Académique Documents
Professionnel Documents
Culture Documents
o Improvement of conditions
I. A BRIEF INTRODUCTION o Rehabilitation of illness
- Combination of:
COMMUNITY o Nursing skills
- Group of people o Public health
- Living together
o Social assistance
- Common interest
- Is a field of nursing practice where services are delivered outside of purely curative
- Geographical boundary
- Place of usual condition institution but in community settings such as home, the school, places of work,
- “Comunicas” health centers, and clinics.
- The patient in CHN - Freeman, 1970: service rendered by a professional nurse to an individuals, families,
communities, and population groups in health centers, clinic, school in order to
HEALTH promote health, prevent illness, provide care for the sick and their respective homes,
- wellness and wellbeing provide effective rehabilitation
- dynamic and evolutionary - Philosophy of CHN: based on the worth and dignity of men
- beliefs and practices - Goals of CHN: to assist the individual, family and the community in attaining their
- a continuum highest level of holistic health
- interplay of factors
- one’s totality PUBLIC HEALTH
- state of complete physical, mental, and social well-being, not merely the absence of - Science and art
disease or infirmity - 3P’s
o Prevention of disease
COMMUNITY HEALTH o Prolonging of life
- paramedical and medical approach o Promotion of health
- focused on health of population - Organized community effort
- aims: - Foundations of health promotion
o health promotion - 3 basic strategies
o disease prevention o Advocate
o management of factors o Enable
o Mediate
NURSING - Goal: “to realize his birth rights and longevity”
- “Nutrix” - Philosophy: “worth and dignity of man”
- Science, art, and social science - 5 core business
- Utilizes nursing process (APIE only) o Disease control
- Assisting the sick to recovery o Injury prevention
- Promoting the health towards OLOF (Optimum Level Of Functioning) o Health protection
- Holistic approach to care o Health public policy
o Promotion of health
COMMUNITY HEALTH NURSING - Determinants of health (OLOF)
- Utilization of nursing process o Socioeconomic
- Different levels of clientele o Political
- Focuses on: o Health care delivery system
o Promotion o Heredity
o Prevention o Behavioral
o Rehabilitation o Environmental
- Special field of nursing
PUBLIC HEALTH NURSING
- Focuses on:
