies to Achieve Health Goals
 Support for health goal
 Assurance of health care
 Increasing investment for PHC
 Development of National Standard
 Milestone in Health Care Delivery System
 RA 1082 – RHU Act
 RA 1891 – Strengthen Health Services
 PD 568 – Restructuring HCDS
 RA 7160 – LGU Code

Health Education (Principles)

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

Health Situation of the Philippines

 Scenario
 In the past 20 years some infectious degenerative diseases are on the rise.
 Many Filipinos are still living in remote and hard to reach areas where it is difficult to deliver
the health services they need
 The scarcity of doctors, nurses and midwives add to the poor health delivery system to the poor
Vital Health Statistics 2005
Projected Population:
 Male – 42,874,766
 Female – 42,362,147
 Both Sexes – 85,236,913
Life Expectancy:
 Female – 70 yrs. old
 Male – 64 yrs. Old
Leading Causes of Morbidity
 Most of the top ten leading causes of morbidity are communicable disease
 These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicella
 Leading non CD are heart problem, HPN, accidents and malignant neoplasms
Leading Causes of Mortality
 The top 10 leading causes of mortality are due to non CD
 Diseases of the heart and vascular system are the 2 most common causes of deaths.
 Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading causes of deaths.

Herbal Medicine – Others

 Aloe vera Gel – abrasions and dermatologic conditions
 American Ginseng (Panax quinquefolius) – boost energy, relieve stress, improve concentration
and enhance physical or cognitive performance.
 Ashwagandha (Withania somnifera) – stress arthritis
 Asian gingseng (Panax ginseng) – enhance health and combat stress and disease
 Bilberry (Vaccinium myrtillus) – vision and peripheral vascular disorders and as antioxidant
 Black Cohosh (Cimicifuga racemosa) – menopausal
 Black Currant and Borage oil (Ribes nigrum and Borago offinalis) – anti-inflammatory,
rheumatoid arthritis
 Capsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatment
 Chamomile (Matricaria recutita) “manzanilla”- skin inflammation, colic, or dyspepsia and
anxiety
 Chaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, cyclical mastalgia
 Chodroitin – osteoarthritis
 Coenzyme Q10 – antioxidant
 Coltsfoot ( Tussilago farfara ) – cough and other respiratory disoders
 Cranberry (Vaccinium macrocarpon) – UTI
 Devil’s Claw ( Harpagophytum procumbers) – anti inflammatory and analgesic
 Echinacea (Echinacea spp.) – acute viral URI symptoms
 Ederberry (Sanbacus nigra) – respiratory tract infection
 Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrine
 Evening Primrose Oil (Oenothera biennis) – eczema, breast pain associated with PMS and
inflammatory condition
 Fenugreek (Trigonella foenum-graecum) – lowering blood glucose
 Feverfew ( Tanacetum parthenium) – migraine headache prophylaxis
 Garlic (Allium sativaum)- help prevent cardiovascular disease and cancer
 Ginger (Zingiber officinale) –nausea and motion sickness, anti-inflammatory
 Ginkgo (Ginkgo biloba) – dementia and intermittent claudication, memory enhancement and
treatment of vertigo nad tinnitus
 Glucosamine – osteoarthritis
 Goldenseal ( Hydrastis Canadensis) – tonic and antibiotic
 Gotu Kola (Centella asiatica) – mental support, wound healing and venous disorders
 Hawtorn ( Crategus species) – CHF and related cardiovascular conditions
 Horebound (Marribium vulgare) – primary cough suppression and expectoration
 Horse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiency
 Ivy (Hedera helix) – coughs, rheumatic disordes and skin disease
 Kava ( piper methysticum) – mild psychoactive and antianxiety property
 Lemon Balm (Melissa officinalis) – sedative and for dyspepsia
 Licorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases, and
infections
 Melatonin – insomia, jet lag
 Milk Thistle – hepatitis, liver desease
 Mints (Mentha species) – minor calcium channel antagonists, used for upper respiratory
problems, irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical
counterirritant
 Nettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diuretic
 Papaya (Carica papaya) – digestive aid, dyspepsia, and for inflammatory, topically applied to
wounds
 Passion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herb
 Pokeroot (Phytolacca Americana) – inflammatory conditions also as an emetic/cathartic
 Pygeum (Pygeum africanum) – mild symptoms of BPH
 Red Clover (Trifolium pratense) – used as a natural estrogen substitute for women’s health
 St. John’s Wort (Hypericum perforatum) – antidepressant effect
 Tea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterial
 Turmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti cancer, and antioxidant
 Uva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diuretic
 Yohimbe – erectile dysfunction

Herbal Medicine Plants Approved by the DOH

These are the list of the ten (10) medicinal plants that the Philippine Department of Health (DOH)
through its “Traditional Health Program” has endorsed. All ten (10) herbs have been thoroughly
tested and have been clinically proven to have medicinal value in the relief and treatment of various
aliments:
 Lagundi (Vitex negundo)
Uses & Preparation:
 Asthma, Cough & Fever – Decoction ( Boil raw fruits or leaves in 2 glasses of water for 15
minutes)Dysentery, Colds & Pain – Decoction ( Boil a handful of leaves & flowers in water to
produce a glass, three times a day)
 Skin diseases (dermatitis, scabies, ulcer, eczema) -Wash & clean the skin/wound with the
decoction
 Headache – Crush leaves may be applied on the forehead
 Rheumatism, sprain, contusions, insect bites – Pound the leaves and apply on affected area

Yerba (Hierba ) Buena (Mentha cordifelia)

Uses & Preparation:
 Pain (headache, stomachache) – Boil chopped leaves in 2 glasses of water for 15 minutes.
Divide decoction into 2 parts, drink one part every 3 hours.

 Rheumatism, arthritis and headache – Crush the fresh leaves and squeeze sap. Massage sap on
painful parts with eucalyptus

 Cough & Cold – Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant)
 Swollen gums – Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use as a
gargle solution

 Toothache – Cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in
aching tooth cavity

 Menstrual & gas pain – Soak a handful of leaves in a lass of boiling water. Drink infusion.

 Nausea & Fainting – Crush leaves and apply at nostrils of patients

 Insect bites – Crush leaves and apply juice on affected area or pound leaves until like a paste,
rub on affected area

 Pruritis – Boil plant alone or with eucalyptus in water. Use decoction as a wash on affected
area.

Sambong (Blumea balsamifera)

Uses & Preparation:
 Anti-edema, diuretic, anti-urolithiasis – Boil chopped leaves in a glass of water for 15 minutes
until one glassful remains. Divide decoction into 3 parts, drink one part 3 times a day.
 Diarrhea – Chopped leaves and boil in a glass of water for 15 minutes. Drink one part every 3
hours.
 Tsaang Gubat (Carmona retusa)
Uses & Preparation:
 Diarrhea – Boil chopped leaves into 2 glasses of water for 15 minutes. Divide decoction into 4
parts. Drink 1 part every 3 hours
 Stomachache – Boil chopped leaves in 1 glass of water for 15 minutes. Cool and strain.

Niyug-niyogan (Quisqualis indica L.)

Uses & Preparation:
 Anti-helmintic – The seeds are taken 2 hours after supper. If no worms are expelled, the dose
may be repeated after one week. (Caution: Not to be given to children below 4 years old)

Bayabas/Guava (Psidium guajava L.)

Uses & Preparation:
 For washing wounds – Maybe use twice a day
 Diarrhea – May be taken 3-4 times a day
As gargle and for toothache – Warm decoction is used for gargle. Freshly pounded leaves are
used for toothache. Boil chopped leaves for 15 minutes at low fire. Do not cover and then let it
cool and strain

Akapulko
(Cassia alata L.)
Uses & Preparation:
 Anti-fungal (tinea flava, ringworm, athlete’s foot and scabies) – Fresh, matured leaves are
pounded. Apply soap to the affected area 1-2 times a day

Ulasimang Bato (Peperonica pellucida)

Uses & Preparation:
 Lowers uric acid (rheumatism and gout) – One a half cup leaves are boiled in two glass of
water over low fire. Do not cover pot. Divide into 3 parts and drink one part 3 times a day
 Bawang (Allium sativum)
Uses & Preparation:
 Hypertension – Maybe fried, roasted, soaked in vinegar for 30 minutes, or blanched in boiled
water for 15 minutes. Take 2 pieces 3 times a day after meals.
 Toothache – Pound a small piece and apply to affected area

Ampalaya (Mamordica Charantia)

Uses & Preparation:

 Diabetes Mellitus (Mild non-insulin dependent) – Chopped leaves then boil in a glass of water
for 15 minutes. Do not cover. Cool and strain. Take 1/3 cup 3 times a day after meals

Reminders on the Use of Herbal Medicine

1. Avoid the use of insecticide as these may leave poison on plants.
2. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low
heat.
3. Use only part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptoms or sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a doctor.

History of Community Health Nursing

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) – Carmen del Rosario, 1st Filipino 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
 1st 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.
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.

