COMMUNITY HEALTH NURSING

Community
A group of people sharing common geographic boundaries/ common values and interests.

Health
The state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. (WHO)

Nursing
Art and Science of rendering care to individuals, families and communities. Assisting and individual, sick or well, in the performance of those activities contributing to health or its recovery in such way as to help him gain independence. (Henderson, 1964)

Community Health Nursing

Direct, goal-oriented and adaptable to the needs of the individual, the family and community during health and illness. (AMA, 1973) An area of human services direct toward developing and enhancing the health capabilities of people. singly, individuals, or collectively, as groups and communities. (Ruth Freeman & Janet Heinrich, 1981)

3 Levels of Clientele
Individual Family Community

Public Health
..the art and science of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts in sanitation of the environment, education of the individual on principles of personal hygiene, prevention of communicable diseases, medical and nursing services for the early diagnosis and preventive treatment of disease and the development of a social machinery, so organizing these benefits to enable every citizen to realize his birthrights of health and longevity. (C.E. Winslow, 1920)

General Philosophy of CHN

Community Health Nursing is based on the worth and dignity of man. (Margaret Shetland)

Standards of care in Public Health Nursing

Standards 1: Assessment Standards 2: Diagnosis Standards 3: Outcomes Identification Standards 4: Planning Standards 5: Assurance Standards 6: Evaluation

Roles and Functions of Community Health Nurse

1. Health Care Provider 2. Manager 3. Community Organizer 4. Epidemiologist 5. Health Educator

FIELDS OF COMMUNITY HEALTH NURSING

A. SCHOOL HEALTH NURSING care of students 1. Health Promotion 2. Disease Prevention & Early Detection 3. Emergency Care 4. Referral B. PUBLIC HEALTH NURSING care of the family in the community C. OCCUPATIONAL HEALTH NURSING care of the workers 1. Health Protection health risk mgt. at work e.g. health hazard identification, risk assessment, control, measures, surveillance, information, training, monitoring 2. Health Promotion health risk assessment e.g. environment, lifestyle, employee, information

FAMILY NURSE CONTACT

I. HOME VISIT
Purposes 1. Give nursing care to the sick, post-partum mother, newborn. 2. Assess living condition of client and their health practices. 3. Give health teachings. 4. Establish relationship with health agency and public. 5. Make use of inter-referral system and promote utilization of community services. Principles of Home Visit 1. Have a purpose or objective 2. Should make use of all available information 3. Consider and prioritize essential needs of the individual and family 4. Should involve the individual and family 5. Should be flexible

II. CLINIC VISIT

A. Pre-consultation health education, admission, registration B. Consultation laboratory and diagnostic examination C. Post-consultation health education, drug dispensing

HEALTH CARE DELIVERY SYSTEM

8 Millennium Development Goals
1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria, and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development

DEPARTMENT OF HEALTH
Vision: Leader, staunch advocate and model in promoting Health for All in the Philippines.

Mission: Guarantee equitable, sustainable, and equality, health for all Filipinos, especially the poor and to lead the quest for excellence in health.

Goal of FOURmula ONE for Health

1. Better health outcomes 2. More responsive health systems 3. Equitable health care financing

FOUR Elements of the Strategy

1. 2. 3. 4. Health Financing Health regulation Health service delivery Good governance

RA 7160 LOCAL GOVERNMENT CODE/ DEVOLUTION CODE

..transform local government units into Self-reliant communities and Active partners in the attainment of national goals through a more Responsive and Accountable local government structure instituted through a system of Decentralization.

Objectives of Local Health Systems/LGU

1. Establish local health systems for effective & efficient delivery of health care services 2. Upgrade the health care mgt. & service capabilities of local health facilities 3. Promote inter LGU linkages & cost sharing schemes for better utilization of resources 4. Foster participation of private, non-government org. and communities 5. Ensure the quality of health service delivery at the local health level

Primary Health Care

Legal Basis: Letter Of Instruction 949, October 1979 by Ferdinand Marcos 1 year after, First International Conference on Primary Health Care in Alma Atta, Russia sponsored by WHO & UNICEF GOAL: Health for All in the Year 2020.

Four Pillars/Cornerstone of Primary Health Care

1. 2. 3. 4. Active Community Participation Intra and intersectoral linkages Use of appropriate technology Support mechanism made available

Levels Of Primary Health Care Worker

1. Village or Barangay Health Workers(V/BHWs) TBA, health auxillary or volunteers 2. Intermediate level health workers MD, PHN, RSI, Midwives

Levels Of Health Care Facilities

1. Primary Level BHS, RHU, Health Centers, Puericulture Centers, Private Practitioners 2. Secondary Level District Hospitals, Provincial Hospitals, Emergency & City Hospitals 3. Tertiary Level Regional, National, Teaching & Training Hospitals, Medical Centers.