- Practice of nursing
- National and local government units 3. RURBAN
- Community health nursing in public sector o The centro/población
COMMUNITY HEALTH NURSING o Mixed type
- Learned practice discipline o Not highly industrialized
- Collaboration with others o Conversion of agricultural lands
- Teaching and delivery of care as a method o Increasing population
- OLOF as the ultimate goal
LEVELS OF CLIENTELE
12 PRINCIPLES OF CHN (ITS COMMUNITY) 1. Individual
1. I-ts objectives are fully understood o Direct recipient of care
2. T-o be available to all o A unit of family
3. S-erves as a team member o Important to community building
4. C-PE and CPD programs are offered o Ability to relate to others
5. O-ffers provision of service evaluation 2. Family
6. M-akes family as a basic unit of service o Basic unit of community care/service
7. M-aintains connection with active groups o Composed of members (father, mother, etc.)
8. U-se of available resources o Functions focused on
9. N-eeds of community is the basis i. Physiologic
10. I-nto educative supervision of all ii. Physical
11. T-otally accurate recording and reporting iii. Economic
12. Y-ou focus on health education iv. Reproductive
v. Socialization
PHILOSOPHY OF CHN (HUMANISTIC Philosophy) 3. Community
1. H-umanistic values of the profession upheld o An organized society
2. U-nique and distinct component of health care o Usual conditions/events to families
3. M-ultiple factors of health considered o Territory and geographical locations
4. A-ctive participation of clients considered o Social avenue of growth
5. N-urse considers availability of resources 4. Population group/aggregates/vulnerable
6. I-nterdependence among members practiced o A group of people who share common characteristics, developmental
7. S-scientific and up-to date stage or common exposure to a particular environmental factors
8. T-ask of nurse vary with time and place o Aggregates and vulnerable groups
9. I-ndependence of people is the end of goal o Care must be prioritized
10. C-onnectedness of health and development regarded o Types of vulnerable groups
i. Infants and young child
3 CLASSIFICATION OF COMMUNITY ii. School age
1. Rural iii. Adolescent
o The province iv. Mother
o Open land v. Elderly
o Forest land vi. Males
o Agricultural/fishing
o Less dense TYPES OF FAMILY
o More spacious 1. Traditional type
o Pollution is low a. Nuclear
2. Urban b. Extended
o The city/metro/capital 2. Non-traditional type
o Non-agricultural land a. 3-generational
o Dense and highly populated b. Dyad
o Highly industrialized c. Single parent
o Pollution is high d. Step parent
e. Blended Supervising Public Health Nurse/Nurse Supervisor at Provincial or City Level
f. Single adult (alone) o BSN, RN, MN/MAN
g. No kin o 5 years PHN experience
h. Compound Nurse Instructor II
i. Gay/cohabitating o BSN, RN, MAN
j. Commune/religious o 3 years PHN experience
k. Living-in o Special training of the functions of the nurse
Regional Training Nurse
STAGES OF FAMILY DEVELOPMENT o BSN, RN, MAN/MPH
a. Beginning (courting, marriage) o 6 years of PHN experience, 3 of which is Nursing Education
b. Child bearing (pregnancy) Regional Nurse Supervisor (Nurse V)
c. Child rearing o BSN, RN, MAN/MPH major in CHN Admin. & Sup.
i. With infants o 5 years PHN experience, 2 of which is Supervisory
ii. With toddlers Nursing Program Supervisor (Nurse VI)
iii. With preschoolers o BSN, RN, MAN/MPH major PHN Administration
iv. With school age o 7 years PHN experience CHN/Training
v. With teenagers Chief Nurse (Nurse VII)
d. Family with middle age members o BSN, RN, MAN/MPH major in CHN
e. Family with aging members o 5 years PHN experience, 3 of which is Assistant Chief Nurse
Assistant Chief Nurse
II. THE RHU IN ACTION o BSN, RN, MAN/MPH major in CHN
o 5 years PHN experience, 2 of which is Supervisory
THE RHU PERSONNEL Occupational Nurse
- 8 core health team members o BSN, RN
o Municipal Health Officer (MD) = 20,000 pop. o Preferably with units in Occupational Nursing
o Public Health Nurse (RN) = 20,000 pop.
o Rural Health Midwife (RM) = 5,000 pop. PERSONAL QUALIFICATION (GIRLAH)
o Dentist (Registered Dentist) = 50,000 pop. G-ood physical and mental health
o Nutritionist (Registered Nutrionist/Dietitian) I-nterest and willingness to work in the community
o Medical Technologist (RMT) R-esourcefulness and creativity
o Pharmacist (RPHar) L-eadership and potential
o Rural Sanitary Inspector (Civil Engineer by Profession) A-ctive member in professional working organization
H-onesty and integrity
LEVELS OF HEALTH WORKERS
1. Village/Barangay Health Workers (VHW/BHW) ROLES OF PHN
2. Intermediate Health Workers 1. Clinician
3. First line personnel 2. Organizer
3. Collaborator
QUALIFICATIONS OF PHN 4. Counselor
Public Health Nurse I, II, & III 5. Educator
o P-rofessional Nurse with current license (RN) 6. Researcher/recorder