Initial Data Base for Family Nursing Practice

A. Family Structure Characteristics and Dynamics
1. Members of the household and relationship to the head of the family.
2. Demographic data-age, sex, civil status, position in the family
3. Place of residence of each member-whether living with the family or elsewhere
4. Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended
5. Dominant family members in terms of decision making especially on matters of health care
6. General family relationship/dynamics-presence of any obvious/readily observable conflict
between members; characteristics, communication/interaction patterns among members.
B. Socio-economic and Cultural Characteristics
1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decision about money and how it is spent
2. Educational Attainment of each Member
3. Ethnic Background and Religious Affiliation
4. Significant others-role (s) they play in family’s life
5. Relationship of the family to larger community-nature and extent of participation of the family
in community activities
C. Home Environment
1. Housing
a. Adequacy of living space
b. Sleeping in arrangement
c. Presence of breathing or resting sites of vector of diseases (e.g. mosquitoes, roaches, flies,
rodents, etc.)
d. Presence of accident hazard
e. Food storage and cooking facilities
f. Water supply-source, ownership, pot ability
g. Toilet facilities-type, ownership, sanitary condition
h. Garbage/refuse disposal-type, sanitary condition
i. Drainage System-type, sanitary condition
2. Kind of Neighborhood, e.g. congested, slum etc.
3. Social and Health facilities available
4. Communication and transportation facilities available
D. Health Status of Each Family Member
1. Medical Nursing history indicating current or past significant illnesses or beliefs and practices
conducive to health and illness
2. Nutritional assessment (especially for vulnerable or at risk members)
 Anthropometric data: measures of nutritional status of children-weight, height, mid-upper
arm circumference; risk assessment measures for obesity : body mass index(BMI=weight
in kgs. divided by height in meters2), waist circumference (WC: greater than 90 cm. in
men and greater than 80 cm. in women), waist hip ration (WHR=waist
circumference in cm. divided by hip circumference in cm. Central obesity: WHR is equal
to or greater than 1.0 cm in men and 0.85 in women)
 dietary history specifying quality and quantity of food or nutrient per day
 Eating/ feeding habits/ practices
3. Developmental assessment of infant, toddlers and preschoolers- e.g. Metro Manila
DevelopmentalScreening Test (MMDST).
4. Risk factor assessment indicating presence of major and contributing modifiable risk factors
for specific lifestyle diseases-e.g. hypertension, physical inactivity, sedentary lifestyle,
cigarette/ tobacco smoking, elevated blood lipids/ cholesterol, obesity, diabetes mellitus,
inadequate fiber intake, stress, alcohol drinking, and other substance abuse.
5. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by
medical practitioners )
6. Results of laboratory/diagnostic and other screening procedures supportive of assessment
findings.
E. Values, Habits, Practices on Health Promotion, Maintenance and
Disease Prevention. Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
 Rest and sleep
 Exercise/activities
 Use of protective measure-e.g. adequate footwear in parasite-infested areas; use of bed nets
andprotective clothing in malaria and filariasis endemic areas.
 Relaxation and other stress management activities
4. Use of promotive-preventive health services

Integrated Management of Childhood Illnesses

(IMCI)
Definition
 IMCI is an integrated approach to child health that focuses on the well-being of the whole
child.
 IMCI strategy is the main intervention proposed to achieve a significant reduction in the
number of deaths from communicable diseases in children under five
Goal

 By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the
goal of reducing it by two thirds by 2015.
Aim
 To reduce death, illness and disability, and to promote improved growth and development
among children under 5 years of age.
 IMCI includes both preventive and curative elements that are implemented by families and
communities as well as by health facilities.
IMCI Objectives
 To reduce significantly global mortality and morbidity associated with the major causes of
disease in children
 To contribute to the healthy growth & development of children
IMCI Components of Strategy
 Improving case management skills of health workers
 § Improving the health systems to deliver IMCI
 Improving family and community practices
**For many sick children a single diagnosis may not be apparent or appropriate

Presenting complaint:
 Cough and/or fast breathing
 Lethargy/Unconsciousness
 Measles rash
 “Very sick” young infant
Possible course/ associated condition:
 Pneumonia, Severe anemia, P. falciparum malaria
 Cerebral malaria, meningitis, severe dehydration
 Pneumonia, Diarrhea, Ear infection
 Pneumonia, Meningitis, Sepsis
Five Disease Focus of IMCI:
 Acute Respiratory Infection
 Diarrhea
 Fever
 Malaria
 Measles
 Dengue Fever
 Ear Infection
 Malnutrition
The IMCI Case Management Process
 Assess and classify
 Identify appropriate treatment
 Treat/refer
 Counsel
 Follow-up
The Integrated Case Management Process
Check for General Danger Signs:
 A general danger sign is present if:
 The child is not able to drink or breastfeed
 The child vomits everything
 The child has had convulsions
 The child is lethargic or unconscious
Assess Main Symptoms
 Cough/DOB
 Diarrhea
 Fever
 Ear problems
Assess and Classify Cough of Difficulty of Breathing

 Respiratory infections can occur in any part of the respiratory tract such as the nose, throat,
larynx, trachea, air passages or lungs.
Assess and classify PNEUMONIA

 Cough or difficult breathing

 An infection of the lungs
 Both bacteria and viruses can cause pneumonia
 Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis
(generalized infection).
** A child with cough or difficult breathing is assessed for:

 How long the child has had cough or difficult breathing

 Fast breathing
 Chest indrawing
 Stridor in a calm child.
Remember:

 ** If the child is 2 months up to 12 months the child has fast breathing if you count 50
breaths per minute or more
 ** If the child is 12 months up to 5 years the child has fast breathing if you count 40
breaths per minute or more.
Color Coding

YELLOW
PINK (Treatment at outpatient GREEN
(URGENT REFERRAL) health facility) (Home management)

OUTPATIENT HEALTH
FACILITY HOME
OUTPATIENT  Treat local infection  Caretaker is counseled on:
HEALTH FACILITY  Give oral drugs  Home treatment/s
 Pre-referral treatments  Advise and teach  Feeding and fluids
 Advise parents caretaker  When to return immediately
 Refer child  Follow-up  Follow-up

 Give first dose of an appropriate

REFERRAL FACILITY
 Emergency Triage and
Treatment ( ETAT)
 Diagnosis, Treatment
 Monitoring, follow-up
SEVERE PNEUMONIA OR
VERY SEVERE DISEASE
antibiotic
 Give Vitamin A
 Treat the child to prevent low
blood sugar
 Refer urgently to the hospital
 Give paracetamol for fever >
38.5oC

 Any general danger sign or  Give an appropriate antibiotic

 Chest indrawing or PNEUMONIA for 5 days
 Stridor in calm child
 Fast breathing
 No signs of pneumonia or
very severe disease
Assess and classify DIARRHEA
A child with diarrhea is assessed for:
 How long the child has had diarrhoea
 Blood in the stool to determine if the child has dysentery
 Signs of dehydration.
Classify DYSENTERY
 Child with diarrhea and blood in the stool
Two of the following signs?
 Abnormally sleepy or
difficult to awaken
 Sunken eyes
 Not able to drink or
drinking poorly
 Skin pinch goes back very
slowly
Two of the following signs :
 Restless, irritable
 Sunken eyes
 Drinks eagerly, thirsty
 Skin pinch goes back
slowly
 Soothe the throat and relieve
cough with a safe remedy
 Advise mother when to return
immediately
 Follow up in 2 days
 Give Paracetamol for fever >
38.5oC
 If coughing more than more
than 30 days, refer for
assessment
 Soothe the throat and relieve the
cough with a safe remedy
 Advise mother when to return
immediately
NO PNEUMONIA :  Follow up in 5 days if not
COUGH OR COLD improving
 If child has no other severe
classification:
 Give fluid for severe dehydration (
Plan C ) OR
 If child has another severe classification
:
 Refer URGENTLY to hospital with
mother giving frequent sips of ORS
on the way
 Advise the mother to continue
breastfeeding
 If child is 2 years or older and there is
SEVERE cholera in your area, give antibiotic for
DEHYDRATION cholera
 Give fluid and food for some
dehydration ( Plan B )
 If child also has a severe classification :
 Refer URGENTLY to hospital with
SOME mother giving frequent sips of ORS
DEHYDRATION on the way

 Not enough signs to
classify as some or severe
dehydration
 Dehydration present
 No dehydration
 Blood in the stool
Does the child have fever?
**Decide:
 Malaria Risk
 No Malaria Risk
 Measles
 Dengue
Malaria Risk
 Any general
danger sign or VERY SEVERE FEBRILE
 Stiff neck DISEASE / MALARIA
 Blood smear ( + )
If blood smear not done:
 NO runny nose,
and
 NO measles, and MALARIA
 Advise mother when to return
immediately
 Follow up in 5 days if not improving
 Home Care
 Give fluid and food to treat diarrhea at
home ( Plan A )
 Advise mother when to return
immediately
NO DEHYDRATION  Follow up in 5 days if not improving
 Treat dehydration before referral unless
the child has another severe
SEVERE classification
PERSISTENT  Give Vitamin a
DIARRHEA  Refer to hospital
 Advise the mother on feeding a child
who has persistent diarrhea
PERSISTENT  Give Vitamin A
DIARRHEA  Follow up in 5 days
 Treat for 5 days with an oral antibiotic
recommended for Shigella in your area
 Follow up in 2 days
DYSENTERY  Give also referral treatment
 Give first dose of quinine ( under medical
supervision or if a hospital is not accessible
within 4hrs )
 Give first dose of an appropriate antibiotic
 Treat the child to prevent low blood sugar
 Give one dose of paracetamol in health
center for high fever (38.5oC) or above
 Send a blood smear with the patient
 Refer URGENTLY to hospital
 Treat the child with an oral antimalarial
 Give one dose of paracetamol in health
center for high fever (38.5oC) or above
 Advise mother when to return immediately
 Follow up in 2 days if fever persists
 NO other causes of
fever
 Blood smear ( – ),
or
 Runny nose, or
 Measles, or Other
causes of fever
No Malaria Risk
 Any general danger
sign or
 Stiff neck
 No signs of very
severe febrile disease
Measles
 Clouding of cornea
or
 Deep or extensive
mouth ulcers
 Pus draining from
the eye or
 Mouth ulcers
 Measles now or
within the last 3
months
Dengue Fever
 Bleeding from nose or
gums or
 Bleeding in stools or
vomitus or
 Black stools or vomitus
 If fever is present everyday for more than 7
days, refer for assessment
 Give one dose of paracetamol in health
center for high fever (38.5oC) or above
 Advise mother when to return immediately
 Follow up in 2 days if fever persists
FEVER : MALARIA  If fever is present everyday for more than 7
UNLIKELY days, refer for assessment
 Give first dose of an appropriate antibiotic
 Treat the child to prevent low blood sugar
 Give one dose of paracetamol in health
VERY SEVERE center for high fever (38.5oC) or above
FEBRILE DISEASE  Refer URGENTLY to hospital
 Give one dose of paracetamol in health
center for high fever (38.5oC) or above
 Advise mother when to return immediately
 Follow up in 2 days if fever persists
FEVER : NO  If fever is present everyday for more than 7
MALARIA days, refer for assessment
 Give Vitamin A
 Give first dose of an appropriate
antibiotic
 If clouding of the cornea or pus
draining from the eye, apply
SEVERE COMPLICATED tetracycline eye ointment
MEASLES  Refer URGENTLY to hospital
 Give Vitamin A
 If pus draining from the eye, apply
tetracycline eye ointment
MEASLES WITH EYE OR  If mouth ulcers, teach the mother to
MOUTH COMPLICATIONS treat with gentian violet
MEASLES  Give Vitamin A
 If skin petechiae or Tourniquet
test,are the only positive signs give
ORS
SEVERE DENGUE  If any other signs are positive, give
HEMORRHAGIC FEVER fluids rapidly as in Plan C
 or  Treat the child to prevent low blood
 Skin petechiae or sugar
 Cold clammy extremities  DO NOT GIVE ASPIRIN
or  Refer all children Urgently to
 Capillary refill more than hospital
3 seconds or
 Abdominal pain or
 Vomiting
 Tourniquet test ( + )