Elements/Components of Primary Health Care

1. 2. 3. 4. 5. 6. 7. Environmental Sanitation Control of Communicable Diseases Immunization Health Education Maternal & Child Health and Family Planning Adequate Food & Proper Nutrition Provision of Medical Care and Emergency Treatment 8. Treatment of Locally Endemic Disease 9. Provision of Essential Drugs

HERBAL MEDICINES
S ambong A mpalaya N iyog-Niyogan T saang-Gubat A kapulko L agundi U lasimang Bato B ayabas B awang Y erba Buena

SENTRONG SIGLA
GOAL: QUALITY HEALTH OBJECTIVE: Better and more effective collaboration between the DOH and LGUs Pillars: 1. Quality assurance 2. Grants and technical assistance 3. Awards 4. Health Promotion

Maternal and Child Health Care

PRE NATAL CARE Pre Natal Visits 1st Trimester 1x (as early in pregnancy) 2nd Trimester 1x (4th month of pregnancy) 3rd Trimester 2x (8th month till 9th month) A. Assessment during Pregnancy 1. History of total pregnancy (LMP, AOG,EDC) 2. Weight 3. Vital Signs (esp. BP) 4. Physical examination 5. Laboratory examinations B. Management 1. Health education 2. Iron supplementation 3. Tetanus Immunization 4. Treatment of disease, referral PRN 5. In goiter-endemic areas iodine supplementation 6. In malaria-endemic areas malaria prophylaxis

Classification of Domiciliary Obstetrical Service

1. Full Term 2. Not a primigravida & with less than 5 pregnancies 3. Without co-existing disease 4. No history of complications/ abnormalities in present & previous pregnancies and deliveries 5. Imminent deliveries

Schedule for Tetanus Toxoid for Pregnant Women

Length of Protection ---------3 years 5 years 10 years lifetime

1st dose anytime in pregnancy 2nd dose 1 month after the 1 st dose 3rd dose 6 months after the 2 nd dose 4th dose 1 year after the 3 rd dose 5th dose 1 year after the 4 th dose

Dose: Route: Site:

0.5ml Intramuscular Deltoid Muscle

 POST PARTUM CARE 1st Visit within 24-48 hours ( most critical peroid) 2nd Visit 6 weeks post partum visit

FAMILY PLANNING SERVICES

Family Planning Priorities
*couples in which mother is between 20-44 yrs. Old *couples having had 3 or more children or pregnancies are too close intervals *when mother is suffering from chronic disease in which pregnancy is contraindicated

Concepts of Family Planning

*decisions should be taken by both marital partners *only if the parents have sincere inner motivation for FP may persist with it *health workers cannot assume that their clients hold the same attitude toward FP *when a couple expresses hostility toward FP it is both wrong to and useless for health worker to insist on it

EXPANDED PROGRAM ON IMMUNIZATION

Launched by DOH in cooperation with WHO and UNICEF last July 1976 Objective reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseases. PD No. 996 (Sept. 16, 1976) Providing for compulsory basic immunization for infants and children below 8 yrs.old PP No. 6 (April 3, 1996) Implementing a United Nations goal on Universal Child Immunization by 1990 RA 7846 ( Dec. 30, 1994) An act requiring compulsory immunization against hepa B for infants and children below 8 y/o

 PD No. 4 ( July 29, 1998) Declaring the period of Sept. 16 Oct. 14, 1998 as Ligtas Tigdas Month and launching the Phil. Measles Elimination Campaign Proclamation No. 46 reaffirming universal child and mother immunization and declaring the polio eradication project of the Philippines Proclamation No. 147 proclamation/declaration of national immunization days Proclamation No. 773 knock out polio days Proclamation No. 1064 AFP surveillance Proclamation No. 1066 National Neonatal Tetanus Elimination Campaign

CONTRA INDICATIONS OF IMMUNIZATION

1. Conditions that require hospitalization 2. AIDS and Immunocompromised for BCG immunization 3. Seizure and Convulsion for DPT A. Infant BCG * 0-11 months or 0-1 year * at birth * 0.05ml ID @ right arm B. DPT Diptheria, Pertussis, Tetanus * 3 doses, 4 weeks, or 1 month interval * 0.5 ml, IM, vastus literalis

C. OPV Polio * 3 doses, 4 weeks/ 1 month * 2-3 drops. Oral route D. Hepa B * 3 doses, 4 weeks * can be given @ birth * target age 1 to 11 months * 0.5 ml, IM, vastus literalis E. Measles * 9-11 months * 0.5 ml, SQ, any arm

Ensuring The Maintenance of Potency of Biological

1. Maintenance of the cold chain - OPV & measles vaccine = freezer - BCG, DPT, HBV & tetanus toxoid = refrigerator compartment 2. Maximum storage & transport period - Regional Health Office = 6 months - Provincial/District Health Office = 3 months - Rural Health Unit = 1 month - Maximum transport period ( cold packs) = 5 days 3. Discarding unused biologicals - Dsicard BCG 4 hours after reconstitution, others by the end of the day