o H-ealth advocate to the community 7. Role model
o N-urses the masses 8. Change agent
Where to apply/submit application 9. Health Advocate
o Municipality – Municipal Mayor 10. Case manager
o City – City Mayor 11. Hospice care
o Province – Governor
o Region – Congressman
FUNCTIONS OF PHN LEVELS OF HEALTH CARE
1. Management Primary health care facility
2. Supervisory Secondary health care facility
3. Nursing care Tertiary health care facility
4. Collaborating
5. Coordinating REFERRAL SYSTEM
6. Health promotion BHS – Rural Health Midwife
7. Training RHU – Public Health Nurse
8. Research MHO – Rural Health Doctor
PHO – Provincial Health Doctor
III. THE HEALTH CARE DELIVERY SYSTEM RHO – Regional Health Doctor
National Agency
STRATEGIES IN DELIVERING HEALTH SERVICES
Specialized Agency
Creation of Restructured Health Care Delivery System (RHCDS) regulated by PD 568
(1976) IV. THE PRIMARY HEALTH CARE
Management Information Systems regulated by R.A. 3753: Vital Health Statistics
Law PRIMARY HEATLH CARE
Primary Health Care (PHC) regulated by LOI 949 (1984): Legalization of Essential health care
Implementation of PHC in the Philippines Universally accessible
Accepted by the people
CREATION OF RHCDS
Full participation of the people
RHO (National Health Agency)
Affordable cost
MHO & PHO
Services provided in every stage of development
BHS & RHU
CHARACTERISTICS
THE LOCAL HEALTH BOARD (LHB)
Acceptable
- Provincial Level
Accessible
- Governor – Chair
Affordable
- Provincial Health Officer – Vice Chair
- Chair, Committee on Health of Sangguniang Panlalawigan Available
- DOH representative Attainable
- NGO representative Sustainable
- City and Municipal Level
- Mayor – Chair LEGAL BASIS
- MHO – Vice Chair May, 1977 – 30th World Health Assembly
- Chair, Committee on Health of Sangguniang Panlalawigan Main health target is the attainment of a socially and economically productive life
- DOH representative by the year 2000.
- NGO representative Alma Ata Declaration
- Factors of effective LHB functions: Goal: HEALTH FOR ALL BY THE YEAR 2000
- 1. The LGU’s financial capability PHC is the KEY to attain the GOAL
- 2. A dynamic and responsive political leadership Alma Ata, USSR, first international conference on PHC, September 6-12, 1978
- 3. Community empowerment Initiated by WHO, UNICEF
LETTER OF INSTRUCTION 949
LEVELS OF PREVENTION o Signed by Pres. Ferdinand Marcos
Primary Prevention o October 19, 1979
Secondary Prevention Underlying Theme:
Tertiary Prevention o HEALTH IN THE HANDS OF THE PEOPLE BY 2020
4 PILLARS OF PHC (SALU) Old DOH Secretary
S-upport mechanism made available o Sec. Paulyn Jean B. Rosell-Ubial
A-ctive community participation Proponent of Phil. Health Agenda 2016-2022
L-inkages both Intra- and Inter- sectoral Current DOH Secretary
U-se of appropriate technology o Sec. Francisco Duque III
BAG TECHNIQUE
Enables the nurse to perform procedures with ease and deftness
Save time and effort
BENEDICT’S TEST Primary Prevention Health Teaching
Purpose Focused on health promotion
o Determine presence of glucose in urine of pregnant women Very difficult for the nurse
o Determine risks of gestational diabetes Time consuming
o Sample: freshly voided urine Less cooperation from participants
o Solution: Benedict’s solution/blue solution PHN needs to provide interactive methods
Results Secondary Prevention Health Teaching
o Blue: negative – none (0) Focused on disease prevention
o Green: traces of reducing glucose (+1) Less difficult for the nurse
o Orange red: moderate traces of glucose (+2) Time is valued
o Brick red: large amount of glucose (+3) More cooperation from participants
PHN needs to provide lively methods
ACETIC TEST
Tertiary Prevention Health Teaching
Purpose
Focused on illness rehabilitation and recovery
o Determine the presence of protein (albumin) in the urine
Easier for the nurse to deliver
o Determine the risk of PIH (pregnancy induced hypertension)
Time is well appreciated
o Sample: freshly voided urine
o Solution: acetic acid Utmost cooperation from participants
Result PHN needs to provide simple methods
o 0: negative – non-cloudy
o +1: distinct cloud but non-granules 2) LOCALLY ENDEMIC & COMMUNICABLE DISEASE CONTROL
o +2: distinct cloud plus definite granules Separate discussion for Communicable Disease Nursing
o +3: dense cloud
o +4: heavy precipitate 3) EXPANDED PROGRAM ON IMMUNIZATION (EPI)
Goal
XII. ELEMENTS OF PRIMARY HEALTH CARE Decrease morbidity and mortality against the immunizable
disease
1) EDUCATION FOR HEALTH Legal Basis
Process where KSA is transferred to people PD 996
Gives better informed choices - Providing for compulsory basic immunization for
3 aspects of health teachings (IEC) infants and children below 8 y/o
Information – knowledge RA 10152
Education – change thru KSA - An act providing for mandatory basic immunization
Communication – exchange of information services for infants and children.