 DO NOT GIVE ASPIRIN

 Give one dose of paracetamol in
health center for high fever
(38.5oC) or above
 Follow up in 2 days if fever persists
 No signs of severe FEVER: DENGUE or child shows signs of bleeding
dengue hemorrhagic HEMORRHAGIC  Advise mother when to return
fever UNLIKELY immediately
Does the child have an ear problem?

 Give first dose of

appropriate antibiotic
 Give paracetamol for
pain
 Tender swelling behind the ear MASTOIDITIS  Refer URGENTLY

 Give antibiotic for 5

days
 Give paracetamol for
 Pus seen draining from the ear and pain
discharge is reported for less than 14 days or ACUTE EAR  Dry the ear by wicking
 Ear pain INFECTION  Follow up in 5 days

 Pus seen draining from the ear and CHRONIC EAR  Dry the ear by wicking
discharge is reported for less than 14 days INFECTION  Follow up in 5 days

 No ear pain and no pus seen draining from

the ear NO EAR INFECTION  No additional treatment
Check for Malnutrition and Anemia
Give an Appropriate Antibiotic:
A. For Pneumonia, Acute ear infection or Very Severe disease
COTRIMOXAZOLE AMOXYCILLIN
BID FOR 5 DAYS BID FOR 5 DAYS

Adult Tablet Syrup

Age or Weight tablet Syrup
2 months up to 12 months ( 4 – < 9 kg ) 1/2 5 ml 1/2 5 ml

12 months up to 5 years ( 10 – 19kg ) 1 7.5 ml 1 10 ml

B. For Dysentery
AMOXYCILLIN
COTRIMOXAZOLE BID FOR 5 DAYS
BID FOR 5 DAYS

SYRUP 250MG/5ML
AGE OR WEIGHT TABLET SYRUP

2 – 4 months

( 4 – < 6kg ) ½ 1.25 ml ( ¼ tsp )

5 ml

4 – 12 months
½ 2.5 ml ( ½ tsp )
( 6 – < 10 kg ) 5 ml

1 – 5 years old
1 ( 1 tsp )
( 10 – 19 kg ) 7.5 ml

C. For Cholera
TETRACYCLINE COTRIMOXAZOLE
QID FOR 3 DAYS BID FOR 3 DAYS

AGE OR WEIGHT Capsule 250mg Tablet Syrup

2 – 4 months ( 4 – < 6kg ) ¼ 1/2 5ml

4 – 12 months ( 6 – < 10 kg ) ½ 1/2 5 ml

1 – 5 years old ( 10 – 19 kg) 1 1 7.5ml

Give an Oral Antimalarial

Primaquine
Primaquine Sulfadoxine +
CHOLOROQUINE Give single dose Pyrimethamine
in health center Give daily for 14
Give for 3 days for P. Falciparum days for P. Vivax Give single dose
 TABLET TABLET TABLET

AGE TABLET ( 150MG ) ( 15MG) ( 15MG) ( 15MG)

DAY1 DAY2 DAY3

2months –

5months ½ ½ ½
¼

5 months –

12 months ½ ½ ½
1/2

12months –

3 years old
1 1 ½
½ ¼ ¾

3 years old –

5 years old 1½ 1½ 1 3/4 1/2 1

GIVE VITAMIN A
AGE VITAMIN A CAPSULES 200,000 IU

6 months – 12 months 1/2

12 months – 5 years old 1

GIVE IRON
Iron Syrup
Iron/Folate Tablet FeSo4 150 mg/5ml
FeSo4 200mg + 250mcg Folate (60mg (6mg elemental iron per
AGE or WEIGHT elemental iron) ml )

2months-4months
(4 – <6kg ) 2.5 ml

4months – 12months
(6 – <10kg ) 4 ml

12months – 3 years (10 –

<14kg) 1/2 5 ml
3years – 5 years ( 14 – 19kg ) 1/2 7.5 ml
GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN
AGE OR WEIGHT TABLET ( 500MG ) SYRUP ( 120MG / 5ML )

2 months – 3 years ( 4 – <14kg ) ¼ 5 ml

3 years up to 5 years (14 – 19 kg ) 1/2 10 ml

GIVE MEBENDAZOLE
 Give 500mg Mebendazole as a single dose in health center if :
 hookworm / whipworm are a problem in children in your area, and
 the child is 2 years of age or older, and
 the child has not had a dose in the previous 6 months

Laws Affecting Public Health and Practice of

CHN
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 chairman
3. Chairman, Committee on Health of Sangguniang Panlalawigan
4. DOH representative
5. NGO representative
City and Municipal Level
1. Mayor – chair
2. MHO – vice chair
3. Chairman, Committee on Health of Sangguniang Bayan
4. DOH representative
5. NGO representative
Effective Local Health System Depends on:
1. The LGU’s 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.

R.A. 1082 – Rural Health Act.

 It created the 1st 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 man’s 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 PWD’s
 provides their rehabilitation, self development and self-reliance and integration into the
mainstream of society
A. 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 months.
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 Breast milk Substitutes
R.A. – 7600 – Rooming In and Breastfeeding Act of 1992

R.A. 8976- Food Fortification Law

R.A. 8980

 promulgates 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

 mandates 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

Levels of Clientele in CHN






Individual
Basic approaches in looking at the individual:
1. Atomistic
2. Holistic
Perspectives in understanding the individual:
1. Biological
 unified whole
 holon
 dimorphism
2. Anthropological
 essentialism
 social constructionism
 culture
3. Psychological
 psychosexual
 psychosocial
 behaviorism
 social learning
4. Sociological
 family and kinship
 social groups
Family
Models:
1. Developmental
 Stages of Family Development
 Stage I – Beginning Family (newly wed couples)
 TASK: compliance with the PD 965 & acceptance of the new member of the family
 Stage II – Early Child Bearing Family (0-30 months old)
 TASK: emphasize the importance of pregnancy & immunization & learn the
concept of parenting
 Stage III –Family with Pre- school Children (3-6yrs old)
 TASK: learn the concept of responsible parenthood
 Stage IV – Family with School age Children (6-12yrs old)
 TASK: Reinforce the concept of responsible parenthood
 Stage V – Family with Teen Agers (13-25yrs old)
 TASK: Parents to learn the concept of “let go system” and understands the
“generation gap”
 Stage VI – Launching Center (1st child will get married up to the last child)
  TASK: compliance with the PD 965 & acceptance of the new member of the family
 Stage VII -Family with Middle Adult parents (36-60yrs old)
 TASK: provide a healthy environment, adjust with a new lifestyle and adjust with
the financial aspect
 Stage VIII – Aging Family (61yrs old up to death)
 TASK: learn the concept of death positively
2. Structural-Functional
a. Initial Data Base
 Family structure and Characteristics
 Socio-economic and Cultural Factors
 Environmental Factors
 Health Assessment of Each MemberValue Placed on Prevention of Disease
b. First Level Assessment
 Health threats: conditions that are conducive to disease, accident or failure to realize
one’s health potential
 Health deficits: instances of failure in health maintenance (disease, disability,
developmental lag)
 Stress points/ Foreseeable crisis situation:
 anticipated periods of unusual demand on the individual or family in terms of
adjustment or family resources
c. Second Level Assessment:
 Recognition of the problem
 Decision on appropriate health action
 Care to affected family member
 Provision of healthy home environment
 Utilization of community resources for health care
d. Problem Prioritization:
1. Nature of the problem
 Health deficit
 Health threat
 Foreseeable Crisis
2. Preventive potential
 High
 Moderate
 Low
3. Modifiability
 Easily modifiable
 Partially modifiable
 Not modifiable
4. Salience
 High
 Moderate
 Low
e. Family Service and Progress Record
Population Group
Vulnerable Groups:
 Infants and Young Children
 School age
 Adolescents
 Mothers
 Males
 Old People
Specialized Fields:
Community Mental Health Nursing
 A unique clinical process which includes an integration of concepts from nursing, mental
health, social psychology, psychology, community networks, and the basic sciences
Occupational Health Nursing
 The application of nursing principles and procedures in conserving the health of workers in all
occupations
School Health Nursing
 The application of nursing theories and principles in the care of the school population

Management of a Child with an Ear Problem






Classification of Ear Infection
1. Mastoiditis – tender swelling behind the ear (in infants, swelling may be above the ear)
 Treatment
a. Antibiotics
b. Surgical intervention
2. Acute Ear Infection – pus draining from the ear for less than 2 weeks, ear pain, red, immobile
ear drum (Acute Otitis Media)
 Treatment
a. Cotrimoxazole,Amoxycillin,or Ampicillin
b. Dry the ear by wicking
3. Chronic Ear Infection – pus draining from the ear for more than 2 weeks (Chronic Otitis
Media)
 Treatment
a. Most important & effective treatment: Keep the ear dry by wicking.
b. Paracetamol maybe given for pain or high fever.
c. Precautions for a child with a draining ear:
 Do not leave anything in the ear such as cotton, wool between wicking treatments.
 Do not put oil or any other fluid into the ear.
 Do not let the child go swimming or get water in the ear.