Fully Immunized Child

When the child received all the vaccines that should be given in the first year of life

Complete Immunized Child

all vaccines given but went beyond one year of age

TYPES OF EPIDEMIOLOGY
1. Descriptive Epidemiology concerned with disease frequency and distribution 2. Analytical Epidemiology 3. Therapeutic/Clinical 4. Evaluation Epidemiology

TYPES OF EPIDEMILOGIC DATA

1. 2. 3. 4. Demographic Data Vital Statistics Environmental Data Health Services Data

National Tuberculosis Program

Specific Objectives

- to vaccinate with BCG the eligible population under EPI to all areas with at least 90% coverage - to identify at least 45% the prevalence of infectious cases annually - to treat effectively and adequately all sputum (+) cases, and those with X-ray lung cavity lesion for a period of 6 months with the use of Short Course Chemotherapy

Key Policies on Case Finding

Direct sputum exam for TB symptomatic and X-ray exam symptomatic, who are (-) after 2 or more sputum exam All DOH service outlets must be passive and active collection points for sputum samples of all identified TB symptomatic All collection points are served by microscopy center with 4-7 days turn around period Validation center must be established to ensure standards and quality of sputum examinations

Tuberculosis
Etiologic Agent gram (-) acid fast bacilli - Mycobacterium tuberculosis Mode of Transmission - airbiorne droplet : coughing, sneezing, singing - direct invasion through mucus membranes or break in the skins DRUG EFFECTS 1. Isoniazid Peripheral Neuritis - Vit. B6 (25-50 mg/day) / Pyridoxine is given bcoz INH interferes with natural vitamin 2. Ethambutol Optic Neuritis 3. Rifampicin orange urine, - effect of birth control, Hep., febrile reaction < health teaching- Increase fluid intake> 4. Streptomycin 8th Cranial Damage tinnitus & vertigo, kidney toxicity

Isolation
Continued until symptoms have declined and there is absence of bacilli in sputum smear (usually achieved within 2 weeks after drug therapy starts Maintain 3 ft. distance

Prevention Strategies
1. BCG vaccination of newborn infants 2. Educate public in mode of spread and methods of control and the importance of diagnosis 3. Improve social condition, which increase the risk of becoming infected such as overcrowding 4. Make available medical laboratory and x-ray facilities for examination 5. Provide public health nursing and outreach services for home supervision of patients

 TYPES OF FAMILY HEALTH PROBLEM 1. Health Threats factors that may bring about disease or accident e.g. broken stairs 2. Health Deficits failure in health maintenance, there is illness already in failure to develop as expected e.g. PTB in the family 3. Foreseeable Crisis an anticipated period of unusual demand on the family in terms of resources, etc. 4. Wellness Condition CRITERIA FOR PRIORITIZING HEALTH PROBLEMS 1. Nature of the problem a deficit/threat/foreseeable crisis 2. Modifiability probability of success to enhance wellness state,decrease,alleviate or eradicate problems through interventions 3. Preventive Potential refers to the nature & magnitude of future problems that will be prevented, if intervention is done 4. Salience familys perception ( how do they see the problem)

FAMILY HEALTH CARE

ENVIRONMENTAL SANITATION
Environmental Sanitation
- Is the control of factors in mans physical environment that maybe deleterious to mans wellbeing -The Program covers the following areas: - Water Sanitation - Food Sanitation - Waste Management

Water Sanitation
3 Types of Water Analysis Physical Analysis - appearance, odor and taste of water Chemical Analysis - done in laboratories - examination of water for the presence of harmful substances - iron, lead, and mercury-effect to neonates babies of mothers who ate mercury-Minimota disease phocomelia Bacteriological Analysis - cholifrom test choliforms remains alive 7-10 days bacteria which are normal residence of human colon - done in public health laboratories

3 Levels of Water Supply

Level I: Point Source Level II: Communal Water Supply/ Water Stand Post - contains a simple distribution system ex. Deep well that marks for 100 houses Level III: Water works system/ Individual Water meter - found in urban areas - has water treatment plant - H2O distributed in pipes- individual water meter ex. MWSI

Water Treatment in a Level III H2O Supply System

1.
2.

3. 4.

5.

Sedimentation - allow water stand for particles to settle Flocculation or coagulation -this involves the addition of a substance that will facilitate sedimentation it attaches to sediments ex. Allum (tawas) Filtration - make use of sand and gravel filters Aeration - not done for purification, it is done to improve the taste of water (taste depends on the O2 in water) - in the process, iron particles are also oxidized Chlorination -make use of chlorine- not good against amoeba-boiling is better