Principles of Health Education PD 147
Considers the HEALTH STATUS - Declaring every Wednesday as National Immunization
It’s a LEARNING PROCESS Days (NIDs)
Involves MOTIVATION RA 7846
- An act requiring compulsory immunization against
BASIC FUNCTION of all health workers
Hepa B for infants and children under 8 y/o
It can be done ANYWHERE
EO 663
It is a COOPERATIVE WORK
- Implementing the national commitment for “Bakuna
It meets the NEED of the Needy
ang Una sa Sanggol at Ina”, attaining World Health
It is achieved by DOING
Organization’s goals to eliminate measles and
It is a SLOW CONTINUOUS PROCESS neonatal tetanus, eradicate polio, control hepatitis B
It utilizes COMMUNITY RESOURCES and other vaccine-preventable diseases.
It is a CREATIVE PROCESS
It helps people attain self-reliance
Coverage of Mandatory Infants and Children Health Immunization Act of Vaccine Dose Route Site # of Dose First Dose Interval
2011 (RA 10152) BCG I: 0/05 ml ID R Deltoid 1 At birth -
Tuberculosis SE: 0.05 ml ID L Deltoid 1 At school -
Diphtheria, Pertussis, Tetanus Hep B 0.5 ml IM (light) Thigh 3 At birth 6th & 14th week
OPV 2 drops PO Mouth 3 6th week 4 weeks
Poliomyelitis
Measles 0.5 ml SC Deltoid 1 9th month -
Measles Pentavalent 0.5 ml IM (deep) Thigh 3 6th week 6, 10, 14 weeks
Mumps (DPT, HIB,
Rubella or German Measles HB)
Hepatitis B Rotavirus 2-3 drops PO Mouth 2 6th week 4 weeks
H. Influenza type B vaccine
Diarrhea (rotaviral) MMR 0.5 ml SC Deltoid 1 12th-15th
month
Four (4) Major Strategies
Sustain high level FIC coverage of at least 90%
Vaccine Minimum Time % Protection Duration of Duration of
Sustain polio free country Mothers Infants
Eliminate measles by 2008 Protection Protection
Eliminate neonatal tetanus by 2008 TT1 As early during 0 None 1 year
pregnancy
ELEMENTS OF EPI TT2 4 weeks after TT1 80% 3 years 1 year
1. Target Setting TT3 6 months after TT2 95% 5 years 1 year
Infants – 3% of entire population TT4 1 year after 99% 10 years 1 year
School entrants – 3% of entire population TT5 1 year after 99% Lifetime 1 year
Pregnant – 3.5% of entire population
12-59 months – in measles HRA 11.5%
XIII. MATERNAL AND CHILD CARE
0-59 months – for OPV 14.5%
15-44 years old women – for TT 11.5%
Reproductive health as a way of life
2. Cold Chain Logistics
Determinants
FEFO – “First Expiry First Out”
o Socioeconomic
Arrange vaccine according to:
o Status of women
Type – duration of storage
o Social and gender issues
Expiration – number of times vaccine is brought out on the field
o Cultural, biological, and psychosocial factors
Storage Elements of Philippine Reproductive Health
6 months – regional o Family planning
3 months – provincial o Maternal and child health and nutrition
1 month – main/municipal center o Prevention and management of reproductive tract infections
5 days – barangay health station o Adolescent reproductive health
Temperature o Prevention and management of abortion and its complications
-15 to -25 OPV & Measles, MMR o Men’s reproductive health
+2 to +8 other vaccines Family Planning
3. Information, Education, and Communication (IEC) o Goal – provide universal access to information and services whenever