Maternal and Child Health Nursing Program

Philosophy
 Pregnancy, labor and delivery and puerperium are part of the continuum of the total life cycle
 Personal, cultural and religious attitudes and beliefs influence the meaning of pregnancy for
individuals and make each experience unique
 MCN is FAMILY CENTERED- the father is as important as the mother
Goals
 To ensure that expectant mother and nursing mother maintain good health, learn the art of child
care, has a normal delivery and bear healthy children
 That every child lives and grows up in a family unit with love and security, in healthy
surroundings, receives adequate nourishment, health supervision and efficient medical attention
and is taught the elements of healthy living
Classification of pregnant women
 Normal – healthy pregnancy
 With mild complications- frequent home visits
 With serious or potentially serious complication – referred to most skilled source of medical
and hospital care
Home Based Mother’s Record (HBMR)
 Tool used when rendering prenatal care containing risk factors and danger signs
Risk Factors
 145 cm tall (4 ft & 9 inches)
 Below 18 yrs old, above 35 yrs old
 Have had 4 pregnancies
 With TB, goiter, heart disease, DM, bronchial asthma, severe anemia
 Last baby born was less than 2 years ago
 Previous cesarian section delivery
 History of 2 or more abortions, difficult delivery, given birth to twins, 2 or more babies born
before EDD, stillbirth
 Weighs less than 45 kgs. or more than 80 kgs.
Danger Signs
1. any type of vaginal bleeding
2. headache, dizziness, blurred vision
3. puffiness of face and hands
4. pallor
Prenatal Care
Schedule of Visits
 1st – as early as pregnancy, 1st trimester
 2nd – 2nd trimester
 3rd & subsequent visits – 3rd trimester
 More frequent visits for those at risk with complications
Tetanus Toxiod Immunization Schedule for Women
Minimum Age Percent
Vaccine Interval Protected Duration of Protection

As early as possible
TT1 during pregnancy 0% None

Infants born to the mother will be protected from

At least 4 weeks neonatal tetanus. Gives 3 years protection for the
TT2 later 80% mother from the tetanus.

Infants born to the mother will be protected from

neonatal tetanus.
At least 6 months Gives 5 years protection for the mother.
TT3 later 90%

TT4 At least 1 year later 99% Gives 10 years protection for the mother

Gives lifetime protection for the mothers. All Infants

TT5 At least 1 year later 99% born to that mother will be protected.
Dose: 0.5ml
Route: Intramuscular
Site: Right or Left Deltoid/Buttocks
Components of Prenatal Visits
 History – taking
 Determination of obstetrical score- G, P, TPAL, AOG, EDD
 U/A for Proteinuria, glycosuria and infxtn
 Dental exam
 Wt. Ht. BP taking
 Exam of conjunctiva and palms for pallor
 Abdominal exam – fundic ht, Leopold’s maneuver and FHT
 Exam of breasts, face, hands and feet for edema and neck for thyroid enlargement
 Health teachings- nutrition, personal hygiene, common complaints
 Tetanus toxoid immunization
 Iron supplementation – from 5th mo. Of pregnancy – 2 mos. Postpartum
 In goiter endemic areas – iodized capsule once a year
 In malaria infested areas- prophylactic Chloroquine (150 mg/tab ) 2 tabs/ wk for the whole
duration of pregnancy

National Health Plan

FACEBOOK

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

Definition
 National Health Plan is a long-term directional plan for health; the blueprint defining the
country’s health – PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS
Goal
 to enable the Filipino population to achieve a level of health which will allow Filipino to lead a
socially and economically-productive life, with longer life expectancy, low infant mortality,
low maternal mortality and less disability through measures that will guarantee access of
everyone to essential health care
Objectives
 promote equity in health status among all segments of society
 address specific health problems of the population
 upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient,
and effective one in the provision of solutions to changing the health needs of the population
 promote active and sustained people’s participation in health care
Health Plans Towards “Health In The Hands Of The People In The Year
2020”
1. Major Health Plan
 23 IN 93
 Health for more in 94
 Think health…… Health Link
 5 in 95
2. Priority Program in Year 2000
 Plan 50
 Plan 500
 Women’s health
 Children’s health
 Healthy Lifestyle
 Prevention & Control of Infectious Disease
3. Priority Program in the Year 2005
 Ligtas Buntis Campaign
 Mag healthy Lifestlye tayo
 TB Network
 Blood Donation Program (RA 7719)
 DTOMIS
 Ligtas Tigdas Campaign
 Murang Gamot
 Anti Tobacco Signature Campaign
 Doctors to the Barrios Program
 Food Fortification Program
  Sentrong Sigla Movement
4. National Health Events for 2006
JANUARY

 National Cancer Consciousness Week – (16-22)

FEBRUARY

 Heart Month
 Dental Health Month
 Responsible Parenthood Campaign National Health Insurance Program
MARCH

 Women’s Health Month

 Rabies Awareness Month
 Burn Injury Prevention Month
 Responsible Parenthood Campaign
 Colon and Rectal Cancer Awareness Month
 World TB Day – (24)
APRIL

 Cancer in Children Awareness Month

 World Health Day – (7)
 Bright Child Week Phase I
 Garantisadong Pambata (11-17)
MAY

 Natural Family Planning Month

 Cervical Cancer Awareness Month
 AIDS Candlelight Memorial Day – (21)
 World No Tobacco Day – (31)
JUNE

 Dengue Awareness Month

 No Smoking Month
 National Kidney Month
 Prostate Cancer Awareness Month
JULY

 Nutrition Month
 National Blood Donation Month
 National Disaster Consciousness Month
AUGUST

 National Lung Month

 National Tuberculosis Awareness Month
 Sight-Saving Month
 Family Planning Month
 Lung Cancer Awareness Month
SEPTEMBER

 Generics Awareness Month

 Liver Cancer Awareness Month
OCTOBER

 National Children’s Month

 Breast Cancer Awareness Month
 National Newborn Screening Week (3-9)
 Bright Child Week Phase II Garantisadong Pambata (10-16)
NOVEMBER

 Filariasis Awareness Month

 Cancer Pain Management Awareness Month
 Traditional and Alternative Health Care Month
 Campaign on Violence against Women and Children
DECEMBER

 Firecracker Injury Prevention Campaign:

 “OPLAN IWAS PAPUTOK”

Non-Communicable Diseases and

Rehabilitation
Prevention and Control of Cardiovascular Diseases

 heart – 1st leading cause of death ; blood vessels – 2nd

 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
 Causes: environmental 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
 Predisposing Factor: Hypertension (HPN),Diabetes Mellitus (DM), Smoking
  Minor Risk Factor: stress, strong family history, obesity
Cardiovascular Disease
Period of Life Type of CVD Prevalence

At birth to early 2/ 1000 school children (aged 5-

childhood Congenital Heart Disease 15 yrs. old)

Early to late 1/1000 school children (aged 5-15

childhood Rheumatic Fever/ Rheumatic Heart Disease yrs. old)

Diseases of Heart Muscles Essential

Early Adulthood Hypertension 10/100 adults

Coronary Artery Disease Cerebrovascular

Middle age to old age Accident 5/100 adults
Cardiovascular Disease
Diseases Causes/ Risk factors

Congenital Heart Disease Maternal Infections, Drug intake, Maternal Disease, Genetic

Rheumatic Fever/Rheumatic Heart

Disease Frequent Streptoccocal Sore Throat

Essential Hypertension Heredity, High Salt Intake

Coronary Artery Disease Smoking, Obesity, Hypertension, Stress Hyperlipidemia, Diabetes

(Heart Attack) Mellitus Sedentary Life Style

Cerebrovascular Accident
(Stroke) Hypertension, Arteriosclerosis
Primary Prevention: CVD
Disease Primordial Specific Protection

 Adequate treatment of viral

infection during
 Prevention of viral infection and intake of pregnancy.
harmful drugs during pregnancy.  Genetic counseling of
Congenital Heart  Avoidance of marriage between blood blood related married
Disease relatives couples.

 Prevention of recurrent sore throat thru  Identification of cases of

adequate environmental sanitation; rheumatic fever
Rheumatic Heart avoidance of overcrowding; adequate  Prophylaxis with penicillin
Disease treatment or erythromycin

 From early childhood

Essential  low salt diet  Continued low salt diet and
Hypertension  adequate physical exercise adequate exercise

Coronary Heart  Prevention of development/ acquisition of  cessation of smoking

Disease (Heart risk factors  control /treatment of
Attack)  cigarette smoking diabetes, hypertension
 high fat intake  weight reduction
 high salt intake  change to proper diet
 Adjustment of activities

 all measures to control

Cerebrovascular hypertension &
Accident  all measures to prevent hypertension & progression of
(Stroke) arteriosclerosis arteriosclerosis
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
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.
 3rd 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
CA type Prevention Detection

Lung No smoking None

Uterine Monogamy, Safe sex Pap’s smear every 1-3 yrs

Cervical Monogamy, Safe sex Pap’s smear every 1-3 yrs

Hep B vaccination, Less alcohol intake,

Liver Avoidance of moldy foods None

Regular medical checkup

Colon High fiber diet after 40 yrs of age
Rectum Low fat intake Fecal occult blood test DRE Sigmoidoscopy

No smoking, betel nut chewing, Oral

Mouth hygiene Regular dental check-ups

Monthly SBE, Yearly exam by doctor,

Breast none Mammography for 50 yrs old and above females

Skin No excessive sun exposure Assessment of skin

Prostate none Digital transrectal exam

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:
1. Surgery
2. Radiation Therapy
3. Chemotherapy
Nat’l 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
Prevention and Control of Kidney Disease

1. 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.
2. Acute Nephritis: A severe inflammation of the kidney caused by infection, degenerative
disease, or disease of the blood vessels.
3. Chronic Renal Failure: A progressive deterioration of renal function that ends as uremia and its
complications unless dialysis or kidney transplant is performed.
4. Neprolithiasis: A disorder characterized by the presence of calculi in the kidney.
5. Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into the urine
because of increased permeability of the glomerular capillary membrane
6. Urinary Tract Infection: A disease caused by the presence of pathogenic microorganisms in the
urinary tract with or without signs and symptoms.
7. Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials back
into the blood and secretion, collection, and conduction of urine.
8. Urinary Tract Obstruction: A condition wherein the urine flow is blocked or clogged.
Program on Mental Health and Mental Disorders
Mental Health
 Mental health is not merely the absence of mental illness. According to the World Health
Organization (WHO) Manual on Mental Health, a person is in a state of sound mental health
when,
 He feels physically well
 His thought are organized
 His feelings are modulated
 His behaviors are coordinated and appropriate (*note: behaviors considered “normal” may
vary according to cultural norms)
 Any person may develop mental illness regardless of race, nationality, age, sex civil status and
socio-economic background may develop mental illness.
Causes of Mental Illness
A Combination or One of These:
1. Biological factors
 Like hereditary predisposition, poor nutrition
2. Physical Factors
 Physical injuries, intoxication
3. Psychological Factors
 Failure to adjust to the difficulties in life.
4. Socio-economic Factors
 Unemployment, housing problems
How is Mental Illness Detected?
1. Interview and assessment by the Clinical Social Worker.
2. Psychological testing and evaluation.
3. Psychiatric interview and mental status examination.
Is Mental Illness Curable?
 Yes. Mental illness is curable if detected early and prompt and adequate treatment is given.
Treatment depends on severity of illness and includes:
 Pharmacotherapy (use of medicines)
 Various therapies (physical, recreational, occupational, environmental)
 Psychotherapy and others
Prevention of Mental Illness
1. Maintain good physical health.
2. Choose worthwhile activities and develop a hobby
3. Solve problems as they come and avoid excessive worrying.
4. Cultivate friendships and choose a friend to confide in.
5. Strike a happy medium between work and play.
6. Recognize early signs and symptoms.
Some Early Signs of Symptoms Mental Illness
 Persistent disturbance in sleep and appetite
 Over sensitiveness and excessive irritability
 Loss of interest in activities or responsibilities of previous concern
 Constant complaint of headaches, weakness of hands and feet and other bodily complaints.
 Persistent seclusion of oneself from other people.
 Frequent attacks of palpitations usually expressed as “nerbiyos” & associated with unexplained
fears.
 Frequent attacks of dizziness & fainting.
 Exaggerated and /or unfounded suspicions
 Persistent worrying, forgetfulness & absentmindedness.
Program on Drug Dependence/ Substance Abuse
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.
Program on the Elderly/Geriatric Nursing Services
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
Programs on Blindness, Deafness and Osteoporosis

 Cataract- main causes of blindness

 VAD- main cause of childhood blindness; most serious eye problem of Filipino children below
6 yrs. old
 Osteoporosis special problem in women, highest bet. 50—79 yrs. old, MENOPAUSE main
cause