4. Assessment and Evaluation for the Program and wherever these are needed
5. Surveillance, Research, and Studies o Pertinent Laws
PD 965
- A decree requiring applicant for marriage license to
receive instructions on family planning and
responsible parenthood
EO 119
- Reorganizing the ministry of health, its attached Health Service Packages
agencies and for other purposes o Prenatal Periods
Principles of Family Planning Prenatal Visits
o Responsible parenthood 1st visit – ASAP upon pregnancy
o Respect for life 2nd visit – every month (2nd tri)
o Birth spacing 3rd visit – every 2 weeks (3rd tri)
o Informed choice Every week (3rd trimester)
Natural family planning (SAVES) XIV. ESSENTIAL DRUGS AND ALTERNATIVE THERAPIES
o Spacing pregnancies
o Achieving pregnancy Legal Basis
o Value based marital bond o R.A. 9502 – Cheaper Medicine Act
o Empowerment o R.A. 6675 – Generic Drugs Act
o Safe motherhood o R.A. 6425 – Dangerous Drugs Act (old)
o R.A. 9165 – Comprehensive Dangerous Drugs Act of 2002
Natural Family Planning Method
o Lactation Amenorrhea Method BOTIKA NG BARANGAY PROGRAM
o Ovulator/Cervical Mucus/Billing’s Method Goal
o Basal Body Temperature Method o Equity
o Sympthothermal Symptoms o Availability
o Accessibility
Artificial Family Planning Method o Safe and effective
o Pills o Priority for marginalized
o Condoms Objectives
o DMPA (Depo Medroxy Progesterone Acetate) o To rationalize the distribution of common drugs and medicines
o IUD (Intra-Uterine Device)
o Vaginal Methods (Spermicide, Diaphragm, Cervical Cap) LIST OF OTC DRUGS UNDER BOTIKA NG BARANGAY
o Norplant Analgesic/Antipyretic – Paracetamol
Antacid – Aluminum Hydroxide
Permanent Family Planning Methods Antihelmintic – Albendazole, Mebendazole
o Bilateral Tubal Ligation (Female Sterilization) Anti-allergic – Diphenhydramine
o Vasectomy (Male Sterilization) NSAID – Mefenamic Acid, Ibuprofen
Antivertigo – Meclozine
Maternal Health Program Bronchodilator – Lagundi
o 14-49 years old female reproductive age Diuretic – Sambong
o PD 965 Antitussive – Dextromethorphan
- the Responsible Parenthood and Reproductive Health Act of Anti-motility – Loperamide
2012 (Republic Act No. 10354), informally known as the Solution Correcting Water – ORS
Reproductive Health Law or RH Law, is a law in the Philippines, Laxatives – Bisacodyl
which guarantees universal access to methods on Antiscabies – Benzyl Benzoate
contraception, fertility control, sexual education, and maternal Antiemetic – Ferrous Sulfate
care. Antifungals – Benzoic Acid, ASA
Vitamins – Ascorbic Acid, Vit. A, B1, B6, B12
Strategic Thrusts Multivitamins – Folic Acid + Ferrous + Zinc
o BEmOC (Basic Emergency Obstetric Care) Minerals – Calcium (lactate) (carbonate)
o 4 prenatal visits Disinfectant – Hydrogen Peroxide
o Responsible parenthood and provision of appropriate health package to Anti-infectives – Amoxicillin, Cotrimoxazole
women of reproductive age 18-35 years Other – Metformin, Glibenclamide, Captopril, & Salbutamol
WALONG WASTONG GAMOT (CARIPPON)
Cotrimoxazole – antibacterial (Trimethoprim, Sulfametoxazole)
Amoxicillin/Amphicillin – effect is generally bacteriostatic
Rifampicin -
Isoniazid
Pyrazinamide
Paracetamol
Oresol
Nifedipine