Nursing Law: Republic Act No. 9173 –

Philippine Nursing Act of 2002
 Republic Act No. 9173
RA9173

AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION,

REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE
KNOWN AS “THE PHILIPPINE NURSING ACT OF 1991” AND FOR OTHER
PURPOSES
Be it enacted by the Senate and the House of Representatives of the Philippines
in Congress assembled:
ARTICLE I
Title
Section 1. Title. – This Act shall be known as the “Philippine Nursing Act of 2002.”
ARTICLE II
Declaration of Policy
Section 2. Declaration of Policy. – It is hereby declared the policy of the State to assume
responsibility for the protection and improvement of the nursing profession by instituting measures
that will result in relevant nursing education, humane working conditions, better career prospects
and a dignified existence for our nurses.
The State hereby guarantees the delivery of quality basic health services through an adequate
nursing personnel system throughout the country.
ARTICLE III
Organization of the Board of Nursing
Section 3. Creation and Composition of the Board. – There shall be created a Professional
Regulatory Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson
and six (6) members. They shall be appointed by the president of the Republic of the Philippines
from among two (2) recommendees, per vacancy, of the Professional Regulation Commission,
hereinafter referred to as the Commission, chosen and ranked from a list of three (3) nominees, per
vacancy, of the accredited professional organization of nurses in the Philippines who possess the
qualifications prescribed in Section 4 of this Act.
Section 4. Qualifications of the Chairperson and Members of the Board. – The Chairperson and
Members of the Board shall, at the time of their appointment, possess the following qualifications:
(a) Be a natural born citizen and resident of the Philippines;
(b) Be a member of good standing of the accredited professional organization of nurses;
(c) Be a registered nurse and holder of a master’s degree in nursing, education or other allied
medical profession conferred by a college or university duly recognized by the Government:
Provided, That the majority of the members of the Board shall be holders of a master’s degree in
nursing: Provided, further, That the Chairperson shall be a holder of a master’s degree in nursing;
(d) Have at least ten (10) years of continuous practice of the profession prior to appointment:
Provided, however, That the last five (5) years of which shall be in the Philippines; and
(e) Not have been convicted of any offense involving moral turpitude; Provided, That the
membership to the Board shall represent the three (3) areas of nursing, namely: nursing education,
nursing service and community health nursing.
Section 5. Requirements Upon Qualification as Member of the Board of Nursing. – Any person
appointed as Chairperson or Member of the Board shall immediately resign from any teaching
position in any school, college, university or institution offering Bachelor of Science in Nursing
and/or review program for the local nursing board examinations or in any office or employment in
the government or any subdivision, agency or instrumentality thereof, including government-owned
or controlled corporations or their subsidiaries as well as these employed in the private sector.
He/she shall not have any pecuniary interest in or administrative supervision over any institution
offering Bachelor of Science in Nursing including review classes.
Section 6. Term of Office. – The Chairperson and Members of the Board shall hold office for a
term of three (3) years and until their successors shall have been appointed and qualified: Provided,
That the Chairperson and members of the Board may be re-appointed for another term.
Any vacancy in the Board occurring within the term of a Member shall be filled for the unexpired
portion of the term only. Each Member of the Board shall take the proper oath of office prior to the
performance of his/her duties.
The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of
their term under Republic Act No. 7164 until their replacements have been appointed by the
President and shall have been duly qualified.
Section 7. Compensation of the Board Members. – The Chairperson and Members of the Board
shall receive compensation and allowances comparable to the compensation and allowances
received by the Chairperson and members of other professional regulatory boards.
Section 8. Administrative Supervision of the Board, Custodian of its Records, Secretariat and
Support Services. – The Board shall be under the administrative supervision of the Commission.
All records of the Board, including applications for examinations, administrative and other
investigative cases conducted by the Board shall be under the custody of the Commission. The
Commission shall designate the Secretary of the Board and shall provide the secretariat and other
support services to implement the provisions of this Act.
Section 9. Powers and Duties of the Board. – The Board shall supervise and regulate the practice of
the nursing profession and shall have the following powers, duties and functions:
(a) Conduct the licensure examination for nurses;
(b) Issue, suspend or revoke certificates of registration for the practice of nursing;
(c) Monitor and enforce quality standards of nursing practice in the Philippines and exercise the
powers necessary to ensure the maintenance of efficient, ethical and technical, moral and
professional standards in the practice of nursing taking into account the health needs of the nation;
(d) Ensure quality nursing education by examining the prescribed facilities of universities or
colleges of nursing or departments of nursing education and those seeking permission to open
nursing courses to ensure that standards of nursing education are properly complied with and
maintained at all times. The authority to open and close colleges of nursing and/or nursing
education programs shall be vested on the Commission on Higher Education upon the written
recommendation of the Board;
(e) Conduct hearings and investigations to resolve complaints against nurse practitioners for
unethical and unprofessional conduct and violations of this Act, or its rules and regulations and in
connection therewith, issue subpoena ad testificandum and subpoena duces tecum to secure the
appearance of respondents and witnesses and the production of documents and punish with
contempt persons obstructing, impeding and/or otherwise interfeming with the conduct of such
proceedings, upon application with the court;
(f) Promulgate a Code of Ethics in coordination and consultation with the accredited professional
organization of nurses within one (1) year from the effectivity of this Act;
(g) Recognize nursing specialty organizations in coordination with the accredited professional
organization; and
(h) Prescribe, adopt issue and promulgate guidelines, regulations, measures and decisions as may
be necessary for the improvements of the nursing practice, advancement of the profession and for
the proper and full enforcement of this Act subject to the review and approval by the Commission.
Section 10. Annual Report. – The Board shall at the close of its calendar year submit an annual
report to the President of the Philippines through the Commission giving a detailed account of its
proceedings and the accomplishments during the year and making recommendations for the
adoption of measures that will upgrade and improve the conditions affecting the practice of the
nursing profession.
Section 11. Removal or Suspension of Board Members. – The president may remove or suspend
any member of the Board after having been given the opportunity to defend himself/herself in a
proper administrative investigation, on the following grounds;
(a) Continued neglect of duty or incompetence;
(b) Commission or toleration of irregularities in the licensure examination; and
(c) Unprofessional immoral or dishonorable conduct.
ARTICLE IV
Examination and Registration
Section 12. Licensure Examination. – All applicants for license to practice nursing shall be required
to pass a written examination, which shall be given by the Board in such places and dates as may be
designated by the Commission: Provided, That it shall be in accordance with Republic Act No.
8981, otherwise known as the “PRC Modernization Act of 2000.”
Section 13. Qualifications for Admission to the Licensure Examination. – In order to be admitted to
the examination for nurses, an applicant must, at the time of filing his/her application, establish to
the satisfaction of the Board that:
(a) He/she is a citizen of the Philippines, or a citizen or subject of a country which permits Filipino
nurses to practice within its territorial limits on the same basis as the subject or citizen of such
country: Provided, That the requirements for the registration or licensing of nurses in said country
are substantially the same as those prescribed in this Act;
(b) He/she is of good moral character; and
(c) He/she is a holder of a Bachelor’s Degree in Nursing from a college or university that complies
with the standards of nursing education duly recognized by the proper government agency.
Section 14. Scope of Examination. – The scope of the examination for the practice of nursing in the
Philippines shall be determined by the Board. The Board shall take into consideration the
objectives of the nursing curriculum, the broad areas of nursing, and other related disciplines and
competencies in determining the subjects of examinations.
Section 15. Ratings. – In order to pass the examination, an examinee must obtain a general average
of at least seventy-five percent (75%) with a rating of not below sixty percent (60%) in any subject.
An examinee who obtains an average rating of seventy-five percent (75%) or higher but gets a
rating below sixty percent (60%) in any subject must take the examination again but only in the
subject or subjects where he/she is rated below sixty percent (60%). In order to pass the succeeding
examination, an examinee must obtain a rating of at least seventy-five percent (75%) in the subject
or subjects repeated.
Section 16. Oath. – All successful candidates in the examination shall be required to take an oath of
profession before the Board or any government official authorized to administer oaths prior to
entering upon the nursing practice.
Section 17. Issuance of Certificate of Registration/Professional License and Professional
Identification Card. – A certificate of registration/professional license as a nurse shall be issued to
an applicant who passes the examination upon payment of the prescribed fees. Every certificate of
registration/professional license shall show the full name of the registrant, the serial number, the
signature of the Chairperson of the Commission and of the Members of the Board, and the official
seal of the Commission. A professional identification card, duly signed by the Chairperson of the
Commission, bearing the date of registration, license number, and the date of
issuance and expiration thereof shall likewise be issued to every registrant upon payment of the
required fees.
Section 18. Fees for Examination and Registration. – Applicants for licensure and for registration
shall pay the prescribed fees set by Commission.
Section 19. Automatic Registration of Nurses. – All nurses whose names appear at the roster of
nurses shall be automatically or ipso facto registered as nurses under this Act upon its effectivity.
Section 20. Registration by Reciprocity. – A certificate of registration/professional license may be
issued without examination to nurses registered under the laws of a foreign state or country:
Provided, That the requirements for registration or licensing of nurses in said country are
substantially the same as those prescribed under this Act: Provided, further, That the laws of such
state or country grant the same privileges to registered nurses of the Philippines on the same basis
as the subjects or citizens of such foreign state or country.
Section 21. Practice Through Special/Temporary Permit. – A special/temporary permit may be
issued by the Board to the following persons subject to the approval of the Commission and upon
payment of the prescribed fees:
(a) Licensed nurses from foreign countries/states whose service are either for a fee or free if they
are internationally well-known specialists or outstanding experts in any branch or specialty of
nursing;
(b) Licensed nurses from foreign countries/states on medical mission whose services shall be free
in a particular hospital, center or clinic; and
(c) Licensed nurses from foreign countries/states employed by schools/colleges of nursing as
exchange professors in a branch or specialty of nursing; Provided, however, That the
special/temporary permit shall be effective only for the duration of the project, medical mission or
employment contract.
Section 22. Non-registration and Non-issuance of Certificates of Registration/Professional License
or Special/Temporary Permit. – No person convicted by final judgment of any criminal offense
involving moral turpitude or any person guilty of immoral or dishonorable conduct or any person
declared by the court to be of unsound mind shall be registered and be issued a certificate of
registration/professional license or a special/temporary permit. The Board shall furnish the
applicant a written statement setting forth the reasons for its actions, which shall be incorporated in
the records of the Board.
Section 23. Revocation and suspension of Certificate of Registration/Professional License and
Cancellation of Special/Temporary Permit. – The Board shall have the power to revoke or suspend
the certificate of registration/professional license or cancel the special/temporary permit of a nurse
upon any of the following grounds:
(a) For any of the causes mentioned in the preceding section;
(b) For unprofessional and unethical conduct;
(c) For gross incompetence or serious ignorance;
(d) For malpractice or negligence in the practice of nursing;
(e) For the use of fraud, deceit, or false statements in obtaining a certificate of
registration/professional license or a temporary/special permit;
(f) For violation of this Act, the rules and regulations, Code of Ethics for nurses and technical
standards for nursing practice, policies of the Board and the Commission, or the conditions and
limitations for the issuance of the temporarily/special permit; or
(g) For practicing his/her profession during his/her suspension from such practice; Provided,
however, That the suspension of the certificate of registration/professional license shall be for a
period not to exceed four (4) years.
Section 24. Re-issuance of Revoked Certificates and Replacement of Lost Certificates. – The Board
may, after the expiration of a maximum of four (4) years from the date of revocation of a
certificate, for reasons of equity and justice and when the cause for revocation has disappeared or
has been cured and corrected, upon proper application therefor and the payment of the required
fees, issue another copy of the certificate of registration/professional license. A new certificate of
registration/professional license to replace the certificate that has been lost, destroyed or mutilated
may be issued, subject to the rules of the Board.
ARTICLE V
Nursing Education
Section 25. Nursing Education Program. – The nursing education program shall provide sound
general and professional foundation for the practice of nursing. The learning experiences shall
adhere strictly to specific requirements embodied in the prescribed curriculum as promulgated by
the Commission on Higher Education’s policies and standards of nursing education.
Section 26. Requirement for Inactive Nurses Returning to Practice. – Nurses who have not actively
practiced the profession for five (5) consecutive years are required to undergo one (1) month of
didactic training and three (3) months of practicum. The Board shall accredit hospitals to conduct
the said training program.
Section 27. Qualifications of the Faculty. – A member of the faculty in a college of nursing
teaching professional courses must:
(a) Be a registered nurse in the Philippines;
(b) Have at least one (1) year of clinical practice in a field of specialization;
(c) Be a member of good standing in the accredited professional organization of nurses; and
(d) Be a holder of a master’s degree in nursing, education, or other allied medical and health
sciences conferred by a college or university duly recognized by the Government of the Republic of
the Philippines. In addition to the aforementioned qualifications, the dean of a college must have a
master’s degree in nursing. He/she must have at least five (5) years of experience in nursing.
ARTICLE VI
Nursing Practice
Section 28. Scope of Nursing. – A person shall be deemed to be practicing nursing within the
meaning of this Act when he/she singly or in collaboration with another, initiates and performs
nursing services to individuals, families and communities in any health care setting. It includes, but
not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler,
preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses
are primarily responsible for the promotion of health and prevention of illness. A members of the
health team, nurses shall collaborate with other health care providers for the curative, preventive,
and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery
is not possible, towards a peaceful death. It shall be the duty of the nurse to:
(a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but
not limited to, traditional and innovative approaches, therapeutic use of self, executing health care
techniques and procedures, essential primary health care, comfort measures, health teachings, and
administration of written prescription for treatment, therapies, oral topical and parenteral
medications, internal examination during labor in the absence of antenatal bleeding and delivery. In
case of suturing of perineal laceration, special training shall be provided according to protocol
established;
(b) establish linkages with community resources and coordination with the health team;
(c) Provide health education to individuals, families and communities;
(d) Teach, guide and supervise students in nursing education programs including the administration
of nursing services in varied settings such as hospitals and clinics; undertake consultation services;
engage in such activities that require the utilization of knowledge and decision-making skills of a
registered nurse; and
(e) Undertake nursing and health human resource development training and research, which shall
include, but not limited to, the development of advance nursing practice; Provided, That this
section shall not apply to nursing students who perform nursing functions under the direct
supervision of a qualified faculty: Provided, further, That in the practice of nursing in all settings,
the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe
nursing practice. The nurse is required to maintain competence by continual learning through
continuing professional education to be provided by the accredited professional organization or any
recognized professional nursing organization: Provided, finally, That the program and activity for
the continuing professional education shall be submitted to and approved by the Board.
Section 29. Qualification of Nursing Service Administrators. – A person occupying supervisory or
managerial positions requiring knowledge of nursing must:
(a) Be a registered nurse in the Philippines;
(b) Have at least two (2) years experience in general nursing service administration;
(c) Possess a degree of Bachelors of Science in Nursing, with at least nine (9) units in management
and administration courses at the graduate level; and
(d) Be a member of good standing of the accredited professional organization of nurses; Provided,
That a person occupying the position of chief nurse or director of nursing service shall, in addition
to the foregoing qualifications, possess:
(1) At least five (5) years of experience in a supervisory or managerial position in nursing; and
(2) A master’s degree major in nursing; Provided, further, That for primary hospitals, the maximum
academic qualifications and experiences for a chief nurse shall be as specified in subsections (a),
(b), and (c) of this section: Provided, furthermore, That for chief nurses in the public health nursing
shall be given priority. Provided, even further, That for chief nurses in military hospitals, priority
shall be given to those who have finished a master’s degree in nursing and the completion of the
General Staff Course (GSC): Provided, finally, That those occupying such positions before the
effectivity of this Act shall be given a period of five (5) years within which to qualify.
ARTICLE VII
Health Human Resources Production, Utilization and Development
Section 30. Studies for Nursing Manpower Needs, Production, Utilization and Development. – The
Board, in coordination with the accredited professional organization and appropriate government or
private agencies shall initiate undertake and conduct studies on health human resources production,
utilization and development.
Section 31. Comprehensive Nursing Specialty Program. – Within ninety (90) days from the
effectivity of this Act, the Board in coordination with the accredited professional organization
recognized specialty organizations and the Department of Health is hereby mandated to formulate
and develop a comprehensive nursing specialty program that would upgrade the level of skill and
competence of specialty nurse clinicians in the country, such as but not limited to the areas of
critical care, oncology, renal and such other areas as may be determined by the Board. The
beneficiaries of this program are obliged to serve in any Philippine hospital for a period of at least
two (2) years and continuous service.
Section 32. Salary. – In order to enhance the general welfare, commitment to service and
professionalism of nurses the minimum base pay of nurses working in the public health institutions
shall not be lower than salary grade 15 prescribes under Republic Act No. 6758, otherwise known
as the “Compensation and Classification Act of 1989”: Provided, That for nurses working in local
government units, adjustments to their salaries shall be in accordance with Section 10 of the said
law.
Section 33. Funding for the Comprehensive Nursing Specialty Program. – The annual financial
requirement needed to train at least ten percent (10%) of the nursing staff of the participating
government hospital shall be chargeable against the income of the Philippine Charity Sweepstakes
Office and the Philippine Amusement and Gaming Corporation, which shall equally share in the
costs and shall be released to the Department of Health subject to accounting and auditing
procedures: Provided, That the department of Health shall set the criteria for the
availment of this program.
Section 34. Incentives and Benefits. – The Board of Nursing, in coordination with the Department
of Health and other concerned government agencies, association of hospitals and the accredited
professional organization shall establish an incentive and benefit system in the form of free hospital
care for nurses and their dependents, scholarship grants and other non-cash benefits. The
government and private hospitals are hereby mandated to maintain the standard nurse-patient ratio
set by the Department of Health.
ARTICLE VIII
Penal and Miscellaneous Provisions
Section 35. Prohibitions in the Practice of Nursing. – A fine of not less than Fifty thousand pesos
(P50,000.00) nor more than One hundred thousand pesos (P100,000.00) or imprisonment of not
less than one (1) year nor more than six (6) years, or both, upon the discretion of the court, shall be
imposed upon:
(a) any person practicing nursing in the Philippines within the meaning of
this Act:
(1) without a certificate of registration/professional license and professional identification card or
special temporary permit or without having been declared exempt from examination in accordance
with the provision of this Act; or
(2) who uses as his/her own certificate of registration/professional license and professional
identification card or special temporary permit of another; or
(3) who uses an invalid certificate of registration/professional license, a suspended or revoked
certificate of registration/professional license, or an expired or cancelled special/temporary permits;
or
(4) who gives any false evidence to the Board in order to obtain a certificate of
registration/professional license, a professional identification card or special permit; or
(5) who falsely poses or advertises as a registered and licensed nurse or uses any other means that
tend to convey the impression that he/she is a registered and licensed nurse; or
(6) who appends B.S.N./R.N. (Bachelor of Science in Nursing/Registered Nurse) or any similar
appendage to his/her name without having been coferred said degree or registration; or
(7) who, as a registered and licensed nurse, abets or assists the illegal practice of a person who is
not lawfully qualified to practice nursing.
(b) any person or the chief executive officer of a judicial entity who
undertakes in-service educational programs or who conducts review
classes for both local and foreign examination without permit/clearance
from the Board and the Commission; or
(c) any person or employer of nurses who violate the minimum base pay
of nurses and the incentives and benefits that should be accorded them as
specified in Sections 32 and 34; or
(d) any person or the chief executive officer of a juridical entity violating
any provision of this Act and its rules and regulations.
ARTICLE IX
Final Provisions
Section 36. Enforcement of this Act. – It shall be the primary duty of the Commission and the
Board to effectively implement this Act. Any duly law enforcement agencies and officers of
national, provincial, city or municipal governments shall, upon the call or request of the
Commission or the Board, render assistance in enforcing the provisions of this Act and to prosecute
any persons violating the same.
Section 37. Appropriations. – The Chairperson of the Professional Regulation Commission shall
immediately include in its program and issue such rules and regulations to implement the
provisions of this Act, the funding of which shall be included in the Annual General Appropriations
Act.
Section 38. Rules and Regulations. – Within ninety (90) days after the effectivity of this Act, the
Board and the Commission, in coordination with the accredited professional organization, the
Department of Health, the Department of Budget and Management and other concerned
government agencies, shall formulate such rules and regulations necessary to carry out the
provisions of this Act. The implementing rules and regulations shall be published in the Official
Gazette or in any newspaper of general circulation.
Section 39. Reparability Clause. – If any part of this Act is declared unconstitutional, the remaining
parts not affected thereby shall continue to be valid and operational.
Section 40. Repealing Clause. – Republic Act No. 7164, otherwise known as the “Philippine
Nursing Act of 1991” is hereby repealed. All other laws, decrees, orders, circulars, issuances, rules
and regulations and parts thereof which are inconsistent with this Act are hereby repealed, amended
or modified accordingly.
Section 41. Effectivity. – This act shall take effect fifteen (15) days upon its publication in the
Official Gazette or in any two (2) newspapers of general circulation in the Philippines.
Approved,
FRANKLIN DRILON
President of the Senate
JOSE DE VENECIA JR.
Speaker of the House of Representatives
This Act, which originated in the House of Representative was finally passed by the House of
Representatives and the Senate on October 15, 2002 and October 8, 2003 respectively.
OSCAR G. YABES
Secretary of Senate
ROBERTO P. NAZARENO
Secretary General House of Represenatives
Approved: October 21, 2002
GLORIA MACAPAGAL-ARROYO
President of the Philippines

Nursing Procedures in the Community

Clinic Visit
 process of checking the client’s 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
Thermometer Technique
 to assess the client’s 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
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
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 physician’s written
prescription
 can be done only by nurses accredited by ANSAP
 Nutrition
Principles of Nutrition

1. Digestion – process by which food substances are changed into forms that can be absorbed
through cell membranes
2. Absorption – the taking in of substance by cells or membranes
3. Metabolism – sum of all physical and chemical processes by which a living organism is formed
and maintained and by which energy is made available
4. Storage – some nutrients are stored when not used to provide energy; e.g. carbohydrates are
stored either as glycogen or as fat

Nutrients
1. Carbohydrates – the primary sources are plant foods
Types of Carbohydrates
a. Simple (sugars) such as glucose, galactose, and fructose

b. Complex such as starches (which are polysaccharides) and fibers (supplies bulk or roughage to
the diet)
2. Proteins – organic substances made up of amino acids
3. Lipids – organic substances that are insoluble in water but soluble in alcohol and ether.

 Fatty acids – the basic structural units of all lipids and are either saturated (all the carbon
atoms are filled with hydrogen) or unsaturated (could accommodate more hydrogen than it
presently contains)
 Food sources of lipids are animal products (milk, egg yolks and meat) and plants and plant
products (seeds, nuts,oils)
4. Vitamins – organic compounds not manufactured in the body and needed in small quantities to
catalyze metabolic processes.
a. Water-soluble vitamins include C and B-complex vitamins

b. Fat-soluble vitamins include A, D, E, and K and these can be stored in limited amounts in the
body
5. Minerals – compounds that work with other nutrients in maintaining structure and function of the
body
a. Macronutrients – calcium, phosphate, sodium, potassium, chloride, magnesium and sulfur

b. Micronutrients (trace elements) – iron, iodine, copper, zinc, manganese and fluoride The best
sources are vegetables, legumes, milk and some meats
6. Water – the body’s most basic nutrient need; it serves as a medium for metabolic reactions
within cells and a transporter fro nutrients, waste products and other substances
 Philippine Health Care Laws
REPUBLIC ACT – an act passed by the Congress of the Philippines, while the form of government
is Republican government.
 Republic Act 349 – Legalizes the use of human organs for surgical, medical and scientific
purposes.
 Republic Act 1054 – Requires the owner, lessee or operator of any commercial, industrial or
agricultural establishment to furnish free emergency, medical and dental assistance to his
employees and laborers.
 Republic Act 1080 – Civil Service Eligibility
 Republic Act 1082 – Rural Health Unit Act
 Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
 Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be paid January 31 of
each year
 Republic Act 1891 – Act strengthening Health and Dental services in the rural areas
 Republic Act 2382 – Philippine Medical Act which regulates the practice of medicines in the
Philippines
 Republic Act 2644 – Philippine Midwifery Act
 Republic Act 3573 – Law on reporting of Communicable Diseases
 Republic Act 4073 – Liberalized treatment of Leprosy
 Republic Act 4226 – Hospital Licensure Act requires all hospital to be licensed before it can
operative
 Republic Act 5181 – Act prescribing permanent residence and reciprocity as qualifications for
any examination or registration for the practice of any profession in the Philippines
 Republic Act 5821 – The Pharmacy Act
 Republic Act 5901 – 40 hours work for hospital workers
 Republic Act 6111 – Medicare Act
 Republic Act 6365 – Established a National Policy on Population and created the Commission
on population
 Republic Act 6425 – Dangerous Drug Act of 1992
 Republic Act 6511 – Act to standardize the examination and registration fees charged by the
National Boards, and for other purposes.
 Republic Act 6675 – Generics Act of 1988
 Republic Act 6713 – Code of Conduct and Ethical Standards for Public Officials and
Employees
 Republic Act 6725 – Act strengthening the prohibition on discrimination against women with
respect to terms and condition of employment
 Republic Act 6727 – Wage Rationalization Act
 Republic Act 6758 – Standardized the salaries
 Republic Act 6809 – Majority age is 18 years old
 Republic Act 6972 – Day care center in every Barangay
 Republic Act 7160 – Local Government Code
 Republic Act 7164 – Philippine Nursing Act of 1991
 Republic Act 7170 – Law that govern organ donation
 Republic Act 7192 – Women in development nation building
 Republic Act 7277 – Magna Carta of Disabled Persons
 Republic Act 7305 – The Magna Carta of public Health Workers
 Republic Act 7392 – Philippine Midwifery Act of 1992
 Republic Act 7432 – Senior Citizen Act
 Republic Act 7600 – Rooming In and Breastfeeding Act of 1992
 Republic Act 7610 – Special protection of children against abuse, exploitation and
discrimination act
 Republic Act 7624 – Drug Education Law
 Republic Act 7641 – New Retirement Law
 Republic Act 7658 – An act prohibiting the employment of children below 15 years of age
 Republic Act 7719 – National Blood Service Act of 1994
 Republic Act 7875 – National Health Insurance Act of 1995
 Republic Act 7876 – Senior Citizen Center of every Barangay
 Republic Act 7877 – Anti-sexual harassment Act of 1995
 Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of 1992
 Republic Act 8042 – Migrant Workers and Overseas Filipino Act of 1995
 Republic Act 8172 – Asin Law
 Republic Act 8187 – Paternity Leave Act of 1995
 Republic Act 8203 – Special Law on Counterfeit Drugs
 Republic Act 8282 – Social Security Law of 1997 (amended RA 1161)
 Republic Act 8291 – Government Service Insurance System Act of 1997 (amended PD 1146)
 Republic Act 8344 – Hospital Doctors to treat emergency cases referred for treatment
 Republic Act 8423 – Philippine Institute of Traditional and Alternative Medicine
 Republic Act 8424 – Personal tax Exemption
 Republic Act 8749 – The Philippine Clean Air Act of 1999
 Republic Act 8981 – PRC Modernization Act of 2000
 Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002
 Republic Act 9173 – Philippine Nursing Act of 2002
 Republic Act 9288 – Newborn Screening Act
PRESIDENTIAL DECREE – An order of the President. This power of the President which allows
him/her to act as legislators was exercised during the Marshall Law period.
 Presidential Decree 46 – An act making it punishable for any public officials or employee,
whether of the national or local government, to receive directly or indirectly any gifts or
valuable things
 Presidential Decree 48 – Limits benefits of paid maternity leave privileges to four children
 Presidential Decree 69 – Limits the number of children to four (4) tax exemption purposes
 Presidential Decree 79 – Population Commission
 Presidential Decree 147 – Declares April and May as National Immunization Day
 Presidential Decree 148 – Regulation on Woman and Child Labor Law
 Presidential Decree 166 – Strengthened Family Planning program by promoting participation
of private sector in the formulation and implementation of program planning policies.
 Presidential Decree 169 – Requiring Attending Physician and/or persons treating injuries
resulting from any form of violence.
 Presidential Decree 223 – Professional Regulation Commission
 Presidential Decree 442 – Labor Code Promotes and protects employees self-organization and
collective bargaining rights. Provision for a 10% right differential pay for hospital workers.
 Presidential Decree 491 – Nutrition Program
 Presidential Decree 539 – Declaring last week of October every as Nurse’s Week. October 17,
1958
 Presidential Decree 541 – Allowing former Filipino professionals to practice their respective
professions in the Philippines so they can provide the latent and expertise urgently needed by
the homeland
 Presidential Decree 568 – Role of Public Health midwives has been expanded after the
implementation of the Restructed Health Care Delivery System (RHCDS)
 Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child Adoption
 Presidential Decree 626 – Employee Compensation and State Insurance Fund. Provide benefits
to person covered by SSS and GSIS for immediate injury, illness and disability.
 Presidential Decree 651 – All births and deaths must be registered 30 days after delivery.
 Presidential Decree 825 – Providing penalty for improper disposal garbage and other forms of
uncleanliness and for other purposes.
 Presidential Decree 851 – 13th Month pay
 Presidential Decree 856 – Code of Sanitation
 Presidential Decree 965 – Requiring applicants for Marriage License to receive instruction on
family planning and responsible parenthood.
 Presidential Decree 996 – Provides for compulsory basic immunization for children and infants
below 8 years of age.
 Presidential Decree 1083 – Muslim Holidays
 Presidential Decree 1359 – A law allowing applicants for Philippine citizenship to take Board
Examination pending their naturalization.
 Presidential Decree 1519 – Gives medicare benefits to all government employees regardless of
status of appointment.
 Presidential Decree 1636 – requires compulsory membership in the SSS and self-employed
 Presidential Decree 4226 – Hospital Licensure Act
PROCLAMATION – an official declaration by the Chief Executive / Office of the President of the
Philippines on certain programs / projects / situation
 Proclamation No.6 – UN’s goal of Universal Child Immunization; involved NGO’s in the
immunization program
 Proclamation No. 118 – Professional regulation Week is June 16 to 22
 Proclamation No. 499 – National AIDS Awareness Day
 Proclamation No. 539 – Nurse’s Week – Every third week of October
 Proclamation No. 1275 – Declaring the third week of October every year as “Midwifery Week”
LETTER OF INSTRUCTION – An order issued by the President to serve as a guide to his/her
previous decree or order.
 LOI 47 – Directs all school of medicine, nursing, midwifery and allied medical professions and
social work to prepare, plan and implement integration of family planning in their curriculum
to require their graduate to take the licensing examination.
 LOI 949 – Act on health and health related activities must be integrated with other activities of
the overall national development program. Primary Health Care (10-19-79)
 LOI 1000 – Government agencies should be given preference to members of the accredited
professional organization when hiring
EXECUTIVE ORDER – an order issued by the executive branch of the government in order to
implement a constructional mandate or a statutory provision.
 Executive Order 51 – The Milk Code
 Executive Order 174 – National Drug Policy on Availability, Affordability, Safe, Effective and
Good Quality drugs to all
 Executive Order 180 – Government Workers Collective Bargaining Rights Guidelines on the
right to Organize of government employee.
 Executive Order 203 – List of regular holidays and special holidays
 Executive Order 209 – The Family Code (amended by RA 6809)
 Executive Order 226 – Command responsibility
 Executive Order 503 – Provides for the rules and regulations implementing the transfer of
personnel, assets, liabilities and records of national agencies whose functions are to be devoted
to the local government units.
 Executive Order 857 – Compulsory Dollar Remittance Law
Other Important Information
 Administrative Order 114 – Revised/updated the roles and functions of the Municipal Health
Officers, Public Health Nurses and Rural Midwives
 ILO Convention 149 – Provides the improvement of life and work conditions of nursing
personnel.

Primary Health Care (PHC)

Overview
 May 1977 -30th 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.
Rationale for Adopting Primary Health Care
 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.
 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
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
1. Barangay Health Workers – trained community health workers or health auxiliary volunteers or traditional
birth attendants or healers.
2. 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 people’s participation
at all levels of decision-making; planning, implementing, monitoring and evaluating. Any undertaking
must also be based on the people’s needs and problems (PCF, 1990)
 Part of the people’s 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
 Through community participation and cohesiveness of people’s organization they can generate support for
health care through social mobilization, networking and mobilization of local resources. Leadership and
management skills should be develop among these people. Existence of sustained health care facilities
managed by the people is some of the major indicators that the community is leading to 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 nongovernment organization and people’s
organization.
6. Recognition of interrelationship between the health and development
 Health- Is not merely the absence of disease. Neither is it 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 multidimensional. It has
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.
8. Decentralization
 This ensures empowerment and that empowerment can only be facilitated if the administrative structure
provides local level political structures with more substantive responsibilities for development initiators.
This also facilities proper allocation of budgetary resources.
Elements of Primary Health Care
1. Education for Health
 Is one of the potentmethodologies 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.
2. Locally Endemic Disease Control
 The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate.
Example Malaria Control and Schistosomiasis Control
3. 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
4. Maternal and Child Health and Family Planning
 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.
5. Environmental Sanitation and Promotion of Safe Water Supply
 Environmental Sanitation is defined as the study of all factors in the man’s environment, which exercise or
may exercise deleterious effect on his well-being and survival. Water is a basic need for life and one factor
in man’s environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and
Sanitation is necessary for basic promotion of health.
6. Nutrition and Promotion of Adequate Food Supply
 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.
7. 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.
8. Supply of Essential Drugs
 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
Major Strategies of Primary Health Care
1. Elevating Health to a Comprehensive and Sustained National Effort.
 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.
2. 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.
3. 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.
4. Advancing Essential National Health Research
 Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research
using intersectoral, multi-disciplinary 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

Reproductive Health
Definition
 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(country’s 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
 Breast and Reproductive Tract Cancers and other Gynecological Conditions
 Men’s 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 ensures 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
 Traits and Qualities of a Health Worker
Efficient
 plans with the people, organizes, conducts, directs health education activities according to the
needs of the community
 knowledgeable about everything relevant to his practice; has the necessary skills expected of
him
Good listener
 hears what’s being said and what’s behind the words
 always available for the participant to voice out their sentiments and needs
Keen observer
 keep an eye on the proceedings, process and participants’ behavior
Systematic
 knows how to put in sequence or logical order the parts of the session
Creative/Resourceful
 uses available resources
Analytical/Critical thinker
 decides on what has been analyzed
Tactful
 brings about issues in smooth subtle manner
 does not embarrass but gives constructive criticisms
Knowledgeable
 able to impart relevant, updated and sufficient input
Open
 invites ideas, suggestions, criticisms
 involves people in decision making
 accepts need for joint planning and decision relative to health care in a particular situation; not
resistant to change
Sense of humor
 knows how to place a touch of humor to keep audience alive
Change agent
 involves participants actively in assuming the responsibility for his own learning
Coordinator
 brings into consonance of harmony the community’s health care activities
Objective
 unbiased and fair in decision making
Flexible
 able to cope with different situations
 Under Five Clinic Program
Overview
 The first five years of life form the foundations of the child’s physical and mental growth and
development. Studies have shown the mortality and morbidity are high among this age group.
The Department of Health established the Under Five Clinic Program to address this problem.
Program Objectives and Goals

 Monitor growth and development of the child until 5 years of age.

 Identify factors that may hinder the growth and development of the child.
Activities and Strategies

1. Regular height and weight determination/ monitoring until 5 years old. 0-1 year old=monthly 1
year old and above =quarterly
2. Recording of immunization, vitamins supplementation, deworming and feeding.
3. Provision of IEC materials (ex. Posters, charts, and toys) that promote and enhance child’s
proper growth and development.
4. Provision of a safe and learning – oriented environment for the child.
5. Monitoring and Evaluation.